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Kim J, Rhu J, Lee E, Ryu Y, An S, Jo SJ, Oh N, Han S, Park S, Choi GS. Left lobe living donor liver transplantation using the resection and partial liver segment 2-3 transplantation with delayed total hepatectomy (RAPID) procedure in cirrhotic patients: First case report in Korea. Ann Hepatobiliary Pancreat Surg 2024:ahbps.24-005. [PMID: 38556878 DOI: 10.14701/ahbps.24-005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/24/2024] [Accepted: 02/28/2024] [Indexed: 04/02/2024] Open
Abstract
In liver transplantation, the primary concern is to ensure an adequate future liver remnant (FLR) volume for the donor, while selecting a graft of sufficient size for the recipient. The living donor-resection and partial liver segment 2-3 transplantation with delayed total hepatectomy (LD-RAPID) procedure offers a potential solution to expand the donor pool for living donor liver transplantation (LDLT). We report the first case involving a cirrhotic patient with autoimmune hepatitis and hepatocellular carcinoma, who underwent left lobe LDLT using the LD-RAPID procedure. The living liver donor (LLD) underwent a laparoscopic left hepatectomy, including middle hepatic vein. The resection on the recipient side was an extended left hepatectomy, including the middle hepatic vein orifice and caudate lobe. At postoperative day 7, a computed tomography scan showed hypertrophy of the left graft from 320 g to 465 mL (i.e., a 45.3% increase in graft volume body weight ratio from 0.60% to 0.77%). After a 7-day interval, the diseased right lobe was removed in the second stage surgery. The LD-RAPID procedure using left lobe graft allows for the use of a small liver graft or small FLR volume in LLD in LDLT, which expands the donor pool to minimize the risk to LLD by enabling the donation of a smaller liver portion.
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Affiliation(s)
- Jongman Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eunjin Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Youngju Ryu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sunghyo An
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Jun Jo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Namkee Oh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seungwook Han
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sunghae Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Cruz Mususú W, García-Lopez A, Lozano-Suarez N, Gómez-Montero A, Orellano-Salas M, Vargas-Pérez L, Escobar-Chaves X, Girón-Luque F. Understanding the dynamics of deceased organ donation and utilization in Colombia. Rev Panam Salud Publica 2024; 48:e24. [PMID: 38464873 PMCID: PMC10921909 DOI: 10.26633/rpsp.2024.24] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/19/2023] [Indexed: 03/12/2024] Open
Abstract
Objective To obtain a comprehensive overview of organ donation, organ utilization, and discard in the entire donation process in Colombia. Methods A retrospective study of 1 451 possible donors, distributed in three regions of Colombia, evaluated in 2022. The general characteristics, diagnosis, and causes of contraindication for potential donors were described. Results Among the 1 451 possible donors, 441 (30.4%) fulfilled brain death criteria, constituting the potential donor pool. Families consented to organ donation in 141 medically suitable cases, while 60 instances utilized legal presumption, leading to 201 eligible donors (13.9%). Of those, 160 (11.0%) were actual donors (in whom operative incision was made with the intent of organ recovery or who had at least one organ recovered). Finally, we identified 147 utilized donors (10.1%) (from whom at least one organ was transplanted). Statistically significant differences were found between age, sex, diagnosis of brain death, and donor critical pathway between regions. A total of 411 organs were transplanted from 147 utilized donors, with kidneys being the most frequently procured and transplanted organs, accounting for 280 (68.1%) of the total. This was followed by 85 livers (20.7%), 31 hearts (7.5%), 14 lungs (3.4%), and 1 pancreas (0.2%). The discard rate of procured deceased donors was 8.1%. Conclusions About one-tenth of donors are effectively used for transplantation purposes. Our findings highlight areas of success and challenges, providing a basis for future improvements in Colombia.
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Affiliation(s)
| | - Andrea García-Lopez
- Colombiana de TrasplantesBogotáColombiaColombiana de Trasplantes, Bogotá, Colombia
| | | | - Andrea Gómez-Montero
- Colombiana de TrasplantesBogotáColombiaColombiana de Trasplantes, Bogotá, Colombia
| | | | | | | | - Fernando Girón-Luque
- Colombiana de TrasplantesBogotáColombiaColombiana de Trasplantes, Bogotá, Colombia
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Silva AMD, Benites PT, Zulin MEG, Ferreira Júnior MA, Cardoso AIDQ, Cury ERJ. Global legislation regulating the donation, procurement and distribution processes of organs and tissues from deceased donors for transplants: A scoping review. Heliyon 2024; 10:e26313. [PMID: 38375299 PMCID: PMC10875591 DOI: 10.1016/j.heliyon.2024.e26313] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction Organ transplantation is one of the most successful advances in modern medicine. However, a legal system is necessary for its practice to be free from ethical flaws and to respect donors, recipients, and family members. Objective To map the global legislation regulating the donation, capture and distribution processes of organs and tissues from deceased donors for transplants. Method A scoping review according to the Joanna Briggs Institute was conducted in the following databases: Medline, CINAHL, Virtual Health Library, SCOPUS, Web of Science, Science Direct, and EMBASE, as well as gray literature, and reported according to the PRISMA extension for scoping reviews. Results We identified 3302 records, of which 77 were analyzed which enabled mapping the type of consent adopted and the existence of current legislation for harvesting organs and tissues after circulatory and brain death. Conclusion Opt-out consent predominates in Europe, and there is harvesting after brain and circulatory death. Opt-out predominates in the Americas, while Opt-in and harvesting of organs and tissues after brain death predominate in Asia and Oceania. The procurement of organs and tissues from deceased donors is practically non-existent in Africa.
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Affiliation(s)
- Aline Moraes da Silva
- Doctoral student in Health and Development of the Midwest Region at the Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | | | | | - Marcos Antonio Ferreira Júnior
- Graduate and Post-Graduation Program in Nursing, Integrated Health Institute, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | | | - Elenir Rose Jardim Cury
- Post-Graduation Program in in Health and Development of the Midwest Region at the Federal University of Mato Grosso do Sul, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
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Bollen J, Bhatia N, Tibballs J. Feasibility of organ donation following voluntary assisted dying in Australia: lessons from international practice. Med J Aust 2024; 220:165. [PMID: 38238879 DOI: 10.5694/mja2.52206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/13/2023] [Indexed: 02/19/2024]
Affiliation(s)
- Jan Bollen
- Radboud University Medical Centre (Radboudumc), Nijmegen, Netherlands
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Kim SH, Wi YM, Moon C, Kang JM, Kim M, Kim J, Kim JM, Seok H, Shi HJ, Lee SJ, Lee JY, Jeong SJ, Choe PG, Huh K, Lee SO, Kim SI. Recommendations for SARS-CoV-2 testing and organ procurement from deceased donors in the Republic of Korea. Korean J Transplant 2023; 37:145-154. [PMID: 37614183 PMCID: PMC10583974 DOI: 10.4285/kjt.23.0034] [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: 06/22/2023] [Revised: 07/20/2023] [Accepted: 07/20/2023] [Indexed: 08/25/2023] Open
Abstract
We present a summary of the evidence on testing for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and organ procurement from deceased donors and provide recommendations based on current clinical data and the guidelines from major transplant organizations. Because of the limited historical experience with coronavirus disease 2019 (COVID-19), certain recommendations in this document are based on theoretical rationales rather than clinical data. The recommendations in this manuscript may be subject to revision as subsequent clinical studies provide definitive evidence regarding COVID-19 in organ procurement.
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Affiliation(s)
- Si-Ho Kim
- Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Yu Mi Wi
- Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Chisook Moon
- Division of Infectious Diseases, Department of Internal Medicine, Inje University Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Ji-Man Kang
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Minhwa Kim
- Korea Organ Donation Agency, Seoul, Korea
| | - Jungok Kim
- Division of Infectious Diseases, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeri Seok
- Division of Infectious Diseases, Department of Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hye Jin Shi
- Division of Infectious Diseases, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Su Jin Lee
- Division of Infectious Disease, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ji Yeon Lee
- Division of Infectious Diseases, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Su Jin Jeong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyungmin Huh
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Il Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Bollen J, Hempton C, Bhatia N, Tibballs J. Feasibility of organ donation following voluntary assisted dying in Australia: lessons from international practice. Med J Aust 2023; 219:202-205. [PMID: 37393567 DOI: 10.5694/mja2.52016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/16/2023] [Accepted: 05/26/2023] [Indexed: 07/04/2023]
Affiliation(s)
- Jan Bollen
- Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands
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Ismail AJB, Ahmad ND, Ching CS, Lean CS, Keong TTB, Zaini MI, Kheng CP. Barriers to the identification of possible organ donors among brain-injured patients admitted to intensive care units. Korean J Transplant 2023; 37:85-94. [PMID: 37435142 PMCID: PMC10332283 DOI: 10.4285/kjt.23.0009] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 07/13/2023] Open
Abstract
Background Improving organ donation rates requires better detection of possible organ donors, which in turn necessitates identifying barriers preventing the identification of possible organ donors. The objectives of this study were to determine the actual rate of possible deceased organ donors among nonreferred cases and to identify barriers to their identification as possible donors. Methods This retrospective observational study used 6 months of data collected from two intensive care units (ICUs). Possible organ donors were defined as patients with a Glasgow Coma Scale score <5 and evidence of severe neurological damage. Barriers that led to the nonidentification of these patients as possible organ donors were also identified. Results Fifty-six of 819 patients admitted to the ICUs during the study period were detected as possible organ donors, representing a 6.83% possible organ donor detection rate. Nonclinical barriers to the identification of possible organ donors were found to be more significant than clinical barriers (55% vs. 45%, respectively). The most significant nonclinical barrier was an unknown reason, despite patients being medically suitable for deceased organ donation and fulfilling the criteria for possible organ donor classification. Unresolved sepsis was the main clinical barrier. Conclusions The significant rate of unreferred possible deceased organ donors found in this study reveals the need to increase awareness and knowledge among clinicians of the proper detection of possible donors at an early stage to avoid the loss of possible deceased organ donors, and thereby increase the deceased organ donation rate in Malaysian hospitals.
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Affiliation(s)
| | - Nor Diyanah Ahmad
- Department of Anaesthesiology and Intensive Care, Hospital Sultanah Aminah, Johor Bahru, Malaysia
| | - Chong Si Ching
- Department of Anaesthesiology and Intensive Care, Hospital Queen Elizabeth, Kota Kinabalu, Malaysia
| | - Cheah Siew Lean
- Department of Anaesthesiology and Intensive Care, Jesselton Medical Center, Kota Kinabalu, Malaysia
| | - Tony Tan Beng Keong
- Department of Anaesthesiology and Intensive Care, Hospital Sultanah Aminah, Johor Bahru, Malaysia
| | - Mohd Izzwan Zaini
- Department of Anaesthesiology and Intensive Care, Hospital Sultanah Aminah, Johor Bahru, Malaysia
| | - Cheah Phee Kheng
- Department of Accident and Emergency Medicine, Hospital Wanita & Kanak-Kanak, Kota Kinabalu, Malaysia
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Klein TT, O'Leary MJ, Staub L, Cavazzoni E. Organ donation by children in Australia, 2000-2019: impact of the 2009 National Reform Program. A population-based registry data study. Med J Aust 2023. [PMID: 37247848 DOI: 10.5694/mja2.51978] [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: 08/31/2022] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To assess the impact of the 2009 National Reform Program for organ donation in Australia on the number and characteristics of organ donors under 16 years of age. DESIGN, SETTING, PARTICIPANTS Retrospective observational time series study; analysis of Australia and New Zealand Organ Donation (ANZOD) registry data for all consented potential deceased organ donors under 16 years of age during 2000-2019, and of numbers of donors aged 16 years or more reported in ANZOD annual reports. MAIN OUTCOME MEASURES Difference between 2000-2008 (pre-reform) and 2009-2019 (reform period) in annual organ donor rates (donors per million population), by age group (under 16 years, 16 years or more), reported as incidence rate ratio (IRR). SECONDARY OUTCOMES Differences in child donor characteristics during 2000-2008 and 2009-2019. RESULTS During 2000-2019, 400 children under 16 years of age were consented potential deceased organ donors, of whom 374 were actual deceased donors (94%): 146 during 2000-2008, 228 during 2009-2019. The median annual rate was 3.3 (interquartile range [IQR], 3.0-4.3) actual donors per million population during 2000-2008 and 4.2 (IQR, 3.6-5.2) donors per million population during 2009-2019 (IRR, 1.15; 95% confidence interval [CI], 0.93-1.42). In contrast, the difference between the two periods was statistically significant for donors aged 16 years or more, rising from 11.7 (IQR, 11.2-11.8) to 19.9 (IQR, 18.3-24.4) actual donors per million population (IRR, 1.75; 95% CI, 1.66-1.85). The median age of actual organ donors under 16 was similar during 2000-2008 (11 years; IQR, 7-14 years) and 2009-2019 (10 years; IQR, 4-14 years), as was the proportion of donors in this age group under 10 kg (2000-2008: four of 146, 3%; 2009-2019: 14 of 228, 6%). CONCLUSIONS Despite its overall effect on organ donation rates, the National Reform Program was not effective in increasing the numbers of donors under 16 years of age. Relying on broad initiatives for adult donors may not be appropriate for achieving this aim.
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Affiliation(s)
- Tal T Klein
- Children's Hospital at Westmead, Sydney, NSW
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Silva E Silva V, Silva A, Rochon A, Lotherington K, Hornby L, Wind T, Bollen J, Wilson LC, Sarti AJ, Dhanani S. Outcomes from organ donation following medical assistance in dying: A scoping review. Transplant Rev (Orlando) 2023; 37:100748. [PMID: 36774782 DOI: 10.1016/j.trre.2023.100748] [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: 11/24/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023]
Abstract
AIM To collate and summarize the current international literature on the transplant recipient outcomes of organs from Medical Assistance in Dying (MAiD) donors, as well as the actual and potential impact of organ donation following MAiD on the donation and transplantation system. BACKGROUND The provision of organ donation following MAiD can impact the donation and transplantation system, as well as potential recipients of organs from the MAiD donor, therefore a comprehensive understanding of the potential and actual impact of organ donation after MAiD on the donation and transplantation systems is needed. DESIGN Scoping review using the JBI framework. METHODS We searched for published (MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Academic Search Complete), and unpublished literature (organ donation organization websites worldwide). Included references discussed the actual and potential impact of organ donation following MAiD on the donation and transplantation system. All references were screened, extracted and analysed by two independent reviewers. RESULTS We included 78 references in this review and our finding were summarized across three categories: (1) Impact in the donor pool: (2) statistics on organ donation following MAiD; and (3) potential and actual impact of MAiD on the donation and transplant system. CONCLUSIONS The potential impact of the MAiD donor on the transplant waiting list is relatively small as this process is still rare, however, due to the current organ shortage worldwide the contribution of this procedure should not be disregarded. Additionally, despite being limited, the existing research provided scanty evidence that organs retrieved from MAiD donors are associated with satisfactory graft function and survival rates and that outcomes from transplant recipients are comparable to those of organs from donation following brain death and may be better than those of organs from other types of donation after circulatory determined death. Still, further studies are required for comprehensive and reliable evidence.
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Affiliation(s)
| | - Amina Silva
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Andrea Rochon
- School of Nursing, St. Lawrence College, Kingston, ON, Canada
| | | | | | - Tineke Wind
- Maastricht University Medical Centre, Maastricht, Netherlands
| | - Jan Bollen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc Medical Center Nijmegen, Nijmegen, Netherlands
| | | | - Aimee J Sarti
- Department of Critical Care, The Ottawa Hospital, Ottawa, ON, Canada
| | - Sonny Dhanani
- Faculty of Medicine, Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
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Radi E, Ghanavati M, Khoundabi B, Rahmani J, Nahafizadeh K, Shadnoush M, Broumand B, Ghobadi O. The effect of the Iranian family approach-specific course (IrFASC) on obtaining consent from deceased organ donors' families. Korean J Transplant 2022; 36:237-244. [PMID: 36704808 PMCID: PMC9832597 DOI: 10.4285/kjt.22.0041] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 12/24/2022] Open
Abstract
Background A family approach and obtaining consent from the families of potential brain-dead donors is the most important step of organ procurement in countries where an opt-in policy applies to organ donation. Health care staff's communication skills and ability to have conversations about donation under circumstances of grief and emotion play a crucial role in families' decision-making process and, consequently, the consent rate. Methods A new training course, called the Iranian family approach-specific course (IrFASC), was designed with the aim of improving interviewers' skills and knowledge, sharing experiences, and increasing coordinators' confidence. The IrFASC was administered to three groups of coordinators. The family consent rate of participants in the same intervals (12 months for group 1, 6 months for group 2, and 3 months for group 3) was measured before and after the training course. The Wilcoxon signed-rank test was used to make comparisons. Results The family consent rate was significantly different for all participants before and after the training, increasing from 50.0% to 62.5% (P=0.037). Furthermore, sex (P=0.005), previous training (P=0.090), education (P=0.068), and duration of work as a coordinator (P=0.008) had significant effects on the difference in families' consent rates before and after IrFASC. Conclusions This study showed that the IrFASC training method could improve the success of coordinators in obtaining family consent.
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Affiliation(s)
- Ehsan Radi
- Iranian Research Center of Organ Donation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Matin Ghanavati
- Iranian Research Center of Organ Donation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Batoul Khoundabi
- Iranian Research Center of Organ Donation, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Research Center for Health Management in Mass Gathering, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran,Iran Helal Institute of Applied-Science and Technology, Tehran, Iran
| | - Jamal Rahmani
- Iranian Research Center of Organ Donation, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Katayoun Nahafizadeh
- Iranian Research Center of Organ Donation, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Department of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Shadnoush
- Iranian Research Center of Organ Donation, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Department of Clinical Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behrooz Broumand
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Tehran, Iran
| | - Omid Ghobadi
- Iranian Research Center of Organ Donation, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Corresponding author: Omid Ghobadi Iranian Research Center of Organ Donation, No. 790, Valiasr St, Tehran 1435674536, Iran, Tel: +98-91-3121-2411, Fax: +98-91-2065-1521, E-mail:
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11
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Kang I, Lee JM, Lee JG. The first successful report of liver transplantation from category III donation after circulatory death in South Korea: a case report. Korean J Transplant 2022; 36:294-297. [PMID: 36704811 PMCID: PMC9832591 DOI: 10.4285/kjt.22.0016] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/18/2022] [Accepted: 08/22/2022] [Indexed: 11/25/2022] Open
Abstract
Deceased donor liver transplantation (DDLT) using donations after brain death (DBDs) has been widely performed in Korea. However, to date, there is no report regarding donation after circulatory death (DCD) category III. A 56-year-old male patient diagnosed with hepatitis B virus-associated liver cirrhosis underwent DDLT using DCD category III. The recipient's recovery was uneventful, and he was discharged on postoperative day 37. Currently, the patient is alive, with no complications 20 months after transplantation. This case suggests that DCD with LT is both feasible and safe. Further studies are required to validate this finding.
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Affiliation(s)
- Incheon Kang
- Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jae-myeong Lee
- Division of Acute Care Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jae Geun Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea,Corresponding author: Jae Geun Lee Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea, Tel: +82-2-2228-2138, Fax: +82-2-313-8289, E-mail:
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12
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Silva AMD, Ferreira Júnior MA, Cardoso AIDQ, Ivo ML, Almeida JPF, Melo RDS. Costs related to obtaining organs for transplantation: A systematic review. Transplant Rev (Orlando) 2022; 36:100724. [PMID: 36029555 DOI: 10.1016/j.trre.2022.100724] [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: 06/03/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The number of transplants in the world is growing, although there is a demand that exceeds supply. It is worth mentioning that the costs for obtaining organs are considered high. However, few studies have been developed on analyzing the costs of obtaining organs and tissues for transplants in order to support the decision-making of managers and health professionals. OBJECTIVE To summarize the studies related to the cost of obtaining organs for transplants from a deceased donor. METHOD A systematic literature review was conducted in the following databases: PubMed, Cochrane Library CINAHAL, Virtual Health Library (BVS), SCOPUS, Web of Science and EMBASE, using the following descriptors: Costs and cost analysis; Donor Selection; Tissue and Organ Procurement; Tissue and Organ Harvesting; and Tissue Donors, in studies published until April 2021. The risk of bias assessment was performed using the Joanna Briggs Institute's Checklist for Economic Assessments. It was not possible to perform a meta-analysis due to the heterogeneity of the studies. RESULTS A total of 1731 studies were identified, of which 11 were analyzed. The cost of kidneys in US dollars (USD) ranged between USD $1672 and USD $25,058. Obtaining a liver ranged from USD $586 to USD $44,478. Heart procurement ranged from USD $633 to USD $24,264. The combined heart-lung transplant ranged from USD $860 to USD $23,203. Obtaining the pancreas ranged from USD $413 to USD $29,708. CONCLUSIONS Cost of obtaining organs for transplants from a deceased donor is substantial and varies widely across different studies. The overall cost of failures to obtain organs is currently unknown. Understanding organ procurement expenses can help clarify areas in which organ and tissue procurement can improve in cost and efficiency.
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Affiliation(s)
- Aline Moraes da Silva
- Health and Development of the Midwest Region at the Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil.
| | - Marcos Antonio Ferreira Júnior
- Graduate Program in Nursing, Integrated Health Institute, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | | | - Maria Lucia Ivo
- Graduate Program in in Health and Development of the Midwest Region at the Federal University of Mato Grosso do Sul, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
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da Silva Knihs N, Schuantes Paim SM, Dos Santos J, Dos Reis Bellaguarda ML, Silva L, Magalhães ALP, Treviso P, Schirmer J. Care bundle for family interview for pediatric organ donation. J Pediatr Nurs 2022; 64:56-63. [PMID: 35152001 DOI: 10.1016/j.pedn.2022.01.010] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE to develop a care bundle for best practices in conducting the family interview for organ and tissue donation with the families of children and adolescents. DESIGN AND METHODS methodological study, with a qualitative approach, developed in Brazil, in three stages: literature review, qualitative study with professionals and family members, and development of the care bundle. RESULTS Nine studies were selected and 17 health professionals and nine family members were interviewed. With this data, the care bundle was developed in three categories: communication of death, emotional support and information about organ and tissue donation. The recommendations were evaluated by five external professionals and all of them assessed the bundle as having the highest possible quality. CONCLUSIONS the care bundle was built following the stages of integrative literature review and interviews with professionals working in this scenario and family members who have already gone through a family interview for organ and tissue donation of children and adolescents. PRACTICE IMPLICATIONS the use of this material is seen as an important resource to support the professional during the conduction of the family interview in a scenario as sensitive and challenging as the care to family members facing death and the decision of organ and tissue donation of children and adolescents. Furthermore, the care bundle can increase the quality of family interviews and impact the reduction of family refusals. DESCRIPTORS Practice Guideline as Topic. Tissue and Organ Procurement. Patient Care Team. Nursing. Pediatrics. Communication.
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Affiliation(s)
| | | | - Juliana Dos Santos
- Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | - Lucía Silva
- Federal University of São Paulo, São Paulo, São Paulo, Brazil.
| | | | - Patrícia Treviso
- Vale dos Sinos University, Porto Alegre, Rio Grande do Sul, Brazil
| | - Janine Schirmer
- Federal University of São Paulo, São Paulo, São Paulo, Brazil.
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Millán DAC, Fajardo-Cediel W, Tobar-Roa V, García-Perdomo HA, Autrán-Gómez AM. Strategies to Mitigate the Impact of COVID 19 Pandemic on Organ Donation and Kidney Transplantation in Latin America. Curr Urol Rep 2021; 22:59. [PMID: 34913144 PMCID: PMC8724642 DOI: 10.1007/s11934-021-01076-4] [Citation(s) in RCA: 1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW COVID-19 pandemics have severely affected Latin America. It has resulted in SARS-CoV-2-associated clinical adverse outcomes, but also in social and economic deterioration. Consequently, it generated a significant negative impact on organ donation and kidney transplantation (KTx) activity in our region, leading to a negative impact on these patients' survival and quality of life. For this reason, this article aimed to describe applicable logistics, organizational and clinical strategies to mitigate the effect of the COVID-19 pandemic on kidney donation and transplantation in our region. RECENT FINDINGS Absenteeism to hemodialysis sessions in patients with end-stage renal disease has been described in up to 54% in Latin America. Not surprisingly, there was a reduction in organ donation and transplants between 21 and 59%. Also, there is a higher incidence of COVID-19 positive tests in the waiting list population than KTx recipients (9.9%). However, there was a higher mortality rate in KTx recipients than the waiting list population (32%). Additionally, 59% of living donor kidney transplant programs suspended the evaluation of new donors due to the COVID-19 pandemic. Throughout this manuscript, we summarize some practical tips to resume organ donation and KTx during pandemics in Latin America, such as selecting healthy donors and recipients, universal SARS-CoV-2 screening, implementing COVID-19 accessible pathways, and telehealth as a standard, and postpone all non-urgent visits.
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Affiliation(s)
- David Andrés Castañeda Millán
- Department of Surgery, Urology Unit, Hospital Universitario Nacional de Colombia, Universidad Nacional de Colombia, Bogotá, Colombia.
| | | | - Verónica Tobar-Roa
- Urology Department and Kidney Transplant Unit, Clínica FOSCAL, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | | | - Ana María Autrán-Gómez
- Oficina de Investigación Confederación Americana de Urologia (CAU), Buenos Aires, Argentina
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May PJ, Macher-Heidrich S, Schäfer M, Smit H, Pasch W, May AT, Frings G, Fischer M. [Considerations for quality assurance of discussions with relatives in direct association with organ donation]. Anaesthesist 2021; 71:437-443. [PMID: 34652456 DOI: 10.1007/s00101-021-01054-y] [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: 04/23/2021] [Revised: 07/28/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Discussions with relatives are relevant and crucial aspects of the organ donation process and contribute to a consolidated and sustainable decision by the families of the deceased. Despite the great importance of family care, there is no systematic analysis of the quality of this communication, in contrast to the diagnosis of irreversible loss of brain function, organ retrieval and organ transplantation. For this reason, organ donation experts were interviewed about recurring characteristics of communication with relatives of the deceased. The aim of this qualitative study was to define criteria for the assessment of the structure and quality of the communication process with relatives for internal quality management in Germany. METHODS Based on a systematic literature review and with the help of the 5‑stage S2PS2 (system for creating a questionnaire) procedure according to Kruse, interview guidelines were initially developed. As a second step, in guideline-based interviews 10 experienced organ donation experts were questioned about structural, procedural and ethical aspects of their discussions with relatives. Following the interviews, a software-based qualitative content analysis was carried out with a combined inductive-deductive category system. Finally, the first quality assurance measures for the interviews with relatives were developed in a multistep process, closely following the methodological principles V1.1 of the Institute for Quality Assurance and Transparency in Health Care (IQTIG). The individual research steps were accompanied by an expert group consisting of physicians, nurses, theologians and ethicists utilizing an anonymous Delphi procedure. RESULTS In the qualitative content analysis, 5 main categories with 30 subcategories on quality relevant aspects could be identified (including, standardization and technique of conversation, interview framework and context factors, professional expertise of the interviewers, wishes of the organ donation experts). On this basis, 6 criteria for the structural quality and 7 criteria for the process quality of the discussions with relatives were formulated and summarized in a respective quality bundle. These criteria address, among other things, interprofessional communication, structured training concepts, regular further training of all team members, use of standardized communication and counselling strategies as well as documented preliminary meetings and debriefings, including supervising elements. They emphasize interdisciplinary professionalism and process management in a protected environment as well as quality assured communication and documentation. Recommendations were made for expanding the existing documentation for the organ donation process and for documenting the preliminary meetings and debriefings. CONCLUSION Recurring communication and process characteristics as well as requirements for the members of the treatment team who conduct the conversation can be identified for the interviews with relatives, which show potential for improvement to various degrees. This justifies the structured derivation of a quality bundle for the structural and process quality family care related to organ donation, which should enable a low-threshold entry into an institution internal systematic quality assessment of communication with relatives in Germany. Due to the different legal, medical and social specifics in an international context, the study results cannot be directly transferred to other countries.
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Affiliation(s)
- Peter-Johann May
- Research Unit für Qualität und Ethik im Gesundheitswesen, Private Universität für Gesundheitswissenschaften, Medizinische Informatik und Technik, Hall in Tirol, Österreich.
| | | | - Melanie Schäfer
- Klinik für Operative Intensivmedizin und Intermediate Care, Universitätsklinik Aachen, Aachen, Deutschland
| | - Heiner Smit
- Ehemaliger Bevollmächtigter der Deutschen Stiftung Organtransplantation, DSO, Moers, Deutschland
| | - Wolfgang Pasch
- Fliedner Fachhochschule Düsseldorf, Düsseldorf, Deutschland
| | - Arnd T May
- Zentrum für Angewandte Ethik, Erfurt, Deutschland
| | - Gero Frings
- Klinik für Anästhesie, Intensivmedizin & Akut-Schmerztherapie, St. Bernhard-Hospital Kamp-Lintfort, Kamp-Lintfort, Deutschland
| | - Michael Fischer
- Research Unit für Qualität und Ethik im Gesundheitswesen, Private Universität für Gesundheitswissenschaften, Medizinische Informatik und Technik, Hall in Tirol, Österreich
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Silva E Silva V, Hornby L, Lotherington K, Rochon A, Regina Silva A, Pearson H, MacNutt L, Robertson A, Werestiuk K, Kuhl D, John P, Dhanani S, Sarti A. Burnout, compassion fatigue and work-related stressors among organ donation and transplantation coordinators: A qualitative study. Intensive Crit Care Nurs 2021; 68:103125. [PMID: 34454831 DOI: 10.1016/j.iccn.2021.103125] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 07/07/2021] [Accepted: 07/17/2021] [Indexed: 11/05/2022]
Abstract
AIM Organ and Tissue Donation Coordinators (OTDCs) are healthcare professionals who manage deceased organ donation cases. This study investigated the experiences and perceptions of OTDCs, pertaining to compassion fatigue, burnout, and resilience as it relates to their daily work. METHODOLOGY A qualitative descriptive study was undertaken using semi-structured interviews conducted with a convenience sample of OTDCs. SETTING A Canadian Organ Donation Organization. FINDINGS Seven out of the ten OTDCs contacted participated in this study. Coordinators all agreed that they work in a high-pressure and demanding environment and the constant exposure to work-related stress and grief has resulted in the majority of them experiencing signs and symptoms of burnout and compassion fatigue occurring throughout their career. Participants described that the emotional toll of work-related stressors and difficult cases led them to use a variety of defence strategies to protect and support their well-being. They also recognised that more strategies to help mitigate work-related stressors and to prevent burnout and compassion fatigue are needed and that management and institutions should lead the development of such interventions. CONCLUSION Our results describe how coordinators' mental health is affected by their daily work. Further research is needed to comprehensively examine these work-related stressors and to generate additional data to support the development of interventions to mitigate burnout and compassion fatigue among OTDCs.
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Affiliation(s)
- Vanessa Silva E Silva
- Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario K1G 4J5, Canada; Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, Ontario K1H 5B2, Canada.
| | - Laura Hornby
- University of Ottawa,75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada
| | - Ken Lotherington
- Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario K1G 4J5, Canada; Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, Ontario K1H 5B2, Canada
| | - Andrea Rochon
- Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario K1G 4J5, Canada; Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, Ontario K1H 5B2, Canada
| | - Amina Regina Silva
- Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario K1G 4J5, Canada; Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, Ontario K1H 5B2, Canada
| | - Hilary Pearson
- HDL Consulting, 120 S. State College Blvd, CA 92821, Canada
| | - Linda MacNutt
- HDL Consulting, 120 S. State College Blvd, CA 92821, Canada
| | - Adrian Robertson
- Manitoba Transplant Program, 820 Sherbrook St, Winnipeg, MB R3A 1R9, Canada
| | - Kim Werestiuk
- Manitoba Transplant Program, 820 Sherbrook St, Winnipeg, MB R3A 1R9, Canada
| | - David Kuhl
- HDL Consulting, 120 S. State College Blvd, CA 92821, Canada; University of British Columbia, Department of Family Practice, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, British Columbia V6T 1Z3, Canada
| | - Peggy John
- Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario K1G 4J5, Canada; Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, Ontario K1H 5B2, Canada
| | - Sonny Dhanani
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, Ontario K1H 5B2, Canada; University of Ottawa,75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada
| | - Aimee Sarti
- Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario K1G 4J5, Canada; Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, Ontario K1H 5B2, Canada
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Domínguez-Gil B, Ascher N, Capron AM, Gardiner D, Manara AR, Bernat JL, Miñambres E, Singh JM, Porte RJ, Markmann JF, Dhital K, Ledoux D, Fondevila C, Hosgood S, Van Raemdonck D, Keshavjee S, Dubois J, McGee A, Henderson GV, Glazier AK, Tullius SG, Shemie SD, Delmonico FL. Expanding controlled donation after the circulatory determination of death: statement from an international collaborative. Intensive Care Med 2021; 47:265-281. [PMID: 33635355 PMCID: PMC7907666 DOI: 10.1007/s00134-020-06341-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/21/2020] [Indexed: 12/14/2022]
Abstract
A decision to withdraw life-sustaining treatment (WLST) is derived by a conclusion that further treatment will not enable a patient to survive or will not produce a functional outcome with acceptable quality of life that the patient and the treating team regard as beneficial. Although many hospitalized patients die under such circumstances, controlled donation after the circulatory determination of death (cDCDD) programs have been developed only in a reduced number of countries. This International Collaborative Statement aims at expanding cDCDD in the world to help countries progress towards self-sufficiency in transplantation and offer more patients the opportunity of organ donation. The Statement addresses three fundamental aspects of the cDCDD pathway. First, it describes the process of determining a prognosis that justifies the WLST, a decision that should be prior to and independent of any consideration of organ donation and in which transplant professionals must not participate. Second, the Statement establishes the permanent cessation of circulation to the brain as the standard to determine death by circulatory criteria. Death may be declared after an elapsed observation period of 5 min without circulation to the brain, which confirms that the absence of circulation to the brain is permanent. Finally, the Statement highlights the value of perfusion repair for increasing the success of cDCDD organ transplantation. cDCDD protocols may utilize either in situ or ex situ perfusion consistent with the practice of each country. Methods to accomplish the in situ normothermic reperfusion of organs must preclude the restoration of brain perfusion to not invalidate the determination of death.
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Affiliation(s)
| | - Nancy Ascher
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Alexander M Capron
- Scott H. Bice Chair in Healthcare Law, Policy and Ethics, Department of Medicine and Law, University of Southern California, Los Angeles, CA, USA
| | - Dale Gardiner
- Intensive Care Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Alexander R Manara
- Consultant in Intensive Care Medicine, The Intensive Care Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - James L Bernat
- Department of Neurology and Medicine, Active Emeritus, Dartmouth Geisel School of Medicine, Hanover, NH, USA
| | - Eduardo Miñambres
- Transplant Coordination Unit and Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Jeffrey M Singh
- University of Toronto, and Trillium Gift of Life Network, Toronto, Canada
| | - Robert J Porte
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - James F Markmann
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Kumud Dhital
- Department of Cardiothoracic Surgery, Sant Vincent'S Hospital, Sidney, Australia
| | - Didier Ledoux
- Department of Anesthesia and Intensive Care, University of Liège, Liège, Belgium
| | - Constantino Fondevila
- General and Digestive Surgery, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Sarah Hosgood
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Dirk Van Raemdonck
- University Hospitals Leuven and Catholic University Leuven, Leuven, Belgium
| | - Shaf Keshavjee
- Toronto General Hospital, University of Toronto, Toronto, Canada
| | - James Dubois
- Bioethics Research Center, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrew McGee
- Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane City, Australia
| | - Galen V Henderson
- Director of Neurocritical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Stefan G Tullius
- Division of Transplant Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sam D Shemie
- Pediatric Intensive Care, Montreal Children's Hospital, McGill University, Medical Advisor, Deceased Donation, Canadian Blood Services, Montreal, Canada
| | - Francis L Delmonico
- Chief Medical Officer, New England Donor Services, 60 1st Ave, Waltham, MA, 02451, USA.
- Department of Surgery, Harvard Medical School at Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
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Shi WY, Gao H. [A summary of China's 70 years of development in diagnosis and treatment targeting corneal diseases]. Zhonghua Yan Ke Za Zhi 2020; 56:401-8. [PMID: 32842324 DOI: 10.3760/cma.j.cn112142-20200401-00236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Since the founding of the People's Republic of China, the diagnosis and treatment technology of corneal diseases has developed rapidly. In the field of infectious keratopathy, China was the first country that discovered chlamydia trachomatis in the world, which promoted the study on the pathogenesis as well as the diagnosis and treatment of infectious keratitis, especially fungal keratitis. In the aspect of surgical technology, we have learned from other countries and innovated different types of transplantation surgeries suitable for patients with corneal diseases in China. Regarding the construction of eye banks, the cornea donation process and the operation techniques have been developed and standardized. In addition, to improve the cornea disease-related inspection level, new equipment such as specular microscopy and confocal microscopy has been introduced. These efforts have decreased corneal diseases from the first blinding eye disease to the second in our country. In the past 70 years, China's diagnosis and treatment technology in corneal diseases has achieved remarkable progresses, but there are still many shortcomings. Standing on the shoulders of the older generations of ophthalmologists, we should continue to serve the patients with corneal diseases wholeheartedly. We would like to send congratulations on the 70th anniversary of Chinese Journal of Ophthalmology with this article. ( Chin J Ophthalmol, 2020, 56: 401-408).
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Abstract
Donation after circulatory death (DCD) is an increasing source of liver grafts for transplantation, yet outcomes have been inferior compared to donation after brain death liver transplantation. These worse outcomes are mainly due to the severe graft injury resulting from mandatory warm ischemia during DCD organ recovery. New evidence, however, indicates that improved donor selection and surgical techniques can decrease the risk of graft failure and ischemic cholangiopathy (IC). Under current best practices, DCD organs are retrieved with the super-rapid technique, optimizing timing and protecting the liver graft from detrimental warm ischemia. Graft viability is influenced by both the quantity and quality of warm ischemia, which is unique to each donor and causes various degrees of pathophysiologic consequences. Evidence also shows that the choice of preservation solution and premortem heparin administration influences graft viability. Additionally, although the precise mechanism of IC remains unknown, stasis of blood during donor warm ischemia may cause the formation of microthrombi in the peribiliary vascular plexus and ischemia of the bile duct. Importantly, thrombolytic protocols show a possible preventive modality for IC. Finally, while ex vivo machine perfusion technology has gained an interest in DCD liver transplantation, further studies are necessary to evaluate the effectiveness of this evolving field to improve graft quality and transplant outcomes.
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Affiliation(s)
- Koji Hashimoto
- Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
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20
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Witjes M, Kruijff PEV, Haase-Kromwijk BJJM, van der Hoeven JG, Jansen NE, Abdo WF. Physician Experiences with Communicating Organ Donation with the Relatives: A Dutch Nationwide Evaluation on Factors that Influence Consent Rates. Neurocrit Care 2019; 31:357-64. [PMID: 30767119 DOI: 10.1007/s12028-019-00678-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background The aim of this nationwide observational study is to identify modifiable factors in communication about organ donation that influence family consent rates. Methods Thirty-two intensivists specialized in organ donation systematically evaluated all consecutive organ donation requests with physicians in the Netherlands between January 2013 and June 2016, using a standardized questionnaire. Results Out of 2528 consecutive donation requests, 2095 (83%) were evaluated with physicians. The questionnaires of patients registered with consent or objection in the national donor registry were excluded from analysis. Only those questionnaires, in which the family had to make a decision about donation, were analyzed (n = 1322). Independent predictors of consent included: requesting organ donation during the conversation about futility of treatment (OR 1.8; p = 0.004), understanding of the term ‘brain death’ by the family (OR 2.4; p = 0.002), and consulting a donation expert prior to the donation request (OR 3.4; p < 0.001). Conclusions Our study showed that decoupling the organ donation conversation from the conversation about futility of treatment was associated with lower family consent rates. Comprehension of the concept of brain death by the family and consultation with a transplant coordinator before the organ donation request by the physician could positively influence consent rates. Electronic supplementary material The online version of this article (10.1007/s12028-019-00678-8) contains supplementary material, which is available to authorized users.
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Abstract
PURPOSE OF REVIEW Kidney transplantation is the best treatment for end-stage renal disease. However, due to organ shortage, suboptimal grafts are increasingly being used. RECENT FINDINGS We carried out a review on the methods and techniques of organ optimization in the cadaveric setting. Donor care is the first link in a chain of care. Right after brain death, there is a set of changes, of which hormonal and hemodynamic changes are the most relevant. Several studies have been conducted to determine which drugs to administer, although in most cases, the results are not definitive. The main goal seems rather achieve a set of biochemical and hemodynamic objectives. The ischemia-reperfusion injury is a critical factor for kidney damage in transplantation. One of the ways found to deal with this type of injury is preconditioning. Local and remote ischemic preconditioning has been studied for various organs, but studies on the kidney are scarce. A new promising area is pharmacological preconditioning, which is taking its first steps. Main surgical techniques were established in the late twentieth century. Some minor new features have been introduced to deal with anatomical variations or the emergence of donation after circulatory death. Finally, after harvesting, it is necessary to ensure the best conditions for the kidneys until the time of transplantation. Much has evolved since static cold preservation, but the best preservation conditions are yet to be determined. Conservation in the cold has come to be questioned, and great results have appeared at temperatures closer to physiological.
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Affiliation(s)
- Edgar Tavares-da-Silva
- Urology and Renal Transplantation Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal.,Centro de Investigação em Meio Ambiente, Genética e Oncobiologia (CIMAGO), Coimbra, Portugal
| | - Arnaldo Figueiredo
- Urology and Renal Transplantation Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal. .,Faculty of Medicine, University of Coimbra, Coimbra, Portugal. .,Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal. .,Centro de Investigação em Meio Ambiente, Genética e Oncobiologia (CIMAGO), Coimbra, Portugal.
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Waller KMJ, Hedley JA, Rosales BM, De La Mata NL, Thomson IK, Walker J, Kelly PJ, O'Leary MJ, Cavazzoni E, Wyburn KR, Webster AC. Effect of language and country of birth on the consent process and medical suitability of potential organ donors; a linked-data cohort study 2010-2015. J Crit Care 2020; 57:23-29. [PMID: 32014644 DOI: 10.1016/j.jcrc.2020.01.025] [Citation(s) in RCA: 1] [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: 10/29/2019] [Revised: 12/02/2019] [Accepted: 01/20/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Australia has unmet need for transplantation. We sought to assess the impact of cultural and linguistic diversity (CALD) on family consent and medical suitability for organ donation. METHOD Cohort study of New South Wales donor referrals, 2010-2015. Logistic regression estimated effects of primary language other than English and birthplace outside Australia (odds ratios OR, with 95% confidence intervals, 95%CI). Outcomes were whether families were asked for consent to donation, provided consent for donation, and whether the referral was medically suitable for donation. RESULTS Of 2977 organ donor referrals, a similar proportion of families had consent for donation was sought between non-English speakers and English speakers (p = .07), and between overseas-born compared to Australian-born referrals (p = .3). However, consent was less likely to be given for both non-English speakers than English speakers (OR 0.44, 95%CI:0.29-0.67), and those overseas-born than Australian-born (OR 0.54, 95%CI:0.41-0.72). For referrals both overseas-born and non-English speaking, families were both less likely to be asked for consent (OR 0.67; 95%CI:0.49-0.91) or give consent (OR 0.24; 95%CI0.16-0.37). There was no difference in medical suitability between English speakers and non-English speakers (p = .6), or between Australian-born and overseas-born referrals (p = .6). CONCLUSION Intervention to improve consent rates from CALD families may increase donation.
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Affiliation(s)
- Karen M J Waller
- Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - James A Hedley
- Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Brenda M Rosales
- Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Nicole L De La Mata
- Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Imogen K Thomson
- Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - John Walker
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Economics, Faculty of Arts and Social Sciences, University of Sydney, Sydney, Australia.
| | - Patrick J Kelly
- Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Michael J O'Leary
- New South Wales Organ and Tissue Donation Service, Sydney, Australia.
| | - Elena Cavazzoni
- New South Wales Organ and Tissue Donation Service, Sydney, Australia.
| | - Kate R Wyburn
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Renal Department, Royal Prince Alfred Hospital, Sydney, Australia.
| | - Angela C Webster
- Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia.
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Hong JW, Chung SW, Ahn SJ, Lee WJ, Lew DH, Kim YO. Analysis of factors involved in brain-death donor processing for face transplantation in Korea: How much time is available from brain death to transplantation? Arch Plast Surg 2019; 46:405-13. [PMID: 31462025 DOI: 10.5999/aps.2019.00150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 07/03/2019] [Indexed: 11/23/2022] Open
Abstract
Background Face transplantation has naturally evolved from reconstructive procedures. However, few institutions perform face transplantations, because it is time-consuming and it is necessary to justify non-vital organ transplantation. We investigated the process of organ donation from brain-dead patients and the possibility of incorporating face transplantation into the donation process. Methods A retrospective review was performed of 1,074 brain-dead patients from January 2015 to December 2016 in Korea. We analyzed the time intervals from admission to brain death decisions (first, second, and final), the causes of brain death, and the state of the transplanted organs. Results The patient base (n=1,074) was composed of 747 males and 327 females. The average period between admission to the first brain death decision was 8.5 days (±15.3). The average time intervals between the first brain death decision and medical confirmation using electroencephalography and between the first brain death decision and the final determination of brain death were 16 hours 58 minutes (±14 hours 50 minutes) and 22 hours 57 minutes (±16 hours 16 minutes), respectively. The most common cause of brain death was cerebral hemorrhage/stroke (42.3%), followed by hypoxia (30.1%), and head trauma (25.2%). Conclusions When face transplantation is performed, the transplantation team has 22 hours 57 minutes on average to prepare after the first brain death decision. The cause of brain death was head trauma in approximately one-fourth of cases. Although head trauma does not always imply facial trauma, surgeons should be aware that the facial tissue may be compromised in such cases.
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Danet Danet A, Jimenez Cardoso PM, Pérez Villares JM. Emotional paths of professional experiences in transplant coordinators. Nefrologia 2019; 40:74-90. [PMID: 31420101 DOI: 10.1016/j.nefro.2019.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/27/2018] [Revised: 05/02/2019] [Accepted: 05/12/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVE To look at transplant coordinators' professional narratives and explore their emotional experiences, coping strategies, needs and demands in relation to the donation interview. MATERIALS AND METHODS Exploratory, transversal, multicenter design, using grounded theory, qualitative approach and content analysis of open-ended questionnaire and semistructured interviews with 22 transplant coordinators from the Andalusian Public Health System. Categories of analysis: Transplant coordination: perceptions, functions, impact and consequences; Positive/gratifying aspects and negative/ difficult aspects; Donation interview; Coping strategies; Needs, demands and suggestions. RESULTS Transplant coordinators maintain a polarized perspective on their work, which they describe as a challenge and an opportunity. They highlight both their satisfaction and professional commitment as their work difficulties and requirements, which represent stress factors with an impact on professionals' perceptions, life styles, identity or physical and psychical life. Most gratifying work aspects refer to professional excellence, successful transplants and relationship with patients and their families. The donation interview is considered to be the most stressful moment, in response to which coordinators develop different emotional paths, conditioned by their experience, families' response to donation and its interpretation by the health team and professional (self) evaluation. Main professional demands are training strategies, group therapies and institutional support. CONCLUSIONS The complexity and emotional intensiveness of transplant coordination require special interventions aiming to enable professionals towards an improvement of their emotional heath and management.
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Affiliation(s)
- Alina Danet Danet
- Ciber Epidemiología y Salud Pública, Madrid, España; Escuela Andaluza de Salud Pública, Granada, España.
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Parsa P, Taheri M, Rezapur-Shahkolai F, Shirahmadi S. Attitudes of Iranian students about organ donation: a qualitative study. BMC Med Ethics 2019; 20:36. [PMID: 31138188 DOI: 10.1186/s12910-019-0372-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 05/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Organ donation is a life-saving process for patients suffering from an advanced organ failure. A disparity between donated organs and required organs for transplantation is one of the major problems in Iran. Since personal attitudes about organ donation is a main factor influencing willingness to donate organ, the present study sought to provide a deeper understanding of the attitudes of university students in Iran regarding organ donation. METHODS This qualitative study was conducted in 2016. Semi-structured interviews were held for collecting data from eighty five students from various universities in Hamadan city, Iran. Using a purposive sampling method, the students were selected based on the maximum variation. The content analysis method was used for data analysis by the research team and criteria for the study's rigor was considered. RESULTS Overall, the students had positive attitudes toward organ donation by brain-dead patients. Nevertheless, not of them stated that they would become an organ donor. During the data analysis, 376 primary codes, 13 categories, and 6 themes were developed. Themes were "cognitive readiness", "mediators of decision making", "beliefs and motivations", "interactions with the health system", "dependency", and "integrity of the body". Also, thirteen sub-themes were developed. CONCLUSION Many factors influence the students' attitudes toward organ donation. Identification and explanation of these factors can help healthcare managers and policymakers for planning and improving the organ donation culture in the society.
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Tackmann E, Dettmer S. Measures influencing post-mortem organ donation rates in Germany, the Netherlands, Spain and the UK : A systematic review. Anaesthesist 2019; 68:377-83. [PMID: 31101922 DOI: 10.1007/s00101-019-0600-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/28/2019] [Accepted: 04/10/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND German post-mortem organ donation rates have been declining since 2010. Several transplantation scandals led to a negative portrayal of organ donation in the media. Spain, the UK and the Netherlands achieved a rise in organ donation rates while retaining organ donation legislation. METHODS A systematic review of publications focusing on (1) organ donation legislation, (2) data on post-mortem organ donation rates and (3) measures to increase post-mortem organ donation rates in Europe was conducted in November 2017 in PubMed, PsycINFO and Web of Science. Quality parameters of the World Bank and the World Health Organization (WHO) were studied to analyze national health services, frequent causes of death and life expectancy. RESULTS Quality parameters of national health services were similar in all countries. The Netherlands and Germany have an opt in system. An increase of 37.4% in post-mortem organ donation rates from 2008 to 2015 in the UK was accomplished through the establishment of a donation task force, adopting parts of the Spanish model, while maintaining an opt in system. Spain has the highest organ donation rate worldwide (39.7 per million persons in 2015). The implementation of transplantation coordinators and the change in legislation in Germany in 2012 has so far shown no effect. Public awareness of organ donation in the Netherlands increased following various information campaigns. CONCLUSION Donation after cardiac death (DCD), expanded donor criteria, increasing public awareness and introduction of an organ donor register should be discussed as measures to increase organ donation rates in Germany.
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Tan L, Liang ZF, Xie XB, Zhao Y, Peng FH, Lan GB, Yu SJ, Wang Y, Tang XT, Song L, Liu F, Fang CH, Nie MH, Guo Y, Xie DD, Yan C, Peng LK. [Outcome of kidney transplantation with graft from intracerebral hemorrhage donors]. Zhonghua Yi Xue Za Zhi 2019; 99:1106-10. [PMID: 30982261 DOI: 10.3760/cma.j.issn.0376-2491.2019.14.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To analyze the data of kidney transplantation with allografts from intracerebral hemorrhage donors of China donation after citizen's death (CDCD) and provide evidence to guide the clinical practice. Methods: The clinical data of CDCD donors (age ≥10 years)and corresponding kidney allograft recipients, which were done by Second Xiangya Hospital of Central South University during January 1 2013 to December 31 2017, were analyzed retrospectively. Results: 327 CDCD cases were analyzed, the number and percentage of intracerebral hemorrhage donors were gradually increasing and the percentage reached to 39.5% in 2017. The discarding rateof kidney allografts donated by intracerebral hemorrhage donors was higher than those donated by non-intracerebral hemorrhage donors, but intracerebral hemorrhage donor may not be a risk factor for DGF after the rigorous evaluation of kidney allografts. For 145 primary recipients transplanted in 2016 and had a 22±4 month follow-up, the recipients accepted the kidney from intracerebral hemorrhage donors had a higher level of serum creatinine[(130±60)μmol/L vs (111±38) μmol/L,P<0.05]and a lower eGFR[(61±23) ml·min(-1)·(1.73m(2))(-1) vs (70±23) ml·min(-1)·(1.73m(2))(-1),P<0.05] compared to the recipients accepted the kidney from non-intracerebral hemorrhage donors. Conclusion: The number and percentage of organ donation from intracerebral hemorrhage donor is increasing, but the intracerebral hemorrhage donor may be a risk factor for long-term outcome of kidney transplantation.
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Danet Danet A, Jimenez Cardoso PM. Emotional experiences of health professionals in organ procurement and transplantation. A systematic review. Cir Esp 2019; 97:364-376. [PMID: 30929746 DOI: 10.1016/j.ciresp.2019.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/31/2018] [Revised: 12/20/2018] [Accepted: 01/24/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The objective was to explore, discuss and synthesize the emotional experiences of health professionals during the process of organ procurement and transplantation. METHODS A systematic review was made in Medline, Science Direct and the Virtual Library of the Andalusian Public Health System, selecting 16 original articles for inclusion in the review, with qualitative evaluation and narrative synthesis. RESULTS The results revealed the main use of qualitative methodology, and 4emergent themes were identified: working in organ procurement and transplantation; the transition of professional roles; emotional experiences; and, coping strategies and emotional management. This systematic review revealed the complex and diverse character of professionals' emotional experiences as well as the importance of the interpersonal relationship. CONCLUSIONS Intense emotional experiences related to the sense of responsibility, the work challenge and coping strategies based on reward searching explained important contradictions and tensions about professional roles and functions, especially during the donation interview.
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Affiliation(s)
- Alina Danet Danet
- Ciber Epidemiología y Salud Pública, Madrid, España; Escuela Andaluza de Salud Pública, Granada, España.
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van Reeven M, Pirenne J, Muiesan P, Fondevila C, IJzermans JNM, Polak WG. Policies towards donation after circulatory death liver transplantation: the need for a guideline? J Hepatobiliary Pancreat Sci 2019; 26:128-136. [PMID: 30776194 DOI: 10.1002/jhbp.614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Liver transplantation (LT) using grafts from donation after circulatory death (DCD) is evolving to standard of care in many countries. Various transplant centers have developed a protocol for DCD-LT. The existence of numerous protocols may cause inconsistencies. Knowledge of these differences may help improve the outcome of DCD-LT. METHODS An internet-based survey was sent to 119 transplant surgeons among four countries: Belgium (BE), the Netherlands (NL), Spain (ES) and the United Kingdom (UK). RESULTS Thirty-three percent of all respondents indicated having no specific age limit for DCD-LT donors, and if there was a limit, half of them ignored it. Calculation of donor warm ischemia time (dWIT) varied substantially between countries. In ES and the UK, the starting point of dWIT was defined as deterioration of saturation/blood pressure, while in NL, cardiac arrest was used as starting point. Seventy-eight percent of the respondents used a super-rapid sterno-laparotomy as procurement technique. Surgeons from NL and BE mainly used aortic perfusion (95% and 72%), while dual perfusion was more common in the UK (90%) and ES (91%). CONCLUSIONS This study demonstrates major differences in approach to DCD-LT. To assure both donors and recipients a consistent standard of care, a consensus meeting on DCD-LT is highly recommended.
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Affiliation(s)
- Marjolein van Reeven
- Division of Hepatopancreatobiliary and Transplant Surgery, Department of Surgery, Erasmus University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Jacques Pirenne
- Division of Abdominal Transplant Surgery, Department of Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Paolo Muiesan
- Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Constantino Fondevila
- Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jan N M IJzermans
- Division of Hepatopancreatobiliary and Transplant Surgery, Department of Surgery, Erasmus University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Wojciech G Polak
- Division of Hepatopancreatobiliary and Transplant Surgery, Department of Surgery, Erasmus University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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Viñuela-Prieto JM, Soria-García AM, González-Romero M, Candel FJ. Bacterial contamination rate and associated factors during bone and tendon allograft procurement from Spanish donors: exploring the contamination patterns. J Hosp Infect 2019; 102:287-294. [PMID: 30772451 DOI: 10.1016/j.jhin.2019.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/18/2018] [Accepted: 02/08/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Allograft contamination during extraction represents a major limiting factor for tissue bank availability. Contamination rates remain persistently high independent of the hospital, country or year considered. AIM To analyse the factors associated with contamination of bone and tendon samples extracted from Spanish donors. METHODS Data for 1162 bone and tendon samples extracted from 102 donors between 2014 and 2017 were collected retrospectively from the hospital database. Descriptive statistics, potentially associated factors and correlation of contamination between samples extracted from different anatomical locations of the same donor were analysed. FINDINGS In total, 227 (19.54%) of the extracted samples [131 (18.49%) bone samples and 96 (20.92%) tendon samples] rendered positive cultures and were discarded. Male sex [odds ratio (OR) 2.023; P=0.019], extraction of >10 samples per donor (OR 1.997; P<0.001) and extraction time >240 min (OR 1.755; P=0.001) were factors independently associated with a higher contamination rate. Meanwhile, the tissue sample type 'bone-patellar tendon-bone' was associated with a significantly lower contamination rate (OR 0.446; P=0.001). Significant correlation between certain localization of contaminated samples and the concordance of bacterial species was also observed. CONCLUSION Factors related to the extraction procedure, such as total extraction time, extraction sequence, number of samples extracted and anatomical location of extracted samples, play a major role in allograft contamination. Further optimization of procedures, guided by the contamination patterns analysed in this study, should help to increase tissue bank availability.
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Affiliation(s)
- J M Viñuela-Prieto
- Transplant Coordination Department, Hospital Clínico San Carlos, Madrid, Spain; School of Medicine, Complutense University, Madrid, Spain.
| | - A M Soria-García
- Transplant Coordination Department, Hospital Clínico San Carlos, Madrid, Spain
| | - M González-Romero
- Transplant Coordination Department, Hospital Clínico San Carlos, Madrid, Spain
| | - F J Candel
- Transplant Coordination Department, Hospital Clínico San Carlos, Madrid, Spain; Health Research Institute, Hospital Clínico San Carlos, Madrid, Spain
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Chang W. Extracorporeal Life Support in Organ Transplant Donors. Korean J Thorac Cardiovasc Surg 2018; 51:328-332. [PMID: 30402392 PMCID: PMC6200175 DOI: 10.5090/kjtcs.2018.51.5.328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/02/2018] [Accepted: 03/16/2018] [Indexed: 11/28/2022]
Abstract
Background Extracorporeal life support (ECLS) can be applied in brain-dead donors for organ perfusion before donation, thereby expanding the donor pool. The aim of this study was to examine the benefits and early clinical outcomes of ECLS for organ preservation. Methods Between June 2012 and April 2017, 9 patients received ECLS with therapeutic intent or for organ preservation. The following data were collected: demographics, purpose and duration of ECLS, cause of death, dose of vasoactive drugs, and need for temporary dialysis before organ retrieval. The early clinical outcomes of recipients were studied, as well as survival and graft function at 1 month. Results ECLS was initiated for extracorporeal cardiopulmonary resuscitation in 5 patients. The other patients needed ECLS due to hemodynamic deterioration during the assessment of brain death. We successfully retrieved 18 kidneys, 7 livers, and 1 heart from 9 donors. All organs were transplanted and none were discarded. Only 1 case of delayed kidney graft function was noted, and all 26 recipients were discharged without any significant complications. Conclusion The benefits of protecting the vital organs of donors is significant, and ECLS for organ preservation can be widely used in the transplantation field.
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Affiliation(s)
- Wonho Chang
- Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Seoul Hospital
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Cheung TK, Cheng TC, Wong LY. Willingness for deceased organ donation under different legislative systems in Hong Kong: population-based cross-sectional survey. Hong Kong Med J 2018; 24:119-127. [PMID: 29633715 DOI: 10.12809/hkmj176831] [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] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Under the current opt-in system, the deceased organ donation rate remains low in Hong Kong. An opt-out system and an opt-in system combined with organ allocation priority (ie, priority to donors as transplant recipients) have been proposed to encourage willingness among the general population towards deceased organ donation. This study aimed to compare willingness, and its determinants, across these three legislative systems. METHODS A random telephone survey of Hong Kong permanent residents aged ≥18 years was conducted between August and October 2016 using an anonymous questionnaire. Willingness towards deceased organ donation was compared between the legislative systems with McNemar's test. Determinants of willingness were tested by logistic regression. RESULTS The proportion of those willing to consider deceased organ donation under the current opt-in system would significantly increase after combining it with allocation priority (64.5% vs 73.4%; P=0.018). "Fairness or reciprocity" was the major reported reason underlying the increase. In contrast, willingness would decrease after introducing the opt-out system (60.1%), although not significantly (P=0.336). The reduction might be attributable to a "belief of being forced to donate". Under the allocation priority system, reduced willingness to donate was associated with advanced age, lower educational attainment, and lower monthly household income. Under the opt-out system, reduced willingness was associated with being married, having a lower household income, and distrust of local government. CONCLUSIONS An opt-in system with allocation priority could induce willingness to donate, whereas an opt-out system may reduce willingness. The findings have implications for policy-making and promotion of organ donation.
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Affiliation(s)
- T K Cheung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - T C Cheng
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - L Y Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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González-Méndez MI, López-Rodríguez L. Organ donation after controlled cardiac death under Maastricht category iii: Ethical implications and end of life care. Enferm Clin (Engl Ed) 2017; 29:39-46. [PMID: 29241598 DOI: 10.1016/j.enfcli.2017.10.009] [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: 06/22/2017] [Revised: 10/18/2017] [Accepted: 10/21/2017] [Indexed: 11/25/2022]
Abstract
The decrease in potential donation after brain death has resulted in a need to evaluate alternative sources. Donation after cardiac death is a good option. The objectives of this article are to describe the Maastricht type iii controlled organ donation characteristics and to determine end-of-life care and the role of nurses in the donation process. In this type of donation, cardiocirculatory arrest is predictable after the limitation of life sustaining treatments. These are patients for whom there are no effective therapy options and, in the context of an organised and planned practice involving all the professionals involved in the care of the patient, the decision is made, in consultation with the family, to withdraw life support measures. This limitation of life sustaining treatments is never carried out with the aim of making a Maastricht iii donation, but to avoid prolonging the dying process through useless and possibly degrading interventions. The obligation of the health team is to provide a dignified death and this not only includes the absence of pain, but the patient and their family must be guaranteed a feeling of calmness and serenity. Once the decision has been taken to withhold or withdraw measures, the nurse has an important role in the implementation of a palliative care plan in where physicians, nurses and patients/families should be involved and whose focus should be on patients' dignity and comfort, considering their physical, psychological and spiritual needs.
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Affiliation(s)
| | - Luís López-Rodríguez
- Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, España; Unidad de Apoyo a la Calidad, Hospital Virgen del Rocío, Sevilla, España
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Tackmann E, Dettmer S. [Acceptance of post-mortem organ donation in Germany : Representative cross-sectional study]. Anaesthesist 2017; 67:118-125. [PMID: 29230502 DOI: 10.1007/s00101-017-0391-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 07/21/2017] [Revised: 11/04/2017] [Accepted: 11/15/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The German post-mortem organ donation rate has dropped by one third since 2010. Furthermore, 958 patients died in 2015 in Germany while waiting for an organ. To decrease organ shortage, an amendment of the transplantation law was established in 2012. An information package including an organ donor card is sent to all German citizens via the postal service. A voluntary national transplantation register was introduced in 2016 to improve transparency in the organ donation process. The influence of several transplantation scandals starting in 2012 on organ donation rates is in question. Therefore, the objective of this article is to discuss approval and objections to post-mortem organ donation among the next of kin of potential donors and the general public in Germany. METHODS Binary logistic regression of data from the 2014 survey by the Federal Centre for Health Education on attitudes towards organ and tissue donation in Germany was conducted, aiming to identify influencing factors on the likelihood of organ donor card possession. Additionally, data of the German Organ Transplantation Foundation on post-mortem organ donations in Germany in 2014 were studied to highlight reasons for approval and objections by next of kin of potential and explanted post-mortem organ donors. Methods of documentation of the deceased's will according to data of the German Organ Transplantation Foundation were analyzed. RESULTS Male gender and lack of knowledge about organ donation decrease the likelihood of having an organ donor card. Of the respondents in the survey of the Federal Centre for Health Education 71.0% would donate their own organs, whereas only one third possess an organ donor card. Health insurances and physicians are the most important providers of organ donor cards in Germany. An increase in the percentage of organ donor card possession following the amendment of the transplantation law could not be observed by 2016. Fear of organ trade and unjust organ allocation are the main reasons for rejecting organ donation among the general public. Previous transplantation scandals are a primary reason for a negative change in attitudes. Main reasons for objection among the next of kin of potential organ donors are known objections of the deceased and the lack of knowledge about the will of the deceased. In addition, only 58.1% of all explanted organ donors documented their will in written or verbal form. CONCLUSION Education on organ donation can be a means to increase organ donation rates. The effects of the change in legislation and the establishment of the transplant register need to be evaluated. Further research regarding the influence of religion, especially among religious minorities, on organ donation rates in Germany needs to be conducted to identify possible obstacles. Moreover, the use of social networks to address potential organ donors has proven to increase registration numbers and could easily be implemented in Germany.
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Affiliation(s)
- E Tackmann
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - S Dettmer
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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Calvo-Calvo MÁ, Morgado Almenara I, Gentil Govantes MÁ, Moreno Rodríguez A, Puertas Cruz T, García Álvarez T, Carmona Vílchez MD. Socio-sanitary profile and information for living kidney donors and recipients in three Andalusian hospitals. Nefrologia 2017; 38:304-314. [PMID: 29129387 DOI: 10.1016/j.nefro.2017.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/19/2017] [Revised: 08/05/2017] [Accepted: 08/10/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Information provided by health professionals to potential donors and recipients is essential for an autonomous and objective decision to make a living kidney donation. OBJECTIVES To determine the characteristics of the information received by living kidney donors and recipients, to find out their socio-sanitary profile, their socio-demographics, financial and labour characteristics, health and the caregiving activity of these donors and recipients. METHODS Observational, descriptive and cross-sectional study of the population of living kidney donors and recipients from the University Hospitals Puerta del Mar (Cádiz), Virgen del Rocío (Seville), and the University Hospital Complex of Granada, between 08/04/2014 and 08/06/2015. RESULTS AND CONCLUSIONS According to the 40 living kidney donors and their 40 recipients surveyed, it is mainly nephrologists who make people aware and provide information about living kidney donation. Almost half of recipients require more information so the evaluation processes and pre-donation information should be updated. In general, the living kidney donor is female, aged 50, with primary/secondary education, lives with a partner and is related to the kidney recipient. Also, the living kidney donor is in paid employment, is overweight, perceives her health as very good or good, and does not smoke or drink alcohol. However, the typical living kidney recipient is male, aged 44 and has completed secondary school studies and vocational training. Furthermore, he does not work, perceives his health as good or regular, and he is an independent person for activities of daily living.
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Affiliation(s)
- Manuel-Ángel Calvo-Calvo
- Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, España; Unidad de Gestión Clínica de Nefrología y Urología, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - Isabel Morgado Almenara
- Unidad de Gestión Clínica de Nefrología y Urología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | | | - Teresa Puertas Cruz
- Servicio de Nefrología y Trasplante Renal, Complejo Hospitalario Universitario de Granada, Granada, España
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Allen RD, Pleass HC. Improving organ donation rates and transplantation in Australia. Med J Aust 2017; 207:287-288. [PMID: 28954614 DOI: 10.5694/mja17.00590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/03/2017] [Indexed: 11/17/2022]
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Potter JE, Herkes RG, Perry L, Elliott RM, Aneman A, Brieva JL, Cavazzoni E, Cheng AT, O'Leary MJ, Seppelt IM, Gebski V; COMFORT study investigators. COMmunication with Families regarding ORgan and Tissue donation after death in intensive care (COMFORT): protocol for an intervention study. BMC Health Serv Res 2017; 17:42. [PMID: 28095838 DOI: 10.1186/s12913-016-1964-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 12/17/2016] [Indexed: 11/14/2022] Open
Abstract
Background Discussing deceased organ donation can be difficult not only for families but for health professionals who initiate and manage the conversations. It is well recognised that the methods of communication and communication skills of health professionals are key influences on decisions made by families regarding organ donation. Methods This multicentre study is being performed in nine intensive care units with follow-up conducted by the Organ and Tissue Donation Service in New South Wales (NSW) Australia. The control condition is pre-intervention usual practice for at least six months before each site implements the intervention. The COMFORT intervention consists of six elements: family conversations regarding offers for organ donation to be led by a “designated requester”; family offers for donation are deferred to the designated requester; the offer of donation is separated from the end-of-life discussion that death is inevitable; it takes place within a structured family donation conversation using a “balanced” approach. Designated requesters may be intensivists, critical care nurses or social workers prepared by attending the three-day national “Family Donation Conversation” workshops, and the half-day NSW Simulation Program. The design is pre-post intervention to compare rates of family consent for organ donation six months before and under the intervention. Each ICU crosses from using the control to intervention condition after the site initiation visit. The primary endpoint is the consent rate for deceased organ donation calculated from 140 eligible next of kin families. Secondary endpoints are health professionals’ adherence rates to core elements of the intervention; identification of predictors of family donation decision; and the proportion of families who regret their final donation decision at 90 days. Discussion The pragmatic design of this study may identify ‘what works’ in usual clinical settings when requesting organ donation in critical care areas, both in terms of changes in practice healthcare professionals are willing and able to adopt, and the effect this may have on desired outcomes. The findings of this study will be indicative of the potential benefits of the intervention and be relevant and transferrable to clinical settings in other states and countries. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613000815763 (24 July 2013). ClinicalTrials.gov: NCT01922310 (14 August 2013) (retrospectively registered). Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1964-7) contains supplementary material, which is available to authorized users.
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Sah B, Ayer A, Yadav BN, Jha S, Yadav SK. Development of a Valid and Reliable Questionnaire to Identify Professional Opinion Regarding Organ Transplantation System. Int J Organ Transplant Med 2017; 8:146-156. [PMID: 28924463 PMCID: PMC5592102] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Currently, the Nepalese law permits organ donation by an individual who falls into the category of a "close relative" of the recipient. There is a need for expansion of the live organ donor pool beside close relatives. Different systems of organ transplantation are followed by several countries and the professional opinions that underpin these systems need to be studied. OBJECTIVE To generate a questionnaire related to different organ transplant systems and validate it so that it can be used to collect mass professional opinions. METHODS Item generation, item reduction, item scaling, and pretesting were used to develop a questionnaire. The final version of the questionnaire was reviewed by experts for its content validity and then was used twice for participants at a 20-day interval to calculate Cronbach's alpha for testing its internal consistency and Intra-class correlation for testing its test and retest reliability. RESULTS The questionnaire was found to be valid and reliable with an overall Cronbach's alpha of 0.701. Intra-class correlation scores for each question in both test and retest were correlated. CONCLUSION A valid and reliable questionnaire was developed that can be used to collect mass professional opinions to assist policy makers to establish a better organ transplant system.
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Affiliation(s)
- B. Sah
- Department of Forensic Medicine and Toxicology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal,Correspondence: Bikash Sah, Assistant Professor, Department of Forensic Medicine and Toxicology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal, E-mail:
| | - A. Ayer
- Department of Conservative Dentistry & Endodontics, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - B. N. Yadav
- Department of Forensic Medicine and Toxicology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - S. Jha
- Department of Forensic Medicine and Toxicology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - S. K. Yadav
- Institute of Liver Transplant and Regenerative Medicine. Medanta, The Medicity, New Delhi (NCR), India
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Kim MH, Jun KW, Moon IS, Kim JI. Clinical importance of congenital anomalies of the inferior vena cava in organ procurement surgery from a deceased donor: two case reports. Ann Surg Treat Res 2016; 91:260-264. [PMID: 27847799 PMCID: PMC5107421 DOI: 10.4174/astr.2016.91.5.260] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 03/31/2016] [Accepted: 05/16/2016] [Indexed: 12/04/2022] Open
Abstract
Congenital anomalies of the inferior vena cava (IVC) are rare but important problems in living donors for kidney transplantation, especially in cases of a short left renal vein and accompanying vascular and urological anatomic variations. However, the clinical impacts of IVC anomalies in deceased donors have yet to be reported. The unexpected presence of an IVC in an unusual position poses challenges to surgeons and increases the risk of bleeding during organ removal. Accompanying vascular variations can cause unexpected bleeding and injury and therefore technical complications in procurement and subsequent implantation. During cold perfusion, inadequate venous drainage or insufficient cooling can induce graft damage. Our cases highlight the need for all transplant surgeons to confirm the anatomy of the aorta, IVC, and major vessels early in the surgical procedure and, should an anomaly be detected, know how to manage the problem.
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Affiliation(s)
- Mi-Hyeong Kim
- Division of Vascular and Transplantation Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kang-Woong Jun
- Division of Vascular and Transplantation Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In-Sung Moon
- Division of Vascular and Transplantation Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji-Il Kim
- Division of Vascular and Transplantation Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kute VB, Patel HV, Shah PR, Modi PR, Shah VR, Rizvi SJ, Pal BC, Modi MP, Shah PS, Varyani UT, Wakhare PS, Shinde SG, Ghodela VA, Patel MH, Trivedi VB, Trivedi HL. Increasing access to kidney transplantation for sensitized recipient through three-way kidney paired donation with desensitization: The first Indian report. World J Clin Cases 2016; 4:351-355. [PMID: 27803919 PMCID: PMC5067500 DOI: 10.12998/wjcc.v4.i10.351] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 07/01/2016] [Accepted: 07/22/2016] [Indexed: 02/05/2023] Open
Abstract
The combination of kidney paired donation (KPD) with desensitization represents a promising method of increasing the rate of living donor kidney transplantation (LDKT) in immunologically challenging patients. Patients who are difficult to match and desensitize due to strong donor specific antibody are may be transplanted by a combination of desensitization and KPD protocol with more immunologically favorable donor. We present our experience of combination of desensitization protocol with three-way KPD which contributed to successful LDKT in highly sensitized end stage renal disease patient. All recipients were discharged with normal and stable allograft function at 24 mo follow up. We believe that this is first report from India where three-way KPD exchange was performed with the combination of KPD and desensitization. The combination of desensitization protocol with KPD improves access and outcomes of LDKT.
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Hoste P, Ferdinande P, Hoste E, Vanhaecht K, Rogiers X, Eeckloo K, Van Deynse D, Ledoux D, Vandewoude K, Vogelaers D. Recommendations for further improvement of the deceased organ donation process in Belgium. Acta Clin Belg 2016; 71:303-12. [PMID: 27594299 DOI: 10.1080/17843286.2016.1216259] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Belgium has achieved high deceased organ donation rates but according to the medical record data in the Donor Action database, deceased potential donors are still missed along the pathway. Between 2010 and 2014, 12.9 ± 3.3% of the potential donors after brain death (DBD) and 24.6 ± 1.8% of the potential donors after circulatory (DCD) death were not identified. Conversion rates of 41.7 ± 2.1% for DBD and 7.9 ± 0.9% for DCD indicate room for further improvement. We identify and discuss different issues in the monitoring of donation activities, practices and outcomes; donor pool; legislation on deceased organ donation; registration; financial reimbursement; educational and training programs; donor detection and practice clinical guidance. The overall aim of this position paper, elaborated by a Belgian expert panel, is to provide recommendations for further improvement of the deceased organ donation process up to organ procurement in Belgium.
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Tordoff CC, Bodenham AR. Outcomes following out-of-hospital cardiac arrest: What is the potential for donation after circulatory death? J Intensive Care Soc 2016; 17:97-102. [PMID: 28979472 DOI: 10.1177/1751143715613796] [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] [Indexed: 11/17/2022] Open
Abstract
We conducted a prospective observational study on 100 consecutive patients admitted to intensive care units at Leeds General Infirmary following out-of-hospital cardiac arrest. In the non-survivors, we reviewed their potential for organ donation via donation after circulatory death. Out of the 100 patients, 53 did not survive to hospital discharge. Out of these non-survivors, 13 died very suddenly within the intensive care unit and 3 other patients subsequently died in a general ward following discharge from the intensive care unit. One patient became brainstem dead, with out-of-hospital cardiac arrest secondary to a subarachnoid haemorrhage, rather than a primary cardiac cause. This patient went on to donate via the brain death mode. The remaining 36 patients had treatment withdrawn in the intensive care unit. Of these, 29 were referred to the transplant team for potential donation after circulatory death, and 14 were deemed to be medically suitable for organ donation. However, the families of only seven agreed to proceed with the donation process. Of these seven, only one went on to donate, primarily because the majority did not die within the 3-h window for acceptable warm ischaemia. In this series, the potential for donation after circulatory death following out-of-hospital cardiac arrest was limited. We would suggest an open dialogue between intensive care unit staff and transplant teams about the realistic potential for organ donation in each case. When clinicians believe it is unlikely that donation after circulatory death will proceed due to a failure to die within the pre-requisite time, then not starting with the donation after circulatory death process should be seriously considered.
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Affiliation(s)
- Claire C Tordoff
- Department of Anaesthesia, Leeds Teaching Hospital NHS Trust, Leeds, UK.,Department of Anaesthesia and Intensive Care Medicine, Leeds General Infirmary, Leeds, UK
| | - Andrew R Bodenham
- Department of Anaesthesia and Intensive Care Medicine, Leeds General Infirmary, Leeds, UK
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Chakradhar K, Doshi D, Srikanth Reddy B, Kulkarni S, Padma Reddy M, Sruthi Reddy S. Knowledge, Attitude and Practice Regarding Organ Donation among Indian Dental Students. Int J Organ Transplant Med 2016; 7:28-35. [PMID: 26889371 PMCID: PMC4756262] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Of the overall 9.5 million deaths annually in India, nearly 100,000 are due to organ failure. To save and extend lives, organ donation and organ transplantation have become the only hope. Health care professionals (HCPs) are a key element in facilitating cadaveric organ donation process. OBJECTIVE To assess and compare the knowledge, attitude, and practice regarding organ donation among undergraduate dental students. METHODS A cross-sectional study was conducted among 298 undergraduate dental students of the Panineeya Institute of Dental Sciences and Hospital, Hyderabad, India. A 27-item self-administered questionnaire, which assessed the levels of knowledge (Q1-13), positive attitude (Q14-24) and practice habits (Q25-27) regarding organ donation with dichotomous scale (Yes/No). RESULTS As compared to males, females reported better mean±SD scores in knowledge (8.22±1.51) and practice (0.91±0.8); higher mean±SD attitude scores (8.55±1.56) were reported among males (p<0.001). While second year dental students had higher scores for their knowledge (8.55±1.56) and practice (1.02±0.44) compared to other year of training, third year students showed a significant higher mean attitude score (1.73±1.17) (p=0.02). Hindus and Muslims scored significantly lower mean knowledge, attitude and practice habits compared to others (Christians, Jains and Athesists) (p<0.001). There was a positive correlation between mean knowledge, attitude, and practice habits. CONCLUSION There are an average level of knowledge and low levels of positive attitude and practice habits among studied dental students towards organ donation and transplantation.
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Affiliation(s)
- K. Chakradhar
- Correspondence: Dr. K. Chakradhar, Post-Graduate Student, Master of Dental Surgery, Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Hospital, Road No. 5, Kamala Nagar, Dilsukhnagar, Hyderabad - 500 060, India, Tel: +91-970-456-3254, Fax: +91-402-404-5037 ,E-mail:
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Povar Marco J, Javierre Loris MÁ, Garcés Sanjosé C, Sánchez Miret JI. [Role of the hospital emergency department staff in the organ donation process: opinions of professionals working in the Spanish autonomous community of Aragon]. Emergencias 2015; 27:46-49. [PMID: 29077334] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To determine the opinion of hospital emergency department staff on their involvement in the process of organ and tissue procurement and on aspects that might improve their participation. MATERIAL AND METHODS Emergency department physicians and nurses responded to a questionnaire during a course on the procurement of organ and tissue donations in the emergency setting. A total of 149 questionnaires were received from 78 nurses (52%) and 71 emergency physicians (48%) from 10 hospitals. Sixty-three percent of the respondents worked in hospitals with intensive care units and 37% in centers without such units. RESULTS The respondents felt that the greatest difficulties in the donation process are related to communication and conveyance of information to the patient's families (39.6%) and to the assessment of prognosis (29.2%). The physicians felt that evaluating prognosis was the main hurdle, whereas the nurses thought that communication with the family presented the greatest problem (P=.021). They also felt that the health care professional's involvement in the donation process was the key to improving organ procurement (83.1%). The availability of protocols (47.2%) and the need for training opportunities (31%) were considered necessary for increasing the involvement of emergency department staff in the process. CONCLUSION The attitudes of hospital emergency department staff to organ and tissue donation are very positive, as suggested by their opinion that their own involvement in the process is the most important factor to target for improvement. These emergency physicians and nurses would like relevant protocols and training in the organ donation process.
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Affiliation(s)
- Javier Povar Marco
- Servicio de Urgencias, Hospital Universitario Miguel Servet, Zaragoza, España. Universidad de Zaragoza, España
| | | | - Cristina Garcés Sanjosé
- Servicio de Urgencias, Hospital Universitario Miguel Servet, Zaragoza, España. Universidad de Zaragoza, España
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Sağiroğlu M, Günay O, Balci E. Attitudes of Turkish Medical and Law Students towards the Organ Donation. Int J Organ Transplant Med 2015; 6:1-7. [PMID: 25737771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Attitudes of medical and law personnel towards organ donation are very important. OBJECTIVE To compare the attitudes of the medical and law students towards organ donation. METHODS 498 students in the 1(st) and 4(th) grades of the medical and law faculties of Erciyes University, Kayseri, Turkey, in 2011-12 academic year, were included in this study. A questionnaire consisting of 31 questions on socio-demographic characteristics of the students and their attitudes towards organ donation and transplantation was administered to the participants. RESULTS The percentage of the students who donated organs was 1%. Approximately, 48% of the medical students and 34% of the law students stated that they think to donate organs. The percentage of the students with a positive attitude towards organ donation was found significantly higher among the medical students than the law students, and higher among the 4th grade compared to the 1(st) grade. CONCLUSION The percentages of the students who have donated organs and think to donate are rather low. Medical students' attitude towards organ donation was more positive than the law students.
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Afzal Aghaee M, Dehghani M, Sadeghi M, Khaleghi E. Awareness of Religious Leaders' Fatwa and Willingness to Donate Organ. Int J Organ Transplant Med 2015; 6:158-64. [PMID: 26576261 PMCID: PMC4644568] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND It is believed that religious leaders' positive attitude towards organ donation can be an effective factor in Muslims' inclination to donate organs. OBJECTIVE To assess the knowledge of freshmen students in Mashhad University of Medical Sciences about religious leaders' fatwa on organ donation and its effect on their willingness to donate organs. METHODS This cross-sectional study was conducted in 2013 on 400 freshmen of various medical disciplines, selected using a simple random sampling in Mashhad, Iran. Data were collected by a valid and reliable researcher-made questionnaire. Data were analyzed by multiple logistic regression analysis. RESULTS 41.5% of the students were aware of religious authorities' views on organ donation and 55.6% were willing to donate organs. Participants' main reasons for lack of willingness to donate organs included the fear of organ donation before the brain death is confirmed (52%), unwillingness to disfigure their body (51%), and belief in the burial of organs (50%). The willingness to organ donation for students who were aware of religious leaders opinion was more than twice more than those who were not (OR: 2.56, 95% CI: 1.75-4.52). Also, female gender, the Shia religion and awareness of the correct definition of brain death were associated factors affecting the desire to donate organs, although their effects were not statistically significant on regression model. CONCLUSION A considerable proportion of students were not aware of the religious leaders' fatwa on organ donation. The most important factor for the desire to donate organs was the awareness of religious leaders' fatwa. Therefore, it seems necessary that religious leaders' fatwa be known to all by appropriate methods.
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Affiliation(s)
- M. Afzal Aghaee
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - M. Dehghani
- Department of Epidemiology, School of Medicine. Shahroud University of Medical Sciences, Shahroud, Iran
| | - M. Sadeghi
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Correspondence: Masoumeh Sadeghi, Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran, E-mail: sadeghi.masoume.@gmail.com, Tel: +98-917-305-4293
| | - E. Khaleghi
- Department of Organ Transplant, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Berntzen H, Bjørk IT. Experiences of donor families after consenting to organ donation: a qualitative study. Intensive Crit Care Nurs 2014; 30:266-74. [PMID: 24815873 DOI: 10.1016/j.iccn.2014.03.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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: 11/03/2013] [Revised: 02/12/2014] [Accepted: 03/14/2014] [Indexed: 10/25/2022]
Abstract
AIM The aim of this study was to investigate the experience of Norwegian donor families during organ donation after brain death. METHODS This was a qualitative study using personal interviews. Twenty donor-family members from thirteen different situations were interviewed about their experience of being a close relative in an organ donation situation. The principles of qualitative content analysis were used. FINDINGS An experience of strain caused by the organ donation situation was identified. Lack of comprehension and awareness of the process of organ donation contributed to this, and continuing information after the consent was given appeared to be necessary. Reconciliation with the decision of organ donation and the subsequent situation was gained through understanding the organ donation process, through recognition of the increased strain and through satisfaction resulting from the contribution made by organ donation. Healthcare personnel were key persons in contributing to such understanding and recognition. CONCLUSION When attending to families in an organ donation situation, the focus must be on ensuring comprehension of the situation both through information provided in the hospital and during follow-up. It seems essential to arrange for a period of parting that can contribute to reconciliation, and to offer follow-up according to individual needs.
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Affiliation(s)
- Helene Berntzen
- Division of Emergencies and Critical Care, Oslo University Hospital, Norway.
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Abstract
A prominent defence of a market in organs from living donors says that if we truly care about people in poverty, we should allow them to sell their organs. The argument is that if poor vendors would have voluntarily decided to sell their organs in a free market, then prohibiting them from selling makes them even worse off, at least from their own perspective, and that it would be unconscionably paternalistic to substitute our judgements for individuals' own judgements about what would be best for them. The author shows that this 'Laissez-Choisir Argument' for organ selling rests on a mistake. This is because the claim that it would be better for people in poverty to sell their organs if given the option is consistent with the claim that it would be even better for them to not have the option at all. The upshot is that objections to an organ market need not be at all paternalistic, since we need not accept that the absence of a market makes those in poverty any worse off, even from their own point of view. The author goes on to argue that there are strong theoretical and empirical reasons for believing that people in poverty would in fact be harmed by the introduction of a market for live donor organs and that the harm constitutes sufficient grounds for prohibiting a market.
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Puybasset L, Bazin JE, Beloucif S, Bizouarn P, Crozier S, Devalois B, Eon B, Fieux F, Gisquet E, Guibet-Lafaye C, Kentish N, Lienhart A, Nicolas-Robin A, Otero Lopez M, Pelluchon C, Roussin F, Beydon L. Critical appraisal of organ procurement under Maastricht 3 condition. ACTA ACUST UNITED AC 2014; 33:120-7. [PMID: 24406262 DOI: 10.1016/j.annfar.2013.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The ethics committee of the French Society of Anesthesia and Intensive Care (Sfar) has been requested by the French Biomedical Agency to consider the issue of organ donation in patients after the decision to withdraw life-supportive therapies has been taken. This type of organ donation is performed in the USA, Canada, the United Kingdom, the Netherlands and Belgium. The three former countries have published recommendations formalizing procedures and operations. The French Society of Anesthesia and Intensive Care (Société française d'anesthésie et de reanimation [Sfar]) ethics committee has considered this issue and envisioned the different aspects of the whole process. Consequently, it sounded a note of caution regarding the applicability of this type of organ procurement in unselected patients following a decision to withdraw life-supportive therapies. According to French regulations concerning organ procurement in brain-dead patients, the committee stresses the need to restrict this specific way of procurement to severely brain-injured patients, once confirmatory investigations predicting a catastrophic prognosis have been performed. This suggests that the nature of the confirmatory investigation required should be formalized by the French Biomedical Agency on behalf of the French parliamentarians, which should help preserve population trust regarding organ procurement and provide a framework for medical decision. This text has been endorsed by the Sfar.
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Affiliation(s)
- L Puybasset
- Unité de neuro-anesthésie-réanimation, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - J-E Bazin
- Département d'anesthésie-réanimation, Hôtel-Dieu, boulevard Léon-Malfreyt, BP 69, 63003 Clermont-Ferrand cedex, France
| | - S Beloucif
- Service d'anesthésie-réanimation, hôpital Avicenne, 125, rue de Stalingrad, 93009 Bobigny cedex, France
| | - P Bizouarn
- Département-service d'anesthésie-réanimation, hôpital Laënnec, CHU de Nantes, boulevard Jacques-Monod, BP 1005, 44093 Nantes cedex 1, France
| | - S Crozier
- Service de neurologie, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - B Devalois
- Service de médecine palliative, centre hospitalier René-Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France
| | - B Eon
- Département d'anesthésie-réanimation, hôpital Sainte-Marguerite, BP 29, 13274 Marseille cedex 9, France
| | - F Fieux
- Département d'anesthésie-réanimation, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75745 Paris cedex 10, France
| | - E Gisquet
- Centre de sociologie des organisations, 19, rue Amélie, 75007 Paris, France
| | - C Guibet-Lafaye
- Centre Maurice-Halbwachs-CNRS, 48, boulevard Jourdan, 75014 Paris, France
| | - N Kentish
- Groupe de recherche FAMIREA, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75745 Paris cedex 10, France
| | - A Lienhart
- Département d'anesthésie-réanimation, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex 12, France
| | - A Nicolas-Robin
- Département d'anesthésie-réanimation, hôpital de la Pitié-Salpêtrière, boulevard de l'Hôpital, 75013 Paris, France
| | - M Otero Lopez
- Département d'anesthésie-réanimation, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - C Pelluchon
- Département de philosophie, université de Poitiers, 36, rue de la Chaîne, 86022 Poitiers, France
| | - F Roussin
- Département d'anesthésie-réanimation, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75745 Paris cedex 10, France
| | - L Beydon
- Pôle d'anesthésie-réanimation, centre hospitalier universitaire, 4, rue Larrey, 49033 Angers cedex 01, France. lbeydon.angers.@invivo.edu
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