1
|
Skaczkowski G, Barrett A, Olver I, Dollman J, Gunn KM. 'It is a life changing experience': The experiences of living kidney donors who live in rural Australia. Aust J Rural Health 2023; 31:866-877. [PMID: 37335838 DOI: 10.1111/ajr.13008] [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: 10/15/2022] [Revised: 03/19/2023] [Accepted: 05/28/2023] [Indexed: 06/21/2023] Open
Abstract
INTRODUCTION A growing body of research has examined the physical, psychological, social and financial impacts of living kidney donation. However, little is known about the unique experiences or additional burdens faced by living donors from regional or remote locations. OBJECTIVE To explore the experiences of living kidney donors who live outside metropolitan centres and to determine how support services could be orientated to better meet their unique needs. DESIGN/SETTING/PARTICIPANTS Seventeen living kidney donors participated in semistructured telephone interviews. Qualitative data were analysed using thematic analysis. FINDINGS Eight themes were identified: (1) donor's emotional well-being is influenced by the recipient's outcome, (2) varied levels of access to medical support and other important services in rural areas, (3) travel takes a toll on time, finances and well-being, (4) varied level of financial impact, (5) medical, emotional and social challenges, (6) both lay and health professional support is valued, (7) varied levels of knowledge and experiences accessing information and (8) a worthwhile experience overall. CONCLUSION Despite many challenges, and travel adding to the complexity, rural living kidney donors generally consider it to be a worthwhile experience. The provision of additional emotional, practical and educational support would be welcomed by this group.
Collapse
Affiliation(s)
- Gemma Skaczkowski
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Alison Barrett
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Ian Olver
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - James Dollman
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Kate M Gunn
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| |
Collapse
|
2
|
Wu Y, Li M, Li L. Knowledge and Attitude of Chinese Non-Medical University Students Toward Living Organ Donation: A Narrative Analysis. J Multidiscip Healthc 2022; 15:2693-2702. [PMID: 36466728 PMCID: PMC9717434 DOI: 10.2147/jmdh.s386172] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/27/2022] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE This study aims to explore Chinese non-medical university students' knowledge and attitudes toward living organ donation. METHODS In this study, sixteen in-depth, semi-structured interviews were conducted at a Chinese university. Data collection lasted from April 2020 to May 2020. The interviews were recorded and transcribed verbatim. The method of content analysis was used to analyze non-medical university students' knowledge and attitudes toward living organ donation. RESULTS Qualitative content analysis of the collected data yielded five themes. Themes involve (1) benefits of living organ donation; (2) disincentives to living organ donation; (3) ways to understand living organ donation; (4) ways to promote the dissemination of living organ donation; and (5) traditional Chinese culture as incentives to living organ donation. CONCLUSION This study suggests that almost all participants have positive attitudes toward living organ donation on condition that recipients are their lineal relatives including their parents, children, and siblings. What concerns participants most is the adverse impact of living organ donation on their health. These findings could shed some insight into how to strengthen the knowledge of non-medical university students regarding living organ donation.
Collapse
Affiliation(s)
- Yijin Wu
- School of Translation Studies, Qufu Normal University, Rizhao, People’s Republic of China
| | - Mengzhen Li
- School of Translation Studies, Qufu Normal University, Rizhao, People’s Republic of China
| | - Linzi Li
- Department of Obstetrics, Rizhao Maternal and Child Health Hospital, Rizhao, People’s Republic of China
| |
Collapse
|
3
|
Prionas A, Craddock C, Papalois V. Feasibility, Safety and Efficacy of Enhanced Recovery After Living Donor Nephrectomy: Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2020; 10:E21. [PMID: 33374793 DOI: 10.3390/jcm10010021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 11/05/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 12/25/2022] Open
Abstract
This meta-analysis aims to compare enhanced recovery after surgery (ERAS) vs. standard perioperative practice in the management of living kidney donors. Primary endpoints included mortality, complications, length of stay (LOS) and quality of life after living donor nephrectomy. Medline, Embase, Scopus, Cochrane and Web of Science databases were searched. In total, 3029 records were identified. We then screened 114 full texts. Finally, 11 studies were included in the systematic review corresponding to 813 living donors. Of these, four randomized controlled trials were included in the meta-analysis. ERAS resulted in shorter LOS (95CI: −1.144, −0.078, I2 = 87.622%) and lower incidence of post-operative complications (95CI: 0.158, 0.582, I2 = 0%). This referred to Clavien–Dindo I-II complications (95CI: 0.158, 0.582, I2 = 0%). There was no difference in Clavien–Dindo III-V complications (95CI: 0.061,16.173, I2 = 0%). ERAS donors consumed decreased amounts of narcotics during their hospital stay (95CI: −27.694, −8.605, I2 = 0%). They had less bodily pain (95CI: 6.735, 17.07, I2 = 0%) and improved emotional status (95CI: 6.593,13.319, I2 = 75.682%) one month postoperatively. ERAS protocols incorporating multimodal pain control interventions resulted in a mean reduction of 1 day in donors’ LOS (95CI: −1.374, −0.763, I2 = 0%). Our results suggest that ERAS protocols result in reduced perioperative morbidity, shorter length of hospital stay and improved quality of life after living donor nephrectomy.
Collapse
|
4
|
Girgenti R, Buttafarro M. [The Good Samaritan Donor Experience]. G Ital Nefrol 2018; 35:35-6-2018-11. [PMID: 30550041] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The need for patients with a chronic kidney failure and on dialysis to embark on a kidney transplant process, poses the challenge to identify alternative and effective surgical strategies to overcome the insufficient number of deceased donors. The purpose is to allow the considerable number of patients on the kidney transplant waiting lists to receive appropriate treatment in time and under the most favorable clinical conditions. Living donation from a significant other is becoming increasingly widespread, on a national and international level. Furthermore, in the last years clinical experience is showing a special kind of kidney living donation : the Good Samaritan donation, i.e. when the donor has no emotional or blood bond with the recipient and decides to become a donor as a mere act of generosity, with no remuneration or reward in return. This article, after a brief analysis of the phenomenon through data obtained from recent international studies, shares the direct experience of the Clinical Psychology Service at IRCCS - ISMETT with regard to the psychological assessment and support throughout the clinical process of a Good Samaritan kidney donor. Sharing our experience and starting a discussion on this issue is the result of the need to define shared guidelines on the psychological approach to be used with potential Good Samaritan donors.
Collapse
Affiliation(s)
- Rosario Girgenti
- Psicologo Clinico e di Comunità, Psiconcologo, Psicoterapeuta Cognitivo Comportamentale, Responsabile dell'Unità Operativa di Psicologia Clinica Ismett, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione - IRCCS, Palermo
| | - Marinella Buttafarro
- Psicologa Clinica, Psicoterapeuta Sistemico Relazionale IIPR, Psicologa Clinica Ismett, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione - IRCCS, Palermo
| |
Collapse
|
5
|
Van Pilsum Rasmussen SE, Henderson ML, Bollinger J, Seaman S, Brown D, Durand CM, Segev DL, Sugarman J. Perceptions, motivations, and concerns about living organ donation among people living with HIV. AIDS Care 2018; 30:1595-1599. [PMID: 29724118 DOI: 10.1080/09540121.2018.1469724] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 12/23/2022]
Abstract
Recent changes to United States law now permit people living with HIV (PLWH) to donate organs to HIV-infected (HIV+) recipients under research protocols. PLWH may have unique motivations for and concerns about living donation and understanding them is critical to ensuring the integrity of this novel approach to organ transplantation. We conducted in-depth interviews with PLWH from an urban HIV clinic who had previously indicated their willingness to be a living donor. Interviews elicited information on their motivations, perceived benefits, and concerns regarding living donation. Codes were identified inductively and then organized into themes and subthemes. Two coders independently analyzed the interviews and reconciled differences in coding by consensus. Thematic saturation was reached after 20 interviews. Motivations for living donation among PLWH included an altruistic desire to help others as well as HIV-specific motivations including solidarity with potential recipients and a desire to overcome HIV-related stigma. Perceived benefits of living donation included gratification from saving or improving the recipient's life and conferring a sense of normalcy for the HIV+ donor. Concerns about donation included the possibility of a prolonged recovery period, organ failure, and transmission of another strain of the virus to the recipients. PLWH had unique motivations, perceived benefits, and concerns about living donation in addition to those previously identified in the general population. These unique factors should be addressed in research protocols, informed consent processes, and the education and training of independent living donor advocates so that these endeavors are ethically sound.
Collapse
Affiliation(s)
| | - Macey L Henderson
- a Department of Surgery , Johns Hopkins University , Baltimore , USA.,b School of Nursing , Johns Hopkins University , Baltimore , USA
| | - Juli Bollinger
- c Berman Institute of Bioethics , Johns Hopkins University , Baltimore , USA
| | - Shanti Seaman
- d Department of Medicine , Johns Hopkins School of Medicine , Baltimore , USA
| | - Diane Brown
- d Department of Medicine , Johns Hopkins School of Medicine , Baltimore , USA
| | - Christine M Durand
- d Department of Medicine , Johns Hopkins School of Medicine , Baltimore , USA
| | - Dorry L Segev
- a Department of Surgery , Johns Hopkins University , Baltimore , USA.,b School of Nursing , Johns Hopkins University , Baltimore , USA.,e Department of Epidemiology , Johns Hopkins University Bloomberg School of Public Health , Baltimore , USA
| | - Jeremy Sugarman
- c Berman Institute of Bioethics , Johns Hopkins University , Baltimore , USA.,d Department of Medicine , Johns Hopkins School of Medicine , Baltimore , USA
| |
Collapse
|
6
|
Hunt HF, Rodrigue JR, Dew MA, Schaffer RL, Henderson ML, Bloom R, Kacani P, Shim P, Bolton L, Sanchez W, Lentine KL. Strategies for Increasing Knowledge, Communication, and Access to Living Donor Transplantation: an Evidence Review to Inform Patient Education. Curr Transplant Rep 2018; 5:27-44. [PMID: 30873335 DOI: 10.1007/s40472-018-0181-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Purpose of review Inadequate knowledge of the benefits, risks and opportunities for living donation is an important, potentially modifiable barrier to living donor transplantation. We assessed the current state of the evidence regarding strategies to increase knowledge, communication and access to living donor transplantation, as reported in peer-reviewed medical literature. Recent Findings Nineteen studies were reviewed, categorized as programs evaluated in randomized controlled trials (8 studies) and programs supported by observational (non-randomized) studies (11 studies). Content extraction demonstrated that comprehensive education about living donation and living donor transplantation involves multiple learners - the transplant candidate, potential living donors, and social support networks - and requires communicating complex information about the risks and benefits of donation, transplantation and alternative therapies to these different audiences. Transplant centers can help transplant patients learn about living donor transplantation through a variety of formats and modalities, including center-based, home-based and remote technology-based education, outreach to dialysis centers, and social media. Evaluation of these strategies and program themes informed a new Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) public education brochure. Summary Increasing transplant candidate knowledge and comfort in talking about living donation and transplantation can reduce educational barriers to pursuit of living donor transplants. Ongoing efforts are needed to develop, refine and disseminate educational programs to help improve transplant access for more patients in need of organ donors.
Collapse
Affiliation(s)
- Heather F Hunt
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,LIVE ON Organ Donation, Inc., Longmeadow, MA
| | - James R Rodrigue
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,Beth Israel Deaconess Transplant Institute, Boston, MA
| | - Mary Amanda Dew
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
| | - Randolph L Schaffer
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,Scripps Clinic, La Jolla, CA
| | - Macey L Henderson
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,Johns Hopkins University, Transplant Center & School of Nursing, Baltimore, MD
| | - Randee Bloom
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA
| | - Patrick Kacani
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA
| | - Pono Shim
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA
| | - Lee Bolton
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA
| | - William Sanchez
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,Mayo Clinic, Rochester, MN
| | - Krista L Lentine
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,Saint Louis University School of Medicine & Transplant Center, St. Louis, MO
| |
Collapse
|
7
|
Shepherd L, O'Carroll RE, Ferguson E. An international comparison of deceased and living organ donation/transplant rates in opt-in and opt-out systems: a panel study. BMC Med 2014; 12:131. [PMID: 25285666 PMCID: PMC4175622 DOI: 10.1186/s12916-014-0131-4] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 07/16/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Policy decisions about opt-in and opt-out consent for organ donation are based on limited evidence. To fill this gap we investigated the difference between deceased and living organ donation rates in opt-in and opt-out consent systems across a 13 year period. We controlled for extensive covariates and estimated the causal effect of consent with instrumental variables analysis. METHOD This panel study used secondary data analysis to compare organ donor and transplant rates in 48 countries that had either opt-in or opt-out consent. Organ donation data were obtained over a 13-year period between 2000 and 2012. The main outcome measures were the number of donors, number of transplants per organ and total number (deceased plus living) of kidneys and livers transplanted. The role of consent on donor and transplant rates was assessed using multilevel modeling and the causal effect estimated with instrumental variables analysis. RESULTS Deceased donor rates (per-million population) were higher in opt-out (M = 14.24) than opt-in consent countries (M = 9.98; Β = -4.27, 95% confidence interval (CI) = -8.08, -0.45, P = .029). However, the number of living donors was higher in opt-in (M = 9.36) than opt-out countries (M = 5.49; B = 3.86, 95% CI = 1.16, 6.56, P = .006). Importantly, the total number of kidneys transplanted (deceased plus living) was higher in opt-out (M = 28.32) than opt-in countries (M = 22.43; B = -5.89, 95% CI = -11.60, -0.17, P = .044). Similarly, the total number of livers transplanted was higher in opt-out (M = 11.26) than opt-in countries (M = 7.53; B = -3.73, 95% CI = -7.47, 0.01, P = .051). Instrumental variables analysis suggested that the effect of opt-in versus opt-out consent on the difference between deceased and living donor rates is causal. CONCLUSIONS While the number of deceased donors is higher than the number of living donors, opt-out consent leads to a relative increase in the total number of livers and kidneys transplanted.
Collapse
|