bluuebunny/crossref_metadata_2025 huggingface dataset:
Domino Liver Transplantation: A Practical Option in the Face of the Organ Shortage
Authors: Carrera Maria T. , Bogue Eileen Heanue , Schiano Thomas D.
Published: July 2017

This case study describes a domino liver transplantation in which a patient with familial amyloid polyneuropathy received a cadaveric liver, and the explanted liver was in turn transplanted into a second recipient. Familial amyloid polyneuropathy is an autosomal dominant inherited disease associated with a mutant form of the protein transthyretin. Liver transplantation is the only definitive treatment for this disease. Transplantation removes the source of mutant transthyretin, halts the progression of this otherwise fatal disease, and significantly palliates many underlying symptoms. This case study illustrates that domino transplantation is a practical option to provide a liver transplant for a patient with this disease and a second listed patient from a single cadaveric liver organ, thus alleviating the organ donor shortage. Transplantation offers the only cure for the genetic defect that causes familial amyloid polyneuropathy, appears to result in subjective and objective improvement in neurological function, and eliminates the mortality associated with the disease. A signed informed consent was provided for publication of this case study.
Culture, Brain Death, and Transplantation
Authors: Bowman Kerry W. , Richard Shawn A.
Published: July 2017

From the social sciences, we know the space between life and death is historically and culturally constructed, fluid and open to dispute. The definition of death has cultural, legal, and political dimensions. As healthcare becomes more culturally diverse, the interface between culture and the delivery of healthcare will increase. In our increasingly pluralistic, interdependent society, there is a growing demand to integrate healthcare, including transplantation, into a broader context that respects both individual and cultural diversity. It is important that we first consider and explore what elements of Western healthcare practices including definitions and advances, such as brain death and organ donation, are culturally influenced. This article highlights some of the cultural influences on brain death by focusing on Western and Japanese perspectives on the permissibility of organ procurement from brain-dead persons. It also offers 4 recommendations for healthcare workers working cross-culturally.
Advanced Assessment of Hemodynamic Parameters during Donor Care
Authors: Powner David J. , Crommett John W.
Published: July 2017

Detailed evaluation of cardiovascular function by hemodynamic “profiling” during donor care may be necessary to select appropriate treatment for hypotension. Preload, systemic vascular resistance, heart rate, and contractility are all determinants of cardiac output and blood pressure. This review discusses the measurement, physiological limitations, and pharmacological manipulation of those variables during care of selected donors.
Donation after Cardiac Death: Two Case Studies
Authors: Nelson Helen M. , Lewis Jonathan P.
Published: July 2017

Few transplant centers consider using lungs from cardiac death donors because of warm ischemic damage. In certain scenarios, the recovery and transplantation of lungs from cardiac death donors are appropriate. A young person with a severe neurologic and spinal cord injury, who is not brain dead and who is otherwise healthy, should be considered as a cardiac death donor. A protocol should be established with local lung transplant surgeons to facilitate the successful procurement of lungs from cardiac death donors. In addition, when patients present to hospital emergency rooms with nonsurvivable injuries either in cardiac arrest or with extremely labile vital signs, uncontrolled donation after cardiac death can be considered. It is important to obtain informed consent from the family and to suspend any previous do-not-resuscitate orders before initiating resuscitative efforts. If an organ procurement coordinator and team are within close proximity to the hospital, consideration should be given to uncontrolled donation after cardiac death.
Minimal Intervention Programs for Weight Loss in Heart Transplant Candidates: A Preliminary Examination
Authors: Park Tricia L. , Perri Michael G. , Rodrigue James R.
Published: July 2017

Context

Overweight can be a contraindication for cardiac transplantation, and empirical findings suggest that obesity may pose serious posttransplant health risks that can increase morbidity and mortality.

Objective

This study assessed the relative effectiveness of 2 minimal intervention programs to assist weight loss in heart transplant candidates.

Design

A randomized trial was employed to assess changes in body weight.

Setting

A large, tertiary care hospital in a Southern locale.

Patients

Forty-three heart transplant candidates (74% men, 79% married, 86% white), with a mean pretreatment body mass index of 32.4 (SD=4.4).

Interventions

Patients were randomly assigned to a bibliotherapy weight-loss program or a bibliotherapy plus telephone contact weight-loss program.

Main Outcome Measures

Change in body weight over 3 months and return rate of measures of program adherence (3-day food diaries and self-monitoring postcards).

Results

An intent-to-treat analysis showed a significant weight loss at posttreatment for the sample as a whole. Within-group analyses indicated that a significant weight change ( P<.05) in the telephone contact group (mean[SD]=-2.76[4.96] kg) but not the bibliotherapy-only group (mean[SD]=-1.02[2.97] kg). Participants in the telephone contact group returned more 3-day food diaries and self-monitoring postcards, with pounds lost significantly correlated with the number of completed self-monitoring postcards. These findings suggest that a minimal intervention program involving information plus limited professional contact may represent a viable approach to assisting overweight transplant candidates in weight management.
Development of a Questionnaire to Assess Attitudes and Beliefs toward Organ Donation among Asians
Authors: Jindal Rahul M. , Joseph John T. , Baines Lyndsay S.
Published: July 2017

In the United Kingdom, people from the Indian subcontinent have a higher incidence of kidney failure, are less likely to receive a kidney transplant, and have a higher mortality rate from renal disease. In addition, Asians are reluctant donors; white people make up 95% of the donor pool. We developed a questionnaire to determine the knowledge and attitudes toward organ donation in the Asian communities. The setting was a public forum; the aims were (1) to study the attitudes of Asians toward organ donation, (2) to validate our questionnaire, and (3) to initiate a campaign of increasing awareness of organ donation and transplantation in the Asian community in the greater Glasgow area. Our survey suggested that Asians have an awareness of organ donation and transplantation, and they would donate an organ to a family member; however, they did not carry a donor card. Respondents unanimously agreed that lobbying by religious leaders was the best means to promote awareness.
Transplant Coordination Program: A Useful Tool to Improve Organ Donation in Venezuela
Authors: Milanés Carmen Luisa , Gonzalez Leyda , Hernández Eddy , Arminio Anabella , Clesca Paul , Rivas-Vetencourt Pedro A.
Published: July 2017

Donor shortage is the single most important limitation for allowing adequate growth of transplant programs. Transplant coordination programs have been shown to provide solutions to this situation worldwide. To evaluate the efficacy of transplant coordination programs in Venezuela, a pilot program was implemented at a 1200-bed teaching hospital. The implementation of this program included an assessment of the hospital's donation practices such as donor identification, maintenance, brain-death diagnosis, family consent for donation, and timely transport and allocation of organs and tissues. A follow-up 1 year after the implementation of the transplant coordination program demonstrated a 7-fold increase in the number of donors compared with the 2 previous years when the program did not exist. During the first year of application, the transplant coordination program resulted in solutions in how to address issues surrounding the procurement process in a hospital with a high potential donor rate; a linkage between the coordinator and the medical staff through educational activities; increased skills of hospital staff; and a methodology that should be applied extensively in hospitals with high donor potential to deal with the organ shortage.
Proposed Treatment Guidelines for Donor Care
Authors: Powner David J. , Darby Joseph M. , Kellum John A.
Published: July 2017

The complex care of the organ donor during preparation for organ removal and provision of the best organs for transplantation is often the responsibility of the organ procurement coordinator. To assist in that process the following clinical problem-based guidelines have been developed. A standard order set is recommended to initiate treatment and to provide a continuing laboratory database. As clinical concerns arise from that database, past medical history, or ongoing donor care, section of these guidelines may serve as references for specific interventions. Physician consultation and collaboration with other bedside care providers are encouraged throughout.
Future Immunosuppressive Agents in Solid-Organ Transplantation
Authors: Gabardi Steven , Cerio Jeffrey
Published: July 2017

Objective

To review the pharmacology, pharmacokinetics, efficacy, and safety of mycophenolate sodium, everolimus, and FTY720.

Study Selection and Data Extraction

Clinical trials and abstracts evaluating mycophenolate sodium, everolimus, and FTY720 in solid-organ transplantation were considered for evaluation. English-language studies and published abstracts were selected for inclusion.

Data Synthesis

Mycophenolate sodium has recently been approved by the Food and Drug Adminstration for marketing in the United States; everolimus and FTY720 are immunosuppressive agents that may soon be available in the United States. These agents have proven efficacy in reducing the incidence of acute rejection in solid-organ transplantation. Clinical trials have shown that these newer agents are relatively well tolerated. The most common adverse events associated with these agents were gastrointestinal and hematologic effects (mycophenolate sodium); hyperlipidemia, increased serum creatinine, and hematologic effects (everolimus); and gastrointestinal effects, headache, and bradycardia (FTY720).

Conclusion

Mycophenolate sodium has been approved in some European countries and the United States. Everolimus has been approved in some European countries and a new drug application has been submitted to the Food and Drug Administration. FTY720 is currently in phase III clinical trials and submission to the Food and Drug Administration for approval is a few years away. The approval of these agents will furnish the transplant practitioner with even more options for immunosuppression.
Nonprescription Analgesics and Their Use in Solid-Organ Transplantation: A Review
Authors: Gabardi Steven , Luu Linh
Published: July 2017

Objective

To review the pharmacology, adverse events, drug interactions, and use of the nonprescription analgesics in solid-organ transplant recipients.

Study Selection and Data Extraction

Studies evaluating nonprescription analgesics in solid-organ transplantation were considered for evaluation. English-language studies were selected for inclusion.

Data Synthesis

Nonprescription analgesics (aspirin, choline salicylate, magnesium salicylate, sodium salicylate, ibuprofen, ketoprofen, naproxen sodium, and acetaminophen) are the most commonly purchased over-the-counter agents in the United States. These agents, although generally considered safe, have been associated with a number of toxicities. The salicylates and nonsteroidal anti-inflammatory drugs have been associated with gastrointestinal damage, hematologic changes, liver and kidney dysfunction, and breathing difficulties. Acetaminophen has been shown to induce hematologic changes and liver and renal dysfunction.

Conclusion

A closer look at the nonprescription analgesics reveals their potential for harm when used by solid-organ transplant recipients. In this patient population, the salicylates and nonsteroidal anti-inflammatory drugs should generally be avoided if possible, because of their potential toxicities, especially renal dysfunction. Low-dose aspirin, for the prevention of cardiovascular and cardiocerebral events, appears to be safe, but patients must still be followed closely. Acetaminophen is generally considered the nonprescription analgesic and antipyretic of choice in transplant recipients because of its favorable toxicity profile. However, it is imperative that patients and transplant practitioners are aware that this agent is not without toxicities and proper monitoring is advised.
Living Kidney Donor Decision Making: State of the Science and Directions for Future Research
Authors: Nolan Marie T. , Walton-Moss Benita , Taylor Laura , Dane Kathryn
Published: July 2017

Background

The Federal government and transplantation organizations have called for further study of living donation at a time when 3 new living donor protocols are being introduced throughout the United States that promise to significantly increase the donor pool and change the face of living donation. Donation to a once incompatible and sometimes unknown recipient may now occur through the use of plasmapheresis therapy or paired and nondirected living donor protocols.

Objective

To describe the state of the science on living kidney donor decision making, and to provide recommendations for future research to guide donor education and care.

Data Sources

Automated literature search using PubMed and CINAHL scientific literature databases.

Study Data Extraction

Research papers on living donor decision making from 1997 to 2003. Studies available only as abstracts were excluded. Data Synthesis Studies of living kidney donor decision making and outcomes have been limited in scope, with small sample sizes and inconsistent reports of racial and ethnic characteristics of the sample. The retrospective nature of the majority of living donor studies is a significant limitation.

Conclusions

Future prospective studies that are diverse by sex, race, and ethnicity will contribute to our knowledge of factors that influence the decision to be a living kidney donor.
Shopping for a Transplant: When Noncompliant Patients Seek Wait Listing at Multiple Hospitals
Authors: Bramstedt Katrina A. , Stowe Judy , Kotz Margaret
Published: July 2017

United Network for Organ Sharing policy allows patients to be listed for a transplant at multiple hospitals. This strategy can sometimes lessen the transplant waiting time for patients because waiting times vary geographically. We explore the ethical dilemma of “shopping for a transplant” by presenting the case of a patient with an addictive disorder who was listed for liver transplantation at one hospital on the east coast of the United States and was seeking listing at 2 additional hospitals in midwestern United States, when marijuana use was suspected by 1 of the latter 2 facilities. Although the transplant team at this facility deferred listing the patient, the team's bioethicist posed the concept of a duty to notify the facility where the patient was already listed for transplantation about any confirmed substance abuse, in an effort to prevent a scarce resource from being allocated to an individual who is noncompliant.
Increasing Organ Recovery from Level I Trauma Centers: The In-House Coordinator Intervention
Authors: Shafer Teresa J. , Ehrle Ronald N. , Davis Kimberly D. , Durand Roger E. , Holtzman Samuel M. , Van Buren Charles T. , Crafts Nicholas J. , Decker Phillip J.
Published: July 2017

Purpose

Daily presence of organ procurement organization staff in level I trauma centers combined with early family contact and interaction can increase donation rates.

Methods

A successful in-house coordinator program already in place at 2 level I trauma centers in Houston was replicated in 6 other level I trauma centers in New York City, Los Angeles, and Seattle. Organ procurement organization staff were placed inside the 8 trauma centers to provide early family support in potential donor situations and day-to-day donation system management. Comparison data were obtained on 83 level I trauma centers nationally. Data from 1999 to 2000 were compared with data from 2001 to 2002.

Results

Despite demographic differences, the 8 centers with in-house coordinators had higher consent rates (60% vs 53%) and conversion rates (55% vs 45%) than centers without them. Conversion of potential to actual donors was 22% higher in centers with in-house coordinators than in centers without them. Donation rates were affected by donor age, ethnicity, previous family discussion of donation, the family's initial reaction to the request (favorable, unfavorable, undecided), amount of time family spent with the in-house coordinator, presence of the in-house coordinator during explanation of brain death, whether the request was made at the same time as the brain-death explanation, and, in cases where donation was mentioned to the family before the formal request, who first mentioned donation to the family.

Conclusions

In-house coordinators improve the donation process by interacting with families and staff earlier and more often during potential organ donations and improving donation systems through closer relationships with hospital staff.
Financial Considerations Insurance and Coverage Issues in Intestinal Transplantation
Authors: Chaney Michael
Published: July 2017

Objective

To increase healthcare workers' knowledge of reimbursement concerns.

Methods

Chronological survey of transplants reimbursed at the University of Nebraska Medical Center from December 1997 to October 2003, which include accounts of 30 patients who received intestine transplants.

Conclusions

Gross billed hospital charges for the past 30 transplantations ranged from $112094 to $667597. Length of stay ranged from 18 to 119 days. Charges include organ procurement fees. All 30 intestine transplants were reimbursed by third-party healthcare coverage; combination of coverage; and/or patient and family payments, which resulted in adherence to financial guidelines prearranged by the hospital. Financial guidelines are usually cost plus a percentage. Thirteen transplantations occurred after April 2001, when Medicare made a national coverage decision to reimburse this form of transplantation. Since then, obtaining surgical authorization and reimbursement is easier. Most insurance companies and state public health agencies accept intestinal transplantations as a form of treatment. Researching transplant coverage before evaluation is essential to be compensated adequately. Financial guidelines will secure the fiscal success of the program. Educating patients to insurance and entitlements may reduce the out-of-pocket cost to patients. Transplant financial coordinators coordinate these efforts for the facility. The best coverage option for the patient and transplant programs is a combination of commercial healthcare coverage, secondary entitlement program, and fund-raising. With length of stay ranging up to 119 days and a lifetime of posttransplant outpatient follow-up care, it is beneficial for the facility to also have a fundraising program to assist patients.
Validation and Refinement of the Questionnaire for Lung Transplant Patients
Authors: Dabbs Annette De Vito , Kim Yookyung , Vensak Judith , Studer Sean , Iacono Aldo
Published: July 2017

Context

The Questionnaire for Lung Transplant Patients was designed to assess symptoms and activity tolerance in lung transplant recipients during their post-transplant evaluations. The initial psychometric evaluation determined that the questionnaire was clinically useful, reliable, and valid.

Objective

To report the results of further psychometric analyses in a new, expanded sample of lung transplant recipients and to demonstrate the iterative manner by which instruments are refined and tested.

Methods

Internal consistency, test-retest stability, convergent validity, factorial validity, and group differences attributable to age, gender, and transplant type were determined in a pooled sample of 177 lung transplant recipients. Sensitivity to change over time was measured in a subsample (n=51) who provided repeated measures data.

Results

The Questionnaire for Lung Transplant Patients and its subscales were internally consistent (Kuder Richardson reliability of 0.73–0.95). Test-retest stability was high (intraclass correlations >0.70). Symptoms showed a significant curvilinear pattern with a tendency to decrease over time before rising again at the 12-month measurement for the total questionnaire (F=6.8, P=.012) and 2 subscales—Respiratory (F=5.6, P=.022) and Activities of Daily Living (F=19.7, P<.001). Convergent construct validity correlations ranged from 0.29 to 0.53 and were consistent with theoretical expectations. Factorial analysis confirmed 3 domains that coincided with the Respiratory, General, and Activities of Daily Living subscales.

Conclusions

The Questionnaire for Lung Transplant Patients is a reliable and valid measure for assessing physical symptoms and activity intolerance after lung transplantation in individual recipients, recipients in aggregate, and comparison groups, on one occasion and serially over time. These results will guide future refinement and testing of the Questionnaire for Lung Transplant Patients.
The Influence of Psychosocial Evaluation on Candidacy for Liver Transplantation
Authors: Flamme Nancy E. , Terry Colin L. , Helft Paul R.
Published: July 2017

Context

Although medical factors clearly dominate the evaluation of appropriateness for liver transplant, psychosocial factors are an important dimension in the evaluation process.

Objective

To understand more about the weight assigned to psychosocial factors in the decision to list patients for liver transplant and about whether such differences create hidden inequities in the transplant allocation system.

Design

We conducted a mail survey of liver transplant surgeons and psychosocial evaluators at busy transplant centers assessing the importance these professionals assigned to psychosocial factors in evaluations for liver transplant candidacy.

Participants

Liver transplant surgeons and psychosocial evaluators from the highest volume liver transplant centers in the United States.

Intervention

Mail survey

Results

Psychosocial evaluators assigned greater importance to availability of transportation, adaptation to stress, and coping skills than did surgeons. Transplant psychosocial evaluators were less likely than transplant surgeons to recommend that a patient with a history of poor social support be listed for liver transplant. We found no correlation between relative weight assigned to psychosocial factors and median wait times at transplant centers. These differences suggest that the relationship between the factors identified by psychosocial evaluators as important and transplant outcomes should be studied. Overall, more research into the predictive and ethical aspects of psychosocial evaluation for liver transplant is needed.
Infection, Rejection, and Hospitalizations in Transplant Recipients Using Telehealth
Authors: Leimig Renata , Gower Gayle , Thompson Denise A. , Winsett Rebecca P.
Published: July 2017

Context

Telehealth technology serves individuals who live in geographical areas that prohibit easy access to specialized health care and can provide transplant recipients with access to transplant center personnel for adjunctive follow-up care.

Objective

To compare infection, rejection, and hospitalization events in subjects randomized to telehealth or to standard posttransplant care.

Study Design, Study Participants, Setting and Research Procedure

This longitudinal prospective study compared transplant outcomes (infections, rejections, and hospitalizations) of 106 subjects who were randomized to either the telehealth (n=53) or standard care (n=53) group and met the 6-month study end point. Sex, race, and transplant type were evenly distributed within the 2 groups. Subjects received primary follow-up care from nurse practitioners. The telehealth visits were conducted via live interactive sessions with digitized equipment used to perform physical examinations.

Main Outcomes

Infections, rejections, and hospitalizations were summarized for each of the groups. Subgroup analyses were performed by sex, transplant type, and time since transplant.

Results

No differences were found between the telehealth and standard care groups for infections, rejections, or hospitalizations at the 6-month data end point. Overall, females had twice as many infections as males ( P = .01). In this analysis, group assignment did not affect study outcomes.

Conclusions

The rates of infection, rejection, and hospitalization in a sample of primarily long-term transplant patients did not differ between patients who received telehealth follow-up and patients who received standard care, indicating that this delivery system can be used to provide follow-up care after transplant.
Managing the Failing Heart: Total Circulatory Assist—A Case Study
Authors: Allen Yvonne , Collins Rachel , Lester Charnetta , Savage Laura , Vijayan Sajitha
Published: July 2017

Congestive heart failure remains one of the leading causes of cardiac death and disability. As pharmacological therapies have advanced, patients are living longer and more productive lives. However, at some point, these interventions begin to fail. Circulatory assist devices have revolutionized the management of patients with end-stage heart disease. These devices successfully bridge patients to cardiac transplantation. The Syncardia Total Artificial Heart provides biventricular support for the failing heart. This case study illustrates the challenges of caring for patients with such a device.
Health Literacy Skills of Kidney Transplant Recipients
Authors: Gordon Elisa J. , Wolf Michael S.
Published: July 2017

Context

Although low health literacy can affect patients' treatment decision making, comprehension of health information, and medication adherence, little is known about health literacy skills of kidney transplant recipients.

Objective

To examine the relationship among kidney transplant recipients' health literacy levels, transplant knowledge, and graft function.

Design

Cross-sectional study of 124 adult kidney transplant recipients.

Main Outcome Measures

Health literacy was assessed via the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the Rapid Estimate of Adult Literacy in Medicine-Transplantation (REALM-T). Data on recipients' transplant numeracy, knowledge needs, and demographics were collected via semistructured interviews. Multivariable linear regressions were used to assess the relationship between health literacy and graft function.

Results

Most kidney recipients (91%) had adequate health literacy (S-TOFHLA); however, 81% were unfamiliar with at least 1 kidney transplant–related term (REALM-T). The 5 least familiar terms were sensitization (50%), urethra (45%), trough level (41%), blood urea nitrogen (32%), and toxicity (31%). Numeracy levels varied: 21% knew the likelihood of 1-year graft survival; 29% knew that half of kidney recipients have problems with the transplant in the first 6 months; 68% were aware of the risk of death within the first year after transplantation; and 86% knew the normal range for creatinine in kidney recipients. Patients with lower health literacy (REALM-T) had higher creatinine levels.

Conclusions

Transplant providers should intervene with better patient education materials to improve patients' health literacy, which may improve patients' medication adherence or transplant outcomes.
How Do Communities Want Their Information? Designing Educational Outreach on Organ Donation for Asian Americans
Authors: Wong Kristine A. , Cárdenas Vicky , Shiu-Thornton Sharyne , Spigner Clarence , Allen Margaret D.
Published: July 2017

Context

Support of organ donation among Asian Americans has been limited, but lack of access to information and prevalence of misinformation are 2 barriers that might be counteracted by public education.

Objective

To solicit advice from 4 Asian American communities on the design of a culturally appropriate educational campaign on organ donation and transplantation.

Design and Setting

Cross-sectional, multilingual survey administered at community festivals and supermarkets.

Participants

201 Asian American respondents.

Main Outcome Measures

The components of an effective public education outreach campaign on organ donation were defined for 4 Asian American communities.

Results

Media venues ranked highest for information dissemination on organ donation/transplantation were, in descending order, mainstream television, ethnic newspapers, mainstream newspapers, and ethnic television. Most respondents preferred a spokesperson of Asian American descent, but opinions differed by ethnicity as to whether an effective spokesperson needed to be of the same Asian ethnicity as the respondents. Respondents were further divided by ethnicity on their preference for a locally or nationally well-known spokesperson. The most compelling scenario to promote organ donation was an Asian American waiting for a transplant, followed by an organ donor family or individual, and, last, a transplant recipient. Different advertisements for organ donation appealed to different Asian ethnic groups.

Conclusions

Community-based research gives communities the opportunity to collaborate with health professionals in designing health education programs that target their own populations. Because key aspects influencing campaign efficacy can vary by ethnicity, these important differences need to be taken into account in outreach planning.
Strategies to Advance Living Kidney Donation: A Single Center's Experience
Authors: Kranenburg Leonieke , Zuidema Willij , Weimar Willem , Hilhorst Medard , Ijzermans Jan , Passchier Jan , Busschbach Jan
Published: July 2017

In Europe, living kidney donation rates differ considerably from country to country. These differences are related to deceased kidney donation rates: countries with higher deceased donation rates have lower living donation rates. Despite the differences, all countries have one thing in common, namely, the shortage of kidneys for transplantation. Living kidney donation is a good option to alleviate these shortages. In our center, 60% to 70% of all kidney transplants come from living donors. This article describes various strategies that may have contributed to these high living donation rates: team attitude, educational materials and meetings, and alternative donation programs (exchange donation, domino-paired donation, Good Samaritan donation). Also described are some less conventional strategies for increasing rate of living kidney donation that are not used in the Netherlands but may offer some good perspectives (eg, the “Norwegian approach” and home-based educational programs).
Engaging the Third Estate: The Transplant Growth and Management Collaborative
Authors: Dowell Shannon , Dawson Anthony , McBride Virginia
Published: July 2017

The Organ Donation and Transplantation Collaboratives that occurred within the United States from 2004 to 2008 helped contribute to a significant increase in organ donors and transplants across the country. Centers were needed to accommodate and maintain this increase in capacity to perform successful transplantations for candidates on the waiting list. The Transplant Growth and Management Collaborative was created to help fulfill this new performance level expectation. In 2007 the US Department of Health and Human Services, Health Resources and Services Administration published a best-practice report based on high-performing centers that experienced a significant increase in volume while maintaining expected, or higher than expected, outcomes. The report produced a change package that outlined common strategies, key change concepts, and actions used at the best-practice centers that could be adapted by other transplant programs by using Plan-Do-Study-Act cycles to test the impact of the changes. This change package and use of the Plan-Do-Study-Act cycles formed the foundation of the Collaborative that occurred from October 2007 through October 2008 to spread best practices to transplant programs willing to commit to making changes that could result in a 20% increase in transplant volume. More than 120 transplant centers participated at some point in the Collaborative. Although preliminary results of the Collaborative show that only a few participating programs achieved the 20% volume increase goal, many participating centers reported putting successful models in place for each of the strategies identified in the best-practice change package.
Correlates of Support for Living Donation among African American Adults
Authors: Robinson Dana H. Z. , Borba Christina P. C. , Thompson Nancy J. , Perryman Jennie P. , Arriola Kimberly R. Jacob
Published: July 2017

Context

Living donation is studied with much less intensity among African Americans than among the general population. Examination of barriers to living donation can lead to effective strategies to educate dialysis patients and their families about this alternative.

Objective

To explore the correlates of likelihood of becoming a living donor among community-recruited African American adults.

Design/Participants

Cross-sectional data were gathered via self-administered questionnaire from 425 African American adults, age 18 years and older, who were recruited from 9 churches in Atlanta.

Main Outcome Measures

Self-reported likelihood of becoming a living donor to a close family member, an extended family member or friend, or a stranger.

Results

More than three-quarters of participants were willing to act as living donors to a close family member or spouse and two-thirds to friends or extended family. For likelihood of donating to a friend or extended family member, only willingness to engage in deceased donation was significantly associated; to a stranger, both willingness to engage in deceased donation and attitudes toward donation were significantly associated. Knowledge of and personal experiences with donation and/or transplantation were not significantly associated with likelihood of any type of living donation.

Conclusions

Findings indicate widespread support for living donation to a close family member or spouse. These findings have important implications for dialysis patients who must decide whether to approach friends and/or family about the possibility of serving as a living donor and emphasize the need for interventions to help facilitate this process.
Development and Validation of a Tool for Assessing Understanding of Brain Death
Authors: Tawil Isaac , Marinaro Jonathan , Brown Lawrence H.
Published: July 2017

Background

Death by neurological criteria is often misunderstood by laypersons even though they make decisions about withdrawal of care and organ donation. No validated questionnaire for determining laypersons' understanding of brain death exists. Such a tool could be useful in clinical, educational, and research settings.

Methods

Brain death experts and a focus group of laypersons were used to develop a 5-item questionnaire with face validity. The questionnaire explores 3 concepts: apnea, irreversibility, and differentiation between cardiac death, brain death, and persistent vegetative state. The questionnaire was administered to separate groups of laypersons and experts and was readministered 7 to 10 days later. Test-retest reliability for individual items and overall score was measured by using Spearman rank correlation. Internal consistency of the questionnaire was measured by using Cronbach α. Utility of the questionnaire in discriminating between scores of laypersons and experts was evaluated by using a t test.

Results

Twelve laypersons and 13 experts participated. The test-retest correlation was significant for all questions (Spearman ρ range, 0.43–0.94) and raw score (Spearman ρ=0.91, P < .001). Internal consistency was fair (Cronbach α = 0.64). The questionnaire enabled discrimination of laypersons from experts, with mean (SD) raw scores of 3.0 (1.1) vs 4.8 (0.6), respectively ( t test, P < .001). Removal of 1 item improved internal consistency (Cronbach α =0.70), but with a corresponding decrease in discriminatory ability.

Conclusions

This simple 5-item questionnaire for evaluating understanding of brain death has test-retest reliability, internal consistency, and can be used to discriminate between persons who do and do not understand brain death.
Digital Imaging of Extended Criteria Donor Livers to Facilitate Placement and Utilization
Authors: Guarrera James V. , Samstein Benjamin , Goldstein Michael J. , Arrington Ben , Dorritie Richard , Lapointe-Rudow Dianne , Renz John F. , Emond Jean C.
Published: July 2017

The disparity between organ supply and demand has necessitated more aggressive use of livers from extended criteria donors. Organ sharing between donor service areas and transplant centers in other regions is common. Confidence in the graft quality is greatly improved with a digital image taken in conjunction with the recovery surgeon's report and biopsy data. Three cases in which digital images of various levels of quality allowed the recipient's surgery to proceed, minimized the cold ischemia time, and yielded excellent outcomes are described. Another case in which a picture was not available and the liver was discarded after importation is also presented for comparison.
Assessing Historical Compliance with Medical Recommendations among Transplant Candidates: Preliminary Findings
Authors: Madan Alok , White-Williams Connie , Borckardt Jeffery J. , Rayburn Barry K. , Bush Beverly A. , Thurstin A. Hal
Published: July 2017

Context

Noncompliance with medical recommendations by transplant candidates and recipients carries serious consequences for morbidity and mortality. Few patient-specific, objective measures for assessing historical compliance exist.

Objective

To address this gap, a psychometric and exploratory analysis of an interview-based, global measure of clinician-rated judgment of historical compliance was undertaken.

Methods

All findings are based on a retrospective chart review of the medical and psychosocial evaluations of 96 consecutive potential heart transplant candidates seen at a large Southeastern academic medical center.

Results

Preliminary results demonstrated adequate interrater reliability and discriminant validity for the measure. Additionally, results from hierarchical multivariable regression analysis revealed years of education to be positively associated with clinician-rated judgment of historical compliance.

Conclusions

This study provides preliminary psychometric support for the use of a measure of historical compliance among heart transplant candidates. Findings from this study also are consistent with the literature to date and may be reflective of a psychobiological process that mediates the relationship between socioeconomic status and health outcomes.
Decision Making and Psychosocial Outcomes among Living Kidney Donors: A Pilot Study
Authors: Sharp John , McRae Alison , McNeill Yvonne
Published: July 2017

With an increasing number of available kidney transplant donors comes greater demand for systematic screening of prospective donors to ensure the integrity of the donor's decision and to minimize the risk of a poor postoperative outcome. The present study was intended to explore psychosocial outcomes after kidney donation, aspects of donors' decision making, and donors' experience of the transplantation process. It was hoped that this pilot study would inform the design of a large-scale longitudinal prospective investigation of psychosocial outcomes of kidney donation. In this cross-sectional, retrospective investigation, all patients who had received psychosocial screening before their kidney donation were approached. Seventeen of 43 previous kidney donors responded to a postal questionnaire. Donors' health-related quality of life was higher than population norms on all dimensions. Most participants reported involving someone else in the decision-making process. Donors indicated high levels of satisfaction with virtually all aspects of the donation process. The generalizability of the findings in the context of the limitations of the present pilot study is discussed and specific suggestions for the design of future studies are provided.
Gastrointestinal Symptoms in Kidney Transplant Recipients: What about Silent Sufferers?
Authors: van Dijk Marja , Niesing Jan , van der Heide Jaap J. Homan , de Maar Eltjo F. , Ploeg Rutger J. , van Son Willem J. , Seelen Marc A. J.
Published: July 2017

Context

Transplantation improves health-related quality of life in patients with end-stage renal disease. However, primarily because of adverse effects of medication, among other gastrointestinal symptoms, health-related quality of life is not completely restored to normal. Although many patients have various gastrointestinal symptoms only a small proportion may be reported spontaneously.

Objective

To evaluate the prevalence of gastrointestinal symptoms in kidney transplant recipients, also the difference between spontaneously reported symptoms and symptoms elicited by specific questioning was assessed. The burden of these symptoms in daily life also was analyzed.

Design

A single-center, sequential, mixed method study to assess the difference between spontaneous patient reports of gastrointestinal symptoms and active screening by a questionnaire in kidney transplant patients.

Patients

In February 2008, patients received a questionnaire on gastrointestinal symptoms; notes in medical records were consulted for patients scoring less than 100. In June 2008, those patients received a second, extended questionnaire aimed to assess the burden of gastrointestinal symptoms in daily life.

Results

Ninety-two of 513 patients eventually proved to have gastrointestinal symptoms. Completed questionnaires were compared with notes in the patients' files of the past year. A total of 51 of these 92 patients appeared to have not mentioned their gastrointestinal symptoms during the outpatient clinic visits. Of these 51 patients, 37 reported a significant impact of gastrointestinal symptoms on daily life.

Conclusions

The silent sufferer exists. Specific questioning helps to improve communication concerning bothersome gastrointestinal symptoms. To assess the burden of these symptoms, a validated questionnaire should be developed.
Organ Donation Procedures: An Epidemiological Study
Authors: Roza Bartira de Aguiar , Pestana José Osmar Medina , Barbosa Sayonara de Fatima Faria , Schirmer Janine
Published: July 2017

Objective

To evaluate the impact of organ and tissue donation processes on family members of deceased donors and the probability that they would be an organ or tissue donor in the future.

Methods

Cross-sectional survey of 69 families of deceased donors of the organ procurement organizations of the Federal University of São Paulo.

Results

Donors were predominantly men (57%vs 43%) with a median age of 35.9 years. The primary causes of death were classified as natural (65%), traumatic injury (33%), and other (1%). Of the family members surveyed, 40% had an elementary school education and 59% were unemployed. Family members expressed an understanding of the brain death diagnosis (67%). Among them, 74% had no doubt about brain death and had time to ask questions. The diagnosis was provided by the doctor responsible for the patient (89%). Family members also used funeral aid benefit (63%), perceived organ donation positively (97%), and indicated that they would donate again (79%). A significant relationship was found between families that took advantage of the funeral aid benefit and families that would donate again (79% vs 22%, P= .002).

Conclusion

The intent to donate organs for transplantation may be based more on moral and cultural factors that go beyond the family members' knowledge about the donation process per se.
Bridge to Decision: SWAT Team Approach Used by Mayo Clinic Arizona's Cardiac Transport Team
Authors: Staley Linda L. , Dobberpuhl Jeff , Pierce Christopher N. , Scott Robert L. , Jaroszewski Dawn E. , Arabia Francisco A.
Published: July 2017

Objective

Patients in acute cardiogenic shock are the most challenging patients to manage. Unless a mechanical circulatory assist device is placed, maintaining end-organ function can be difficult. Transporting cardiogenic shock patients to tertiary care centers for higher level care also is difficult. The Mayo Clinic Arizona uses a SWAT team approach to deploy a specialized medical or surgical multidisciplinary team to implant mechanical circulatory assist devices at referring hospitals and transport patients back to Mayo Clinic Arizona.

Results

The cardiac transport team at Mayo Clinic Arizona got 23 referrals from 15 local community hospitals from February 2006 to September 2009. The medical team deployed for transfers of 6 patients, 3 of whom survived to hospital discharge. The surgical transport team deployed for transfers of 17 patients (6 with left ventricular assist devices, 2 with right ventricular assist devices, 5 with biventricular assist devices, and 4 with extracorporeal membrane oxygenation), of whom 8 survived to hospital discharge. Ten of the 17 referrals (59%) required a surgeon to place a mechanical circulatory assist device at the referring hospital.

Conclusion

The SWAT team approach allows cardiogenic shock patients to be stabilized at the referring hospital by heart failure and cardiac surgical specialists. If necessary, a surgeon from Mayo Clinic Arizona places a mechanical circulatory assist device at the referring hospital to stabilize the patient. Doing so allows safe transport back to the tertiary care center for higher level care and possible transplant evaluation with placement of a long-term durable device.
Too Poor for Transplant: Finance and Insurance Issues in Transplant Ethics
Authors: Laurentine Kyle Alexander , Bramstedt Katrina A.
Published: July 2017

Context

Donor organs are a scarce gift. Additionally, transplantation is very expensive and the United States lacks universal health insurance for all citizens. These facts combine to make personal finance and insurance some of the criteria for wait listing at US transplant centers. Previous research has shown that the poor and the uninsured (as well as women and nonwhites) are less likely to receive a transplant. Living donor candidates are also limited by the US insurance system.

Objective

To determine the effect of finance and insurance variables on access to transplant and living donation.

Design

A qualitative descriptive study of ethics consultation data contained in a research registry approved by the institutional review board at California Pacific Medical Center.

Setting and Participants

This study analyzes research registry data from a large community hospital in Northern California that serves patients from California, Oregon, and Nevada. The registry data are derived from transplant ethics consultations occurring between January 1, 2007, and June 30, 2009.

Main Outcome Measure

This study explores the restriction of access to transplantation and of participation in living donation.

Results

More than a quarter of all transplant ethics consultation reports described the restriction of transplant-related treatment for reasons rooted in finance or insurance. Individuals on the recipient side and on the donor side were hindered with regard to access. Insurance status and personal ability to pay significantly affect access to transplantation in the United States, and this theme is a frequent feature of ethics consultations at California Pacific Medical Center.