bluuebunny/crossref_metadata_2025 huggingface dataset:
Hostility toward Caregivers as a Selection Criterion for Transplantation
Authors: Neil Janice A. , Corley Mary C.
Published: July 2017

Researchers have focused on hostility and aggression of psychiatric patients but little is known about what effects transplant candidates' hostility toward their caregivers has on the care the candidates receive. Hostility is defined as any verbal, nonverbal, or physical behavior which threatens persons or property. Although hostility may be one of the precipitating factors in the need for an organ transplant, it may also be a response of the patient to his or her condition. This study focused on whether transplant coordinators felt that hostility should be used as a criterion for accepting or rejecting a transplant candidate. A nonexperimental descriptive survey design targeted 559 organ transplant coordinators who were members of the North American Transplant Coordinators Organization. Many coordinators in this study (62%) felt that a hostile candidate should not receive an organ transplant. Different methods of caring for hostile patients should be explored, especially for those who are antagonistic and who exhibit aggressive behaviors. Given the scarcity of donor organs, ethical principles must guide the allocation of these organs and the selection of transplant recipients.
Addiction Medicine in Organ Transplantation
Authors: Stowe Judy , Kotz Margaret
Published: July 2017

Allocation of organs for transplant has created medical, ethical, and economic concerns at a time when availability of all organs is extremely limited. Although transplantation is the final treatment for many diseases, it is not available to everyone. Patients' use of alcohol and other drugs has become a controversial and debated issue in the transplant community. Compliance is important for all transplant recipients, but it becomes even more important in patients whose drug or alcohol use has caused their organ disease. The issue of addiction appears to be more critical with transplant patients because of the potential for noncompliance, which may lead to graft loss. Local, regional, and national regulations have also affected the allocation of organs. At The Cleveland Clinic Foundation, a chemical dependency transplant team was formed in response to criteria of the Ohio Solid Organ Transplantation Consortium for transplant patients with addictive disorders. The assessment, treatment, and monitoring of these patients requires specific expertise; a prominent role on transplant teams for specialists in addiction has resulted. The purpose of this article is to describe the responsibilities of the chemical dependency transplant team, the scope of the referral and evaluation process, and the team's appropriate roles with patients and transplant professionals.
Attitudes about Organ and Tissue Donation among the General Public and Blood Donors in Hong Kong
Authors: Li Philip K. T. , Lin C. K. , Lam Peggo K. W. , Szeto C. C. , Lau Joseph T. F. , Cheung Liza , Wong Monita , Chan Andrew Y. T. , Ko W. M.
Published: July 2017

Context

The cadaveric organ and tissue donation rate in Hong Kong is not satisfactory; 1 million blood donors are registered and more than 300 000 are active. However, the current attitudes toward organ and tissue donation in the general public and blood donors of Hong Kong are unknown.

Methods

Random general public (n = 1018) and blood donors (n = 1227) of Chinese origin, with age ranging from 16 to 60 years, were interviewed using a standard verified questionnaire that examines attitudes and knowledge of organ and tissue donation.

Results

The mean age of the general public and blood donors were 32.6 and 28.9 years, respectively. Of the general public, 44.4% were men and among blood donors, 60% were men. About 56% of both groups thought that organ donation is an obligation of citizens. Blood donors were more aware than the general public about the types of organs that can be donated. When compared with the general public, a significantly higher percentage of blood donors were willing to donate their organs (81% vs 53%), had heard about organ donation cards (98.3% vs 89.5%), and had signed the cards (49.9% vs 22.6%). About 70% of both groups who had signed a card were carrying it. Thirty-nine percent of the general public and 17% of blood donors had not decided whether they would donate. For blood donors, 49.7% were willing to donate their relatives' organs, compared with 41.8% of the general public. Most individuals in both groups would not object to their relatives' decision to donate. About two thirds of individuals in both groups disagreed with the concept of an opt-out law, though only 20% of the general public and 14.4% of blood donors would refuse donation if an opt-out law were in practice.

Conclusions

This study shows that blood donors have better knowledge of organ donation and are more willing to donate their organs and sign an organ donation card than the general public. However, a substantial proportion of blood donors have not signed a donor card. It would be useful to design promotion programs to facilitate blood donors' participation in organ donation.
Use of Structured Self-Monitoring in Transplant Education
Authors: Schneider Sally , Winsett Rebecca P. , Reed Laura , Hathaway Donna K.
Published: July 2017

A self-assessment instrument for use at home by transplant recipients was developed to help foster partnership between patients and their healthcare provider. Self-monitoring at home has not replaced the need for close follow-up but does allow patients to provide concrete data to their healthcare provider in order to promote earlier detection of and response to adverse events. Patients are taught the essentials of self-monitoring while they are in the hospital for their transplant. Patients who perform routine self-assessment would be able to detect and provide information about problems early in the course of events. Thus, early intervention could potentially decrease the severity of the problem and prevent repeated hospitalizations. The concern that patients would not be able to perform a reliable self-assessment was unfounded; patients exceeded expectations and embraced the opportunity to communicate physical signs and symptoms effectively.
Grief and Loss in the Workplace
Authors: Albert Pamela L.
Published: July 2017

Throughout history, death and loss have given rise to social ceremonies and commemorative activities that note the death, recognize the place the person occupied in society, and assist the bereaved through the process of grief. Each culture faces death with its own definition of “appropriate” social-emotional reactions, and when death occurs, it provides the occasion for socially conditioned grief reactions and mourning practices. Historically, such practices have incorporated a set of interrelated people, the majority of whom were very knowledgeable of the customs and their purposes. In such a setting, it was possible for close kin, friends, distant kin, and acquaintances to come together to share their loss and grief. However, people may experience a loss that does not fit a socially recognized and sanctioned role. Grief for these people may have to remain private. Although they may have experienced an intense loss, personally or professionally, they may not be given time off from work or have the opportunity to talk about the meaning of their loss. In our modern, compartmentalized society, social ceremonies and commemorative activities tend to be limited primarily to a small circle of the “proper” bereaved individuals. This separation has helped to create a subset of grievers whose legitimacy may not be recognized by society as a whole and whose needs are often not addressed.
Increasing Family Consent for Organ Donation: Findings and Challenges
Authors: Rocheleau Courtney A.
Published: July 2017

There is a growing disparity between the number of organs and tissues needed for transplantation and the number available for donation. As a result, thousands of people die every year while waiting for a transplant. Much of the shortage can be explained by the failure of families to consent to donation. This paper reviews the research that has been conducted to elucidate reasons why families deny consent. This research, together with theoretically motivated research in the areas of persuasion and behavior change, can be used to inform the design of educational and promotional campaigns and to guide policy decisions.
Cultural Analysis of an Organ Procurement Organization
Authors: Gimbel Ronald W. , Strosberg Martin A. , Lehrman Susan E.
Published: July 2017

Organ procurement organizations are a critical link in the acquisition, placement, and transport of human organs for transplantation. Employed within the organ procurement organizations are organ transplant coordinators and support staff who constitute the front line in the challenge to diminish the gap between the supply and demand for organs. Responsibilities are emotionally and physiologically demanding as employees regularly face death and grieving families with empathy and commitment. This study describes and interprets dominant themes embedded in the culture of one such organ procurement organization, geographically located in northeastern United States. The authors used ethnographic research methods to understand the shared meaning system of the members of this organization. Identified themes included coping and sharing, conflicting priorities and uncertainty, and mission and reward. The influence of each theme on the organization is discussed with prescriptive implications for managerial practice.
Psychological Impact of the Physician-Patient Relationship on Compliance: A Case Study and Clinical Strategies
Authors: Pumilia Charles V.
Published: July 2017

This article presents a case of a heart transplant recipient's noncompliance. A patient's probable medical compliance is among the primary psychosocial criteria in determining his or her eligibility for a heart transplant. The ability to predict and facilitate patient compliance remains a challenge to physicians in all areas of medicine and surgery. The accuracy of the compliance prediction is often contingent upon information generated by patient interviews, other medical personnel, and the patient's family members. All too often, this vital information is based on subjective data, creating difficulty for physicians in appraising patient compliance behavior. Such an amorphous data gathering process may leave physicians at a loss to explain the nature and extent of their patients' behaviors. Research has yet to provide consistent objective measures for compliance prediction. Patient compliance affects all corridors of medical practice and is responsible for an innumerable loss of human life, and financial resources each year.
Developmental Approach to Pediatric Transplantation
Authors: Aley Kristen E.
Published: July 2017

Children who need or who have received an organ transplant endure many hospitalizations, procedures, and surgeries. These experiences are often traumatic for children, repeatedly causing intense fear and anxiety. How stressful situations are perceived and responded to by children depend on their cognitive, physical, emotional, and social development. Alternatively, the introduction and repetition of stressful hospitalizations and medical experiences can delay development in any of these areas. It is important that healthcare professionals recognize potentially stressful situations and know how to introduce appropriate interventions to ease anxiety and facilitate each child to reach his or her developmental potential. Healthcare professionals should also have an understanding of child development and the effect it has on the child's understanding and reaction to transplantation.
Pediatric Liver Transplantation
Authors: Phillips Susan K. Jaskowski
Published: July 2017

Pediatric liver transplantation is a fast-growing and challenging field. Healthcare providers must stay informed of advancements in the management of liver transplant candidates and recipients. The goal of this paper is to provide nurses who care for pediatric liver transplant candidates and recipients with a review of the basic medical management of these patients, from the preoperative evaluation to postoperative care.
Retrospective Clinical Comparison of Celsior Solution to Modified Blood Wallwork Solution in Lung Transplantation for Cystic Fibrosis
Authors: Baron O. , Fabre S. , Haloun A. , Treilhaud M. , Habasch O. Al , Duveau D. , Michaud J. L. , Despins P.
Published: July 2017

Objective

To compare the preservative effects of Celsior solution and modified blood Wallwork solution in lung transplantation.

Methods

From 1989 to 2000, 44 lung transplantations for cystic fibrosis were performed: 26 grafts were preserved with modified blood Wallwork solution and 18 with Celsior solution.

Results

Preoperative status of the 2 groups was similar. The ratio of arterial oxygen to fraction of inspired oxygen and the pulmonary vascular resistance on the first postoperative day did not differ significantly between the 2 groups. Early death was 4% (SD, 20%) in the Wallwork group versus 11% (SD, 32%) in the Celsior group (not significant). No death was related to graft failure. The forced expiratory volume in 1 second during the first month after transplantation was 63% (SD, 19%) in the Wallwork group versus 63% (SD, 16%) in the Celsior group (not significant).

Conclusion

Because the solution does not need to be prepared on site and does not require blood from the donor, Celsior seems better than Wallwork solution for preserving lung grafts.
Increasing the Quantity of Lungs for Transplantation Using High-Frequency Chest Wall Oscillation: A Proposal
Authors: Braverman Jane M.
Published: July 2017

The use of chest physiotherapy in donor patient management occupies an established place in most lung procurement protocols. Although its merits remain controversial and uncorroborated by direct data, some studies support the efficacy of chest physiotherapy in a variety of pulmonary patient populations. Comparative studies have shown that an airway clearance technology utilizing high-frequency chest wall oscillation clears pulmonary secretions as well as or better than chest physiotherapy, but has few of its contraindications and disadvantages. The implementation of high-frequency chest wall oscillation as part of the donor lung procurement protocol may increase rates of successful lung recovery by providing effective clearance of obstructing pulmonary secretions containing destructive by-products of inflammation and entrapped pathogens. High-frequency chest wall oscillation may also improve arterial blood gas values, a critical factor in increasing lung procurement rates. Although speculative, the benefits of high-frequency chest wall oscillation on donor lungs might improve perfusion and oxygenation of other organs for possible transplantation.
Prevalence of Cardiovascular Risk Factors before Kidney Transplantation
Authors: Rice Muriel , Martin Judy , Hathaway Donna , Tolley Elizabeth
Published: July 2017

Context

Assessing the prevalence of cardiovascular risk factors is an essential step in developing risk profiles and individualizing interventions to reduce the cardiovascular morbidity and mortality of kidney transplant recipients.

Objective

To examine the prevalence of pretransplant modifiable, potentially modifiable, and nonmodifiable cardiovascular risk factors in patients who received kidney transplants between January 1, 1994, and December 31, 1996.

Design

An exploratory, retrospective nested case-control design was employed to assess pretransplant cardiovascular risk factors in kidney transplant recipients with documented posttransplant cardiovascular events (n=12) and kidney transplant recipients with no documented posttransplant cardiovascular events (n=66). Data were analyzed using frequencies, unpaired t tests, and χ2 analyses.

Results

Significantly higher means of body mass index values greater than 25 kg/m2 (32.3±5.8 kg/m2 vs 28.8±3.4 kg/m2) and serum total cholesterol levels greater than 200 mg/dL (254.5±5.7 mg/dL vs 242.3±39.3 mg/dL) were noted in patients with documented cardiovascular events compared to those with no documented cardiovascular events, respectively. Diabetes was more prevalent in patients with documented cardiovascular events (33%); these patients were also predominantly African American men who had a higher prevalence of family and personal histories of cardiovascular disease (17% and 33%).
Presumed Consent and other Predictors of Cadaveric Organ Donation in Europe
Authors: Gimbel Ronald W. , Strosberg Martin A. , Lehrman Susan E. , Gefenas Eugenijus , Taft Frank
Published: July 2017

Context

Few studies on presumed consent and environmental predictors of cadaveric organ donation in Europe have been published.

Objective

To determine if a presumed consent policy and other variables can be used to predict the cadaveric organ donation rate per million population.

Design

Secondary analysis of published data.

Setting

Europe.

Participants

The unit of analysis for this study is the individual country.

Main Outcome Measure

Cadaveric organ donation rate per million population.

Results

Original and transformed data were subjected to ordinary least-squares regression. All 4 independent variables were significant predictors of cadaveric donation rate, including (1) having a presumed consent (opting-out) policy in practice, (2) number of transplant centers per million population, (3) percentage of the population enrolled in third-tier education, and (4) percentage of population that is Roman Catholic.

Conclusion

Findings may be useful to academics and professionals responsible for organ procurement. Additional research is necessary for practical application of findings. Generalizing these findings beyond Europe may be problematic because of external validity constraints.
Reversible Myocardial Dysfunction after Traumatic Brain Injury: Mechanisms and Implications for Heart Transplantation
Authors: Palac Robert T. , Sumner Glen , Laird Rebecca , O'Rourke Daniel J.
Published: July 2017

Reversible myocardial dysfunction is known to occur in patients with cerebrovascular accidents and brain death. Several mechanisms for transient myocardial dysfunction have been proposed, including increased sympathetic activity, hormone depletion, and a reduction in coronary perfusion pressure. The relative importance of each of these mechanisms remains controversial. We report the case of a 19-year-old man who suffered traumatic brain death associated with reversible myocardial dysfunction despite elevated cardiac enzymes. Myocardial recovery occurred after correcting his hemodynamic instability and hypothermia emphasizing the importance of normalization of coronary perfusion pressure and core body temperature. The mechanisms for reversible myocardial dysfunction and their implications for heart transplantation following traumatic brain death are reviewed. A diagnostic strategy is proposed that would allow early recognition of reversible myocardial dysfunction in brain-dead patients.
Organ and Tissue Procurement System: A Novel Intervention to Increase Organ Donation Rates in Venezuela
Authors: Milanes Carmen Luisa , Hernández Eddy , González Leyda , Sivira Homero , Mamblona Rafael , Clesca Paul , Serrano Leoncio , Becerra José , López Pilar , Fuenmayor Dulce , Guacarán Douglas , D'Leön Elba , Sanna Victor , Guipe Shirley , González Alfredo , Bernal Carlos , Rivas-Vetencourt Pedro A.
Published: July 2017

The limited number of organs and tissues available for transplantation in Venezuela and the need to improve outcomes for patients with life-threatening end-stage organ failure or inadequate quality of life resulted in the development and implementation of an organ and tissue procurement system by the Venezuelan National Transplant Organization. This procurement system, a 24-hour, nationwide, free phone service for detection of potential organ donors, connects callers with transplant coordinators. The on-call coordinator supervises family approach as well as maintenance, transport, and allocation of the organs and tissues. During a period of 21 months, the phone service received 1191 calls (713 requesting information to become a voluntary donor, 207 requesting information about donation and transplantation, and 271 reporting potential donors). Of the potential donors, 74% were men and 67% were aged between 11 and 40 years, and most came from hospital intensive care units, emergency departments, and trauma shock units. The main causes of death were trauma and stroke. Reasons why donation was not accomplished included early cardiorespiratory arrest and denied consent. In conclusion, establishing the procurement system resulted in an increase in the detection, referral, and maintenance of potential donors; doubling of the number of donors per million population; and an increase in the number of cadaveric transplants.
Living Liver Donors: A Coordinator's Perspective
Authors: O'Rourke Marian , Arnott Lindsay , Goldman Jody Scopa
Published: July 2017

Living donor liver transplantation is an acceptable alternative for many patients awaiting a liver transplant. The benefits of living donor liver transplantation to the recipient are many; however, there is also an appreciable risk to the donor. Many people, including healthcare professionals, believe that living donor liver transplantation is not ethically justified because any risk to a donor outweighs the benefit to the recipient. Recent studies show adverse events in this population do not include only medical complications; any complication—medical, social, psychological, financial, or other—must be examined to analyze the true incidence of adverse outcomes in living liver donors.
Electronic Psychosocial Evaluation Tool: Use in a Living Donor Organ Transplant Program
Authors: O'Dell Maureen Iona , Wright Linda
Published: July 2017

Psychosocial evaluation of potential organ donors ensures that these patients are prepared for donation and that their psychosocial issues have been addressed. The determination that the decision to donate an organ has been made voluntarily by a competent individual is a primary concern for living donor transplant programs, which must work to the highest ethical standard in this unique area of medicine. Identification of potential vulnerabilities on the part of the donor permits monitoring and/or intercession both before and after donation. Ensuring the confidentiality of patient information is important and represents a cornerstone of social work practice. At our institution, social workers have developed an electronic recording tool for use in evaluating organ donors; this tool is designed to maximize quality and ease of information gathering, ensure standardization of practice across programs, simplify record keeping, and enhance communication while minimizing time investment and ensuring patient confidentiality.
Religious Altruism and the Living Organ Donor
Authors: Dixon David J. , Abbey Susan E.
Published: July 2017

Potential living organ donors who describe religious motivations as the basis for their donation, particularly in the absence of an emotional or genetic connection to the intended recipient, raise challenges for the transplant team who are more comfortable in assessing relational motivations than religious ones. This article provides a composite case scenario to illustrate some of the biases that may interfere with the assessment of the donor motivated by religious altruism and how religious altruism may be pathologized. The clinical challenges in assessing the religiously altruistic potential living donor are reviewed. Religious approaches to altruism and their implications for living organ donation are reviewed for a sample of the major world religions.
Home Monitoring for Lung Transplant Candidates
Authors: Mullan Beth , Snyder Mariah , Lindgren Bruce , Finkelstein Stanley M. , Hertz Marshall I.
Published: July 2017

Home monitoring by lung transplant recipients has been effective for early detection of clinical problems. This study used an electronic diary for home monitoring by lung transplant candidates to improve communication between candidates and the transplant team. Candidates were randomized into control (52 subjects following standard telephone reporting procedures) and intervention (67 subjects using an electronic diary to record and transmit a range of health-related measures) groups. Outcome measures were monitoring adherence and level of communication (for monitor acceptability and utilization), hospital length of stay after transplantation and survival at 4 months (for clinical effectiveness). Subjects used the diary without difficulty and with good adherence. Subjects and coordinator contacts were similar between groups; intervention group subjects were positive regarding contact based on diary use. There were no significant differences in clinical outcomes between groups. Changing diary questions might improve the effectiveness of electronic monitoring for lung transplant candidates.
Reproductive and Contraceptive Characteristics of Premenopausal Kidney Transplant Recipients
Authors: Kramer Holly J. Mattix , Tolkoff-Rubin Nina E. , Williams Winfred W. , Cosimi A. Benedict , Pascual Manuel A.
Published: July 2017

Objective

To obtain information on menstrual patterns before and after transplantation, desire for future pregnancy, and use of contraception among premenopausal kidney transplant recipients.

Study Design

This observational study collected information using self-administered anonymous questionnaires during a routine outpatient clinic visit.

Results

Of the 107 women who completed the questionnaire, 41 identified themselves as being premenopausal. Among the 41 premenopausal women, approximately half of the women reported their current menstrual patterns as normal and 26% were not using any form of contraception. Overall, 10 women (24%) reported a desire to become pregnant and 4 women (10%) had a successful pregnancy after transplantation. Most of the women who desired a future pregnancy (8/10) were receiving an immunosuppressive regimen that included mycophenolate mofetil.

Conclusion

Kidney transplantation in the current era is associated with a return of normal menstrual function in the majority of female transplant recipients. A substantial fraction of women desire pregnancy after transplantation and many are using an immunosuppressive drug with limited safety data on use during pregnancy. More caution should be used with the use of newer immunosuppressive agents in sexually active premenopausal transplant recipients until more safety data are available.
Families' Understanding of Brain Death
Authors: Siminoff Laura A. , Mercer Mary Beth , Arnold Robert
Published: July 2017

Context

Families' understanding of brain death may be a factor that contributes to decisions regarding organ donation.

Objective

To examine factors related to families' understanding of brain death and how those factors affect families' decisions about organ donation.

Design

Chart reviews were conducted on all deceased patients at 9 trauma hospitals. Interviews were then conducted with healthcare providers who spoke with families about organ donation and family decision makers.

Setting

Southwest Pennsylvania and Northeast Ohio.

Participants

The sample consisted of 403 families of organ donor–eligible patients who reported that someone at the hospital told them the patient was brain dead.

Main Outcome Measures

Families' awareness of brain-death testing procedures, understanding of brain death, and donation decision.

Results

Most families (96%) were told their family member was brain dead, but only 28.3% were able to provide a completely correct definition of brain death. No association between the definition of brain death and willingness to donate was found. Those who donated were less likely to agree with the statement that someone is dead only when the heart stops than those who did not donate. Respondents who accepted that their loved one was dead when informed the patient was brain dead were more likely to donate than those who did not consider the patient dead until mechanical support was turned off and the heart stopped.
Development of a Successful Non—Heart-Beating Organ Donation Program
Authors: Reiner Mark , Cornell Danielle , Howard Richard J.
Published: July 2017

To help alleviate the organ shortage, transplant centers are using organs from expanded-criteria donors, who were considered unsuitable just a few years ago, such as Non—Heart-beating donors. In 1998, we made a concerted effort to increase the number of Non—Heart-beating donors recovered by our organ procurement organization. In this paper, we discuss the steps in establishing this program, including transplant center support, estimating the number of potential Non—Heart-beating donors, organ procurement support, protocol development, hospital development, education, putting the protocol into practice, follow-up, and effect of the program on organ procurement. With the establishment of this program, the number of Non—Heart-beating donors increased from 2% to 5% per year to over 10% for the past 2 years. From these donors, 61 of 82 recovered kidneys were transplanted into 58 patients, and 18 of 20 recovered livers were transplanted. A Non—Heart-beating donor program can significantly add to the number of organ transplants and successful transplantations.
Impact of Long-Term Immunosuppressive Therapy on Psychosocial and Physical Well Being in Liver Transplant Recipients
Authors: Kizilisik A. Tarik , Grewal Hani P. , Shokouh-Amiri M. Hosein , Vera Santiago R. , Hathaway Donna K. , Gaber A. Osama
Published: July 2017

To achieve the fullest potential of transplantation, continuing concern for the recipients' quality of life must be a part of the process. Database records of patients who are currently alive and received transplants between 1982 and 1991 were retrospectively analyzed. Recipients were contacted and asked to answer a quality-of-life questionnaire. Of 105 liver transplant recipients, 51 died within 10 years after transplantation; 47 were contacted. Posttransplant complications included hypertension (64%), posttransplant diabetes mellitus (17%), osteopenia (40%), osteoporosis (26%), and heart disease (17%). Most recipients reported all aspects of their life to be average, if not better than their age-matched peers. Although most recipients complained about side effects of immunosuppressive agents, they were all happy to be alive and agreed that their quality of life showed an impressive favorable change to a level exceeding that of the general population. These results suggest that liver transplantation not only improved survival but also quality of life.
Transplant Coordination Activities in the Başkent University Hospital Network
Authors: Haberal Mehmet , Moray Gokhan , Boyacioglu Sedat , Noyan Turgut , Haberal Cevahir , Turan Münire , Arslan Gülnaz , Erdal Rengin
Published: July 2017

Our transplantation center adopted a new model of operation, with 3 affiliated centers of the Başkent University. The aim of this system is to standardize procedures related to organ procurement and transplantation, to increase organ donation, and to improve the quality of services. The transplant team is composed of a transplant coordinator, and transplant clinicians and surgeons. The transplant coordinator works independently, and promotes organ donation and procurement, organizes interviews with donor families, and is in contact with national and international organ-sharing organizations. The organs and tissues are transplanted in the Ankara hospital of the network if the cadaver organ source is one of the Başkent University hospitals. If no appropriate recipient is available, the organs and tissues are offered to the National Coordination Center for other transplantation centers. To implement this system most efficiently and effectively, periodic situation analyses were made.
Successful Combined Heart-Liver Transplantation in a Patient with Hemochromatosis
Authors: Haynes Hwajoo , Farroni Jennifer
Published: July 2017

Hemochromatosis is a disorder of excess iron deposition in tissues that may cause multiorgan dysfunction. Because the early symptoms of hemochromatosis are nonspecific, the diagnosis is frequently overlooked until significant organ failure has developed. The primary cause of death in these patients is usually liver cancer related to cirrhosis. Patients who are candidates for liver transplantation should be referred for evaluation. For patients with severe cardiomyopathy, in addition to end-stage liver disease, combined transplantation may be performed. Although there is a limited number of combined heart-liver transplantations that have been performed, successful outcomes can be achieved with close monitoring and a multidisciplinary team approach. In this case report, we will discuss the prevalence, pathophysiology, and treatment of hemochromatosis and potential complications of combined heart-liver transplantation.
Donor and Nondonor Families' Accounts of Communication and Relations with Healthcare Professionals
Authors: Haddow Gillian
Published: July 2017

The cadaveric organ procurement scheme in the United Kingdom is based on a voluntary, opt-in system. However, regardless of whether and how individuals make their wishes known about organ donation before death, health professionals are required to seek the families' “lack of objection” before organ removal. Relationships between families and healthcare professionals have been identified as important regarding patients who receive mechanical ventilation, familial understanding of brain stem death, organ donation requests, and postoperative care. This qualitative study was conducted over a 2-year period in Scotland. Semistructured interviews with donor (n=19) and nondonor families (n=4) explored their accounts of communication and interaction with healthcare professionals. The data suggest strategies that can support relatives, including early direct and tacit communication regarding recovery prospects, provision of clear and timely information about brain death, assurances regarding respectful treatment of the decedent's body, wearing nonsurgical attire, and follow-up care, if needed.
Management of Opportunistic Infections in Solid-Organ Transplantation
Authors: Chiu Loretta M. , Domagala Beata M. , Park Jeong M.
Published: July 2017

Solid-organ transplantation is often the last alternative in many patients with end-stage organ disease. Although advances in immunosuppressive regimens, surgical techniques, organ preservation, and overall management of transplant recipients have improved graft and patient survival, infectious complications remain problematic. Bacterial, fungal, viral, and parasitic infections are implicated after transplantation depending on numerous factors, such as degree of immunosuppression, type of organ transplant, host factors, and period after transplantation. Proper prophylactic and treatment strategies are imperative in the face of chronic immunosuppression, nosocomial and community pathogens, emerging drug resistance, drug-drug interactions, and medication toxicities. This review summarizes the pathophysiology, incidence, prevention, and treatment strategies of common post-transplant infections.
Polyomavirus Nephropathy in Kidney Transplantation
Authors: Trofe Jennifer , Gordon Jennifer , Roy-Chaudhury Prabir , Koralnik Igor J. , Atwood Walter J. , Alloway Rita R. , Khalili Kamel , Woodle E. Steve
Published: July 2017

Polyomavirus nephropathy has become an important complication in kidney transplantation, with a prevalence of 1% to 8%. Unfortunately, the risk factors for polyomavirus nephropathy and renal allograft loss are not well defined. The definitive diagnosis is made through assessment of a kidney transplant biopsy. Recently, noninvasive urine and serum markers have been used to assist in polyomavirus nephropathy diagnosis and monitoring. Primary treatment is immunosuppression reduction, but must be balanced with the risks of rejection. No antiviral treatments for polyomavirus nephropathy have been approved by the Food and Drug Administration. Although cidofovir has shown in vitro activity against murine polyomaviruses, and has been effective in some patients, it is associated with significant nephrotoxicity. Graft loss due to polyomavirus nephropathy should not be a contraindication to retransplantation; however, experience is limited. This review presents potential risk factors, screening, diagnostic and monitoring methods, therapeutic management, and retransplantation experience for polyomavirus nephropathy.
Evaluation of an Immunosuppressant Side Effect Instrument
Authors: Winsett Rebecca P. , Arheart Kris , Stratta Robert J. , Alloway Rita , Wicks Mona N. , Gaber A. Osama , Hathaway Donna K.
Published: July 2017

Background

Clinicians continue to be compelled to evaluate the impact of immunosuppressive medication side effects on the quality of life of transplant recipients. We were asked to develop an instrument to measure side effects in immunosuppressed transplant recipients.

Objective

To construct an instrument that measures the impact and severity of side effects of immunosuppressive medications used in transplantation and to assess the reliability and validity of the newly developed instrument called the Memphis Survey.

Design

The instrument was constructed by a panel of physicians, nurses, and pharmacists with experience in treating transplant recipients. A small group of kidney transplant recipients (n=13) provided pilot data for refining and testing the instrument. A national sample of kidney, liver, and heart transplant recipients (n=505) provided data that were used to further develop the instrument.

Analysis

Factor analysis was used to determine the psychological dimensions underlying the instrument and to guide the construction of scales from the survey items. The instrument scales were then computed from the dataset of 505 transplant recipients to quantify the impact of immunosuppressant side effects on the quality of life of transplant recipients.

Results and Conclusion

Analyses showed the final instrument scales to be valid and reliable. Exploratory analysis suggests the need for further testing of the instrument to determine gender differences.
An Analysis of the Long-Term Complications of Intestine Transplant Recipients
Authors: Andersen Deborah A. , Horslen Simon
Published: July 2017

Background

One-year survival rates for intestine transplant recipients have increased to 70%, but it is believed that the complications following the procedure do not diminish after the first year as is seen in other forms of solid-organ transplantation.

Objective

To review the ongoing medical requirements of an increasing number of long-term survivors of intestinal transplantation.

Method

A retrospective medical chart review was completed on all patients who received intestinal transplantation at the University of Nebraska Medical Center from September 1990 through March 2003. One hundred forty-six transplantations were performed on 128 patients—53 intestinal, 70 liver/intestinal, and 23 intestinal with liver and pancreas or kidney.

Results

Seventy-six patients survived longer than 365 days and form the study group. Major reasons for readmissions were infections, gastrointestinal complications, dehydration, and rejection. The average number of rehospitalizations per patient per year remained constant. Death in patients with more than 365 days survival (N=23) was the result of sepsis (56%) and multiple other complications (44%).

Conclusion

The number of readmissions each year per patient remains constant and medical problems remain complex and life threatening. Patients with intestinal transplantation will continue to require regular expert follow-up care and careful attention to even the smallest medical problem even years following transplantation.
Quality of Life 1 Year after Lung Transplantation
Authors: Kugler Christiane , Strueber Martin , Tegtbur Uwe , Niedermeyer Jost , Haverich Axel
Published: July 2017

Lung transplantation is a viable therapeutic option for patients with end-stage lung disease. The focus of interest has shifted from advances in surgical techniques to improved quality of life for the transplant recipient. A prospective longitudinal repeated measures design was used to determine the impact of lung transplantation on quality of life and life satisfaction. Using 4 measurement points (before transplantation, after 8 weeks, and after 6 and 12 months), 61 patients were followed from before to 1 year after successful lung transplantation. Quality of life was measured using 2 generic (SF-36, Quality of Life Profile for Chronic Diseases) and 1 lung-specific (Saint George's Respiratory Questionnaire) questionnaires. All dimensions of the health-related scores improved significantly after transplantation, except bodily pain. Patients reported the most significant improvements until 6 months after transplantation. Lung transplantation had no influence on social functioning or role emotional. The Saint George's Respiratory Questionnaire ratings showed similar significantly better scores for transplant recipients at 6 months, and stagnations for most dimensions afterward.
Relationships between Sex, Race, and Social Class and Social Support Networks in Kidney, Liver, and Pancreas Transplant Recipients
Authors: Cetingok Muammer , Winsett Rebecca P. , Russell Cynthia L. , Hathaway Donna K.
Published: July 2017

Context

The contribution of social support networks to the recovery of transplant recipients is an important assessment in measuring improved physical and psychosocial well-being. Social support networks are described by structure, type, and function.

Objectives

(1) To describe the levels of structure (size, formal and informal support), type (concrete, emotional, and informational), and function (criticalness, direction, closeness, frequency, and duration) of the social support network and (2) to examine the relationships between individual characteristics of sex, race, and social class and social support networks.

Methods

This exploratory-descriptive study was done in a Mid-south transplant center. A total of 258 kidney, liver, and pancreas transplant recipients participated, 61% of whom were less than 50 years old. Instruments included a demographic questionnaire, the social support network pie chart, and the social support network grid. Descriptive statistics and analysis of variance were used with a .05 significance level.

Results

The social support network comprised extended family (67%), with a mean of 13.68 members. Emotional support was the most prevalent type of support reported. The mean (SD) duration of support was 7.9 (4.9) years. Sex, race, and social class had no main relationships with structure and type of support. However, women had a main effect with closeness (F=4.98, P<.03) and African Americans had significantly higher levels of frequency of support (F=7.51, P<.01) and longer duration of support (F=9.07, P< .01) than did whites. Social and nursing intervention may improve the network closeness in males and may also augment support frequency and duration for whites.
Psychiatric Differences between Liver Transplant Candidates with Familial Amyloid Polyneuropathy and Those with Alcoholic Liver Disease
Authors: Telles-Correia Diogo , Barbosa A. , Mega Inês , Direitinho M. , Morbey A. , Monteiro E.
Published: July 2017

Background

Psychiatric diagnoses are very common in liver transplant candidates, and such diagnoses are predictive of a poor clinical evolution and quality of life after transplantation. Also, nonadherence before the transplant is predictive of nonadherence after the transplant.

Methods

We studied the psychiatric and psychosocial profiles of 85 liver transplant candidates, comprising consecutive patients attending outpatient clinics of a liver transplantation unit at a public hospital. Interviews and questionnaires were used to measure personality traits, symptoms of anxiety and depression, social support, and adherence. These patients were broken into 3 groups: patients with familial amyloid polyneuropathy (n=20), patients with alcoholic liver disease (n=33), and patients with other liver diseases (n=32).

Results

About 58% of patients had a current psychiatric diagnosis (24.8%, major depressive disorder, 22.3% generalized anxiety disorder, 8.3% adaptive disorder, 2.3% abuse of or dependence on substances other than alcohol). Current psychiatric diagnosis did not differ between patients with familial amyloid polyneuropathy and patients with alcoholic liver disease. Patients with alcoholic liver disease showed lower scores for 2 protective personality traits, social support and adherence to medication, than other patients. Patients with familial amyloid polyneuropathy showed higher scores for those traits.

Conclusions

All patients waiting for a liver transplant should undergo psychiatric and psychological assessment. Some psychological characteristics such as personality traits and social support differ between clinical groups, so it may be useful to design different approaches for each group. Patients with alcoholic liver disease may require a special approach to improve adherence to medication.
Health Care Professionals: What Do They Know about Organ Donation?
Authors: Castellana Teresa Pont , Burralló Núria Masnou , Gozalo Rosa Maria Gràcia , Barreto Marcelo , Guilera Enric Duque , Díez Júlia Portillo , Granè Natalia Vila , Barò Pere Salamero , Vilarnau Rosa Deulofeu
Published: July 2017

Background

Although donor detection is influenced by the legal system and family refusal, underreporting due to erroneous knowledge of donation criteria and a lack of familiarity with the procedure among medical professionals is also a contributing factor.

Objective

To investigate the outlook of critical health professionals participating in our postgraduate courses (2001 to 2006) about organ donation.

Methods

We administered an in-depth survey, evaluating attitudes, knowledge, roles, and experiences related to organ and tissue donation and transplantation, to 350 participants before and after the postgraduate courses.

Results

We collected 690 surveys from 350 attendees. In the first survey, 280 (80%) of them showed a positive attitude toward organ donation, 210 (60%) toward tissue donation, and 24 (7%) declared lack of knowledge about the subject. Only 175 (50%) had relatives who had donated organs. Sixty-three participants (18%) believed brain death is not equivalent to death, 176 (50%) claimed a lack of adequate training in this area, and 211 (60%) felt uncomfortable approaching families for donation. Only 88 (25%) were able to state the percentage of people receiving an organ in Spain, and 36 (10%) reported the correct number. After the course, the participants declared progress in attitudes toward and comfort levels with donation. Furthermore, family refusal in our hospital decreased from 33% to 8% to 11%.

Conclusion

Continuous training of health care professionals about transplant, the legal system, and communication skills are crucial for successful organ and tissue donation.
Adapting Patient Education for Potential Liver Transplant Recipients in a Climate of Chronic Donor Organ Shortfall
Authors: Ashcroft Peter
Published: July 2017

Liver transplantation is the established treatment for selected patients with acute liver failure or decompensated chronic liver disease. The procedure is not without its risks, however, and not every patient will survive. Although seldom recognized in the literature, education of patients is vital to the safety and success of transplantation. Before patients are accepted onto the transplant waiting list, both the patients and their families/caregivers must gain a complete understanding of the transplant process. In Birmingham, patients are not accepted onto the waiting list until a support package is agreed upon and in place. Patients and their partners/caregivers are required to attend a group teaching session presented by the transplant coordinators. This form of group teaching was introduced in response to the ever-increasing workload of the team due to an increase in the number of patients on the waiting list brought about by the chronic shortage of donor organs. An audit of this method of teaching was undertaken, and its effects on patients, their caregivers, and the coordinator team are described.