bluuebunny/crossref_metadata_2025 huggingface dataset:
Social Network Mapping with Transplant Recipients
Authors: Lewis Kim , Winsett Rebecca P. , Cetingok Muammer , Martin Judy , Hathaway Donna K.
Published: July 2017

Social support can have great influence on health, well-being, and general quality of life To promote awareness of the social network that surrounds each transplant recipient, transplant social workers are now using the Social Network Map as an intervention. Because perceptions of availability and accessibility of support are key elements in the use of social network resources, awakening an individual's awareness of available resources is a significant first step in enhancing social support and, ultimately, quality of life. The Social Network Map is used to establish dialogue regarding individuals' needs and sources of support, and then how the support system can meet those needs. Transplant social workers thus foster active use of those people in transplant recipients' networks who can meet the particular needs recipients identify.
Why is Transmission of Vancomycin-Resistant Enterococci on the Increase?
Authors: Frohloff Gayle
Published: July 2017

Nosocomial infections continue to escalate in response to antibiotic usage and breaches in infection control practices. Historically, naturally occurring bacteria that cause infection when present in an unfamiliar environment have been successfully treated with antibiotics. However, antibiotic resistance has kept ahead of antibiotics and creates a situation in which infection no longer responds to antibiotics. In the (hypothetical) case presented in this article, a person entering a hospital for a simple procedure may acquire a nosocomial infection, with a resulting increase in morbidity and mortality. Reservoirs of enterococci naturally occur in animals and humans, although the misuse of antibiotics in humans and animals has given rise to enterococci resistance, namely vancomycin-resistant enterococci. Once established in these reservoirs, vancomycin-resistant enterococci are easily transmitted by direct or indirect mechanisms and are proving difficult to control in hospitals, other healthcare settings, and in the community.
Donor Action: An International Initiative to Alleviate Organ Shortage
Authors: Roels Leo , Wight Celia
Published: July 2017

Context

Donor Action, an international initiative to alleviate organ shortage, provides a comprehensive state-of-the-art methodology that helps critical care units develop a tailor-made approach to optimize donation practices and performance.

Objective

To report the impact of the Donor Action methodology on organ donation rates in 8 countries (70 critical care units) in North America and Europe.

Design

Baseline data on the clinical potential for donation, staff attitudes, knowledge toward donation, self-reported confidence in performing a range of donation roles, and educational requirements were gathered. These data were analyzed using the Donor Action database and improvement measures were introduced to address identified weaknesses.

Results

Following introduction of the program's improvement measures, which addressed identified weaknesses, donations increased on average by 53% ( P=.0017) per country at 1 year. Sustained improvements settled at 70% to 160% increases at 3 years. Although Donor Action is at various stages of implementation in different countries, the number of centers and countries demonstrating an immediate awareness effect is increasing and sustained effects in centers with the longest follow-up promise a significant impact on donation rates as more countries implement this methodology.
Use of Behavioral Contingency Contracting with Heart Transplant Candidates
Authors: Cupples Sandra A. , Steslow Barbara
Published: July 2017

For many years, behavioral contingency contracting has been useful in increasing compliance in a variety of patient populations. More recently, this type of contracting has been used to facilitate communication and motivate behavioral change among patients referred for transplantation. This article discusses the theoretical basis of behavioral contingency contracting and describes the development and implementation of a multipurpose behavioral contract for patients receiving heart transplants. The scarcity of donor organs and the stringent posttransplant regimen mandates that psychosocial as well as medical variables be considered during the transplant evaluation process. Behavioral contingency contracting is useful in identifying those individuals with the potential to maintain a transplanted organ capably.
Reducing Adverse Effects of Immunosuppressive Agents in Kidney Transplant Recipients
Authors: Aalamian Ziba
Published: July 2017

Success in solid organ transplantation with minimal complications can now be achieved for most patients, and a remarkable rate of graft and patient survival can also be expected. However, the potential for adverse events and comorbid conditions increases with longer graft survival. Although the immunosuppressive regimen is central to the outcome of the transplant recipient and directly impacts the survival of the graft, chronic use of immunosuppressive agents is associated with metabolic disturbances such as hypertension, hyperlipidemia, loss of bone density, nephrotoxicity, and diabetes, which may contribute to other comorbid conditions. In addition, changes in appearance, gingival hyperplasia, hirsutism, alopecia, and weight gain disrupt quality of life and may lead to noncompliance with the immunosuppressive regimen. New immunosuppressive medications, including mycophenolate mofetil, sirolimus, basiliximab, and daclizumab, have allowed for experimentation with new regimens designed to reduce or allow discontinuation of corticosteroids and calcineurin inhibitors. This review highlights the impact and cost of immunosuppressive side effects and the potential for new immunosuppressive regimens to reduce this substantial clinical burden in transplantation.
Health Locus of Control and Adherence with Home Spirometry Use in Lung Transplant Recipients
Authors: Lindgren Bruce R. , Snyder Mariah , Sabati Navid , Adam Terrence , Pieczkiewicz David , Finkelstein Stanley M.
Published: July 2017

Home monitoring is an effective tool that can be used to promote the health of lung transplant recipients, but only if the recipients transmit data to the healthcare team. This study examines the relationship of the Multidimensional Health Locus of Control scale to adherence with home spirometry use. Form C of this scale was mailed to 139 eligible lung and heart-lung transplant recipients. Eighty-three respondents returned the questionnaire. The respondents were on average 4 years older and had greater adherence than nonrespondents. Men tended to score higher than women on all the subscales. These scales were not related to type of transplant or underlying disease. Adherence was also unrelated to the Multidimensional Health Locus of Control scale, with little difference in adherence across persons with various levels of the health locus of control subscales.
A Review of “Chest Tubes” during Donor Care and after Transplantation
Authors: Powner David J.
Published: July 2017

Thoracostomy tubes, also called chest tubes, are commonly present after transplantation or during donor care. The function of the thoracostomy tube is to provide a conduit for transporting fluid, gas, or blood from the pleural cavity to an attached drainage unit. Malfunction of the tube or parts of the unit assembly may lead to serious consequences and jeopardize transplant recipient recovery or donor organs. This review discusses the components of the thoracostomy tube and drainage unit assembly, normal operation, routine evaluation, and common problems that the organ procurement or transplantation coordinator may need to anticipate or treat.
Retransplantation of Multiple Organs: How Many Organs Should One Individual Receive?
Authors: Griffin Lisa
Published: July 2017

Every year, the transplant waiting list gets longer, while donor numbers essentially remain the same. This makes the responsibility of being good stewards of this precious and limited resource greater than ever. Transplant teams, who are both committed to their patients and aware of this important responsibility, are left to make the difficult and ethical decisions regarding retransplantation. Retransplantation of organs in pediatric patients presents a different set of issues to consider, and the results are promising. This case study presents a boy who received a kidney transplant for focal segmental glomerulosclerosis at age 5. At age 11, because of the recurrence of focal segmental glomerulosclerosis and severe cardiomyopathy, he required a rare combined kidney-heart transplant. At age 17, he developed chronic renal failure and posttransplant coronary artery disease, most likely related to a period of noncompliance, and required yet another combined kidney-heart transplant. He is currently alive and well 2 years after transplantation.
Intestinal Transplantation in Pediatric Patients
Authors: Park Beverly Kosmach
Published: July 2017

Intestine transplantation has evolved into a feasible alternative for children with permanent intestinal failure and life-threatening complications related to total parenteral nutrition. Although the first transplantations were done nearly 40 years ago, long-term survival has only been achieved in the last decade. Nearly 700 intestinal transplantations have been performed internationally since 1985, with an overall patient survival of greater than 50%. Improvements in patient selection, medical management, and assessment and treatment for rejection and infection have contributed to the increased survival. This article will discuss current results and medical management strategies for this innovative type of transplantation for children with end-stage short gut syndrome.
Complications following Split-Liver Transplantation: A Pediatric Case Study
Authors: Phillips Susan K. Jaskowski
Published: July 2017

Liver transplantation using split and reduced livers has helped to expand the donor pool for pediatric patients in the presence of a severe cadaveric organ donor shortage. However, this technique has been associated with an increased rate of postoperative complications. The purpose of this paper is to review a case report of postoperative complications experienced by a pediatric patient following split-liver transplantation for fulminant hepatic failure of unknown etiology.
The Effects of Information and Support on Individuals Awaiting Cadaveric Kidney Transplantation
Authors: Russell Cynthia L. , Brown Kristi
Published: July 2017

Context

No empirical studies exist to direct nursing interventions for individuals during the long period of waiting for a transplant.

Objective

To measure the effect of information and support on hope and uncertainty for individuals awaiting cadaveric kidney transplantation.

Design

Randomized, controlled study.

Setting

A university-affiliated hospital in the Midwest from 1997 to 1999.

Patients

Fifty participants awaiting cadaveric kidney transplantation.

Interventions

The control group received no intervention phone calls or mailings, which was the current standard of care. The treatment group received phone calls and mailings once every month for 6 months.

Main Outcome Measures

Hope, measured by the Herth Hope Index, and uncertainty, measured by the Mishel's Uncertainty in Illness Scale for Adults, were evaluated at the beginning of the study and 6 months later.

Results

No statistically significant effect of the nursing intervention was found on hope and uncertainty in this sample (F = 0.5322, P = .81). Hope was found to be negatively related to uncertainty both before ( r = $0.53, P = .0001) and after ( r = $0.59, P = .0001) intervention. No significant change was found between hope before and after intervention, and uncertainty before and after intervention in the treatment group (F = 1.10, P = .40) or the control group.

Conclusion

The individuals indicated that definite needs were met by the information and support intervention even though the results did not statistically support the effect of the nursing intervention.

Conclusions

Several conclusions can be drawn from the findings of this study. First, even though the nursing intervention of providing information and support did not have a statistically significant effect on levels of hope and uncertainty in individuals awaiting kidney transplantation, anecdotal reports from the respondents indicated that the phone calls and mailed information were helpful and appreciated. Valuable information, potentially impacting the outcomes of kidney transplantation, was gathered by the researchers and shared with the transplant team. Secondly, levels of hope were relatively high, whereas levels of uncertainty were moderate in this sample of individuals waiting for cadaveric kidney transplantation. Furthermore, in this sample, the average time since diagnosis of ESRD was more than 4 years and the average waiting time was more than 1 year. There may have been a change over time from viewing the waiting experience as a negative experience to a positive opportunity. Thirdly, the finding of a negative relationship between hope and uncertainty provided support to the growing body of knowledge of this association. Finally, time on the waiting list, gender, and marital status were not associated with levels of hope or uncertainty. Generally, the findings of this study are consistent with existing literature and add to the growing body of knowledge related to the midrange theories of hope and uncertainty.
Single-Center Analysis of Living Donor Nephrectomy: Hand-Assisted Laparoscopic, Pure Laparoscopic, and Traditional Open
Authors: Slakey Douglas P. , Hahn Julie Cauvin , Rogers Ethan , Gauthier Philippe M. , Ruiz-Deya Gilberto , Rice Janet C.
Published: July 2017

Context

Laparoscopic living donor nephrectomy has been shown to be a safe method for removing kidneys for transplantation, but concerns have been raised regarding safety and long-term kidney function.

Objective

To compare safety and long-term kidney function in hand-assisted laparoscopic, pure laparoscopic, and traditional open living donor nephrectomy.

Method

The charts of 48 patients with more than 1 year follow-up were reviewed. Thirty-four consecutive patients underwent laparoscopic live donor nephrectomy, and 14 had open donor nephrectomy. All kidneys functioned immediately at transplantation. In the laparoscopic group, 11 had the pure laparoscopic technique, and 23 patients had hand-assisted laparoscopic nephrectomy.

Results

Total operative and warm ischemic times were reduced with the hand-assisted technique when compared with pure laparoscopy. Operative and warm ischemic times were similar in open nephrectomy and hand-assisted laparoscopy. Long-term follow-up of serum creatinine levels revealed no significant differences between the 3 groups. Complication rates in the 3 groups were similar.

Conclusion

Laparoscopic donor nephrectomy appears to be comparable to open donor nephrectomy in terms of safety and long-term graft function.
Graft Expression of p38 and Tumor Necrosis Factor-α in Heart Transplantation in Rats
Authors: Zhang Xiaopeng , Cao Yuemin , Meng Aihong , Bai Yushan
Published: July 2017

Objectives

To investigate the expression of p38 mitogen-activated protein kinase and its relationship with myocardial apoptosis and tumor necrosis factor-α during acute cardiac allograft rejection and to study the effects of tacrolimus on the expression of the kinase.

Methods

Rats were divided into 3 groups: isograft (Lewis heart to Lewis rat; control group), allograft (Brown Norway heart to Lewis rat), and tacrolimus-treated allograft (Brown Norway heart to tacrolimus-treated Lewis rat). Grafts were collected 1, 3, 5, and 7 days after transplantation for determination of histopathological features, apoptosis of cardiac cells (by terminal deoxynucleotidyl transferase–mediated dUTP-biotin nick labeling), number of cells positive for both p38 and CD8 (by laser scanning confocal imaging), and expression of the kinase (by Western immunoblotting) and tumor necrosis factor-α (by reverse-transcriptase polymerase chain reaction).

Results

Compared with isografts from the control group, grafts from the untreated allograft group had significantly more apoptotic cells, greater expression of tumor necrosis factor-α and p38 mitogen-activated protein kinase, and more CD8-p38 double-positive cells at 5 and 7 days ( P<.05). The increases were prevented by treatment with tacrolimus.

Conclusions

The findings that the number of apoptotic cells, the number of CD8-p38 double-positive cells, the expression of tumor necrosis factor-α and p38 mitogen-activated protein kinase all increased during the same period in the allografts in nonimmunosuppressed recipients suggests that intragraft expression of p38 would be associated with the rejection in acute cardiac allograft rejection. Tacrolimus may alleviate rejection partly by inhibiting p38 mitogen-activated protein kinase.
Expanding the Donor Pool: The Elderly Non—Heart-Beating Donor
Authors: Anton Mary-Ellen , Schatz-Salzman Debra
Published: July 2017

The need for transplantable organs continues to far outweigh the number of organs available for transplantation through donation. To date, many avenues for expanding the donor pool have been explored, including Non—Heart-beating donor protocols and the expansion of acceptable criteria. This case study reviews the successful procurement of a liver and kidney from a 72-year-old Non—Heart-beating donor.
Ethical Aspects of Living Donor Kidney Transplantation and Recipient Adherence to Treatment
Authors: Wright Linda , Daar A. S.
Published: July 2017

Living donor kidney transplantation comprises approximately 30% of kidney transplantations in the United States and is an effective form of renal replacement therapy, with low risk to the donor. Twenty percent of living donors do not have a genetic relationship with their recipients. In the selection of living donors, guiding ethical principles include altruism, the absence of coercion or monetary reward, patient autonomy, beneficence, and nonmaleficence. In order for the benefit of living donor kidney transplantation to outweigh the risk, evidence that the proposed recipient will care for the transplanted organ must exist. Nonadherence to treatment has been identified as a major risk factor for graft rejection. When nonadherence to treatment regimens leads to loss of the graft, the consequences are felt by the recipient, donor, and the treatment team. The decision to transplant an organ to a noncompliant patient from a cadaveric or a living donor raises issues of patient autonomy, justice, paternalism, and benevolence versus nonmaleficence.
Clinical Integration of Billing for a Pediatric Nephrology and Transplant Program
Authors: Tietjen Andrea L. , Orsini Jenoveva , Mulgaonkar Shamkant , Morgan Debbie
Published: July 2017

Purpose

To develop and implement a billing process that fully integrates all activities of a pediatric nephrology and transplant program, by facilitating and coordinating data from patients, physicians, hospitals, and third-party billing services to maximize revenues.

Methods

Financial operations were analyzed via a randomized audit of patient charts that focused on office procedures and revenue collection. Results based on monthly reports documenting revenue received and outstanding, procedures billed, and patient registration accuracy.

Results

The combination of improvements in patient registration, chart documentation, new billing sheets with procedure and diagnosis codes, physician in-service education, upgraded charges, and the recredentialing of all practice physicians realized an increase in revenue collections from 18% in 2000 to 89% in 2001.

Conclusion

The need to integrate and coordinate information is vital for both billing accuracy and revenue collections. Integration of clinical services and billing procedures has maximized performance, profitability, and accuracy while decreasing administrative time and costs.
Ethical Concerns for Organ Transplant Coordinators
Authors: Levi Benjamin H. , Green Michael J.
Published: July 2017

A great deal has been written about the ethics of organ transplantation. Much of it has (appropriately) concerned issues of policy—for example, how best to allocate scarce organs, avoid conflicts of interest, and increase the pool of potential donors. Although these discussions are important, they often fail to provide much context for applying relevant ethical precepts to the day-to-day activities of those directly involved in organ procurement. The purpose of this paper is to provide such a context by reviewing several key conceptual issues, drawing attention to various ethical and procedural distinctions, and offering some practical recommendations for addressing these issues with physicians and other healthcare providers.
The Tissue Donation Experience: A Comparison of Donor and Nondonor Families
Authors: Rodrigue James R. , Scott Michael P. , Oppenheim Anneliese R.
Published: July 2017

Context

Although there has been an increase in studies examining the experiences of organ donor and nondonor families, scant empirical research specifically concerning tissue donation has been conducted.

Objective

To assess the perceptions and attitudes of both donor and nondonor next of kin to whom a tissue donation request had been directed.

Design

Cross-sectional, 2-group analysis of a telephone survey.

Setting and Participants

Participants were 507 adults who consented to tissue donation and 507 adults who refused consent to tissue donation following the death of a family member. All donation requests were made by telephone by trained staff.

Main Outcome Measure

The primary outcome measures were demographic and contextual information surrounding the donation request, perceptions and attitudes toward tissue donation, and reasons for donation or refusal to donate.

Results

Findings suggest that most tissue donor family members were satisfied with the request and donation experience. Also, there were important differences in attitudes and perceptions between donor and nondonor family members, with nondonors reporting more negative attitudes and beliefs about tissue donation.
A Comparative Study of Quality of Life among the Age Groups of Kidney Transplant Recipients
Authors: Cetingok Muammer , Winsett Rebecca P. , Hathaway Donna K.
Published: July 2017

Context

Quality of life and transplant age are 2 major concerns of professionals and researchers. Both variables are contemplated in transplant allocation decisions as a result of longer graft and patient survival and the likelihood of achieving a reasonably good quality of life for patients of all ages. Studies are warranted to understand if quality of life might serve as a moderating variable to balance question of age and transplant allocations.

Objective

To determine if there are differences in the pretransplant and posttransplant quality of life of kidney transplant recipients with respect to age.

Design, Participants, Setting, and Outcome Measures

This study comparatively examined the differences in pretransplant and posttransplant quality of life of kidney transplant recipients in 5 age groups (18–29 years, 30–39, 40–49, 50–59, and older than 60). A sample of 293 patients admitted to a midsouthern US transplant center and selected on a convenience-sampling basis were included in the study. Multiple measures of quality of life were used, including the Quality of Life Index, the Adult Self-Image Scale, and the Sickness Impact Profile.

Results

Both the pretransplant and posttransplant quality of life of all age groups of kidney transplant recipients were similar, with the exception that the recipients in the age range of 30 to 49 years reported better posttransplant quality of life on the Sickness Impact Profile Psychosocial measure (F = 2.18, P = .02).

Conclusions

Quality of life outcomes do not appear to favor one age group over another, although psychosocial outcomes may warrant some additional consideration.
BK Virus in Kidney Transplantation: A Case Study
Authors: Boyum Denise A.
Published: July 2017

Prevention as well as treatment of viral infections in transplant recipients relies on minimal immunosuppressive therapy consistent with graft survival and the use of antiviral therapies in proportion to perceived risk. BK virus creates an even greater challenge in posttransplant management and graft survival because of difficulty in diagnosing and treatment. BK nephropathy develops in 1% to 5% of transplant recipients, with loss of allograft function occurring in 50% of the cases. We present a case of a 67-year-old man who developed BK virus allograft nephropathy 9.5 months after transplantation. His allograft function was extended through rigorous treatment with an antiviral agent, reduction of immunosuppressant, and monitoring in an outpatient setting.
Posttransplant Malignancy
Authors: Trofe Jennifer , Beebe Thomas M. , Buell Joseph F. , Hanaway Michael J. , First M. Roy , Alloway Rita R. , Gross Thomas G. , Woodle E. Steve
Published: July 2017

In the past few decades, great advances have been made in the field of solid-organ transplantation. A greater understanding of immune system function, the development of modern immunosuppression, and advancements in surgical technique have led to marked improvements in both recipient and graft survivals, as well as recipients' quality of life. However, improved survival rates have also led to prolonged exposure to chronic immunosuppression, which increases the risk for the development of posttransplant malignancies. In addition, older transplant candidates are being considered, carrying with them the increased likelihood of pre-existing malignancy. Consequently, the potential risk of posttransplant malignancy must be considered. Moreover, as long-term transplant survivors continue to age, posttransplant malignancies will be seen more frequently. This review presents the more commonly encountered posttransplant malignancies and the measures that are currently being utilized to prevent and treat them.
Factors during Donor Care That May Affect Liver Transplantation Outcome
Authors: Powner David J.
Published: July 2017

Publications are reviewed that identify factors during donor care and characteristics of the donor liver that may be associated with outcome following liver transplantation. The procurement coordinator has the opportunity to influence cold ischemia time, blood pressure, the serum sodium concentration and, perhaps, liver glycogen reserves. These variables may significantly affect postimplantation graft performance and graft or recipient survival. Summaries of those publications comprising this database are presented, and several limitations in their interpretation are discussed.
Is There a Role for Living Donor Intestine Transplants?
Authors: Fryer Jonathan , Angelos Peter
Published: July 2017

The use of living donors with intestinal transplantation is controversial because it may not significantly improve candidate access to organs when intestine-only grafts are needed, and may involve excessive donor risk when combined liver-intestine grafts are required. Although limited data are available for comparison at this time, graft and patient survival rates for intestinal transplantations using living donors are no different than for deceased donor transplantations. Potential benefits that may be provided to the intestine transplant recipient through the use of living donors include better HLA matching, shorter ischemia times, better bowel preparation, and better opportunities for introducing immunomodulatory strategies. Conversely, living intestine donors are at risk for mortality, significant morbidity, financial loss, and psychologic trauma. The long-term outcomes of living intestine donors have not yet been reported. Ultimately, these data are essential before the wider use of living donors can be advocated for intestinal transplantation.
Stage-Specific Educational Interventions for Patients with End-Stage Renal Disease: Psychological and Psychiatric Considerations
Authors: Curtis Carmen E. , Rothstein Marcos , Hong Barry A.
Published: July 2017

To optimize the success of educational interventions for adults with end-stage renal disease, we developed a psychosocial framework of illness adjustment. Currently, no stage-specific guidelines are available for understanding the psychosocial concerns of patients with end-stage renal disease nor are there specific models of coping with the disease. The content and implementation of educational programs must correspond to a patient's stage of adjustment to the illness. Psychological or psychiatric concerns may also affect participation in and response to educational interventions. Recommendations for structuring and implementing educational interventions about renal replacement that are specific to the unique psychosocial tasks associated with adjusting to each stage of end-stage renal disease are presented. Increased information about this disease and the treatment options available can be instrumental in improving patients' quality of life.
Patient Adherence or Patient Self-Management in Transplantation: An Ethical Analysis
Authors: Redman Barbara K.
Published: July 2017

Adherence of patients to transplantation regimens has been problematic. Patient self-management of the chronic diseases that frequently lead to transplantation is now the standard of practice, although that practice has been incompletely implemented. Through its focus on developing patients' skills and confidence in their ability to perform medical management, maintain important life roles, and manage the negative emotions that often accompany chronic conditions, patient self-management has the potential to support effective adherence of patients in an ethically satisfactory way. A professional decision to transplant should carry with it a commitment to help patients self-manage, including patients with low levels of literacy. Viewing adherence as patients' work to be accomplished within a framework of patient self-management offers an option for improving transplant outcomes. Testing this option is an important next step.
Use of Failure Mode and Effects Analysis for Proactive Identification of Communication and Handoff Failures from Organ Procurement to Transplantation
Authors: Steinberger Dina. M. , Douglas Stephen V. , Kirschbaum Mark S.
Published: July 2017

A multidisciplinary team from the University of Wisconsin Hospital and Clinics transplant program used failure mode and effects analysis to proactively examine opportunities for communication and handoff failures across the continuum of care from organ procurement to transplantation. The team performed a modified failure mode and effects analysis that isolated the multiple linked, serial, and complex information exchanges occurring during the transplantation of one solid organ. Failure mode and effects analysis proved effective for engaging a diverse group of persons who had an investment in the outcome in analysis and discussion of opportunities to improve the system's resilience for avoiding errors during a time-pressured and complex process.
Defining High Risk in Adult Kidney Transplantation
Authors:   High Risk Renal Transplant Consensus Group
Published: July 2017

Background

Because identifiable factors contribute to allograft loss, and because no consensus has been reached on the definition of high risk, an interdisciplinary group of nurses, physicians, pharmacists, and social workers was convened in May 2008.

Objective

Participants sought to reach consensus about the current state of science and best practices related to the definition and management of high-risk kidney transplant recipients.

Methods

An expert facilitator with extensive experience in leading consensus teams guided consensus-building activities, which included discussion and small-group work.

Results

This consensus group conceptualized the definition of the “high-risk” kidney transplant recipient and provided information to guide the multidisciplinary team in their assessment of these patients before and after transplant. Three key areas, which were conceptualized as independent scales, had a substantial impact on outcomes: (1) transplant recipient medical factors, (2) donor and recipient immunological factors, and (3) transplant recipient psychosocial factors. Though depicted separately, alteration of a specific risk on one scale could influence some risk factors on another scale. In addition, the kidney allograft itself must be considered in the assessment of high risk.

Conclusions

The continuum of risk described here should be useful to transplant clinicians in their assessment of high-risk adult kidney transplant patients, may aid centers in developing a more complete definition of high risk, and may lead to risk-reduction efforts.
A Clinical Group's Attempt to Raise Awareness of Organ and Tissue Donation
Authors: Rykhoff Margot E. , Coupland Catherine , Dionne Joanna , Fudge Brad , Gayle Charlene , Ortner Terri-Lynn , Quilang Kristina , Savu Geta , Sawany Fatima , Wrobleska Marzena
Published: July 2017

Context

Little is known about factors that influence attitudes and beliefs about organ and tissue donation among health science college students.

Objective

To assess health sciences college students' knowledge, attitudes, and beliefs about organ donation and to determine if an educational session increases awareness and influences their attitudes and beliefs related to organ donation.

Design

Quantitative quasi-experimental study with semistructured questions administered to a convenience sample.

Setting

School of health sciences in a large, urban, multicultural community college in Ontario, Canada.

Participants

240 health sciences' college students from 6 academic programs: bachelor of nursing from first and fourth year, practical nursing, paramedic, funeral services, and occupational therapy/physical therapy assistant.

Intervention

An educational session and 7-minute audiovisual presentation on organ donation. The educational session included a 20-minute PowerPoint presentation addressing statistics of organ and tissue need and donation; types of donation—deceased (brain-dead), live, and tissue; clarification on the criteria for brain death; donor cards; family consent, including clarification that the family member has the ultimate decision to sign it and the importance of communicating one's wishes to one's family; and religious beliefs and common myths and misconceptions.

Results

Of 235 students who completed the postintervention survey, 86% (n=202) were more aware of organ donation, and 85% (n=199) were more aware of living donation. Awareness of the need for family consent for donation increased significantly (from 52% to 96%, P< .001). The percentage of participants willing to donate their organs increased from 52% to 63% (n=26, P<.01). Among the 20% of participants (n = 47) who responded that they would not donate their organs, the predominant rationale was “fear.”

Conclusions

Educational sessions in the health sciences curriculum can increase awareness of organ and tissue donation.
Individual and Environmental Correlates and Predictors of Early Adherence and Outcomes after Liver Transplantation
Authors: Stilley Carol S. , DiMartini Andrea F. , de Vera Michael E. , Flynn William B. , King Jennifer , Sereika Susan , Tarter Ralph E. , Dew Mary Amanda , Rathnamala Geetha
Published: July 2017

Context

Little is known about patients' contribution to health outcomes after liver transplantation. Yet, in other transplant recipients, nonadherent behavior is directly related to the leading causes of morbidity and mortality in liver transplant recipients.

Objective

To examine patient and environmental factors in relation to all aspects of adherence to the posttransplantation regimen and health outcomes in the first 6 months after transplantation.

Design

A descriptive analysis of individual and environmental factors in relation to adherence and health outcomes at 6 months after liver transplantation.

Participants, Setting

One hundred fifty-two adult liver transplant recipients at the University of Pittsburgh Medical Center.

Main Outcome Measures

Adherence to medication taking, appointment keeping, lifestyle changes, mood, quality of life, and clinical markers of liver function.

Results

Nonadherence was prevalent (47% with appointments, 73% with medication); relapse to drug/alcohol use occurred among a few recipients (5.6%), all with a history of substance abuse before transplantation. Patterns of coping, decision making, attitude, and social support were correlated with adherence, clinical markers, and psychological function (r = 0.22–0.45). Avoidant coping, affective dysregulation, and caregiver support emerged as robust predictors of negative clinical and mental health outcomes (β = .224-.363).

Conclusion

This information about liver transplant recipients is important for researchers and clinicians. Researchers can develop guidelines by using stable but modifiable characteristics of patients to identify transplant candidates at risk of nonadherence. Such guidelines would enable clinicians to prepare patients better to manage the posttransplant regimen.
Multiorgan Transplant Program in a Nonacademic Center: Organizational Structure and Outcomes
Authors: Jabbour Nicolas , Singhal Ashish , Ghuloom Adel E. , Monlux Roy D. , Bag Remzi , Dugan Rebecca , Sigle Gary
Published: July 2017

Given the complexity of solid organ transplantation, it is reasonable to believe that numerous factors are at play in achieving the enviable outcomes reported. The aim of this study is to examine the role of an organizational structure in maintaining the outcomes of a multiorgan transplant program at a nonacademic center. A retrospective analysis of 2378 solid organ transplants at Nazih Zuhdi Transplant Institute between March 1985 and December 2008 was performed. The 1-year and 3-year patient and graft survival rates, rate of retransplantation, and median length of hospital stay were compared with US national data released by the Scientific Registry of Transplant Recipients in January 2009. The 1-year patient survival rates were 87.5% for heart, 95.1% for kidney, 75.8% for lung, 89.6% for liver, and 100.0% for pancreas. The 3-year patient survival rates were 73.5% for heart, 89.7% for kidney, 57.8% for lung, 87.7% for liver, and 100.0% for pancreas. A well-structured transplant program along with competent medical, administrative, and ancillary support can achieve comparable patient and graft survival rates independent of volume.
Airway Pressure Release Ventilation during Adult Donor Care
Authors: Powner David J. , Graham Russell
Published: July 2017

Airway pressure release ventilation is most commonly used during donor care to treat hypoxemia and to avoid high peak airway pressure. The traditional concept of cyclic inhalation/exhalation is replaced by a continuous positive airway inflation interspersed by brief episodes in which the positive pressure is reduced. The variables, Pressure-high, Pressure-low, Time-high, and Time-low, are manipulated to ensure adequate donor oxygenation and carbon dioxide removal. Organ procurement coordinators may find this method of mechanical ventilation in place when donor care is assumed or initiate it as a useful tool in providing donor support.
Organ Transplantation in Egypt
Authors: Paris Wayne , Nour Bakr
Published: July 2017

Concern has increasingly been expressed about the growing number of reports of medical personnel participating in the transplantation of human organs or tissues taken from the bodies of executed prisoners, handicapped patients, or poor persons who have agreed to part with their organs for commercial purposes. Such behavior has been universally considered as ethically and morally reprehensible, yet in some parts of the world the practice continues to flourish. The concept of justice demands that every person have an equal right to life, and to protect this right, society has an obligation to ensure that every person has equal access to medical care. Regrettably, the Egyptian system does not legally recognize brain death and continues to allow the buying and selling of organs. For more than 30 years in Egypt, the ability to pay has determined who receives an organ and economic need has determined who will be the donor. As transplant professionals, it is important that we advocate on behalf of all patients, potential recipients, and donors and for those who are left out and not likely to receive a donor organ in an economically based system. Current issues associated with this debate are reviewed and recommendations about how to address them in Egypt are discussed.
Probing Transplant and Living Donor Candidates about Their Participation in Organ Vending
Authors: Bramstedt Katrina A.
Published: July 2017

The selling of human organs for transplant is illegal in the United States and in most countries; however, such transactions still occur. Transplant hospitals and their personnel have multiple ethical duties, including (1) protecting the safety of their living donors and transplant recipients and (2) protecting the integrity of living donation and transplantation as clinical practices. To date, few psychosocial screening tools exist that pertain specifically to a person's risk or intent of pursuing organ vending (buying or selling). This article presents a series of transplant ethics case consultations that spawned the creation of a set of behavioral prompts for teams to probe with regard to organ vending when screening candidates about their suitability for participation as living donors or transplant recipients.
Quality of Surgical Care in Liver and Small-Bowel Transplant: Approach to Risk Assessment and Antibiotic Prophylaxis
Authors: Kettelhut Valeriya V. , Van Schooneveld Trevor
Published: July 2017

In August 2002, The Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention implemented the National Surgical Infection Prevention project. The goal of the project was to decrease the morbidity and mortality associated with postoperative surgical site infections through appropriate selection and timing of administration and discontinuation of prophylactic antimicrobials. The National Surgical Infection Prevention project, however, excluded transplant surgeries from its focus because of the lack of randomized clinical trials comparing antimicrobial agents. The goals of this article are to (1) provide a framework for risk factors associated with surgical site infections in liver, small-bowel, and multivisceral transplants; (2) review general principles of the appropriate antimicrobial prophylaxis; (3) provide a framework for developing a triage of liver, small-bowel, and multivisceral transplant candidates for appropriate antibiotic prophylaxis; and (4) develop an approach to further quality improvements in transplant surgical care. A multidisciplinary team produced recommendations for antibacterial prophylaxis and monitoring.
Spouse Caregivers of Kidney Transplant Patients: Quality of Life and Psychosocial Outcomes
Authors: Rodrigue James R. , Dimitri Noelle , Reed Amanda , Antonellis Timothy , Pavlakis Martha , Johnson Scott R. , Mandelbrot Didier A.
Published: July 2017

Context

Most kidney transplant programs require patients to identify a primary caregiver who can assist them throughout the transplant process. Little is known about the quality of life, caregiving strain, and psychosocial functioning of these caregivers.

Objectives

To characterize the psychosocial functioning of spouse/partner caregivers.

Design, Settings, and Participants

Cross-sectional survey administered to spouse/partner caregivers of patients before (n = 33) and after (n= 46) kidney transplantation at a transplant center in New England.

Main Outcome Measures

Quality of life, life satisfaction, caregiving strain and benefit, mood, and social intimacy.

Results

Relative to normative samples and published data involving other transplant caregivers, caregivers of kidney transplant patients had favorable quality of life, life satisfaction, psychological, and social intimacy outcomes. Life satisfaction scores were significantly lower for caregivers before than after kidney transplantation, but otherwise the 2 cohorts did not differ significantly from each other. Most caregivers both before and after kidney transplantation reported clinically high levels of caregiving strain, as well as several caregiving benefits.

Conclusion

Our data are consistent with results of other studies in showing that spouses experience considerable caregiving strain both before and after transplantation. However, caregivers of kidney transplant patients overall have good quality of life, life satisfaction, mood, and social intimacy. More prospective research is necessary to characterize better how these outcomes change over time throughout the transplant process.
Choosing to Be a Designated Organ Donor on Their First Driver's License: Actions, Opinions, Intentions, and Barriers of Asian American and Pacific Islander Adolescents in Hawaii
Authors: Albright Cheryl L. , Wong Linda L. , Cruz May Rose Dela , Sagayadoro Tony
Published: July 2017

Context

The factors associated with Asian American and Pacific Islander adolescents' decision to be a designated organ donor on their first driver's license are largely unknown.

Objective

To assess knowledge and attitudes about organ donation and socio-cultural factors associated with designated organ donor status in Asian American and Pacific Islander youth in Hawaii.

Design and Setting

Written surveys and focus groups were conducted at high schools and churches.

Participants

Two hundred eight Asian American and Pacific Islander teens, mean age 16 (SD, 2) years, 52.6% females, and 53.4% Catholic.

Main Outcome Measures

Donor status on driver's license, awareness, attitudes, intentions, and barriers to becoming a designated organ donor.

Results

Eighteen percent of teens with a driver's license are designated organ donors. Twenty-one percent have talked to their parents about becoming a designated donor on their license. Of those without a license, 27.7% intended to become a designated donor. Sex, grade level, and immigrant status were not associated with designated organ donor status; however, Catholics were significantly less likely to be donors. Key barriers to being a designated donor included a lack of knowledge or misperceptions due to urban myths about organ donation, parents completing “organ donor” question on driver's license application, and not wanting to have their body “cut up.”

Conclusions

Future organ donor campaigns should educate ethnic minority adolescents about the importance of becoming a designated organ donor on their first driver's license and counter urban myths about deceased organ donation. Guidelines for how to initiate family discussions about organ donation should be sensitive to cultural and religious beliefs.