bluuebunny/crossref_metadata_2025 huggingface dataset:
Variation in requests for imaging investigations by general practitioners: A multilevel analysis
Authors: Verstappen Wim , Riet Gerben Ter , Van Der Weijden Trudy , Hermsen Jan , Grol Richard
Published: July 2017

Objectives

To describe the variation in the numbers of imaging investigations requested by general practitioners (GPs) and to find likely explanations for this variation.

Methods

Cross-sectional survey of the use of eight imaging investigations by 229 GPs collaborating in 40 local GP groups from five regions in the Netherlands during 1997. A multivariable, multilevel regression analysis was used to link these data with survey data on professional characteristics such as knowledge about and attitude towards test ordering, and with data on contextual factors such as practice type or experience with feedback on test-ordering data.

Results

Data for 221 GPs (97%) were available. After adjustment for practice size and working time, the median number of imaging investigations ordered per GP was 148 (interquartile range 71 to 300), with large differences (up to twofold) between the regions (P<0.001). Overall, chest X-rays were the largest single category (median =48; interquartile range 17 to 100). GPs working in a group practice requested, on average, 34% fewer investigations than their colleagues working in single-person practices (95% confidence interval 17 to 48%).

Conclusions

Only practice type was found to be associated with the number of imaging investigations requested, adjusted for practice size and working time factor. No further explanations were found for the inter-regional differences. Future studies on the ordering of imaging investigations by GPs should attempt to delineate contextual from regional factors.
Do Personal Medical Services contracts improve quality of care? A multi-method evaluation
Authors: Campbell Stephen , Steiner Andrea , Robison Judy , Webb Dale , Raven Ann , Richards Sally , Roland Martin
Published: July 2017

Objectives

To assess whether the new contractual arrangements of first-wave Personal Medical Services (PMS) practices in England improved their quality of care, compared with changes in care provided in a control sample of General Medical Services (GMS) practices.

Methods

Controlled ‘before’ (at or near 1 April 1998) and ‘after’ (at or near 31 March 2001) quantitative observational study in a sample of 23 PMS and 23 GMS practices. Quantitative data focused on access, chronic disease management, mental health care, primary care of older people, costs and patient evaluation using the General Practice Assessment Survey. Case studies were also undertaken in all PMS pilots, involving interviews with general practitioners, nurses, practice managers and Health Authority and Primary Care Group/Trust managers, documentation review, and analysis of site-specific data.

Results

There were improvements in quality of care in PMS sites in all areas of care evaluated, but improvements in care over and above those found in GMS sites (the ‘PMS effect') were only statistically significant for angina care (P =0.05) and elderly care (P =0.04). Teamwork, shared culture, clear objectives and leadership were important catalysts for quality improvement in PMS sites. Improvements in PMS practices came at additional financial cost. There were concurrent improvements in GMS practices. No PMS site succeeded in meeting its aims without successfully introducing effective leadership and management, and changing relationships within the practice (e.g. equalising power between nurses and doctors).

Conclusions

Small but steady improvements were observed in English primary care. PMS contracts facilitated quality improvements in specific areas over and above these broad improvements (the ‘PMS effect') during the study period. New contractual arrangements for health care can be used to improve quality of care. However, the mechanisms that resulted in quality gains, while facilitated by the new contractual arrangements, were not specific or unique to the PMS experiment. Factors such as effective management, clear objectives and flexible professional relationships within practices are likely to be important in determining whether new contractual arrangements result in improved outcomes. The context within which care and services are provided is as important for quality innovations as specific contractual arrangements.
Left Internal Mammary Artery Graft Retransplantation from the Recipient to the Donor Heart: A Case Report
Authors: Kollar Andras , Donaldson Terri , Greer Elaine , Howser Renee , Davis Stacy F. , Drinkwater Davis C.
Published: July 2017

A case of heart transplantation with concomitant coronary artery bypass graft is reported. The patient was an alternate transplant list candidate with a history of bilateral below-knee amputation and 2 previous myocardial revascularization procedures. The previously used and patent left internal mammary artery graft was successfully removed and retransplanted from the recipient to the donor heart.
Management of Variations in Blood Pressure during Care of Organ Donors
Authors: Powner David J. , Darby Joseph M.
Published: July 2017

The organ procurement coordinator commonly must correct and maintain the arterial blood pressure during donor care. This article reviews considerations in the accurate measurement of the blood pressure, causes of hypertension and hypotension, and desirable standards to use in order to provide adequate organ perfusion. Recommendations are presented for treatment of hypotension in a titrated response of intravenous fluids, inotropic support, and vasopressor infusion to maintain the mean arterial pressure above 65 mm Hg. Collaborative interaction between the coordinator and physician consultant remains important throughout management of blood pressure changes during donor care.
Recommendations for Mechanical Ventilation during Donor Care
Authors: Powner David J. , Darby Joseph M. , Stuart Susan A.
Published: July 2017

The organ procurement coordinator usually directs adjustments to the mechanical ventilator during donor care. It is often difficult to achieve optimal oxygen uptake and carbon dioxide removal while avoiding barotrauma or undesirable effects on the cardiac output. Interrelationships among a variety of ventilator parameters must be understood in order to achieve the desired goal of providing the best organs possible. These recommendations review the key ventilator parameters of tidal volume; positive end-expiratory pressure; auto–positive end-expiratory pressure; fraction of inspired oxygen; and flowrate and frequency and their interactions in controlling peak, plateau, and mean and end-expiratory airway pressures.
Use of an HBV-DNA Hybridization Assay in the Evaluation of Equivocal Hepatitis B Virus Tests in Solid Organ Donors
Authors: Domen Ronald E. , Yen-Lieberman Belinda , Nelson Kristine A. , Chua Jimmy , Sholtis William , Tyus Henry , Isada Carlos M.
Published: July 2017

Context

Serological markers for the hepatitis B virus are routinely used in the evaluation of potential organ donors. However, serological tests can be associated with significant false or equivocal results and may not be indicative of the true risk of hepatitis B infection. Studies have recently questioned the significance of an isolated hepatitis B core antibody test in evaluating the suitability of solid organs for transplantation. The ability to detect hepatitis B virus DNA may prove useful when the diagnosis of hepatitis B infection is in doubt.

Design

Serum samples from 16 donors with equivocal or positive hepatitis B core antibody and/or hepatitis B surface antigen serological screening tests were retrospectively tested for the presence of hepatitis B DNA. Any available follow-up data on the placement of organs from these donors was obtained.

Results

One of the 16 (6.3%) donors tested positive for the presence of hepatitis B DNA, but organs from this donor were not recovered or transplanted. Follow-up on 14 organs recovered and transplanted from 6 donors in this group did not show clinical and/or laboratory evidence of hepatitis B infection in the recipients.

Conclusions

In our donor population, there was a low incidence (6.3%) of donors with equivocal or positive hepatitis B core antibody and/or hepatitis B surface antigen serological screening tests who subsequently demonstrated the presence of detectable hepatitis B DNA. Posttransplantation follow-up of the recipients of 14 recovered organs failed to demonstrate any cases of posttransplant hepatitis B infection.
Reducing Transplant Evaluation Costs by Early Identification of Unsuitable Patients
Authors: Hauff Helen , Castro Michelle
Published: July 2017

Many patients undergo a full transplant evaluation and are rejected for transplant on the basis of the test results. Some of these patients could be identified earlier in the evaluation process, thus reducing the cost of undergoing a full evaluation. Subjects in this study were 117 patients who had undergone a heart transplant evaluation over a 6-month period. The rates of acceptance, rejection, deferral, and those deferred and later listed were monitored: 53% were accepted, 17.1% rejected, 18.8% deferred, and a further 11.1% were deferred and then later listed. Of the group that was rejected, 45% were rejected on the basis of the cardiopulmonary exercise test and deemed too well for transplant. Other reasons for patients being rejected were obesity, psychological or social issues, and as a result of other diagnostic testing. The transplant evaluation process can be modified so that the cardiopulmonary exercise test is performed first, which would reduce the ultimate cost of a transplant evaluation from $11330 to $680. The cardiopulmonary exercise test has become an intrinsic part of the cardiac evaluation process and is a strong indicator of a patient's suitability for transplant.
A Center-Based Approach to a Transplant Employment Program
Authors: Carter Joyce M. , Winsett Rebecca P. , Rager Dennis , Hathaway Donna K.
Published: July 2017

The return to work after transplantation has been actively discussed in the transplant community for years. However, despite the desire for transplant practitioners to have recipients return to being healthy, contributing members of society as well as return to work, practitioners often passively support the sick role. We discovered that patients who are returning to work after transplantation may have been out of the work force for several years, and require assistance that we as healthcare providers were unable or untrained to provide. An employment specialist was added to the transplant staff and became a vital part of our attempts to create a proactive employment atmosphere and enhance our patients' quality of life. Adding an advocate for employment in our center has also facilitated the shift in our thinking and approach to care from the sick role to one of rehabilitation and from reactive to proactive. This change in attitude has assisted in empowering our recipients to feel as if they can truly resume a normal life.
Xenotransplantation: The Challenge to Current Psychosocial Attitudes
Authors: Appel James Z. , Alwayn Ian P. J. , Cooper David K. C.
Published: July 2017

Because of the limited availability of transplantable human organs, xenotransplantation, the use of animal organs as an alternative source, has received considerable attention in recent years. Xenotransplantation would provide an unlimited supply of organs, and these organs would be available whenever required. Although the pig is considered the best source for organs, significant immunologic barriers currently prohibit the implementation of a clinical trial of organ transplantation. However, as medical research gains more insight into the mechanisms underlying rejection of pig organs in primates, therapeutic xenotransplantation is becoming more feasible. Clinical trials of porcine cell transplants are currently underway. Although xenotransplantation will minimize the waiting period for an organ and obviate the feelings of guilt or indebtedness commonly experienced by recipients of human organs, several psychosocial issues may hinder the reintegration of patients into society. For example, concerns that infectious pathogens could be transferred to recipients of pig organs will necessitate life-long monitoring and perhaps even temporary isolation of patients. The possible risk of the spread of a xenozoonosis from the patient to other members of the community may inspire public controversy and even fear, which may have an adverse impact on the patient's emotional state. Additionally, some patients may be psychologically disturbed by the need to incorporate pig organs into their body. This article addresses these and other psychosocial issues that may be associated with clinical xenotransplantation.
Mentorship Programs for Transplant Patients
Authors: Wright Linda
Published: July 2017

The concept of mentoring has been used successfully in numerous settings, but only in the past decade have mentoring programs been used with organ transplant recipients. This paper describes how the Toronto Multi Organ Transplant Mentor Programme works, is administered, augments patient care, is evaluated, and has been adapted to meet the needs of various transplant patient populations.
The Death Watch: Certifying Death Using Cardiac Criteria
Authors: DeVita Michael A.
Published: July 2017

In the past, inadequate diagnostic instruments sometimes led to incorrect diagnoses of death, so careful and prolonged observation—the “death watch”—was required. Diagnostic instruments are now accurate and determining the presence or absence of circulation and cerebral function is easy in virtually all cases. Still, ambiguity and controversy in diagnosing death persists because the current criteria, irreversible cessation of cardiac or whole brain function, are ambiguous. Recent reintroduction of Non—Heart-beating organ donation has highlighted the controversy. Data on the ability to achieve restoration of spontaneous circulation are quite consistent, but they support several different sets of reasonable death criteria. This article concludes with a rejection of a fixed notion of “irreversibility” because it does not conform to current practice, is potentially deleterious to social events at the time of death, and the reversibility of cardiopulmonary arrest is dependent on available means of resuscitation. Finally, the time required to ensure irreversible cessation of cardiac function despite potential intervention is too broad to be clinically applicable and is unreasonable. Diagnosis of death should be based on the context in which it occurs because the medical means available determine what is irreversible.
Organ Recovery from a Donor with End-Stage Renal Disease: A Case Study
Authors: Alexander Charles
Published: July 2017

As the field of transplantation enters the new millennium, maximizing organs per donor remains one of the greatest challenges of procurement. This case study outlines nontraditional medical management techniques that facilitated the recovery of 5 transplantable organs from a patient with end-stage renal disease. Strategies utilized in this case included the use of continuous veno-venous hemodialysis and airway pressure release ventilation to maximize the outcomes of the donation. Although the use of these strategies is admittedly limited to hospitals where the resources are available, this case study suggests that utilizing available resources in any clinical setting can make more organs available to people on the waiting list for solid organ transplantation.
Living Donors' Perception of Their Quality of Health after Donation
Authors: Olson Wilmajoan de Graaf , Bogetti-Dumlao Angela
Published: July 2017

To alleviate the long wait on the cadaveric transplant list, recipients are pursuing the option of living donation. Potential donors may have significant concerns about the decision to donate, including the quality of health after donation. This study identifies living donors' perception regarding their quality of health after donating a kidney, and identifies the perception of the adequacy of the medical follow-up after donation. In this retrospective study, the 36-Item Short Form Health Survey was mailed to all kidney donors at the transplant center from January 1995 to December 1998 (n = 118). The study population scored significantly better than the US sample population in all 8 categories of the questionnaire. When comparing scores using the relationship of the donor to the recipient, mean scores of donors who were “distant relatives” were found to be lower in 7 of the 8 categories. Most donors who had follow-up after donation felt it to be excellent to good; yet 50% stated they had no healthcare follow-up after donation. Themes were identified regarding the type of follow-up donors felt they needed after donation. Donors perceived their quality of health after donation as better than the general US population. Donor follow-up needs to be emphasized and followed more systematically.
St John's Wort: A Hidden Risk for Transplant Patients
Authors: Turton-Weeks Susan M. , Barone Gary W. , Gurley Bill J. , Ketel Beverley L. , Lightfoot Meredith L. , Abul-Ezz Sameh R.
Published: July 2017

Herbal medications may cause prescription drug interactions in transplant recipients. After 2 of our kidney transplant recipients started self-medicating with St John's wort, their cyclosporine concentrations were consistently documented to be subtherapeutic. While on St John's wort, one patient developed acute rejection possibly due to low cyclosporine concentrations. Termination of St John's wort returned both patients' cyclosporine concentrations to therapeutic values. Based on the Naranjo Adverse Drug Reaction Probability Scale, our report would achieve a “probable” score, which supports the existence of a St John's wort–cyclosporine adverse drug interaction. St John's wort may induce cytochrome P-450 3A4 activity and/or P-glycoprotein expression, which are both involved in the metabolism and absorption of cyclosporine. Patients using St John's wort concomitantly with cyclosporine or other medications with similar absorption and/or metabolism to cyclosporine need close monitoring. Transplant coordinators are in a critical position to educate transplant recipients about the potential risks of herbal medication usage.
Approaching a Consensus: Psychosocial Support Services for Solid Organ Transplantation Programs
Authors: Skotzko Christine E. , Stowe Judith A. , Wright Carol , Kendall Kay , Dew Mary Amanda
Published: July 2017

Background—

Solid organ transplantation has become an accepted treatment for individuals with end-stage organ dysfunction. Criteria are being developed in the United States to determine medical eligibility for transplant candidates and competencies for transplant centers and physicians. To date, similar criteria for psychosocial services have not been developed.

Design and Setting—

We queried participants in a specialty psychosocial transplant meeting to determine their views of which psychosocial services are essential to the comprehensive care of transplant patients in the United States.

Results—

There was broad based multidisciplinary support for proactive pretransplant screening to discern individual psychosocial needs; focused pretransplant interventions to improve candidacy and future compliance; and posttransplant programs that address psychosocial, rehabilitation, and financial issues.

Conclusion—

Among psychosocial providers of solid organ transplantation services, there is support for expanding routine screening and support services to individuals who are candidates for and undergo solid organ transplantation.
Using Pressure-Limited Mechanical Ventilation in Caring for Organ Donors
Authors: Powner David J. , Delgado Edgar
Published: July 2017

Pressure-limited (controlled) ventilation is commonly employed to provide mechanical ventilation in the intensive care unit when lung compliance is poor or when airway resistance is irreversibly high. Modification of the inspiratory-expiratory ratio to include inspiratory-expiratory ratio reversal and permissive hypercapnia can also be used when lung disease or injury is severe. Because other donor organs often can be saved for transplantation even when the lungs have been badly damaged, the organ procurement coordinator should adopt pressure-limited ventilation as well as inspiratory-expiratory ratio reversal and permissive hypercapnia as potentially helpful methods while providing mechanical ventilation to selected donors.
A 5-Year Analysis of Organ Donors and Recipients in Italy
Authors: Pugliese Orsola , Scuderi Gabriella , Mattucci Dino A. , Chistolini Pietro , Quintieri Francesca
Published: July 2017

This article describes the improvement of organ donation and transplantation in Italy during 1995–1999. In 1999, the mean number of donors per million population reached 13.7 in Italy. In addition, an analysis regarding major characteristics of donors and recipients is presented, focusing particularly on donor characteristics that have changed in the past 5 years. Despite the encouraging results, further efforts are required to reach the European mean, which still remains higher than the Italian national mean. In particular, an increase of organ donation and procurement in regions with a poor activity in this field is crucial. A 1999 law on donation and transplantation should help in solving problems that continue to affect part of the nation, especially preparing the healthcare staff dedicated to organ retrieval to promote organ procurement.
Promoting Organ Donation among High School Students: An Educational Intervention
Authors: Anantachoti Puree , Gross Cynthia R. , Gunderson Susan
Published: July 2017

Objective—

To evaluate the impact of a high school education program to promote organ donation awareness. The primary outcomes were intention to discuss organ donation with family or friends and actual discussion behavior.

Design—

Longitudinal, observational study.

Methods—

665 high school students filled out evaluations at the beginning and at the end of a 1-hour education program. One month later, the students were asked to report whether they had discussed donation.

Results—

After the program, knowledge and attitude scores and the proportion of students who intended to discuss donation increased ( P < .05). At 1-month follow-up, 48% of students reported actual discussion. Intention has a strong, positive relationship with discussion behavior (odds ratio, 8.27; 95% CI, 3.18–21.51). Ethnicity, sex, and attitude of the students were also predictors of donation discussion behavior.

Conclusions—

This program appears to be effective in prompting discussion of organ donation among high school students.
Pretransplant Evaluation of a Patient with Acute Intermittent Porphyria
Authors: Turton-Weeks Susan , Barone Gary W. , Gurley Bill J. , Ketel Beverley L. , Lightfoot Meredith L. , Abul-Ezz Sameh R. , Anderson Karl E.
Published: July 2017

The pretransplant evaluation of a patient with a rare diagnosis requires knowledge of the pathophysiology and the transplant literature. A 55-year-old man presented with hypertensive kidney failure and the clinical diagnosis of acute intermittent porphyria. Complications of acute intermittent porphyria, which is a defect of heme production, are due to the accumulation of heme intermediates often precipitated by medications. Based on animal data, cyclosporine is considered unsafe in patients with acute intermittent porphyria. As part of the pretransplant evaluation, the patient received separate trials of tacrolimus and cyclosporine, which did not stimulate his acute intermittent porphyria. Four months after a kidney transplant, the patient still had no signs of rejection or symptoms of acute intermittent porphyria. This is the first documented patient with acute intermittent porphyria who successfully received a kidney transplant using tacrolimus. Because of individual variations, pretransplant testing of calcineurin inhibitors should be continued in patients with acute intermittent porphyria.
Desire for Control, Coping, and Quality of Life in Heart and Lung Transplant Candidates, Recipients, and Spouses: A Pilot Study
Authors: Kurz Jane M.
Published: July 2017

To understand the interdependence of couples involved in transplantation, both partners need to be included in the same study. This pilot study explored the desire for control, coping, and quality of life in heart and lung transplant candidates, recipients, and spouses, using McCubbin's Double ABCX Model as the conceptual basis. Sixty letters were mailed to randomly selected candidates and recipients at 2 transplant centers. Twenty-five couples completed a demographic sheet and the following surveys: The Desire for Control Scale, the Family Crisis Oriented Personal Evaluation Scale, and the Quality of Life Index. There were 9 pretransplant and 16 posttransplant couples. Analyses included measures of central tendency, analysis of variance, t tests, and correlations. There were statistically significant differences between pretransplant patients' quality of life and all other groups. There were moderate correlations between several patient and spouse variables. It was recommended that healthcare professionals include both patients and spouses when planning interventions.
A Role for Physician Assistants in Organ Procurement
Authors: Anderson Michael E.
Published: July 2017

Healthcare in the United States, as well as the environment in which physician assistants work, is rapidly changing. Consequently, the role of a physician assistant is expanding to meet the needs of patients and physicians of all specialties of medicine and surgery. In organ procurement, physician assistants can be a valuable asset to an organ procurement organization because of their medical education, versatility, and commitment to personalized care to organ donors and their families. Physician assistants are healthcare professionals who are uniquely qualified for a variety of roles within the organization: Clinician, educator, consultant, donor and family liaison, and researcher.
The National Donor Family Council and its Giving, Grieving, Growing Program
Authors: Corr Charles ,   The Executive Committee of the National Donor Family Council
Published: July 2017

This article describes the National Donor Family Council of the National Kidney Foundation and its activities on behalf of organ and tissue donor families. Special emphasis is given to the National Donor Family Council's Giving, Grieving, Growing program.
Substance abuse in Heart Transplant Recipients: A 10-Year Follow-up Study
Authors: Hanrahan Josephine S. , Eberly Carole , Mohanty Pramod K.
Published: July 2017

Context—

Active substance abuse is widely accepted as a contraindication for heart transplantation because of the theory that relapse would occur after transplantation and result in compromise of graft function, lowering long-term survival. Listing “recovering” substance abusers for heart transplantation has been controversial.

Objective—

To determine if substance abuse plays an unfavorable role in the outcome of heart transplantation.

Methods—

The medical records of all patients at our center who received a heart transplant more than 10 years ago were retrospectively reviewed for history of substance abuse.

Results—

From a pool of 189 transplant recipients, 47 patients had a definite history of substance abuse (group 1) and were considered in recovery, whereas 142 patients were clearly without any history of substance abuse (group 2). Group 1 had a significantly greater percentage of patients with a pretransplantation diagnosis of idiopathic cardiomyopathy ( P=.003), a higher occurrence of heart-related cause of death ( P=.017), and a significant prevalence of noncompliance ( P=.0001) and death because of noncompliance ( P=.0004). In contrast, group 2 surprisingly had a significantly higher incidence of death related to infection ( P=.0062), which is unexplained. Despite higher incidence of noncompliance in group 1, there was no significant difference in the overall survival rate between the 2 groups.

Conclusion—

These results suggest that patients with a history of substance abuse can undergo successful heart transplantation with acceptable long-term survival, though they are at greater risk for substance abuse relapse and resulting noncompliance with the treatment regimen. The extent to which relapse of substance abuse and its consequences affect the cost of posttransplantation care remains to be determined.
Tissue Donation: What Does it Mean to Families?
Authors: Beard Jane , Ireland Lynette , Davis Nicola , Barr Jenny
Published: July 2017

Context

Previous research has described families' responses and experiences with the donation process; however, little attention has been paid to families linked to tissue banks that have no affiliation with hospitals or organ procurement agencies.

Objective

To assess the impact of approaches made to families who consented to tissue donation with the Donor Tissue Bank of Victoria, Australia, and to examine how this information could be used to improve the existing service.

Design

An evaluation questionnaire was developed and consisted of 15 questions. The questionnaire was part of a structured follow-up service and was given only to 339 families who consented to donation.

Setting and Participants

Families who are approached about tissue donation are contacted within 24 hours of their family member's death. They are coping with the sudden unexpected death of a family member and have little knowledge of tissue donation or the donor tissue bank.

Main Outcome Measures

Fifty-eight percent of participants completed the questionnaire. The data were quantitatively and qualitatively examined.

Results

The skills and procedures utilized by the transplant coordinators are affirmed by the results, and respondents appear to find contact with the donor tissue bank positive at a terrible time in their lives. Approaches to families must be made sensitively and sufficient information must be given to enable decision making.
What Ails Cadaveric Transplant Programs in India: Perspectives of a Transplant Coordinator
Authors: Singh Pushpa
Published: July 2017

In India, the success of a cadaveric transplant program is limited by the number of available organs. Major reasons for this organ shortage include ignorance and misconceptions about brain death and the organ retrieval process; mistrust in the medical system; fear of mutilation of the body, delay in the funeral ceremonies, and mistreatment in the hospital if the patient has pledged organs following death; nonexistence of an organ procurement agency; and an ineffective organ retrieval and sharing network. Nonexistence of efficient organ coordination is an important factor in the organ shortage. Now, as organ transplant programs are being conceived and implemented in full earnest, transplant coordinators must be included as an indispensable component. Their role will be to educate the public, act as a liaison between the hospital and the society, and coordinate the process of organ procurement by taking consent of grieving relatives of brain dead persons.
Decoupling: What is it and Does it Really Help Increase Consent to Organ Donation?
Authors: Siminoff Laura A. , Lawrence Renee H. , Zhang Amy
Published: July 2017

Although the notion of decoupling is simple and potentially controllable by organ donation requestors, evidence to date of its potential has been inconsistent. The impact of the timing of requests was analyzed using data from a study of organ donor-eligible patients and their families (N=420), involving 9 trauma hospitals located in southwest Pennsylvania and northeast Ohio. In-depth interviews where conducted with family members, healthcare professionals, and organ procurement organization staff involved in the process. Only a weak effect was found for the impact of timing on the decision using a bivariate, correlational analysis. Moreover, we found that raising the issue before rather than after the pronouncement of death was most strongly associated with consent to donation. This effect disappeared after examining decoupling in relation to other factors. However, active consideration of the patient's donation wishes and a clear understanding of the families' initial inclination toward donation were associated with consent to organ donation.
Pediatric Kidney Transplantation: Growth, Development, and Nursing Implications
Authors: Pool Rita , Korus Moira
Published: July 2017

The complex issues related to the growth and development of pediatric kidney transplant recipients are explored in this paper. We divide the pediatric population into 3 age groups—toddlers and preschoolers, school age children, and adolescents—and review the literature describing growth and development in kidney transplant recipients and the normal population briefly for each age group. Planning and delivery of nursing care that is based on the implications of growth and development are discussed, and have relevance for all allied healthcare professionals caring for pediatric kidney transplant recipients and their parents. Allied healthcare professionals in adult settings who provide care to recipients who received a transplant before the age of 18 may also benefit from reviewing this article.
Transplant Coordination as the “Keystone” in Non—Heart-Beating Donations
Authors: Alvarez Joaquin , del Barrio Maria Rosario
Published: July 2017

The shortage of donated organs has become a problem in the transplantation world. Transplant teams are continuously looking for new ways to increase and improve the donor pool. Non—Heart-beating donors could be a source for increasing the number of donors, even though in some countries legal, ethical, or logistical problems obstruct the development of that source. The good results obtained by some groups working with Non—Heart-beating donors should stimulate others to implement this type of policy in their hospitals. We describe the origin and development of our policy on Non—Heart-beating donation, which has become the main source for organ donation in our hospital. We have found that the 5-year survival rate for kidneys from these donors is similar to the survival rate for kidneys obtained from brain-dead donors, and this encourages us to continue to use kidneys from Non—Heart-beating donors.
A Multiethnic Study of the Relationship between Fears and Concerns and Refusal Rates
Authors: Verble Margaret , Bowen Gordon R. , Kay Nancy , Mitoff Jeffrey , Shafer Teresa J. , Worth Judy
Published: July 2017

This study builds on previous research that identified fears and concerns heard by procurement coordinators during the donation discussion and that classified those concerns according to the ease with which they can be addressed. In this study, 53 coordinators working for 4 procurement agencies provided data on 323 donation discussions, including fears and concerns expressed by families. The fears and concerns were analyzed by outcome (consent or refusal), race and ethnicity of the family, frequency of reports, and difficulty in addressing. This research confirms many of the findings of the earlier study. The results also indicate that the types of concerns expressed by donor and non–donor families vary somewhat by the family's race and ethnicity. The results can be used to provide training targeted at raising consent rates and to train minority requestors.
Evaluating the Reliability and Validity of the Questionnaire for Lung Transplant Patients
Authors: Dabbs Annette De Vito , Hoffman Leslie A. , Dauber James H. , Zullo Thomas , Iacono Aldo T.
Published: July 2017

Context

The Questionnaire for Lung Transplant Patients was designed for clinical use by the pulmonary transplant team in the routine evaluation of lung transplant recipients. Using the self-administered questionnaire, recipients check symptoms that they have had since their last evaluation and rate their shortness of breath, cough, and activity tolerance.

Objective

To determine whether the questionnaire meets reliability and validity standards for empirical measurement.

Methods

Demographics and disease-severity characteristics were examined in a cross-sectional survey of 37 recipients. Test-retest and intraclass correlation methods were used to estimate stability, and the Cronbach α was used to estimate internal consistency. Criterion validity was examined by using The Modified Symptom Frequency/Symptom Distress Scale, Functional Performance Inventory, and visual analog scales for cough and shortness of breath as criterion measures. Construct validity was examined to assess the predicted negative correlation between symptoms and functional performance.

Results

The questionnaire and its subscales were internally consistent (Cronbach α = 0.82, 0.76, 0.80, and 0.96), and the questionnaire was stable ( r = 0.70) and reliable (intraclass correlations = 0.80 and 0.90). Significant correlations were found between the questionnaire and all criterion measures ( r = 0.50–0.93). Significant correlations in the predicted negative direction were found between the respiratory subscale and functional performance ( r = −0.51) and between cough ( r = −0.51) and shortness of breath ( r = −0.68) ratings and functional performance.

Conclusions

The Questionnaire for Lung Transplant Patients is reliable and valid, and it provides scientifically sound information for clinical and empirical evaluation of symptoms and their effects on activity tolerance after lung transplantation.
Education, Pay, and Job Status: A National Survey of Transplant Coordinators
Authors: Vincent Mia C. , Repper Suzanne M. , Peters Thomas G.
Published: July 2017

To identify education, pay, and job responsibilities, an informal 19-item survey was sent to 1661 transplant coordinators; 424 (26%) were returned. Respondents worked in all phases of transplantation. Education levels varied widely; most respondents had some formal nursing education. Full-time salaries were from $25000 to $110000 per year; 67% worked 40 to 50 hours and 19% worked more than 50 hours per week. Of 402 clinical coordinators, 280 (70%) took call, and 122 (30%) did not. Call frequency varied with rotations every second, third, and fourth week; 44% of those taking call did not receive additional on-call pay. Nurse-managed clinics (with physician availability) were the predominant workplace for clinical coordinators. Autonomy and contact with patients were the most liked aspects of the job, and the least-liked aspects were on-call status and paperwork. Increased salary and added support staff ranked top among desired changes in the job. Transplant coordinators appear to be committed professionals who are critical to all endeavors in organ transplantation.
Impact of Regulations on Tissue Donation: Mandatory Referral of Hospital Deaths
Authors: Soratti Carlos , Lima Myrtha Ball , Flores Daniel , Ibar Ricardo
Published: July 2017

In Buenos Aires province, there has been surprisingly less tissue procurement activity following cardiac arrest than after brain-death cases. The purpose of this study was to analyse the impact of a regulation that made referral of all irreversible cardiac arrests mandatory to our organ procurement organisation. Data were collected from 7 hospitals in La Plata city during 7 months (from June 2000 to December 2000). The results showed that the regulation was effective because there was a striking increment of tissue procured following cardiac arrest during the analysed period, despite the low efficacy of the regulation (the referrals were 48% of the dead patients).
Interactive Grand Rounds: Challenges in Donor Care: Part 2
Authors: Powner David J.
Published: July 2017

This article is provided as a self-study feature on care of organ donors. Questions and possible responses are provided. Review all the responses for each question.
A Simple Technique for Aortic Cannulation in Organ Donors with Advanced Aortic Disease
Authors: Olson Leslie , Castro V. Lombardo , Schwartz Curtis , Levi D. , Ganz Susan , Nishida Seigo , Cravero Lynn , Burke George , Tzakis Andreas , Miller Joshua , Livingstone Alan
Published: July 2017

Cannulation of the abdominal aorta in organ donors with advanced arteriosclerotic disease or extensive trauma may be problematic owing to difficulty in securing a watertight tie around the diseased aorta, the danger of creating a false passageway in the aorta, and the risk of breaking off plaque particles that can advance into the arteries of donated organs. Cannulation problems can be avoided in these challenging donors by using a simplified technique for cannulation of the thoracic aorta in which a Foley catheter is passed down around the aortic arch, the balloon is inflated, and cool flushing is initiated.
Donor Action Program in the Emilia-Romagna Region of Italy
Authors: Pugliese Maria Rosa , Esposti Daniela Degli , Dormi Ada , Venturoli Nicola , Gaito Paolo Mazzetti , Sestigiani Elena , Monti Marzia , Ghirardini Angelo , Costa Alessandro Nanni , Ridolfi Lorenza
Published: July 2017

Context

The high demand for organs for transplantation necessitates enhancement of organ procurement activity worldwide.

Objective

To detect critical areas in the organ donation process and to assess whether careful monitoring of deaths in each intensive care unit could improve rates of identification of brain death.

Design

Records of patients who died in intensive care units in the Emilia-Romagna region between July 1, 1998 and June 30, 2000 were reviewed through the Donor Action program.

Results

Of the 2469 patients who died during the period studied, 1010 (40.9%) had severe brain damage, as indicated by a score of 3 on the Glasgow coma scale. A total of 857 patients with severe brain damage who had spent more than 6 hours in the intensive care unit (34.7% of all deaths) were considered as potential donors. Signs of brain death were observed in 383 (44.7%) of the 857 patients who died. Rates of identification of brain death increased from 36% to 55% during the study period.

Conclusion

Considering that the characteristics of the study population had not changed, we believe that the Donor Action program was an important factor leading to the observed improvement in identification of brain death.
Family Discussion about Organ Donation among African Americans
Authors: Atkins Lamon , Davis Kimberly , Holtzman Samuel M. , Durand Roger , Decker Phillip J.
Published: July 2017

Context

Relatively little is known about family discussion concerning donation among African Americans in the United States, especially discussion predating the brain death of a family member and the donor request process.

Objectives

To explore the inclination of African Americans to engage in family discussion about organ donation and the characteristics of those who expressed a desire to their families to donate their organs upon death.

Design

Focus groups and a cross-sectional survey.

Setting

A large metropolitan complex in Houston, Tex, with a relatively sizeable African American population.

Participants

A total of 18 persons of African American background participated in 2 focus groups; 375 randomly selected African American residents were surveyed by questionnaire.

Main Outcome Measure

Prodonation family discussion.

Results

Only 10% of subjects were found to be in the “action” (having had a prodonation discussion) or “maintenance” (having had a prodonation discussion and not inclined to alter one's wishes) stages with regard to family discussion. These subjects were not found distinguished from others by age, gender, education, or frequency of religious attendance. They were, however, found differentiated from others by feelings of diffuse support for donation, knowledge of donation, having read or heard a lot about donation, and by the belief that organ donation was not against one's religion—when these variables were individually considered. Yet, when these variables were simultaneously considered in a multivariate discriminant function analysis, diffuse support for donation no longer distinguished those in the action/maintenance stage from other subjects.
Separate, Dedicated Care Teams for Living Organ Donors
Authors: McQuarrie Brenda , Gordon Debra
Published: July 2017

Living donation is an increasingly common option offered to patients in most transplant programs. Staff involved in the education, assessment, and care of this patient group is faced with increasingly complicated assessments both medically and psychologically. Supporting arguments for dedicated care teams for living organ donors include the large number of transplantations performed using living donors, the continued need to promote living organ donation, and the growing complexity of both medical and psychological factors in donor assessments. In addition, there is a need to implement the standards proposed by the 2000 Consensus Group, as well as to develop a body of evidence-based research related both to short- and long-term issues for this patient group. The ethical issues related to simultaneous involvement with both donors and recipients, and a need to ensure confidentiality are additional supporting arguments for the need to provide separate care providers for donors and recipients.
Perceptions of the Donation Process from Adult-to-Adult Living Liver Donors
Authors: Winsett Rebecca P. , Russell Cynthia , Grewal Hani P. , Shokouh-Amiri M. Hosein , Gaber A. Osama
Published: July 2017

Background

Donor safety and the impact on quality of life continue to concern transplant centers as living liver transplantation increases.

Methods

Living liver donors participated in a focus group to discuss their perceptions of the donation process.

Results

The decision to donate was a personal choice made before the request by the recipient or transplant service. Spouses verified their support, but indicated that they were not included in the process. No donors felt coerced. The explanation of the procedure was thorough but excessive. Hospital care was good; however, donors admitted being unprepared for the pain and side effects of pain medications. Ongoing incisional discomfort continued beyond 6 weeks and prevented donors from feeling normal. Donors felt conflicted about competing with the “true” patient for healthcare.

Conclusions

Donors were positive about the need and willingness to donate. Sensitivity to the order of the disclosure process is identified.
One Organ Donation, Three Perspectives: Experiences of Donors, Recipients, and Third Parties with Living Kidney Donation
Authors: Burroughs Thomas E. , Waterman Amy D. , Hong Barry A.
Published: July 2017

Although living kidney donors' experiences with donation have been studied, questions of potential bias in retrospective donor reports remain. This study examined the experience of living kidney donation from 3 perspectives: those of the donor, the recipient, and a third party involved with the donation (ie, a donor triad). Surveys were completed with 174 donor triads to examine triad members' perceptions of donors' concerns before transplantation, whether these concerns came true after transplantation, the donors' experiences with surgery and recovery, and whether they would make the same decision again today. Triad members all agreed that donors were highly satisfied with their donation experience and that the relationship between recipient and donor improved after transplantation. Although recipients and third parties correctly identified the donors' primary concerns, they underestimated the prevalence of 16 of 18 donor concerns, including the donors' willingness to make the same decision again. Recipients also overestimated how painful and difficult the surgery and recovery were for donors. The results suggest that retrospective studies of donors may not be marred by significant misreporting or memory biases and that better education about the donation experience for the entire donor triad might provide better social support for donors, reduce recipients' guilt about donors' pain, and increase donation rates overall.