bluuebunny/crossref_metadata_2025 huggingface dataset:
Living-Related Liver Transplantation: A Thai Family's Stressors and Concerns
Authors: Suzuki Shiho , Kita Yoshiaki , Fukunishi Isao , Kotani Katsuyo , Yamada Ikan , Johnson Karin , Honma Terumi , Aranami Yoshi , Ekataksin Wichai , Ohata Andrew Y.
Published: July 2017

This case study reviews the experience of a Thai family who traveled to Japan for living-related liver transplantation. The recipient experienced multiple problems after transplantation, which placed additional stress on the family. The cultural gap and language barrier resulted in a lack of understanding and often made it difficult for the medical team and family to communicate effectively. However, the use of interpreters helped to resolve these problems. This study shows that it is especially important for transplant coordinators and social workers to facilitate the collaboration and understanding between families and the medical team when cultural and language differences exist.
Benefit Analysis of Administrative and Clinical Computerization of a Large Transplant Center
Authors: Tietjen Andrea L. , Dowell-Cherry Rachel , Mulgaonkar Shamkant , Morgan Debbie
Published: July 2017

Purpose

To evaluate the implementation of a computer system that fully integrates all activities of a transplant center and coordinates secure, live data across the continuum of care.

Methods

Our center implemented a comprehensive patient tracking solution customized at each point of patient entry. Benefits were measured by provider, patient, and staff feedback; time study; and retrospective cost analysis.

Results

Computerization of each patient file maintained current clinical information, which facilitated patient monitoring, expeditious evaluations and listings, marketing, automated correspondence, and regulatory reporting. Enhanced data have allowed for clinical analysis, which has improved outcomes. Data availability has promoted consistency in negotiations with commercial insurers to ensure profitability. Research capacity has been increased through standardized budgets, time study, and cost analysis and has facilitated patient recruitment.

Conclusion

The need to integrate information is vital for data accuracy and integrity. Data integration has maximized performance, profitability, and accuracy while decreasing administrative time and costs.
Ethics and Regulation in Organ Procurement Research
Authors: Ackerman Terrence F. , Winsett Rebecca P.
Published: July 2017

This article explores the role of ethics and regulation in human research conducted by organ procurement agencies; basic ethical principles for human research are outlined. Organ procurement agencies are not required to observe federal regulations; however, voluntary adherence will ensure that procurement research is conducted according to current standards of ethical practice. Although most organ procurement research will qualify for exempt status, this determination should be made by an institutional review board. Even if studies qualify for exempt status, there is a moral presumption that informed consent should be sought, unless certain narrow conditions for waiver of consent are satisfied. Finally, when future research utilizing organ procurement records is anticipated, procurement coordinators should provide sufficiently detailed information to families about such plans to permit their advance informed consent to research activities.
Level of Awareness about Transplantation, Brain Death and Cadaveric Organ Donation in Hospital Staff in India
Authors: Singh Pushpa , Kumar Anant , Pandey Chandra M. , Chandra Hem
Published: July 2017

A questionnaire was distributed in a group of randomly selected hospital staff to ascertain the level and factors associated with awareness regarding organ transplantation, brain death, and cadaveric organ donation. Between October and December 2000, a total of 166 paramedical (nurses, technologists, medical physicists) and 100 nonmedical (administrative, clerical, engineering, social scientists, and miscellaneous) staff of a tertiary referral academic hospital in northern India received this questionnaire. Ninety-seven percent had good to excellent awareness about transplantation, 17.3% of the hospital staff thought that brain death was a reversible process, and 59.4% had misconceptions about the retrieval of cadaveric organs. A significant positive correlation ( r=0.147, P=.01) was observed between the awareness of transplantation, brain death, and organ donation. A significant association was also observed between the workplace (operating room and intensive care unit vs other areas) and awareness of transplantation ( P=.048), and brain death and organ donation ( P=.030).
Life Satisfaction among Kidney Transplant Recipients: Demographic and Biological Factors
Authors: Siegal Bonnie , Halbert R. J. , McGuire M. J.
Published: July 2017

Purpose

The Transplant Learning Center is a program providing education and support for solid-organ transplant recipients taking cyclosporine (Neoral or Sandimmune). One goal of the program is to improve patients' quality of life, which may be influenced by demographic and biological factors, and in turn influences adherence to prescribed medication regimens. We analyzed the results from the initial survey of enrollees to better understand life satisfaction and to test the validity and reliability of the satisfaction scale used in the program.

Method

Patients enter the program through self-selection: all enrollees who received a kidney transplant were included in this analysis. Satisfaction was measured using the Life Satisfaction Index, which includes 8 questions about aspects of satisfaction with the patient's life. Associations between the Life Satisfaction Index and demographic factors, comorbid medical conditions, adverse effects of immunosuppressants, and medication compliance were examined.

Results

All 3676 kidney transplant recipients who completed the initial survey were included. Mean satisfaction scores were highest in persons who were older than 64 years, men, and those who were married. Satsifaction scores were positively correlated with education and income. Mean satisfaction score was significantly lower among persons with medical comorbidities, persons who reported that adverse effects of medications were more frequent, and persons who reported noncompliance with their medication regimen.

Conclusion

The Life Satisfaction Index is a transplant-specific measure of health-related quality of life that can be used to help detect areas of potential concern in the clinical management of kidney transplant recipients.
Loss of the Imagined Past: An Emotional Obstacle to Medical Compliance in Kidney Transplant Recipients
Authors: Baines Lyndsay S. , Jindal Rahul M.
Published: July 2017

Among kidney transplant recipients, the concepts of grief and bereavement have been considered in terms of graft rejection, side effects of drugs, or death of the donor. However, our research suggests that even after a successful kidney transplantation, patients may present with feelings of bereavement, grief, or low mood, which may appear paradoxical because they have just received a much desired transplant. This sense of bereavement should be considered in terms of an imagined past, which may help to understand the patient's current mood changes and medical noncompliance. In the case report presented here, we have used the concept of systemic integrative psychotherapy to analyze change in a patient's life. Based on our research, we suggest that feelings of bereavement and grief are generated as patients come to terms with their past, which has been irretrievably lost to chronic illness, and contemplate their future. Feelings of grief and bereavement in the posttransplant period may be due to the loss of an imagined past, and must be differentiated from the bereavement the patient feels for the donor and the donor family. These feeling of loss, if not resolved, may lead to social isolation and medical noncompliance.
Cultural Sensitivity in the Donation Discussion
Authors: Verble Margaret , Worth Judy
Published: July 2017

Procurement professionals disagree on the necessity for matching donation requestors with donor families by race or ethnicity in order to increase donation rates. However, reports from minority requestors indicate that displays of cultural sensitivity during donation discussions may affect both the discussions and family decisions. In donation discussions with African Americans, Asians, American Indians, and Hispanic people from traditional cultures, requestors should consider factors such as which family representatives to include, cultural familiarity with specific diseases necessitating transplants, forms of address, concepts of time, methods of decision making and communicating refusal, and families' previous experience with the hospital and the American society as a whole.
How Patients Manage Life and Health While Waiting for a Liver Transplant
Authors: Baker M. Susan , McWilliam Carol L.
Published: July 2017

Liver transplantation offers a lifesaving treatment for individuals with terminal disease. An extended waiting period may contribute to anxiety and undermine overall health status, jeopardizing the patient's opportunity for successful transplantation. The purpose of this grounded theory qualitative study was to discover how individuals experience life and health resources during the wait for a liver transplant. In-depth interviews, conducted with 12 adults who had awaited liver transplantation for more than a year, were transcribed verbatim and analyzed using grounded theory methods. The findings portrayed the transplant waiting period to be a process of experiencing confinement, disciplining the self, and ultimately letting go and surrendering one's self to accept available, accessible, and appropriate resources for health. Resources for life and health used by the participants included: following instructions, presenting self positively, seeking information and support, controlling symptoms, using distraction and denial, changing attitudes, setting and achieving new goals, isolating oneself and entrusting oneself to another. The findings suggest the importance of increasing supportive, health-oriented care aimed at promoting resources for everyday living and health during the transplant waiting period.
Renal Cortical Adenoma Incidentally Found during Living Donor Nephrectomy
Authors: Jones Jill R. , Woodside Kenneth J. , Early Marilyn G. , Gugliuzza Kristene K. , Daller John A.
Published: July 2017

We report a living related kidney donor incidentally found to have a renal cortical adenoma at nephrectomy. The patient is a 53-year-old man accepted for living related kidney donation. Predonation workup revealed a solitary left renal artery and, on the right kidney, a main artery with a small accessory artery in the upper pole. No other abnormalities were found in the medical history, physical examination, or laboratory and radiological studies. A left laparoscopic nephrectomy was planned. However, during dissection of the upper pole, a 5-mm mass was noted. The nephrectomy was completed, and the organ was preserved in cold University of Wisconsin solution. Permanent section histology showed that the lesion was mostly likely a renal cortical adenoma. As the risk of malignant transformation with immunosuppression could not be adequately determined, the kidney was not transplanted into the recipient. The donor elected not to have the kidney replaced, and the organ was discarded.
Pain Experienced by Laparoscopic Donor Nephrectomy Patients in an Academic Medical Setting
Authors: Steinhauser Michele M. , Dawson Patricia B. , Barshick Rebecca M. , Janecek Jennifer L.
Published: July 2017

Context

Since 1996, 414 laparoscopic live donor nephrectomy procedures have been completed at our institution. Although this procedure has gained acceptance within the past 5 years, little is known about its nursing implications.

Objective

The purpose of this performance improvement project was to identify pain management practices, satisfaction levels, and clinical outcomes among patients undergoing laparoscopic live donor nephrectomy.

Patients

Data were collected for a convenience sample of 70 patients for 18 months.

Intervention

Several pain management methods were used, including patient-controlled analgesia and intramuscular and oral medications.

Results

Pain ratings ranged from 3.2 to 3.8 for the first 36 hours postoperatively. The mean pain level did not differ significantly between pain regimes. At discharge, patients perceived a mean overall pain level of 5.0 but anticipated a pain level of 6.1. A significant negative correlation between satisfaction and pain rating also was noted.

Conclusions

Opportunities exist to standardize current regimens of pain medications and address pain level and treatment 24 hours postoperatively.
Financial Considerations in Living Organ Donation
Authors: Jacobs Cheryl , Thomas Charlie
Published: July 2017

The shortage of cadaveric organs and increased success of living donor transplantation support the use of living organ donors. Clinical social workers have the opportunity to explore a variety of donor-specific issues when performing psychosocial evaluations of living donors, including motivation, psychological stability, and personal and family consequences of donation, as well as the direct and indirect financial consequences faced by living donors. Although most donor-related medical costs are covered, other associated expenses are not reimbursable and may put donors at risk for financial hardship. Out-of-pocket expenses also serve as a disincentive to donate for some volunteers. During the evaluation process, healthcare professionals should openly discuss how surgery, recovery, and any potential complications might impact prospective donors' financial situation. Donors can then decide whether they are able to realistically handle the costs of donation. We present the financial dilemmas experienced by many living donors and highlight efforts that have been made to deal with them.
Establishing a Transplant Coordinator-Led Living Kidney Donor Follow-up Clinic
Authors: Lumsdaine Jennifer A. , Wigmore Stephen J. , Wooton Donna , Stewart Casey , Akyol Murat , Forsythe John L. R.
Published: July 2017

Background

The long-term risks of renal failure and hypertension are statistically low for living kidney donors as a group, but can have serious consequences for the individual.

Objectives

To describe the experience with a transplant coordinator-led living donor follow-up clinic.

Method

Living kidney donors are reviewed on an annual basis by a designated coordinator (registered nurse). A 24-hour urine collection estimates renal function. Blood pressure and blood chemistry are measured and urinalysis performed. Current health status and wound discomfort are assessed. Any medical problems identified are referred to a specialist hospital department or to the donor's family practitioner.

Results

Fifty-nine appointments were booked and 12 (20%) donors did not attend. Renal function was within acceptable limits for all attending donors. Three donors had raised blood glucose levels and 8 donors were hypertensive; all were referred to family practitioners. Forty-seven donors (35 new, 12 return) completed a questionnaire on the follow-up provided. Thirty-eight (81%) were satisfied with the follow-up, and 47 (100%) agreed this clinic provided adequate follow-up. Thirty-three (70%) donors stated they preferred that the transplant coordinator performed the follow-up, 3 (6%) preferred the family practitioner, and 11 (23%) had no preference.

Conclusions

There are many possible solutions to the provision of lifelong care of living kidney donors. The model of a transplant coordinator-led clinic appears to have a high degree of patient acceptance, perhaps because of the continuity of care provided by a known member of the transplant team. Further work is required to identify reasons for nonattendance.
Exploring Donors' and Recipients' Attitudes about Living Donor Kidney Transplantation
Authors: Pradel Françoise G. , Mullins C. Daniel , Bartlett Stephen T.
Published: July 2017

Context

There is a growing interest in living donor kidney transplantation because of its potential to reduce the current kidney shortage.

Objective

To explore the experience of potential recipients, recipients, potential donors, and donors with regard to living donor kidney transplantation and laparoscopic living donor nephrectomy.

Method

Twenty-five patients participated in a series of focus group interviews. The interviews were tape-recorded and a content analysis was performed.

Results

All participants had a positive attitude toward living donor kidney transplantation and laparoscopic living donor nephrectomy, though this procedure was not a factor that influenced potential donors' decision to donate a kidney. None of the potential donors and donors felt coerced into giving a kidney; they were motivated by a desire to help a loved one who was suffering. The main perceived impediment to donate a kidney was the potential recipients' reluctance to accept the offer. Potential recipients and recipients found it difficult to ask for a kidney and worried about the consequences of a kidney removal on their donor's health. A potential barrier to living donor kidney transplantation was that recipients would never have accepted a kidney if their donor had to pay for the kidney removal. In addition, recipients believed that a kidney from a non–blood-related donor was not as a good a match as a kidney from a blood-related donor.

Conclusion

This exploratory study reveals that donors, potential donors, recipients, and potential recipients had an overall positive attitude toward living donor kidney transplantation and laparoscopic living donor nephrectomy. This study also sheds light on a number of barriers that have not been previously reported.
Unintended Consequences: The Impact of Protocol Change on Critical Care Nurses' Perceptions of Stress
Authors: Dodd-McCue Diane , Tartaglia Alexander , Myer Kevin , Kuthy Susan , Faulkner Ken
Published: July 2017

Context

The Family Communication Coordinator protocol was implemented to facilitate effective communications during potential organ donation cases. Previous research records its effectiveness relative to donor outcome measures. By redefining and clarifying role responsibilities, the protocol may be associated with reduced job stress for those caring for potential donors.

Objectives

To determine the relationship of the Family Communication Coordinator protocol on the role stress of critical care nurses. To examine role stress in terms of role ambiguity, role conflict, and role overload within the context of potential organ donation cases.

Design

Retrospective nonexperimental descriptive design.

Setting

Critical care units of an academic teaching hospital.

Participants

Nineteen critical care nurses with experience before and after implementation of the Family Communication Coordinator protocol.

Main Outcome Measures

Job dimensions, role stress, job satisfaction, and commitment, measured using surveys. These data were supplemented with interviews and hospital records.

Results

The findings demonstrate that the Family Communication Coordinator protocol is associated with reduced role stress. More specifically, the nurses perceived significant reductions in role ambiguity and role conflict, and some reduction in role overload. The findings highlight high satisfaction with the protocol, as well as improved job satisfaction, and professional and organizational commitment.

Conclusions

The results suggest that reduced role stress among critical care nurses is associated with implementation of a protocol already associated with improved organ donation outcomes. The findings suggest positive outcomes also may impact other staff, multidisciplinary functions, and the organization. Similar protocols may be appropriate in other end-of-life situations to reduce uncertainty and stress among critical care professionals.
Hepatotoxicity of Herbal Remedies: An Emerging Dilemma
Authors: Pak Eddy , Esrason Karl T. , Wu Victor H.
Published: July 2017

The surge in consumption of herbal remedies has been stimulated by several factors, including the notion that all herbal products are safe and effective, consumers becoming more proactive in self-treating, and lack of regulation by the Food and Drug Administration. Although herbal remedies are generally perceived as harmless, reports of hepatotoxicity associated with herbal use are accumulating, suggesting they are not completely innocuous. On the basis of various case reports, the liver injury from herbal remedies has ranged from mild elevations of liver enzymes to fulminant liver failure requiring liver transplantation. Although regulation by the Food and Drug Administration may be part of the solution, increasing public awareness and educating healthcare professionals about the potential dangers of herbal preparations will need to be implemented. This article reviews the hepatotoxicity of herbal remedies as reported in the literature and discusses issues related to regulation of herbal preparations.
Use of Antidepressant Drugs in Transplant Recipients
Authors: Kim Jiwon , Phongsamran Paula , Park Susie
Published: July 2017

Depression is the most prevalent psychiatric disorder in transplant recipients and may lead to noncompliance and negative outcomes without psychosocial and pharmacologic interventions. The pharmacologic treatment of depression in this patient population is complicated by complex immunosuppressant drug regimens and multiple potential drug interactions that can adversely affect the newly transplanted organs. This review provides a brief overview of the currently available antidepressant medications and highlights the clinically important features each class of agents in transplant recipients. Newer agents selective serotonin reuptake inhibitors, venlafaxine, bupropion, nefazodone, and mirtazapine are discussed as well as tricyclic antidepressants and monoamine oxidase inhibitors. A brief discussion of St. John's wort and its impact on posttransplant drug therapy is also included.
Treating Gout in Kidney Transplant Recipients
Authors: Baroletti Steven , Bencivenga Gina Ann , Gabardi Steven
Published: July 2017

Objective

To review the etiology, treatment, and preventive strategies of hyperuricemia and gout in kidney transplant recipients.

Data Sources

Primary literature was obtained via Medline (1966-June 2003).

Study Selection and Data Extraction

Studies evaluating treatment and prevention of hyperuricemia and gout in kidney transplantation were considered for evaluation. English-language studies were selected for inclusion.

Data Synthesis

Approximately 14000 kidney transplantations were performed in the United States in 2003, and of those transplant recipients, nearly 13% will experience a new onset of gout. The prevalence of hyperuricemia is even greater. There are several mechanisms by which hyperuricemia and gout develop in kidney transplant recipients. Medication-induced hyperuricemia and renal dysfunction are 2 of the more common mechanisms. Prophylactic and treatment options include allopurinol, colchi cine, corticosteroids, and, if absolutely necessary, nonsteroidal anti-inflammatory drugs.

Conclusion

It is generally recommended to decide whether the risks of prophylactic therapy and treatment outweigh the benefits. Often, the risk of adverse events associated with agents to treat these ailments tends to outweigh the benefits; therefore, treatment is usually reserved for symptomatic episodes of acute gout. Practitioners must also decide if changes in immunosuppressive regimens may be of benefit on a patient-by-patient basis.
Strategies to Prevent Chronic Allograft Nephropathy in Kidney Transplantation: Focus on Calcineurin Inhibitors
Authors: Lo Agnes
Published: July 2017

Chronic allograft nephropathy is one of the leading causes of long-term graft failure in kidney transplant recipients. The etiology of this condition is multifactorial, but administration of calcineurin inhibitors is often implicated. With the introduction of newer immunosuppressive agents, strategies for calcineurin inhibitor minimization, avoidance, and withdrawal have been emerging in the literature. These strategies may improve long-term kidney allograft function, but are not without risks. Results from recent clinical trials evaluating the safety and efficacy of these strategies to prevent chronic allograft nephropathy in kidney transplant recipients are summarized and reviewed. Patients who had never received a calcineurin inhibitor or who had cyclosporine withdrawn from their regimens had better kidney function than patients who received or kept receiving a calcineurin inhibitor. The impact of the improvement in kidney function on long-term graft survival remains to be determined. In addition, the benefit in renal function must be weighed against the bone marrow toxicities and/or metabolic complications associated with these regimens.
Appraisal and Coping as Predictors of Psychological Distress and Self-Reported Physical Disability before Lung Transplantation
Authors: Burker Eileen J. , Evon Donna M. , Sedway Jan A. , Egan Thomas
Published: July 2017

Context

Certain appraisals and coping strategies have been associated with increased levels of psychological distress and disability in other medical populations, but no study has examined this relationship with patients who are awaiting lung transplantation.

Objective

To describe the cognitive appraisal and coping strategies used by patients who are pursuing lung transplantation and to evaluate the extent to which these processes are associated with depression, anxiety, and disability.

Methods

This is a cross-sectional design with 160 participants (42.5% men) who have end-stage lung disease and were evaluated for lung transplantation at a large medical center.

Measures

The outcome variables of depression, anxiety, and physical disability were assessed using the Beck Depression Inventory, Spielberger Trait Anxiety Inventory, and the Sickness Impact Profile, respectively. The predictor variables, coping and appraisal styles, were measured using the COPE and the Stress Threat Questionnaire, respectively. Demographic variables were also assessed.

Results

Patients used a variety of adaptive problem- and emotion-focused coping strategies. Hierarchical multiple regressions demonstrated that harm appraisals and the use of particular types of coping styles; namely, disengagement, avoidance, ruminating and venting emotions, low solicitation of emotional support, and suppressing other activities are maladaptive and were uniquely related to psychological distress and disability.

Conclusions

Maladaptive appraisal and coping styles can serve as markers of emotional distress and disability that may help the transplant team identify patients who may benefit from counseling and psychological interventions.
Potential Living Kidney Donors' Health Education Use and Comfort with Donation
Authors: Waterman Amy D. , Covelli Tonie , Caisley Laura , Zerega Wendy , Schnitzler Mark , Adams David , Hong Barry A.
Published: July 2017

Context

Much living kidney donation research focuses on actual donors rather than all donors who are evaluated by the transplant center.

Objective

To determine (1) what concerns and benefits potential donors saw possible from donation, (2) how they educated themselves before contacting the transplant center, and (3) who were the most comfortable donors.

Design

A telephone survey of 91 potential donors before transplant evaluation.

Setting

Barnes-Jewish Hospital Transplant Center in St Louis, Mo.

Main Outcome Measures

Willingness and comfort donating, key concerns and perceived benefits to donation, hours of transplant-related education.

Results

On a 7-point scale, potential donors were very willing (mean=6.65, SD=0.95) and comfortable (mean=6.31, SD=1.12) donating. They were most concerned that their recipients would die if they could not donate, the evaluation and surgery would be anxiety provoking or painful, and they did not understand what donation would require. Donors previously spent an average of 6 hours reading health resources and 32 hours discussing donation. Using logistic regression, those donors with 0 to 4 concerns (odds ratio=7.1, 95% confidence interval [CI], 2.2–23.16), more than 5 benefits (odds ratio=3.7, 95% CI, 1.2–11.0), and who were family members (odds ratio=4.7, 95% CI, 1.4–15.8) were more likely to be extremely comfortable donating compared to others.

Conclusions

Before evaluation, most potential donors are willing to donate because they think that it is important to improve the health of a loved one. Their knowledge of donation varies and they need clear information about medical testing and support coping with any negative donation outcomes.
Intestinal Rehabilitation: A Management Program for Short-Bowel Syndrome
Authors: Brown Cindy R. , DiBaise John K.
Published: July 2017

Over the last 3 decades, there has been significant improvement in the survival and quality of life of patients who require home parenteral nutrition; however, parenteral nutrition remains costly, is associated with multiple complications, and does not promote the function of the remaining bowel. Intestinal rehabilitation refers to the process of restoring enteral autonomy and decreasing dependence on parenteral nutrition by utilizing dietary, pharmacological, and, occasionally, surgical interventions. A major focus of research has been to identify a trophic factor that will enhance adaptation of the remaining gastrointestinal tract following massive gut resection and allow enteral autonomy. Whether intestinal rehabilitation occurs as the result of increased intestinal adaptation or as the result of a comprehensive approach to care has yet to be determined. This article reviews intestinal failure as the result of short-bowel syndrome and the management strategy of an intestinal rehabilitation program in the care of these patients.
Influenza Vaccine Antibody Responses in Lung Transplant Recipients
Authors: Hayney Mary S. , Welter Deborah L. , Francois Mary , Reynolds Ann Marie , Love Robert B.
Published: July 2017

Context

Lung transplant recipients are at high risk of morbidity and mortality from influenza infection because of altered lung physiology and immunosuppression. Annual influenza immunization is recommended, but the ability to mount an antibody response may be limited by immunosuppressant medications.

Objective

To compare the antibody response rate to influenza vaccine in lung transplant recipients to healthy controls.

Design

Open label study

Setting

Lung transplant clinic and General Clinical Research Center at a university hospital.

Subjects

Sixty-eight single and bilateral lung transplant recipients and 35 healthy controls were enrolled in October and November 2002.

Methods

Each individual underwent blood sampling before receiving the 2002–2003 influenza vaccine and 4 weeks later. Influenza antibody concentrations were measured by hemagglutination inhibition assay. Vaccine response rates (antibody concentration >40 hemagglutination units and at least 4-fold increase in antibody concentration) were compared using χ2. The influence of specific immunosuppressants on vaccine response was compared.

Results

The influenza vaccine response rate for lung transplant recipients was 29/68 (43%) and 22/35 (63%) for the healthy individuals ( Pž < .05; χ2). Among the recipients, mycophenolate mofetil was associated with poorer influenza vaccine antibody response (> 40 hemagglutination units) (62% vs 91%; Pž = .01), whereas sirolimus (91% vs 63%; Pž = .02) was associated with better influenza antibody response compared to those not taking mycophenolate mofetil or sirolimus, respectively.

Conclusion

Lung transplant recipients had lower influenza vaccine response rates than healthy individuals. Influenza vaccine antibody response is influenced by concomitant administration of mycophenolate mofetil or sirolimus. Future studies should measure protection from influenza infection conferred by immunization and alternative vaccination strategies.
The Clinical Utility of the Stress Process Model in Family Caregivers of Liver Transplant Candidates
Authors: Bolden Lois , Wicks Mona Newsome
Published: July 2017

This article describes the important relationship between theory and practice and demonstrates the application of Pearlin and colleagues' Stress Process Model to family caregivers of liver transplant candidates. Theory enhances the use of specific nursing interventions. This connection of theory to practice is especially important in the current health care environment, where the nursing shortage demands efficient and effective patient care. The Stress Process Model is a specific and concrete middle-range theory, which makes it simple to apply in clinical practice and research. This model is particularly useful for nurses who support the family caregivers of clients on the liver transplant list. The model identifies characteristics that predispose caregivers to stress that can interfere with completion of caregiving roles and tasks before and after patients' liver transplantation.
An Educational Intervention on Organ and Tissue Donation for First-Year Medical Students
Authors: Feeley Thomas Hugh , Tamburlin Judith , Vincent Donald E.
Published: July 2017

Context

Medical students and medical professionals have knowledge deficits related to organ and tissue transplantation.

Objective

To implement and evaluate a medical education intervention on organ and tissue donation designed for first-year medical students.

Study Design

Independent sample pretest and posttest design.

Setting and Participants

First-year medical students attending University at Buffalo School of Medicine during fall 2005 and fall 2006 terms.

Intervention

A 1-hour lecture on the background of organ donation, donor eligibility (eg, living vs deceased donation), policies and roles during transplantation (eg, role of physician and organ procurement organization), and the organ-matching process. After the lecture, students participated in a small-group interaction that used standardized patients who role-played 1 of 2 scenarios designed to test students' knowledge and communication about organ and tissue donation.

Outcome Measures

Knowledge, self-efficacy, family discussion, and enrollment into state organ and tissue registry.

Results

Significant increases from pretest to posttest in medical students' knowledge, self-efficacy, and family notification of donation intentions were found. The intervention was successful in increasing students' knowledge and awareness about organ and tissue donation. Future research should implement and evaluate a course-long curriculum on donation.
What Does a Diagnosis of Brain Death Mean to Family Members Approached about Organ Donation? A Review of the Literature
Authors: Long Tracy , Psychol C. , Sque Magi , Addington-Hall Julia
Published: July 2017

Background

What a diagnosis of brain stem death (the term used in the United Kingdom) or brain death (the term used in the United States) means to the family members of potential organ donors is an important issue to explore as biomedicine moves to expand the range of end-of-life technologies that, potentially, blur the demarcation between life and death.

Objective

To provide some insights into how a diagnosis of brain stem death or brain death may be perceived by family members approached about organ donation.

Methods

A review of the literature regarding organ donation was carried out.

Results

Although most publications do not focus specifically on the concept of brain death, those that do so made a valuable contribution, offering potential theoretical frameworks to aid our understanding of what the diagnosis of death by brain-based criteria means to family members of potential organ donors. The diagnosis of brain death is intricately linked to the issue of organ donation and may influence family members' decision making. Also, the perception that death has occurred differs from one person to another.

Conclusions

A sustained increase in the number of organs available for transplantation may never be achieved until the concepts of brain death, brain stem death, and now Non—Heart-beating death (1) are debated more widely within society; (2) a greater degree of consensus is reached within health care; and (3) bereaved family members approached to donate the organs of their deceased relative have a better understanding of what these diagnoses mean.
Living-Related Donors' Quest for Information before Donation
Authors: Nasr Annette Sue , Rehm Roberta S.
Published: July 2017

Context

Providing potential living-related liver donors with all the necessary information before donation can be challenging. What information donors need and are not getting during the evaluation phase has not been defined.

Objective

To increase understanding of the everyday life of living-related liver donors and to suggest educational strategies that could be used by transplant centers during the evaluation process.

Design

An interpretive ethnographic study based on a symbolic interactionism approach. All participants were interviewed; some were reinterviewed in order to better understand their experience as a donor.

Setting

Interviews took place in the clinic, the donor's home, the donor's workplace, and in coffee shops depending on each donor's preference.

Participants

A total of 13 parents who had donated the left lower lobe of their liver to their son or daughter at least 1 year ago.

Main Outcome Measures

Interviews were analyzed by using qualitative research methods of coding, summarizing, and discussing concepts.

Results

The donors viewed the donation as a life-changing event, and 11 of 13 donors described seeking further information in addition to the information given to them by the transplant center. Searching the Internet, reading research articles, and speaking to other donors were activities demonstrated by the participants.
The Living Donor Advocate: A Team Approach to Educate, Evaluate, and Manage Donors across the Continuum
Authors: Rudow Dianne LaPointe
Published: July 2017

Living donor transplant has developed as a direct result of the critical shortage of deceased donors. Federal regulations require transplant programs to appoint an independent donor advocate to ensure safe evaluation and care of live donors. Ethical and pragmatic issues surround the donor advocate. These issues include the composition of a team versus an individual advocate, who appoints them, and the role that the advocate(s) play in the process. A team approach to donor advocacy is recommended. Common goals of the independent donor advocacy team should be protocol development, education, medical and psychosocial evaluation, advocacy, support, and documentation throughout the donation process. The team's involvement should not end with consent and donation but should continue through short- and long-term follow-up and management. Ultimately it is the goal of the independent donor advocacy team to assist donors to advocate for themselves. Once deemed medically and psychologically suitable, donors must determine for themselves what they wish to do and must be free to vocalize this to their team. The decision to donate or not affects the donor first. Optimal outcomes begin with prepared, educated, uncoerced, and motivated donors, and it is the team's goal to help donors reach this point.
A System's Approach to Improve Organ Donation
Authors: Graham Judy M. , Sabeta Maria E. , Cooke Joseph T. , Berg Elaine R. , Osten Wayne M.
Published: July 2017

Using lessons learned from the US Department of Health and Human Services National Donation Breakthrough Collaborative, New York-Presbyterian Healthcare System (NYPHS) partnered with 5 donor service areas covering its member hospitals to improve donation across the system. By integrating established communication networks with the “spread” techniques of the Breakthrough Collaborative, the NYPHS identified hospital champions and best practices and established standardized outcome metrics. The improvements that resulted were a sustained increase of 40.23% in consent rate and an initial 41.7% increase in conversion rate during the first 6 months, although that conversion rate was not sustainable. During the 8 measured periods, 21 hospitals met or exceeded the 75% conversion rate during 1 or more quarters. NYPHS was able to spread these successes and outcome metrics through its established communication networks of quarterly report cards, regular senior leader meetings, and real-time access to a secure member-only Web site, thus keeping organ and tissue donation at the forefront of hospital leaders' priorities.
Attaining Specific Donor Management Goals Increases Number of Organs Transplanted per Donor: A Quality Improvement Project
Authors: Hagan Michael E. , McClean Daniel , Falcone Cassandra A. , Arrington Jeffrey , Matthews Donna , Summe Carrie
Published: July 2017

Most organ procurement organization professionals and transplant surgeons intuitively know that meeting donor management goals improves organ allocation and transplant outcomes. In this era of evidence-based medicine, it is important to know whether the data support this assumption. All 6 organ procurement organizations in the United Network for Organ Sharing's region 10 agreed on 6 specific donor management goals. The organ procurement organizations then compared the number of organs transplanted per donor when goals were met with the number when goals were not met. Results were broken down by donor type: standard-criteria donation, expanded-criteria donation, and donation after cardiac death. For all 6 organ procurement organizations combined, the data for all of 2008 show a substantial and statistically significant improvement in number of organs transplanted per donor for standard criteria donation and total donors when goals are met, with a smaller degree of improvement (although not statistically significant) in the number of organs transplanted per donor for expanded-criteria donation and donation after cardiac death when goals are met.
Technical Aspects of Intravascular Pressure Monitoring during Donor Care
Authors: Powner David J. , John Ambili M.
Published: July 2017

Many biological signals must be measured and interpreted accurately to titrate therapy properly during donor care. Although the technological aspects of intravascular pressure monitoring are usually delegated to bedside nursing colleagues, organ procurement coordinators should be familiar with those devices and methods. The equipment, supplies, and procedures used for arterial and central venous pressure monitoring are reviewed. Transducer leveling and zeroing plus maintenance of the hydraulic tubing system between the transducer and bedside monitor are especially important. These variables may greatly influence the accuracy of the displayed pressures and, therefore, must be considered during donor assessment as treatment is considered.
Distress Associated with Adverse Effects of Immunosuppressive Medication in Kidney Transplant Recipients
Authors: Koller Antje , Denhaerynck Kris , Moons Philip , Steiger Jürg , Bock Andreas , De Geest Sabina
Published: July 2017

Context

For kidney transplant patients, a lifelong intake of medication is mandatory. Health care workers' prioritization of adverse effects often differs from that of their patients, although patients' experience of adverse effects of medication can trigger nonadherence. Understanding how patients experience symptoms is therefore important.

Objective

To present a new method to be used in research to evaluate symptom experience related to adverse effects in adult kidney transplant recipients on maintenance immunosuppressive therapy.

Design

Cross-sectional secondary data analysis.

Patients and Setting

Three hundred fifty-six adult kidney transplant recipients from 2 Swiss transplant outpatient clinics.

Main Outcome Measures

Symptom experience was measured with the Modified Transplant Symptom Occurrence and Symptom Distress Scale. For each item, ridit scores were calculated. A coordinate system with occurrence and distress ratings of each symptom classified symptoms into 4 quadrants: symptoms could have high occurrence/high distress, low occurrence/high distress, high occurrence/low distress, and low occurrence/low distress symptoms. Items farther from the origin represented more extreme profiles.

Results

The proposed method arranges symptoms clearly in sequence of their importance. In our study, fatigue and joint and back pain were the most frequent and distressing symptoms. Symptom profiles for men and women differed: for men impotence and anxiety were key whereas for women listlessness and changed appearance seemed to play important roles.

Conclusions

The 2-dimensional diagram of symptom profiles enables researchers and clinicians to evaluate the impact of symptoms associated with immunosuppressive medications.
Development of a Decision Aid for Adult Cystic Fibrosis Patients considering Referral for Lung Transplantation
Authors: Vandemheen Katherine L. , Aaron Shawn D. , Poirier Charles , Tullis Elizabeth , O'Connor Annette
Published: July 2017

Context

Most adults with cystic fibrosis are eventually required to make a decision about referral for lung transplantation.

Objective

To identify the decisional needs of these patients and to develop a decision aid to address these needs.

Methods

A comprehensive review of the literature, a review of Canadian transplant statistics from 2002 to 2006, and a self-assessment survey of patients who had already made a decision about referral were performed to identify the decisional needs of patients. A decision aid was then developed and evaluated by an expert panel of health care professionals and patients.

Results

Transplant referral patterns vary widely among Canadian cystic fibrosis clinics. Canadian patients with cystic fibrosis who were not residing in transplant centers between 2002 and 2006 were significantly less likely to undergo lung transplants ( P < .001). Decisional needs identified by patients included wanting more information on (1) relocation to the transplant center, (2) the benefits and risks of surgery, and (3) how to cope with anxiety and depression when making the decision. In response to these identified needs, a decision aid for lung transplantation was developed. A panel of health care professionals and patients reviewed the decision aid and agreed that the content was appropriate, easy to understand, and unbiased.

Conclusion

The decisional needs of patients with cystic fibrosis who are considering lung transplantation are not being addressed in Canadian cystic fibrosis clinics, especially in clinics outside of transplant centers. An evidence-based decision aid could serve as a useful tool to help address these needs.
Regionalized Approach to Emergency Medical Services Training for the Care of Patients with Mechanical Assist Devices
Authors: Van de Bussche Todd J. , Edwards Lori G. , Elliott Tonya , Harton Suzie , Rivard Dennis , Wolfe Allen C.
Published: July 2017

Advances in mechanical circulatory assist device technology have allowed dozens of patients with different types of devices to live in any community in the United States. Some of the newer devices pump blood continuously, resulting in patients without pulses. The mechanical circulatory assist device teams and emergency medical services providers in the mid-Atlantic region wondered how best to prepare the community to respond appropriately to emergencies in patients with these mechanical devices.