Deceased donor kidneys allocated out of sequence by Organ Procurement Organizations

The Advancing American Kidney Health (AAKH) initiative has reinvigorated the focus on improving the care of patients with advanced chronic kidney disease. Multiple interventions have been planned, with focus on education campaigns for both clinicians and patients, delaying the progression of kidney disease and improving utilization of home dialysis modalities and kidney transplantation. Value-based care models for patients with advanced kidney disease are being rolled out, with the ESRD treatment choices model starting in January 2021, and the Kidney Care choices model planned to start in January 2022. There is increasing emphasis on the role of the nephrologist as the "captain of the ship", leading efforts in care coordination as physician leaders. The transplant reforms have focused on changes to organ procurement organizations aiming to increase availability of organs, as well as transplants performed, both deceased donor as well as living donor, and removing financial disincentives from live organ donation. The American Society of Nephrology (ASN) and the National Kidney Foundation (NKF) are partnering with the Department of Health and Human Services to develop educational material for clinicians and patients. In this review, we discuss these reforms, as well as potential challenges that have risen, and potential solutions, with emphasis on the Kidney Care Choices model.

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Trends in Discard of Kidneys from Hepatitis C Viremic Donors in the United States

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.10960720 ◽

2021 ◽

Vol 16 (2) ◽

pp. 251-261 ◽

Cited By ~ 1

Author(s):

Su-Hsin Chang ◽

Massini Merzkani ◽

Krista L. Lentine ◽

Mei Wang ◽

David A. Axelrod ◽

...

Keyword(s):

Hepatitis C ◽

Organ Procurement ◽

Deceased Donor ◽

The United States ◽

Nucleic Acid Amplification ◽

Direct Acting Antiviral ◽

Successful Transplantation ◽

Organ Procurement Organizations ◽

Hcv Antibody ◽

Direct Acting

Background and objectivesKidneys from hepatitis C virus (HCV) viremic donors have become more commonly accepted for transplant, especially after effective direct-acting antiviral therapy became available in 2014. We examined the contemporary trend of kidney discard from donors with HCV seropositivity and viremia.Design, setting, participants, & measurementsData from the Organ Procurement and Transplantation Network were used to identify deceased donor kidneys recovered for transplant. The exposure was donor HCV antibody status in the first analyses, and donor HCV antibody and viremia status in the second analyses. Multilevel, multivariable logistic regression was used to assess the association of these HCV exposure measures with kidney discard, adjusted for donor characteristics. Multilevel analyses were conducted to account for similar kidney discard pattern within clusters of organ procurement organizations and regions.ResultsAmong 225,479 kidneys recovered from 2005 to 2019, 5% were from HCV seropositive donors. Compared with HCV seronegative kidneys, the odds of HCV seropositive kidney discard gradually declined, from a multivariable-adjusted odds ratio (aOR) of 7.06 (95% confidence interval [95% CI], 5.65 to 8.81) in 2014, to 1.20 (95% CI, 1.02 to 1.42) in 2019. Among 82,090 kidneys with nucleic acid amplification test results in 2015–2019, 4% were from HCV viremic donors and 2% were from aviremic seropositive donors. Compared with HCV aviremic seronegative kidneys, the odds of HCV viremic kidney discard decreased from an aOR of 4.89 (95% CI, 4.03 to 5.92) in 2018, to 1.48 (95% CI, 1.22 to 1.81) in 2019. By 2018 and 2019, aviremic seropositive status was not associated with higher odds of discard (2018: aOR, 1.13; 95% CI, 0.88 to 1.45; and 2019: aOR, 0.97; 95% CI, 0.76 to 1.23).ConclusionsDespite the decrease in kidney discard in recent years, kidneys from viremic (compared with aviremic seronegative) donors still had 48% higher odds of discard in 2019. The potential of these discarded organs to provide successful transplantation should be explored.

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An Adapted Process and Organ Procurement Perspective on Heart Retransplantation for a Healthy Heart’s Third Life

Progress in Transplantation ◽

10.1177/15269248211024616 ◽

2021 ◽

pp. 152692482110246

Author(s):

Darryl C. Nethercot ◽

Mita Shah ◽

Lisa M. Stocks ◽

Jeffrey M. Trageser ◽

Victor Pretorius ◽

...

Keyword(s):

United States ◽

Organ Procurement ◽

The United States ◽

Matching Process ◽

Organ Procurement Organizations ◽

Third Person ◽

Adapted Process ◽

United Network ◽

Transplanted Hearts

As organ procurement organizations nationwide see an increased opportunity to retransplant already transplanted hearts, we would like to share the overview and process of our 2 successful cases. Heart retransplantation increased our cardiac placement rates by 2.64% and 2% in 2015 and 2019, respectively. Spread across a nation that sees over 3500 heart placements annually, a 2% increase would be substantial. Since 2009, our cases stand as the only documented heart retransplantations in the United States. However, United Network for Organ Sharing data shows that potential exists. From a facilitation perspective, we have developed a protocol to ease the matching process. From a surgical perspective, these cases had no complications and saved 2 lives, with each heart now beating in a third person. We hope that by sharing our process and success, we can familiarize fellow organ procurement organizations and transplant communities with this viable opportunity.

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Family perspectives on organ and tissue donation for transplantation: A principlist analysis

Nursing Ethics ◽

10.1177/0969733016687156 ◽

2017 ◽

Vol 25 (8) ◽

pp. 1041-1050

Author(s):

Marcelo José dos Santos ◽

Lydia Feito

Keyword(s):

Organ Donation ◽

Organ Procurement ◽

Sao Paulo ◽

Tissue Donation ◽

São Paulo ◽

Ethical Considerations ◽

Donation Process ◽

The Family ◽

Organ Procurement Organizations ◽

Family Interview

Background: The family interview context is permeated by numerous ethical issues which may generate conflicts and impact on organ donation process. Objective: This study aims to analyze the family interview process with a focus on principlist bioethics. Method: This exploratory, descriptive study uses a qualitative approach. The speeches were collected using the following prompt: “Talk about the family interview for the donation of organs and tissues for transplantation, from the preparation for the interview to the decision of the family to donate or not.” For the treatment of qualitative data, we chose the method of content analysis and categorical thematic analysis. Participants: The study involved 18 nurses who worked in three municipal organ procurement organizations in São Paulo, Brazil, and who conducted family interviews for organ donation. Ethical considerations: The data were collected after approval of the study by the Research Ethics Committee of the School of Nursing of the University of São Paulo. Results: The results were classified into four categories and three subcategories. The categories are the principles adopted by principlist bioethics. Discussion: The principles of autonomy, beneficence, non-maleficence, and justice permeate the family interview and reveal their importance in the organs and tissues donation process for transplantation. Conclusion: The analysis of family interviews for the donation of organs and tissues for transplantation with a focus on principlist bioethics indicates that the process involves many ethical considerations. The elucidation of these aspects contributes to the discussion, training, and improvement of professionals, whether nurses or not, who work in organ procurement organizations and can improve the curriculum of existing training programs for transplant coordinators who pursue ethics in donation and transplantation as their foundation.

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Variability in Pediatric Brain Death Determination Protocols in the United States

Neurology ◽

10.1212/wnl.0000000000012225 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012225

Author(s):

Conall Francoeur ◽

Matthew J Weiss ◽

Jennifer M Macdonald ◽

Craig Press ◽

David Matthew Greer ◽

...

Keyword(s):

United States ◽

Brain Injury ◽

Organ Procurement ◽

The United States ◽

Cross Sectional Study ◽

Neurologic Examination ◽

National Guidelines ◽

Cross Sectional ◽

Organ Procurement Organizations ◽

Death By Neurologic Criteria

Objective:To determine the variability in pediatric death by neurologic criteria (DNC) protocols between US pediatric institutions and compared to the 2011 DNC guidelines.Methods:Cross-sectional study of DNC protocols obtained from pediatric institutions in the United States (US) via regional organ procurement organizations. Protocols were evaluated across five domains: general DNC procedures, prerequisites, neurologic examination, apnea testing and ancillary testing. Descriptive statistics compared protocols to each other and the 2011 guidelines.Results:One hundred and thirty protocols were analyzed with 118 dated after publication of the 2011 guidelines. Of those 118 protocols, identification of a mechanism of irreversible brain injury was required in 97%, while 67% required an observation period after acute brain injury before DNC evaluation. Most protocols required guideline-based prerequisites such as exclusion of hypotension (94%), hypothermia (97%), and metabolic derangements (92%). On neurologic examination, 91% required a lack of responsiveness, 93% no response to noxious stimuli, and 99% loss of brainstem reflexes. 84% of protocols required the guideline-recommened two apnea tests. CO2 targets were consistent with guidelines in 64%. Contrary to guidelines, fifteen percent required ancillary testing for all patients and 15% permitted ancillary studies that are not validated in pediatrics.Conclusionsand Relevance: Variability exists between pediatric institutional DNC protocols in all domains of DNC determination, especially with respect to apnea and ancillary testing. Better alignment of DNC protocols with national guidelines may improve the consistency and accuracy of DNC determination.

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Hospital-based organ donation memorial ceremony: a grounded theory pilot study

Journal of Hospital Administration ◽

10.5430/jha.v4n3p1 ◽

2015 ◽

Vol 4 (3) ◽

pp. 1

Author(s):

Charles Calhoun Reed ◽

Elma I Fonseca ◽

Regina I Reed ◽

Stacy Foremski ◽

Sara L Gill

Keyword(s):

Grounded Theory ◽

Pilot Study ◽

Organ Donation ◽

Organ Procurement ◽

Social Process ◽

Organ Donor ◽

Hospital Staff ◽

Tree Planting ◽

Individual Level ◽

Organ Procurement Organizations

Objective: Various types of organ donation memorials, to include tree planting, rose garden memorials, candle lighting, donor memorial wall events are conducted throughout the year primarily by organ procurement organizations (OPOs). Although the benefits of such events have not been explored there has been continued interest by hospital staff and administrators to host such events. The purpose of this grounded theory pilot study was to describe the process of healing that a hospital-based organ donation memorial ceremony creates at the individual level and organ donation awareness and advocacy at the community level.Methods: The researchers interviewed nine organ donor family members who were invited to attend a hospital-based organ donation memorial ceremony at one Level I Trauma Center located in South Texas.Results: A 4-stage social process, “makes the hole in the heart smaller”, was identified from the qualitative interview data. Participants journeyed through a four stage process to make the hole in their hearts smaller. The four stages are: choosing to attend, being able to connect, keeping the memory alive and knowing something good came from it. As participants moved between stages their meaning for attendance changed. Families shifted from personal grieving and needing support to supporting other donor families and in the process became advocates for organ donation.Conclusions: The findings from this study validate the benefits of hospital-based organ donation memorial ceremonies. Families reported these ceremonies support their decision to donate, while also providing a means of continued emotional support throughout their grief process. The memorial event provides a safe venue for organ donor families to connect and share with others who have had a similar experience, while acknowledging their loved ones gift of life. Hospital-based organ donation memorial ceremonies and the permanent memorial structure increase awareness of organ donation for the community of donor families, hospital visitors and hospital staff.

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New York Transplant Teams Versus COVID-19

Progress in Transplantation ◽

10.1177/1526924820938346 ◽

2020 ◽

Vol 30 (3) ◽

pp. 194-198 ◽

Cited By ~ 1

Author(s):

Daryle Blackstock ◽

Laura Butler ◽

Samantha Delair ◽

Katherine Dokus ◽

Farrington Eileen ◽

...

Keyword(s):

New York ◽

Organ Procurement ◽

Clinical Care ◽

New York State ◽

Severity Of Illness ◽

Surgical Patient ◽

Work Processes ◽

Hospital Units ◽

Lifetime Experience ◽

Organ Procurement Organizations

New York State, and especially New York City, were hit hard by the coronavirus disease 2019 (COVID-19) virus. While we followed its course in other parts of the world, and began preparations, there was no way we could have been prepared for the volume and severity of illness that began to overflow in our emergency departments and hospital units. We expanded intensive care units into our medical surgical units while turning conference rooms into medical surgical patient care areas. Clinicians at the bedside described war-like situations with numerous patients arresting and requiring ventilator support. Our New York consortia and organ procurement organizations met online 3 times a week and shared creative strategies to address clinical care and work processes. We would like to share strategies from what we hope was a once in a lifetime experience.

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