Would it be ethical to use motivational interviewing to increase family consent to deceased solid organ donation?

Making up 13.4% of the United States population, African Americans (AAs) account for 28.7% of candidates who are currently waiting for an organ donation. AAs are disproportionately affected by end-organ disease, particularly kidney disease, therefore, the need for transplantation among this population is high, and the high need is also observed for other solid organ transplantation. To this end, we worked with the AA community to derive an empirical framework of organ donation strategies that may facilitate AA decision-making. We used a cognitive mapping approach involving two distinct phases of primary data collection and a sequence of data analytic procedures to elicit and systematically organize strategies for facilitating organ donation. AA adults ( n = 89) sorted 27 strategies identified from nominal group technique meetings in phase 1 based on their perceived similarities. Sorting data were aggregated and analyzed using Multidimensional scaling and hierarchical cluster analyses. Among 89 AA participants, 68.2% were female, 65.5% obtained > high school education, 69.5% reported annual household income ≤ $50,000. The average age was 47.4 years (SD = 14.5). Derived empirical framework consisted of five distinct clusters: fundamental knowledge, psychosocial support, community awareness, community engagement, and system accountability; and two dimensions: Approach, Donor-related Information. The derived empirical framework reflects an organization scheme that may facilitate AA decision-making about organ donation and suggests that targeted dissemination of donor-related information at both the individual-donor and community levels may be critical for increasing donation rates among AAs.

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Validation of the factors influencing family consent for organ donation in the UK

Anaesthesia ◽

10.1111/anae.15485 ◽

2021 ◽

Author(s):

R. M. K. Curtis ◽

A. R. Manara ◽

S. Madden ◽

C. Brown ◽

S. Duncalf ◽

...

Keyword(s):

Organ Donation ◽

Factors Influencing ◽

The Uk ◽

Family Consent

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Use of Twitter in communicating living solid organ donation information to the public: An exploratory study of living donors and transplant professionals

Clinical Transplantation ◽

10.1111/ctr.13447 ◽

2018 ◽

pp. e13447 ◽

Cited By ~ 2

Author(s):

Jessica M. Ruck ◽

Macey L. Henderson ◽

Ann K. Eno ◽

Sarah E. Van Pilsum Rasmussen ◽

Sandra R. DiBrito ◽

...

Keyword(s):

Organ Donation ◽

Exploratory Study ◽

Living Donors ◽

Solid Organ ◽

The Public

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Living Organ Donation Role of Ethics for Improved Clinical Practice

Optimizing Health Literacy for Improved Clinical Practices - Advances in Medical Technologies and Clinical Practice ◽

10.4018/978-1-5225-4074-8.ch014 ◽

2018 ◽

pp. 242-259

Author(s):

Pierpaolo Di Cocco

Keyword(s):

Organ Donation ◽

Organ Transplantation ◽

Financial Incentives ◽

Ethical Issues ◽

Supply And Demand ◽

Solid Organ Transplantation ◽

Solid Organ ◽

Live Donor ◽

Live Donation

Solid organ transplantation represents one of the most important achievements in history of medicine. Over the last decades, the increasing number of transplants has not been of the same extent of the number of patients in the waiting lists. Live donation has been implemented in order to reduce the gap between supply and demand. From an ethical standpoint, the donation process from a live donor seems to violate the traditional first rule of medicine—primum non nocere because inevitably exposes healthy persons to a risk in order to benefit another person. In the chapter will be presented the crucial role of ethics and specific ethical issues in the different forms of live donation, such as financial incentives for living donation, reimbursement in unrelated live donation, minor sibling-to-sibling organ donation. The ethical aspects of live donor organ transplantation are continuously evolving; in order to make this strategy more beneficial and lifesaving, everyone involved in the process should make every possible effort with in mind the best interests of the patients.

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LO66: Solid organ donation from the emergency department: A death review

CJEM ◽

10.1017/cem.2019.109 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S31-S32

Author(s):

J. McCallum ◽

R. Yip ◽

S. Dhanani ◽

I. Stiell

Keyword(s):

Emergency Department ◽

Organ Donation ◽

Primary Outcome ◽

Organ Procurement ◽

Care Center ◽

Demographic Data ◽

Tertiary Care ◽

Solid Organ ◽

Organ Donors ◽

Organ Procurement Organization

Introduction: A significant gap exists between the number of people waiting for an organ and donors. There are currently 1,628 people awaiting organ donation in Ontario alone. In 2018 to date, 310 donors have donated 858 organs. The purpose of this study was to determine whether there were missed donors in the Emergency Department (ED) and by what percent those missed donors would increase organ donation overall. Methods: This was a health records and organ donation database review of all patients who died in the ED at a large academic tertiary care center with 2 campuses and 160,000 visits per year. Patients were included from November 1, 2014 – October 31, 2017. We collected data on demographics, cause of death, and suitability for organ donation. Data was cross-referenced between hospital records and the provincial organ procurement organization called Trillium Gift of Life Network (TGLN) to determine whether patients were appropriately referred for consideration of donation in a timely manner. Potential missed donors were manually screened for suitability according to TGLN criteria. We calculated simple descriptive statistics for demographic data and the primary outcome. The primary outcome was percentage of potential organ donors missed in the Emergency Department (ED). Results: There were 606 deaths in the ED from November 1, 2014 – October 31, 2017. Patients were an average of 71 years old, 353 (58%) were male, and 75 (12%) died of a traumatic cause. TGLN was not contacted in 12 (2%) of cases. During this period there were two donors from the ED and 92 from the ICU. There were ten missed potential donors. They were an average of 67 years, 7 (70%) were male, and 2 (20%) died of a traumatic cause. In all ten cases, patients had withdrawal of life sustaining measures for medical futility prior to TGLN being contacted for consideration of donation. There could have been an addition seven liver, six pancreatic islet, four small bowel, and seven kidney donors. The ten missed ED donors could have increased total donors by 11%. Conclusion: The ED is a significant source of missed organ donors. In all cases of missed organ donation, patients had withdrawal of life sustaining measures prior to TGLN being called. In the future, it is essential that all patients have an organ procurement organization such as TGLN called prior to withdrawal of life sustaining measures to ensure that no opportunity for consideration of organ donation is missed.

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P098: Solid organ donation from the emergency department - a systematic review

CJEM ◽

10.1017/cem.2018.296 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S91-S91

Author(s):

J. McCallum ◽

B. Ellis ◽

I. G. Stiell

Keyword(s):

Systematic Review ◽

Emergency Department ◽

Organ Donation ◽

Cardiopulmonary Arrest ◽

Meta Analysis ◽

Organ Transplant ◽

Donation After Cardiac Death ◽

Solid Organ ◽

Organ Donors ◽

Human Adults

Introduction: There is a significant gap between the number of organ donors and people awaiting an organ transplant; therefore it is essential that all potential donors are identified. Given the nature of Emergency Medicine it is a potential source of organ donors. The purpose of this study is to determine what percent of successful donors come from the Emergency Department (ED) and whether there are any missed potential donors. Methods: Electronic searches of EMBASE, MEDLINE, and CINAHL were performed July 7, 2017 using PRISMA guidelines. Primary literature in human adults were included if they described identification of patients in the ED who went on to become successful solid organ donors, or described missed potential donors in the ED. Data on the total population of actual or missed donors was required to allow calculation of a percentage. Studies describing non-solid organ donation, consent, ethics, survey of attitudes, teaching curricula, procurement techniques, donation outside the ED, and recipient factors were excluded. 2 authors independently screened articles for inclusion and discrepancies were resolved through consensus. Quality was assessed using STROBE for observational studies. Heterogeneity of patient populations precluded pooling of the data to conduct a meta-analysis. Results: 1058 articles were identified, 17 duplicates were removed, 800 articles were excluded based on title and abstract, and 217 full text articles were excluded, yielding 24 articles for the systematic review. For neurologic determination of death (NDD), ED patients comprised 4 44% of successful donors. ED death reviews revealed 0 84% of patients dying in the ED are missed as potential donors and hospital-wide death reviews revealed 13 80.9% of missed donors die in the ED. For donation after cardiac death (DCD), 4 20% of successful donors came from the ED and studies investigating potential donors suggest 2 36% of patients dying the in the ED could be potential DCD donors. The most common population of successful DCD organ donors was in traumatic cardiopulmonary arrest (TCPA), with 3.6 8.9% of TCPA patients presenting to the ED becoming successful donors. Conclusion: Patients dying in the Emergency Department are a significant source of both successful organ donors and missed potential donors. Emergency physicians should be familiar with their local organ donation protocol to ensure potential organ donors are not missed.

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Increasing family consent for organ donation: findings and challenges

Progress in Transplantation ◽

10.7182/prtr.11.3.l137501356566175 ◽

2001 ◽

Vol 11 (3) ◽

pp. 194-200 ◽

Cited By ~ 11

Author(s):

Courtney Rocheleau

Keyword(s):

Organ Donation ◽

Family Consent

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De novo malignancy in recipients of solid organ transplant from donors with intracranial cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e13507 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e13507-e13507

Author(s):

Katie Carsky ◽

Christopher Carr ◽

Cassidy Werner ◽

Helmi Khadra ◽

John Blair Hamner ◽

...

Keyword(s):

Risk Factors ◽

Organ Donation ◽

De Novo ◽

Organ Transplant ◽

Solid Organ Transplant ◽

Cns Tumors ◽

Solid Organ ◽

Large Dataset ◽

Additional Risk ◽

De Novo Malignancy

e13507 Background: In 2016, 33,610 organ transplants were performed in the US. Nevertheless, there is a critical deficiency of available organs. Currently, malignant neoplasms in the donor preclude organ donation, with some exceptions, such as certain CNS tumors without metastatic disease. The literature illustrates the risk of CNS tumor transmission with organ transplantation as 0-3% in the absence of additional risk factors, but organs from fewer than 0.5% of the 13,000 patients that die of glioma annually are procured. Given the critical need, we sought to reaffirm the safety of organs from donors with intracranial cancer by examining de novo malignancy outcomes in a large dataset. Methods: We examined the UNOS database to determine whether recipients of solid organ transplant from donors with intracranial cancer were at increased risk of de novo malignancy. Included were 119,430 subjects ages 18 to 65 who underwent heart, heart and lung, intestine, kidney, kidney and pancreas, liver, lung, or pancreas transplant from 1987 to 2012 and for whom there was complete data on donor history of intracranial cancer. 2-by-2 contingency tables were used to calculate odds ratios of exposure to donors with intracranial cancer. Outcomes included five-year survival, composite development of any malignancy, and development of specific malignancies including melanoma, esophageal, stomach, small intestine, pancreas, larynx, mouth, colorectal, primary liver tumor, and metastasis to liver. A p value of ≤ 0.05 was statistically significant. Results: 718 (0.60%) organs came from donors with intracranial cancer. 437 (79.02%) recipients of organs from donors with intracranial cancer survived 5 years, versus 71,055 (77.64%) recipients of organs from donors without intracranial cancer (p = 0.47). 113 (15.74%) recipients of organs from donors with intracranial cancer developed de novo malignancy, versus 17,963 (15.13%) recipients of organs from donors without intracranial cancer (p = 0.60). Of 17 contingency analyses of development of specific malignancies, we detected only 1 statistically significant positive association, de novo colorectal cancer in recipients of solid organ transplant from donors with intracranial cancer (p = 0.048, OR = 2.56). Given the large number of analyses and marginal significance of this in a very large dataset, it is likely type I error. Conclusions: Metastasis of primary CNS tumors beyond the CNS is a rare occurrence without additional risk factors. With the current organ shortage, donors with primary CNS malignancy are ideal candidates for organ donation.

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Solid Organ Donation Between Strangers

The Journal of Law Medicine & Ethics ◽

10.1111/j.1748-720x.2002.tb00412.x ◽

2002 ◽

Vol 30 (3) ◽

pp. 440-445 ◽

Cited By ~ 12

Author(s):

Lainie Friedman Ross

Keyword(s):

Organ Donation ◽

Waiting List ◽

Solid Organ ◽

University Of Minnesota ◽

Ethical Guidelines ◽

Organ Donations ◽

The University ◽

Minnesota Hospital

In August 2000, Arthur Matas and his colleagues de scribed a protocol in which their institution began to accept as potential donors, individuals who came to the University of Minnesota hospital offering to donate a kidney to any patient on the waiting list. Matas and his colleagues refer to these donors as nondirected donors by which is meant that the donors are altruistic and that they give their organs to an unspecified pool of recipients with whom they have no emotional relationship. This paper represents an ethical and policy critique of the nondirected donation protocol that was implemented at the University of Minnesota in August 1999. Specifically, I address the ethical questions: Whether altruistic living solid organ donations by strangers (nondirected donations) should be permitted? And if so, What are appropriate ethical guidelines for such donations?

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