Effect of Transplant Education on Nurses' Attitudes toward Organ Donation and Plans to Work with Transplant Patients

2011 ◽  
Vol 21 (4) ◽  
pp. 317-321 ◽  
Author(s):  
Haley Hoy ◽  
Susan Alexander ◽  
Karen H. Frith
Keyword(s):  
Registered Nurses ◽  
Organ Donation ◽  
Outcome Measure ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Organ Donors ◽  
Survey Tool ◽  
The Past ◽  
Transplant Patients ◽  
Before And After

Context Despite the increase in rates of solid organ transplantation in the past 2 decades, nurses are inconsistently educated regarding issues of organ donation and posttransplant care. Objective To characterize the attitudes of registered nurses before and after a graduate-level elective on issues in transplantation. Design Pre-experimental, pretest and posttest interventional study Participants 30 graduate students, who are registered nurses, who enrolled in a transplant elective at a university in the Southeastern United States Main Outcome Measure Investigator-designed survey tool consisting of 18 questions delivered in an electronic format. Results Statistically significant results were seen in nurses' attitudes toward encouraging others to become organ donors ( P = .04), preparation to discuss transplantation with others ( P< .001), advocacy to discuss transplantation among colleagues ( P = .003), confidence in working with transplant patients ( P = .005), confidence in speaking to communities about organ donation ( P = .001), and plans to encourage others to get involved in transplantation ( P = .03). Conclusion These results support the need for providing focused education on transplantation issues to registered nurses, particularly in the academic setting.

scholarly journals Solid organ donation from the emergency department – missed donor opportunities

CJEM ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. 701-707
Author(s):  
Jessica McCallum ◽  
Ryan Yip ◽  
Sonny Dhanani ◽  
Ian Stiell
Keyword(s):  
Emergency Department ◽  
Organ Donation ◽  
Primary Outcome ◽  
Solid Organ Transplantation ◽  
Medical Futility ◽  
Secondary Outcome ◽  
Solid Organ ◽  
Organ Donors ◽  
Health Records ◽  
Made In

ABSTRACTObjectiveA significant gap exists between people awaiting solid organ transplantation and solid organ donors. The purpose of this study was to determine whether there were missed donors in the emergency department (ED).MethodsWe performed a health records and organ donation database review of all patients dying in a large tertiary ED from November 1, 2014 to October 31, 2017 at two campuses with 160,000 visits per year. Demographic and donor suitability data were collected. The primary outcome was missed potential solid organ donors. Missed potential donors were intubated, had a pulse, and had no donation contraindications. The secondary outcome was cases where no notification was made to the organ donation organization at all.ResultsThere were 605 deaths in the ED. Patients had a mean age of 71.1 years, 58.3% were male, and 12.4% died of a traumatic cause. There were 10 missed potential donors. Missed potential donors had a mean age of 67.4 years, 70.0% were male, and 20.0% died from trauma. In all 10 cases, patients had withdrawal of life-sustaining therapy for medical futility, and referral for donation occurred after death. Missed ED donors could have increased hospital-wide donation up to 10.6%. No notification was made in 12 (2.0%) cases; however, none of these would have been successful solid organ donors.ConclusionThe ED is a source of missed organ donors. All potential donors were missed due to referral after withdrawal of life-sustaining therapy. ED physicians should consider the possibility of solid organ donation prior to the withdrawal of life-sustaining therapy.

The Role of Advanced Practice Nurses in Transplant Center Staffing

2011 ◽  
Vol 21 (4) ◽  
pp. 294-298 ◽  
Author(s):  
Haley Hoy ◽  
Susan Alexander ◽  
Jerita Payne ◽  
Edward Zavala
Keyword(s):  
Registered Nurses ◽  
Social Workers ◽  
Solid Organ Transplantation ◽  
Advanced Practice Nurses ◽  
Record Management ◽  
Solid Organ ◽  
Advanced Practice ◽  
Survey Tool ◽  
Practice Nurses ◽  
Administrative Assistants

Context Despite increased rates of solid organ transplantation and frequent use of advanced practice nurses (APNs) to manage patients, no established staffing model including APNs and their roles exists. Objective To characterize the role and integration of APNs in the staffing models of existing transplant centers. Design Descriptive research using a researcher-designed survey of transplant APN professionals. Participants 53 attendees of a national APN transplant clinical management symposium. Main Outcome Measure Investigator-designed survey tool consisting of 21 questions delivered in a paper format with 1 open-ended question about adequacy of current staffing and ideas for improvement. Results 53 responses from staff members of 21 different transplant centers were collected. In addition to APNs, members of existing transplant staffing models were identified as licensed practical nurses, registered nurses, social workers, administrative assistants, and data managers. The primary responsibilities of APNs were both inpatient and outpatient, before and after transplant, and consisted primarily of collecting patients' medical histories, doing physical examinations, handling clinic visits, and education. Licensed practical and registered nurses handled pretransplant referral management and phone triage duties. Social workers, administrative assistants, and data managers were responsible for social support, medical record management, and regulatory documentation, respectively. Most respondents (57%) found current staffing to be inadequate in their centers and suggested areas for improvement. Conclusion APNs play a vital role in management of transplant patients. Transplant centers use APNs in different capacities, depending on the individual needs of the institution. Across institutions, support staff is crucial in the perception of adequate staffing. Additional research is needed to determine the most efficient use of APNs in transplant centers.

scholarly journals Retrospective screening of solid organ donors in Italy, 2009, reveals unpredicted circulation of West Nile virus

2010 ◽  
Vol 15 (34) ◽  
Author(s):  
M R Capobianchi ◽  
V Sambri ◽  
C Castilletti ◽  
A M Pierro ◽  
G Rossini ◽  
...  
Keyword(s):  
Risk Assessment ◽  
West Nile Virus ◽  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Organ Donors ◽  
West Nile ◽  
Retrospective Survey ◽  
Italian Regions ◽  
Potential Risks

Since the occurrence of West Nile virus (WNV) infection in humans in 2008 in Italy, concerns have been raised about the potential risks associated with solid organ transplantation (SOT). A nationwide retrospective survey showed that 1.2% of SOT donors in 2009 were WNV-seropositive and demonstrated that human WNV infection is distributed throughout several Italian regions. Transmission of WNV or other arboviruses through SOT is a possibility and risk assessment should be carried out before SOT to avoid infection through transplantation.

scholarly journals Impact of Donation Physicians on Deceased Organ Donation: A Systematic Review

2021 ◽  
Author(s):  
Janet E. Squires ◽  
Laura D. Aloisio ◽  
Wilmer John Santos ◽  
Danielle Cho-Young ◽  
Monica Taljaard ◽  
...  
Keyword(s):  
Systematic Review ◽  
Organ Donation ◽  
Interrupted Time Series ◽  
Deceased Donor ◽  
Organ Donors ◽  
Consent Rate ◽  
Team Members ◽  
Study Selection ◽  
Before And After ◽  
Deceased Organ Donation

Abstract Background: An emerging strategy to increase deceased organ donation is to use dedicated donation physicians to champion organ donation. We sought to conduct a systematic review of the effectiveness of donation physicians in improving organ donation outcomes.Methods: A systematic review was conducted following Cochrane principles. MEDLINE, Embase, and CINHAL databases were searched from inception to March 26, 2020. Quantitative studies examining the effects of donation physicians on all deceased organ donation outcomes were considered for inclusion. Review articles, editorials and opinion articles, and case studies were excluded. Study selection was completed independently by two team members; all discrepancies were resolved by consensus. Two team members independently extracted data from studies. Results: A total of 1,017 studies were screened, and 12 met inclusion criteria. Included studies were published between 1994 and 2019. Half used an interrupted time series design (n = 6; 50%), three (25%) were cohort studies, and three (25%) used a before-and-after study design. Outcomes (reported in greater than 50% of included articles) included consent/refusal rate (n = 8; 67%), number of potential donors (n = 7; 58%), and number of actual donors (n = 7; 58%). Across studies and design types, there was an increase in potential organ donors ranging from 8 to 143% (Mdn = 33%), an increase in actual organ donors from 15 to 113% (Mdn = 27%), an increase in donor consent rate from -3 to 258% (Mdn = 12%) and an increase in deceased donor transplants from 13 to 24% (Mdn = 19%) following the introduction of donation physicians.Conclusions: Donation physicians have the potential to significantly improve deceased organ donation. Further implementation and evaluation of donation physician programs is warranted. However, implementation should be undertaken with a clear plan for a methodologically rigorous evaluation of outcomes.

Vasopressin Deficiency and Pressor Hypersensitivity In Hemodynamically Unstable Organ Donors

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Jonathan M. Chen ◽  
Suzanne Cullinane ◽  
Talia B. Spanier ◽  
John H. Artrip ◽  
Ranjit John ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diabetes Insipidus ◽  
Low Dose ◽  
Clinical Evidence ◽  
Pressor Response ◽  
Hemodynamic Instability ◽  
Solid Organ ◽  
Organ Donors ◽  
Plasma Vasopressin ◽  
Before And After

Background —Solid organ donors often develop hypotension due to vasodilation, and recently we observed that a variety of vasodilatory states are characterized by vasopressin deficiency and hypersensitivity. Thus, we investigated the prevalence of vasopressin deficiency in hypotensive solid organ donors without clinical evidence of diabetes insipidus; we also investigated the vasopressor effect of vasopressin replacement in hypotensive donors. Methods and Results —Fifty organ donors were evaluated for hemodynamic instability, (mean arterial pressure [MAP]≤ 70 mm Hg despite the use of catecholamine vasopressors), and in those unstable donors who were not already receiving exogenous vasopressin, low-dose vasopressin was administered as a continuous infusion (0.04 to 0.1 U/min). MAP, catecholamine requirements, serum vasopressin, and serum osmolality were obtained before and after vasopressin administration. Ten patients meeting the enrollment criteria received vasopressin and MAP increased from 72.2±3.5 to 89.8±4.2 mm Hg, ( P <0.05), allowing for complete discontinuation of catecholamine pressors in 4 (40%) patients and a decrement in pressor dose in 4 (40%). Plasma vasopressin levels (2.9±0.8 pg/mL) were low for the degree of hypotension. Conclusions —Hemodynamically unstable organ donors without clinically apparent diabetes insipidus display a defect in the baroreflex-mediated secretion of vasopressin. In these patients, low-dose vasopressin significantly increases blood pressure with a pressor response sufficient to reduce catecholamine administration.

Living Organ Donation Role of Ethics for Improved Clinical Practice

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.

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

CJEM ◽  
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.

scholarly journals Preservation Solutions for Kidney Transplantation: History, Advances and Mechanisms

2019 ◽  
Vol 28 (12) ◽  
pp. 1472-1489 ◽  
Author(s):  
Yimeng Chen ◽  
Jian Shi ◽  
Terry C. Xia ◽  
Renfang Xu ◽  
Xiaozhou He ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Cold Storage ◽  
Solid Organ Transplantation ◽  
Atp Depletion ◽  
Solid Organ ◽  
Hypoxic Injury ◽  
The Past ◽  
Molecular Events ◽  
Preservation Solutions ◽  
Medical Advances

Solid organ transplantation was one of the greatest medical advances during the past few decades. Organ preservation solutions have been applied to diminish ischemic/hypoxic injury during cold storage and improve graft survival. In this article, we provide a general review of the history and advances of preservation solutions for kidney transplantation. Key components of commonly used solutions are listed, and effective supplementations for current available preservation solutions are discussed. At cellular and molecular levels, further insights were provided into the pathophysiological mechanisms of effective ingredients against ischemic/hypoxic renal injury during cold storage. We pay special attention to the cellular and molecular events during transplantation, including ATP depletion, acidosis, mitochondrial dysfunction, oxidative stress, inflammation, and other intracellular mechanisms.

scholarly journals Randomised sham-controlled double-blind trial evaluating remote ischaemic preconditioning in solid organ transplantation: a study protocol for the RIPTRANS trial

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038340
Author(s):  
Aki Uutela ◽  
Ilkka Helanterä ◽  
Karl Lemström ◽  
Arie Passov ◽  
Simo Syrjälä ◽  
...  
Keyword(s):  
Organ Transplantation ◽  
Study Protocol ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Organ Donors ◽  
Ischaemic Preconditioning ◽  
Study Results ◽  
Remote Ischaemic Preconditioning ◽  
Brain Dead ◽  
Transplanted Organs

IntroductionRemote ischaemic preconditioning (RIPC) using a non-invasive pneumatic tourniquet is a potential method for reducing ischaemia-reperfusion injury. RIPC has been extensively studied in animal models and cardiac surgery, but scarcely in solid organ transplantation. RIPC could be an inexpensive and simple method to improve function of transplanted organs. Accordingly, we aim to study whether RIPC performed in brain-dead organ donors improves function and longevity of transplanted organs.Methods and analysesRIPTRANS is a multicentre, sham-controlled, parallel group, randomised superiority trial comparing RIPC intervention versus sham-intervention in brain-dead organ donors scheduled to donate at least one kidney. Recipients of the organs (kidney, liver, pancreas, heart, lungs) from a randomised donor will be included provided that they give written informed consent. The RIPC intervention is performed by inflating a thigh tourniquet to 300 mm Hg 4 times for 5 min. The intervention is done two times: first right after the declaration of brain death and second immediately before transferring the donor to the operating theatre. The sham group receives the tourniquet, but it is not inflated. The primary endpoint is delayed graft function (DGF) in kidney allografts. Secondary endpoints include short-term functional outcomes of transplanted organs, rejections and graft survival in various time points up to 20 years. We aim to show that RIPC reduces the incidence of DGF from 25% to 15%. According to this, the sample size is set to 500 kidney transplant recipients.Ethics and disseminationThis study has been approved by Helsinki University Hospital Ethics Committee and Helsinki University Hospital’s Institutional Review Board. The study protocol was be presented at the European Society of Organ Transplantation congress in Copenhagen 14−15 September 2019. The study results will be submitted to an international peer-reviewed scientific journal for publication.Trial registration numberNCT03855722.

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

CJEM ◽  
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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