Is altruism always sufficient for organ donation? vroom's expectancy theory, for expanding the organ donor pool

BACKGROUND: Worldwide, the supply of organs continues to be much less than the demand. Many studies identify poor knowledge and negative attitude about organ donation for this. The purpose of this study was to assess knowledge and attitude towards organ donation and associated factors among people who accompany patient during hospital visit at tertiary hospital in Ethiopia.METHODS: A hospital-based cross-sectional study was conducted from March 1st to May 31, 2019, at a tertiary hospital and the only transplant center in Ethiopia. The patient companions were interviewed with structured questionnaires. Descriptive statistics were presented and factors associated with good knowledge and favorable attitude were assessed using Binary logistic regression.RESULTS: A total of 414 patient companion participated in the study. The mean age of the respondents was 35+13years, and 252(60.9%) were males. Forty-four (10.6%) of the study participants had good knowledge about organ donation. Male gender was significantly associated with improved knowledge (AOR=2.127 95% CI: 1.036, 4.368). A favorable attitude towards donation was found in 219(52.9%) of the study participants. Participants who had completed secondary education were more likely to have unfavorable attitude towards organ donation (AOR=0.498, 95% CI: 0.290, 0.857).CONCLUSION: Knowledge about organ donation was found to be poor, and attitudes towards organ donation were found to be unfavorable among patient companions at a major medical center in Ethiopia. Strategies focused on education of the general public and broad dissemination of information on the benefits of organ donation will be critical for improving the organ donor pool.

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Abstract 16: Sex Disparities in Organ Donation: Finding an Equal Donor Pool

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.13.suppl_1.16 ◽

2020 ◽

Vol 13 (Suppl_1) ◽

Author(s):

Erika Yee ◽

Seyedeh Maryam Hosseini ◽

Bianca Duarte ◽

Shannon Knapp ◽

Nancy K Sweitzer ◽

...

Keyword(s):

Organ Donation ◽

Family Member ◽

Family Members ◽

Organ Donor ◽

Medical Mistrust ◽

Organ Donors ◽

Donor Pool ◽

Men And Women ◽

Willingness To Donate ◽

Amazon's Mechanical Turk

Introduction: The majority of living organ donors are women, and the majority of deceased organ donors are men. This poses a problem for transplant candidates who have worsened survival with sex mismatched organs. The objective of this study was to identify reasons for disparities in organ donation between sexes and identify strategies to increase organ donors. Methods: We conducted a fifteen question survey using a crowdsourcing marketplace, Amazon’s Mechanical Turk, in September 2019. The survey assessed how participants make decisions about becoming an organ donor. The survey was distributed to U.S. adult participants, including eight write-in questions and two Likert scale questions. Qualitative descriptive analyses were used to understand reasons for and against becoming an organ donor. Quantitative results were compared with t test. Results: Among the 667 eligible participants representing 49 states, 54.9% were women and 63.1% were in the 18-40 age group. The majority of men (64.8%) and women (63.4%) were registered organ donors. Among men and women donors, three themes guided their willingness to donate: desire to help others, personal experience with organ donors/recipients, and believing organs would have no use to the donor once dead. Among men and women non-donors, decisions were guided by three themes: no reason, medical mistrust, considering becoming a donor. Themes varied by sex when considering whether to donate organs of a deceased family member. Women were guided equally by two themes: family member’s wishes and believing the deceased family member had no further use for organs. Men had similar themes but valued the family member’s wishes more. Women’s willingness to donate their own organs to family members (p=0.03) and strangers (p=0.02) was significantly higher than men. Among non-donors, both sexes would consider becoming organ donors if more information was provided. Conclusion: In a national survey of adults, women and men had similar reasons for becoming and not becoming an organ donor. However compared to men, women were more willing to donate their organs and more altruistic in the donation of family members’ organs. Women’s deceased organ donation may increase with further communication of women’s wishes before death and by improved public education about organ donation.

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Assessing unrealised potential for organ donation after out-of-hospital cardiac arrest

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-021-00924-z ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Andrew Fu Wah Ho ◽

Timothy Xin Zhong Tan ◽

Ejaz Latiff ◽

Nur Shahidah ◽

Yih Yng Ng ◽

...

Keyword(s):

Cardiac Arrest ◽

Organ Donation ◽

Organ Donor ◽

Case Scenario ◽

Eligibility Criteria ◽

Donor Pool ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Worst Case ◽

Hospital Cardiac Arrest

Abstract Background Organ donation after brain death is the standard practice in many countries. Rates are low globally. This study explores the potential national number of candidates for uncontrolled donations after cardiac death (uDCD) amongst out-of-hospital cardiac arrest (OHCA) patients and the influence of extracorporeal cardiopulmonary resuscitation (ECPR) on the candidacy of these potential organ donors using Singapore as a case study. Methods Using Singapore data from the Pan-Asian Resuscitation Outcomes Study, we identified all non-traumatic OHCA cases from 2010 to 2016. Four established criteria for identifying uDCD candidates (Madrid, San Carlos Madrid, Maastricht and Paris) were retrospectively applied onto the population. Within these four groups, a condensed ECPR eligibility criteria was employed and thereafter, an estimated ECPR survival rate was applied, extrapolating for possible neurologically intact survivors had ECPR been administered. Results 12,546 OHCA cases (64.8% male, mean age 65.2 years old) qualified for analysis. The estimated number of OHCA patients who were eligible for uDCD ranged from 4.3 to 19.6%. The final projected percentage of potential uDCD donors readjusted for ECPR survivors was 4.2% (Paris criteria worst-case scenario, n = 532) to 19.4% of all OHCA cases (Maastricht criteria best-case scenario, n = 2428), for an estimated 14.3 to 65.4 uDCD donors per million population per year (pmp/year). Conclusions In Singapore case study, we demonstrated the potential numbers of candidates for uDCD among resuscitated OHCA cases. This sizeable pool of potential donors demonstrates the potential for an uDCD program to expand the organ donor pool. A small proportion of these patients might however survive had they been administered ECPR. Further research into the factors influencing local organ and patient outcomes following uDCD and ECPR is indicated.

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Ethical and Legal Implications of Elective Ventilation and Organ Transplantation: “Medicalization” of Dying versus Medical Mission

BioMed Research International ◽

10.1155/2014/973758 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 5

Author(s):

Paola Frati ◽

Vittorio Fineschi ◽

Matteo Gulino ◽

Gianluca Montanari Vergallo ◽

Natale Mario Di Luca ◽

...

Keyword(s):

Organ Donation ◽

Organ Donor ◽

Legal Framework ◽

Organ Donors ◽

Organ Perfusion ◽

Medical Mission ◽

Legal Implications ◽

Legal Context ◽

Successful Transplantation ◽

Italian Context

A critical controversy surrounds the type of allowable interventions to be carried out in patients who are potential organ donors, in an attempt to improve organ perfusion and successful transplantation. The main goal is to transplant an organ in conditions as close as possible to its physiological live state. “Elective ventilation” (EV), that is, the use of ventilation for the sole purpose of retrieving the organs of patients close to death, is an option which offsets the shortage of organ donation. We have analyzed the legal context of the dying process of the organ donor and the feasibility of EV in the Italian context. There is no legal framework regulating the practice of EV, neither is any real information given to the general public. A public debate has yet to be initiated. In the Italian cultural and legislative scenario, we believe that, under some circumstances (i.e., the expressed wishes of the patient, even in the form of advance directives), the use of EV does not violate the principle of beneficence. We believe that the crux of the matter lies in the need to explore the real determination and will of the patient and his/her orientation towards the specific aim of organ donation.

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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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Expanding renal transplantation organ donor pool in Nigeria

Saudi Journal of Kidney Diseases and Transplantation ◽

10.4103/1319-2442.243946 ◽

2018 ◽

Vol 29 (5) ◽

pp. 1181

Author(s):

AdemolaAlabi Popoola ◽

TimothyOlusegun Olanrewaju ◽

BenjaminOlusomi Bolaji ◽

TajudeenOlalekan Ajiboye

Keyword(s):

Renal Transplantation ◽

Organ Donor ◽

Donor Pool

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Transplantation of a Heart Donated After Circulatory Death via Thoraco-Abdominal Normothermic Regional Perfusion. Results from the first Spanish case.

10.21203/rs.3.rs-57954/v2 ◽

2020 ◽

Author(s):

Marina Pérez Redondo ◽

Sara Alcántara Carmona ◽

Susana Villar García ◽

Alberto Forteza Gil ◽

Hector Villanueva Fernández ◽

...

Keyword(s):

Organ Donor ◽

Regional Perfusion ◽

Ex Situ ◽

Donor Pool ◽

Case Presentation ◽

Suitable Candidate ◽

First Case ◽

Normothermic Regional Perfusion ◽

Multiorgan Procurement ◽

Circulatory Death

Abstract BackgroundControlled donation after circulatory death (cDCD) has emerged as one of the main strategies for increasing the organ donor pool. Because of the ischemic injury that follows the withdrawal of life-sustaining therapies, hearts from cDCD donors have not been considered for transplantation until recently. The ex-situ perfusion of hearts directly procured from cDCD donors has been used to allow the continuous perfusion of the organ and the assessment of myocardial viability prior to transplantation. Based on our experience with abdominal normothermic regional perfusion in cDCD, we designed a protocol to recover and validate hearts from cDCD donors using thoraco-abdominal normothermic regional perfusion without the utilization of an ex-situ device.Case presentationWe describe the first case of a cDCD heart transplant performed with this approach in Spain. The donor was a 43-year-old asthmatic female diagnosed with severe hypoxic encephalopathy. She was considered a potential cDCD donor and a suitable candidate for multiorgan procurement including the heart via thoraco-abdominal normothermic regional perfusion. The heart recipient was a 60-year-old male diagnosed with amyloid cardiomyopathy. Cold ischemia time was 55 minutes. The surgery was uneventful.ConclusionsThis case report, the first of its kind in Spain, supports the feasibility of evaluating and successfully transplanting cDCD hearts without the need for ex-situ perfusion based on the use of thoraco-abdominal normothermic regional perfusion opening the way for multiorgan donation in cDCD.

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Knowledge and attitude of law, medicine, and mass-communication students towards deceased organ donation

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20205673 ◽

2020 ◽

Vol 8 (1) ◽

pp. 22

Author(s):

Pragya Paneru ◽

Shyam S. Budhathoki ◽

Samyog Uprety ◽

Birendra K. Yadav ◽

Rashmi Mulmi ◽

...

Keyword(s):

Organ Donation ◽

Organ Failure ◽

Organ Transplantation ◽

Mass Communication ◽

Organ Donor ◽

Cross Sectional Study ◽

World Health ◽

Cross Sectional ◽

Deceased Organ Donation ◽

Knowledge And Attitude

Background: With the global increase in the incidence organ failure and subsequent advancement in the medical technology, organ transplantation is growing as the best choice of treatment among the patients with various kinds of organ failure. However, the rate of deceased organ donation is relatively low in South-East Asia regions, including Nepal. This has created a mismatch between the demand and supply of organs for transplantation. World Health Organization encourages organ transplantation from a deceased organ donor as there is no risk to the donor. Thus, this paper aimed to assess knowledge and attitude of literate group specifically towards deceased organ donation.Methods: This was a cross-sectional study conducted among 299 students selected conveniently from medicine, law, and mass communication streams from 9 different colleges (3 colleges from each stream) of Kathmandu. Data was collected through a self-administered questionnaire. Knowledge level was classified into three different categories based on obtained scores and attitude was analyzed based on five-point Likert scale.Results: Almost half (48.8%) of the respondents while only 7% had high level of knowledge on the organ donation and transplantation. Similarly, 95% of the people had positive attitude towards organ donation. However, there was a weak correlation between knowledge and attitude of the respondents. None of the respondents carried an organ donation card.Conclusions: There is a need to plan robust strategies to educate people on organ donation so that they can make pragmatic decisions to register their names for deceased organ donation.

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Introducing an Organ Donor Registry is Saskatchewan

Health Reform Observer - Observatoire des Réformes de Santé ◽

10.13162/hro-ors.v9i2.4598 ◽

2021 ◽

Vol 9 (2) ◽

Author(s):

Amy Zarzeczny ◽

◽

Luiza Radu ◽

Keyword(s):

Organ Donation ◽

Public Interest ◽

Public Awareness ◽

National Level ◽

Organ Donor ◽

Organ Donors ◽

Media Campaign ◽

Organ Donations ◽

Paper Form ◽

Evaluation Metric

On 3 September 2020, Saskatchewan launched an organ donor registry that allows participants 16 years and older to register their intent to be an organ donor either online or using a paper form. Saskatchewan has historically performed poorly at a national level with low rates of organ donations. Saskatchewan's new registry is intended to increase the numbers of organ donors in the province, while also helping to modernize its organ donation system and ease donation conversations with families. Saskatchewan's introduction of this registry brought the province in line with other provinces and territories across Canada that use similar systems, and provided a response to the surge in public interest around organ donation that followed the Humboldt Bronco bus crash tragedy and related ``Logan Boulet Effect.'' The 2019-2020 and 2020-2021 provincial budgets included dedicated funding for the development and launch of the registry, which was accompanied by a media campaign to increase public awareness. Though it is too early to evaluate the success of the registry, early indications suggest donation rates will be a key evaluation metric. Registries are commonly thought to help increase public awareness of, and support for, organ donation, but improving Saskatchewan's organ donation rates will likely also require companion measures to strengthen the culture and practice of donation in the province.

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Donor organ management

The ESC Textbook of Intensive and Acute Cardiovascular Care ◽

10.1093/med/9780198849346.003.0052 ◽

2021 ◽

pp. 691-705

Author(s):

Arne P Neyrinck ◽

Patrick Ferdinande ◽

Dirk Van Raemdonck ◽

Marc Van de Velde

Keyword(s):

Brain Death ◽

Treatment Strategies ◽

Organ Donor ◽

Hormonal Changes ◽

Physiological Changes ◽

Donor Pool ◽

Potential Donor ◽

Donor Management ◽

Heart Beating ◽

Pituitary Thyroid Axis

Organ transplantation is the standard treatment modality for end-stage organ disease in selected cases. Two types of potential organ donors can be identified: the brain-dead 'heart-beating donors', referred to as DBD (donation after brain death), and the warm ischaemic 'non-heart-beating donors', referred to as DCD (donation after circulatory death). Brain death induces several physiological changes in the DBD donor. An autonomic storm is characterized by massive catecholamine release, followed by autonomic depletion during a vasoplegic phase. This is associated with several hormonal changes (suppression of vasopressin, the hypothalamic-pituitary-adrenal axis, and the hypothalamic-pituitary-thyroid axis) and an inflammatory response. These physiological changes form the basis of organ donor management, including cardiovascular stabilization and hormonal therapy (including vasopressin and analogues, thyroid hormone, and cortisol). Donor management is the continuation of critical care, with a shift towards individual organ stabilization. An aggressive approach to maximize organ yield is recommended; however, many treatment strategies need further investigation in large randomized trials. DCD donors have now evolved as a valid alternative to increase the potential donor pool and challenge the clinician with new questions. Optimal donor comfort therapy and end-of-life care are important to minimize the agonal phase. A strict approach towards the determination of death, based on cardiorespiratory criteria, is prerequisite. Novel strategies have been developed, using ex situ organ perfusion as a tool, to evaluate and recondition donor organs. They might become more important in the future to further optimize organ quality.

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