Donor Families Research Articles

Competences of the Nurse Member of the Intrahospital Commission for Organ and Tissue Donation for Transplantation

Abstract:Introduction: Among the members that compose the Brazilian Intrahospital Commission for Organ and Tissue Donation for Transplantation (Cihdott), the nurse is the professional who has the greatest contact with potential donors and their families because of the care provided to patients in intensive care units, thus becoming a reference for the family. The nurse’s performance as a member of Cihdott has been recognized and related to the success of organ donation. Objective: To identify the competences of the nurse member of Cihdott. Methods: Descriptive study, with a qualitative approach. Nurses who had been members of Cihdott for at least six months and agreed to participate in the research were included, selected by means of the snowball technique. Semistructured interviews were conducted, and data analysis was done by thematic grouping, using Minayo’s referential. Results: Ten nurses, aged between 32 and 50 years and working at a Cihdott for 4 to 11 years, participated in the study. From the data analysis, four categories emerged: “The role of the nurse from the beginning to the end of the donation process”; “Competences and attributions of the Cihdott nurse”; “Personal qualities that influence the professional ambit”; and “Limiting factors for the nurse’s performance.” Final considerations: The nurse member of the Cihdott acts in several activities in the donation and transplantation process, among them: active search, family interview, donor maintenance, follow-up of the organ and tissue removal and transplantation process, organ packaging for transplantation, body reconstitution follow-up, and body return to the donor family, and training with the teams. Besides this, administrative and bureaucratic attributions are part of the Cihdott nurse’s routine.

FAMIY HISTORY RISK ASSESSMENT BY A GENETIC COUNSELOR FOR OVUM DONORS: DATA FOR 582 IN HOUSE OVUM DONORS FROM A SINGLE CLINIC DEMONSTRATES ITS VALUE

This study was designed to explore the benefits of the genetic counselor’s unique expertise in evaluating egg donor family history as well as to quantify the amount and type of additional information captured during the genetics consultation as well as to determine the reasons for disqualification from the donor program as a result of information derived from the genetics consult.

Commentary: Analysis of motivating factors for eye donation among families of eye donors in South India - A questionnaire-based study.

As of today, prevalence of blindness in India is approximated to be 0.45% among the Indian population, in which corneal blindness constitutes 0.9%.[1] Corneal retrieval through eye banking plays a principal role in tackling this issue. India, being a developing country, has the maximum number of eye banks (238) in the world.[2] The retrieval and utilization rates need furtherance compared to developed nations. There is a fourfold need in procurement of corneas to curb cornea-related blindness in India. Shortage of tissues can be resolved by improving awareness and conversion of pledging to donation among our population. In this study,[3] the author has addressed the main motivating factors responsible for eye donation in southern India. A telephonic questionnaire containing 15 questions was taken as the key assessing tool. Most of the questions were directed towards factors inducing donation. Even though the awareness quotient was better in southern India, the willingness to donate was approximately 60%.[4] Another important aspect to take note was that the pledging rates had little correlation to donation as the first-degree relatives of the donor are the primary deciders for donation at retrieval. Previous donation in the family and the effect of grief counselors had better retrieval rates compared to normal. The importance of grief counselors as catalysts[3] in the society has been well elucidated to curb the latter issues, and they are clearly superior compared to other means of promoting eye donation. The obtainment of corneas through hospital corneal retrieval program (HCRP) were less, when comparing the Indian scenario to this study.[5] Maintaining a good contact and providing transport with the chain of hospitals around the vicinity of the eye bank ensures betterment in the HCRP. The HRCP plays a vital role to the eye bank, as it ensures better retrieval and the quality of tissues obtained. It is well known that tissue utilization rates are better in HCRP corneas compared to voluntary donation.[6] An increased rate of voluntary donation may be due to the demography, where this study was conducted. To conclude, even though motivating factors have been pinned down, other factors regarding storage, collection, and tissue utilization (50.5%)[2] are vital for the amelioration of eye banking practices, and the awareness programs should be focused toward the target population.

A mixed-methods study of emotional support for families of organ donors in Hunan Province, China.

BackgroundFamily consent is a prerequisite for the organ donation of the deceased in China. However, a large number of donors are individuals who died due to accidental injuries or unanticipated diseases, which means that most of the families of such donors have just experienced the sudden death of their loved one and have to make a donation decision in a short time. This decision may cause psychological stress and some psychological damage to the minds of relatives of the donors. In addition, cultural sensitivity also has largely caused the relatives of donors inner conflicts and contradictions. And sometimes organ donation may still be stigmatized. However, have they received any emotional support and what is their emotional support needs are some questions that need to be answered. Therefore, this study aims to investigate the emotional support, influencing factors, and needs of the family members of organ donors in Hunan Province, China.Materials and methodsThis is mixed-methods research that combines quantitative and qualitative research methods. A cross-sectional survey was conducted among 102 donor families using a questionnaire to investigate their emotional support status. To further understand their emotional support needs, 12 donor families participated in the semi-structured interview.ResultsThe results confirmed that: (1) A total of 67.7% of the 102 respondents received emotional support or psychological comfort. Thus, only a small number of respondents (31.4%) felt respected by the public. (2) Emotional support came mainly from immediate family members (73.91%), and official organizations such as the Red Cross (43.48%). (3) Marital status, health status, occupation, and coping style can affect the emotional support of the donor families (p < 0.05). (4) Interview showed that the families of donors need emotional support and psychological aid from psychological professionals mostly. And they also wish to receive the understanding and respect of the public.ConclusionMost families of organ donors received emotional support from family, Red Cross, and friends, but only a minority of families of donors reported receiving respect from the public after the donation. And families of donor showed a strong need for emotional support and professional psychological aid from institutions.

P16.30: Assessment of the Impact of the COVID -19 Pandemic on the Number of Brain Deaths, Family Donations, and Organs Used Between 2019-2020 in the Bursa Regional Coordination Center With the Most Donors in Turkey

Introduction: The number of patients diagnosed with SARS-CoV2 worldwide in 2020 is 83,999,3791. According to the World Health Organization (WHO), 1,937,987 patients diagnosed with SARS-CoV2 died in 2020.2 In 2020, 2.3% of patients diagnosed with SARS-CoV2 died. The COVID 19 pandemic caused by SARS-CoV2 negatively impacts all sectors. One of the affected areas is organ supply and transplantation. The number of patients registered in the Transplant Dialysis Surveillance System (TDIS) waiting for solid organs in Turkey in 2020 is 23,923.3 Of the 1,391 reported brain death cases in 2020, 263 involved families donations. Of these, 1059 organs were used. This is 4.42% of the waiting patients.4 The inadequate supply of organs in our country Our study aimed to investigate the impact of the pandemic COVID -19 on the distribution of brain deaths reported in the regional coordination centers of Bursa, which has the highest number of brain deaths and family donations in Turkey by 2019 2020. Materials and Methods: Using the data from the Transplantation Dialysis Monitoring System of the Ministry of Health - Decision Support Unit (TDIS-KDS), the distribution of brain death, family donation, and organs used data reported between 2019 and 2020 in Turkey was studied. This distribution retrospectively assessed the impact of the COVID -19 pandemic. Results: According to the Transplant Dialysis Monitoring System (TDIS) data, there were 2,309 brain deaths in Turkey in 2019, patients with family donations: 619, and the number of organs used: 2504. The number of brain deaths in 2020: 1,391, the number of patients with family donations: 263, and the number of organs used: 1059.3 The number of brain deaths in 2019 Bursa Regional Coordination Center is 280, the number of patients with family donations: 117, the number of organs used: 222. The number of patients with brain death in 2020 is 208, the number of patients with family donations: 70 and the number of organs used: 104. In Turkey, the brain death rate in 2019 is 12.12%, the rate of patiens family donations: 18.90% and the rate of organs used: 8.86%. In Turkey, the brain death rate in 2020 is 14.95%, the rate of patients family donations: 26.61%, and the rate of organs used: 9.82%. The COVID 19 pandemic has had a negative impact on organ donation rates and organ supply for solid organ transplants. However, with organ donation training in the provinces of the Bursa Regional Coordination Center, an increase in brain death rates, family donations, and organs used was observed in Bursa Regional Coordination Centerin 2020. Conclusion: The COVID19 pandemic has adversely affected patients awaiting solid organ transplants. The demand for cadaveric organ transplants has increased in Turkey. Patients without living donors are losing their lives. Social activities and legal incentives encouraging organ donation are increasing organ donation.

233.2: Aftercare for Organ Donor Families: A Content Analysis of Organ Procurement Organization Family Services and Educational Materials

Purpose: Following a sudden and tragic loss, organ donor families’ members experience grief, and may even develop prolonged grief disorder. All US organ procurement organizations (OPOs) provide family support and aftercare services for organ donor families, but the breadth and focus of services vary across OPOs. We assessed the scope and gaps of existing donor family services in the US and its territories. Methods: Family service offerings were identified through each OPOs website (n =57), (Table 1). We used qualitative content analysis to identify topics covered and delivery format; 11 categories were developed inductively based on common services offered by OPOs. The frequency of each service was reported and analyzed using descriptive statistics. Results: Categories of existing donor family services and educational materials included written materials, podcasts, blogs, social media, support groups, provider referrals (referring individuals to specific counselors), on-site counseling, counseling and support services (providing websites and phone numbers to local counseling/support services), family/recipient connections, and celebratory and honorary events (Table 1). Of all services, celebratory and honorary events as well as written materials were universally provided by OPOs (100%). Quilts made in honor of donors were commonly provided by OPOs, in which the donor families can submit a quilt square commemorating their loved one. A third to nearly a half of OPOs offered donor family services such as ‘Social Media,’ ‘Blogs,’ ‘Videos’ and’ ‘Podcasts.’ Social media support services were often offered through Facebook groups to create a sense of community for donor families. Family/recipient connections (98%) and counseling recommendations (86%) were commonly offered, while provider referrals, support groups, and on-site counseling were offered by less than 20% of OPOs. Conclusion: Counseling and support services for organ donor families vary by OPO and can be improved. The development and implementation of evidence-based grief programs tailored to these families can improve quality of services to support donor families.

P11.01: Increasing the Consent for Brain Death Donor Family Members

Introduction & Purpose: Mongolia’s Donor Law was first adopted in 2000 and amended in 2012 and 2018 respectively. The Regulatory department cells, tissues, and organs transplantation of the Center for Health Development has been established in 2018. There are 3 donor hospitals and 2 transplantation hospitals in Mongolia. Our department gets information daily from the donor hospital’s brain death diagnosis committee, if there is a donor with brain death, we make consultations with family members. It may be rejected because of religion, superstition, or personal opinion. Changing such factors will increase the number of family members’ consent and the number of transplantations. Method: The study included 20 family members of the last three years approved by the brain death diagnosis committee for 3 Donor Hospitals. Result: After meeting with those 46 family members, 26/65%/of them accepted and 20/35%/ of them denied. Organ harvesting of 29 kidneys and 20 livers was successfully done from 23 out of 26 consented donors and thus saved 49 lives. The reasons for the rejection of family members are lamas/5 families/, shaman/5 families/, family opinion/3 families/ and lack of information about this/7families/.As well from the studies of organ transplantation and donor’s awareness, 10/22%/ of these families were knowledgeable, of which 5 were approved, donor families. The 23/50%/ families did not have any understanding, of which 7 were members of refused families. Conclusion: From these, we could say that having knowledge about organ donation is increasing the likelihood of approval of becoming a donor. Therefore, it is important to meet with the religious representatives, which is one of the major opposing factors in order to give a proper understanding of donations to the public.

247.1: Conditional Altruistic Living-Donor Kidney Donation in Israel and Its Impact on Living-Donor Kidney Transplant Growth

Introduction: With a limited number of deceased organ donors in Israel, transplant tourism was often used as an alternative source for kidneys until the enactment of the Israel Transplant law in 2008 which severely limited that activity. In an effort to find a legitimate path for the supply of kidneys for transplant, the law approved altruistic donation and established a regulated central governmental mechanism to ensure an altruistic motivation for donation. A year later, in 2009, the Matnat Chaim organization started its initiative to promote altruistic donation within the Jewish sector according the highest imperative of saving another’s life according to religious beliefs and social behaviour. Here, we report the results of that activity over the last 8 years. Methods: We used Israel Transplant Centre database and the Matnat Chaim organization’s database reporting the transplant activity for the period of 2013-2021. We looked at the growth of deceased and living-donor kidney transplantation and the proportion of altruistic kidney donations out of the total number of living-donor transplants over that period. We also reviewed the donors’ pre-donation questionnaires to learn about their preferences regarding their paired recipients in terms of age, social sector and religious observance. Results: Over the period studied, the number of kidney transplant candidates on the waiting list increased from 755 to 917 patients while the number of kidney transplants from deceased donors increased from 127 to 149 (excluding combined kidney-liver or kidney-pancreas transplants). The total number of live-donor transplantation increased from 261 to 476. The primary growth in the number of kidney transplants came from altruistic donations, with an increase from 32 to 215 donors a year (X6.7), and their proportion within the overall live donor total increased from 24 to 66% (figure 1). It should be noted that in many cases, Matnat Chaim was responsible for facilitating donation within the family after an initial interview of patients who approached the organization. Although in the majority of cases altruistic donors donated their kidney to a recipient within their community or religious group, on other occasions donors agreed to change the original directed allocation and donate their kidney within a paired exchange program (48 donors) or directly to a highly sensitized patient on the waiting list. However, for many of the altruistic donors, conditional donation was a prerequisite and had they not been allowed to donate within their community, they would not have donated a kidney at all. Conclusions: Conditional altruistic donation within a community is a legitimate path with a major potential to increase organ donation. Unlike non-conditional donation where kidneys are allocated to the waiting list, our system of conditional altruistic donation may raise some ethical issues; however, we consider it a valid option on a scale between a family donation and altruistic non-directed donation. The abstract is in memory of my friend Rabbi Yeshayahu Heber, the founder and chairman of Matnat Chaim. Rabbi Heber was a transplant recipient who died far before his time during the first wave of the COVID-19 pandemic, in April 2020. Over 1200 kidney recipients are alive today due to his vision and determination.

237.1: ODISSeA: Organ Donation Innovative Strategies For Southeast Asia

Introduction: ODISSeA is an Erasmus+ project funded by the European Commission. An academic postgraduate programme on organ donation (OD) in 8 Southeast Asian (SeA) universities from Malaysia, Myanmar, Philippines and Thailand was designed and developed. The origin comes from the need for a specialized training that builds adequate knowledge, skills and attitude in OD to increase the well-trained specialists that will efficiently coordinate the process of OD in SeA. Methods: Training programmes and OD self-assessment (SA) of clinical knowledge (A/n21) and of non-clinical competencies (B/n18). SeA universities targeted 3 groups: university personnel, faculty members and potential postgraduate trainees. Train the trainers (TxT) blended programme for SeA trainers healthcare professionals (HCPs). Pre and post course evaluation results were compared. Multilevel blended Postgraduate Programme in Organ Donation (PPOD) targeting HCPs combining academic training (online training and local & international seminars) with bedside projects (On-the-job- projects and awareness events). Pre and post course evaluation results were compared. Results: Comparing SA results among trainers and trainees in group A 37% vs 54% scored poor to average while 30% vs 20% scored very good to excellent. The overall average score was 9.21 ± 0.39 SD vs 2.49 ± 0.31 SD respectively. In group B 19% vs 35% scored poor to average while 49% vs 25% scored very good to excellent. The overall average score was 3.43 ± 0.67 SD vs 2.83 ± 0.48 SD respectively. HCPs trained in TxT (n41) pre and post testing shows knowledge increase of 15.14% with an overall average score of 6.67 ± 0.96 SD in pre-test vs 7.68 ± 0.66 SD in post-test. HCPs trained in PPOD (n296) pre and post testing shows knowledge increase of 76.45% with an overall average score of 4.6 ± 0.57 SD in pre-test vs 8.12 ± 0.53 SD in post-test. Conclusion: The innovative approach of ODISSeA as a multilevel educational intervention revealed different results between trainers vs trainees on perception and attitude, clinical knowledge vs non-clinical competencies. Significant knowledge increase was reported upon completion of both, TxT and PPOD. ODISSeA comes to meet the needs identified in deceased organ donation in the SeA region. The project succeeded in establishing recognized academic training in OD in the 8 SeA universities, following the best practices from the most successful European models. Due to covid-19, organ donation decreased in almost all countries worlwide. Malaysia and Thailand were and exception, reporting an increment in the deceased organ donation rates 2020 vs 2019. This increase can be attributed to ODISSeA’s implementation and, in the case of Malaysia, to the creation of Organ and Tissue Procurement Units (UPOH) in 16 hospitals, which was translated to a 155% increment in the organ donation family consent rates since UPOH and ODISSeA postgraduate programme began in January 2020. Acknowledgement to ODISSeA Consortium.

Analysis of motivating factors for eye donation among families of eye donors in South India - A questionnaire-based study.

To report the factors influencing eye donation among families of successful eye donors in India. The consenting family members of 434 deceased individuals who donated eyes between April 2019 and March 2020 were retrospectively interviewed via a telephonic questionnaire survey. Details regarding the donors and their families, motivating factors for eye donation, and time taken for tissue recovery were collected and analyzed. The mean age of donors was 66.8 years, and only 13.9% of them had pledged to donate their eyes before death. For 62.3% of donations, children of donors were the primary consenters for eye donation. In 18.8% of donors, there was a previous history of eye donation in the family. Many donations were motivated by a non-governmental organization volunteer (40.5%) or by a grief counselor at the hospital (27.4%). Hospital-based corneal retrieval programs and donations where the first eye bank contact was made through hospital personnel had the greatest percentage of rapid enucleations (performed within 3 h after death) (48.7% and 49.1%, respectively; P = 0.001 and P = 0.02, respectively). Children of donors, typically in the working-age group, most often make the decision for donation, and hence, future awareness programs should focus on this specific population. All types of hospitals should advocate for eye donation as they are a common point of contact for a grieving family, and health-care professionals at all levels should be considered for training as motivators for eye donation.

Chinese Efforts to Pursue Effective Communication With Family of Potential Organ and Tissue Donor

Within the last decade, deceased organ donation and transplantation in China have made great progress, but there is still much room for improvement. Inefficient communication with the family of potential organ and tissue donors is one of the major reasons for donor loss. In this study, the current progress of the deceased organ donation program in China was summarized, with a particular focus on the analysis of problems and solutions for achieving best practices in communication with the family of potential organ and tissue donors. This paper is in compliance with the Helsinki Congress and the Declaration of Istanbul.

The experiences of family members of deceased organ donors and suggestions to improve the donation process: a qualitative study.

Background:Decisions about organ donation are stressful for family members of potential organ donors. We sought to comprehensively explore the donation process from interviews conducted with family members of patients admitted to pediatric and adult intensive care units in Canada.Methods:We conducted a qualitative study using semistructured, in-depth interviews with 271 family members asked to make an organ donation decision. We recruited participants from all provinces with an organ donation organization (n = 10), and analyzed themes using a modified grounded theory approach. On the basis of these interviews, suggestions were made by researchers and family members on how to improve the process of organ donation.Results:We identified 3 main themes and 9 subthemes. Families need more comprehensive support around the time of donation, including having access to someone with shared experiences, support during specific moments as needed and better support during critical transitions (e.g., when the donor body goes to the operating room). The theme of better connection to recipient(s) included receiving information about the donation surgery (e.g., which organs were recovered), establishing connection with recipients (e.g., via social networks or letters) and planned encounters. Support after donation, such as updates on organ transplantation, early mental health checks and continued connection to donor organizations, could be improved. We derived 20 suggestions for improving the organ donation process, derived from interviews with family members of pediatric and adult organ donors.Interpretation:We found gaps in family support during end-of-life and donation care. Feelings of abandonment, lack of support and poor-to-little follow-up provide the empirical findings needed for hospitals and organ donor organizations to provide better support to donor families.

Standing on Both Sides: Analysis of a Transplant Coordinator's Ethical Position Between the Recipient and the Donor's Family

When an organ is harvested from a deceased donor, how should transplant coordinators handle the issue of contact between the donor's family and the organ recipient? The authors-qualified both by their own considerable practical experience and theoretical investigation-discussed various aspects of the problem, relating to the bioethical issues as well as the practical dilemmas that must be clarified and decided. They proposed a strategy whereby transplant coordinators can analyze their own philosophical attitude toward the issue and respond accordingly in their work to the needs and preferences of both parties. The professionals handling the transplant process need training tailored to the bioethical issues relevant to the challenges they are likely to confront. This training must consist not only of theoretical and ethical guidance but also simulations designed to clarify the clinician's own personal belief system and raise awareness and self-reflection of their own biases.

The Impact of a Gross Anatomy Curriculum With Donor Family Interaction: Thematic Analysis of Student Letters to Silent Mentors.

PurposeTzu Chi University’s anatomy curriculum incorporates interaction with donors’ families and regards body donors as silent teachers and altruistic role models. In this silent mentor program (SMP), students learn about their donor’s life before dissection to better appreciate the selfless donation. This study explores the influence of the program on students’ humanistic literacy based on student letters to silent mentors, which students wrote near the end of the program and laid by the silent mentor during the coffining ceremony.MethodThe study included 125 letters from third-year medical students who took the gross anatomy curriculum in academic years 2015, 2016, and 2017. With student consent, the program collated and published the letters in the open-access SMP yearbook. Using thematic analysis, the authors manually analyzed the letters in their original Mandarin, with the names of students made anonymous to ensure the authors were blind to students’ identity throughout the study.ResultsThe analysis identified 3 themes and 11 subthemes. Theme 1, my silent mentor, included 3 subthemes: life characteristics, altruistic attitude, and expectation of offering body. Theme 2, connection to silent mentor and family, included 4 subthemes: intersubjective bonding, emotive first encounter, spiritual communication, and encouragement from silent mentor. Theme 3, reflection and transformation, included 4 subthemes: reflection on life and death, professional self-expectation, inner transformation, and feedback action.ConclusionsThe findings suggest that interactions with donors’ families increased students’ appreciation of the donation and enhanced students’ humanistic literacy. Further, the letters seem to indicate that the SMP inspired students to develop a grateful, respectful, and empathic attitude toward life and their career. Thus, by implementing similar programs, gross anatomy curricula could go beyond the acquisition of structural knowledge to the cultivation of medical students’ humanistic literacy.

Evaluation of an eLearning System to Train Health Professionals to Communicate about Vascularized Composite Allotransplantation with Donor Families

Introduction: Vascularized composite allotransplantation (VCA) donation relies on obtaining surrogate authorization. Yet, many donor professionals have limited experience discussing composite allograft donation. Using virtual and interactive elements, the eLearning program, Communicating Effectively about Donation for Vascularized Composite Allotransplantation (CEaD-VCA), was developed to enhance the quality of donor professionals' communication approach. Research Questions: We tested the effectiveness of the eLearning program in improving donor professionals' knowledge, preparedness, and confidence leading discussions with families. Design: Donor professionals who primarily obtain family authorization for solid organ and tissue donation were recruited from 2 regional Organ Procurement Organizations. The training was evaluated using a nonrandomized pre-post design. Participants completed an online survey with items assessing their knowledge, preparedness, and confidence for donation discussions. Pre- and post-training responses were compared using paired sample t-tests. Results: The sample included 42 donor professionals. The majority (71.4%) had at least 3 years of work experience, and over half (52.4%) had no experience discussing VCA donation with families. Post-training, significant increases in mean knowledge scores (6.4 pre to 7.0 post, P < 0.01) and mean self-reported preparation (6.6 pre to 7.9 post, P < 0.0001) were observed. There were significant increases in mean confidence scores for discussing face (6.2 pre to 7.9 post, P < 0.0001) and hand (6.2 pre to 8.0 post, P < 0.0001) transplants. Conclusion: The CEaD-VCA program was effective in increasing donor professionals' knowledge, preparation, and confidence when discussing donation, and holds potential for improving donor professional communication during donation discussions.

The First Successful Combined Full Face and Bilateral Hand Transplant

Vascularized composite allotransplantation has redefined the frontiers of plastic and reconstructive surgery. At the cutting edge of this evolving paradigm, the authors present the first successful combined full face and bilateral hand transplant. A 21-year-old man presented for evaluation with sequelae of an 80 percent total body surface area burn injury sustained after a motor vehicle accident. The injury included full face and bilateral upper extremity composite tissue defects, resulting in reduced quality of life and loss of independence. Multidisciplinary evaluation confirmed eligibility for combined face and bilateral hand transplantation. The operative approach was validated through 11 cadaveric rehearsals utilizing computerized surgical planning. Institutional review board and organ procurement organization approvals were obtained. The recipient, his caregiver, and the donor family consented to the procedure. Combined full face (i.e., eyelids, ears, nose, lips, and skeletal subunits) and bilateral hand transplantation (i.e., forearm level) was performed over 23 hours on August 12 to 13, 2020. Triple induction and maintenance immunosuppressive therapy and infection prophylaxis were administered. Plasmapheresis was necessary postoperatively. Minor revisions were performed over seven subsequent operations, including five left upper extremity, seven right upper extremity, and seven facial secondary procedures. At 8 months, the patient was approaching functional independence and remained free of acute rejection. He had significantly improved range of motion, motor power, and sensation of the face and hand allografts. Combined face and bilateral hand transplantation is feasible. This was the most comprehensive vascularized composite allotransplantation procedure successfully performed to date, marking a new milestone in plastic and reconstructive surgery for patients with otherwise irremediable injuries.

Today We Walk. Tomorrow We Dance.

Today We Walk. Tomorrow We Dance Allen Callaci Roughly 10 years ago I was helicoptered from my local community hospital to Cedars-Sinai with less than a 25% chance of surviving the brief flight. I left work early, not feeling well that afternoon, and shortly after arriving home, blacked out across my bathroom floor. The heart that had been beating inside me for 40-plus years was in complete collapse. After more than 40 years, it was discovered that the circumflex branch of my left coronary artery had been underdeveloped since birth. My other arteries overcompensated over the ensuing decades, which slowly wore my heart down. I was tired in the years leading up to my transplant but I attached that weariness to my rich and active life, which was filled to the rim with working two jobs, being a grad student and occasionally singing in a rock ’n’ roll band. They say life changes in an instant. Mine changed quicker than that. I left work that afternoon thinking I’d be back in a day or so and catching a Bruce Springsteen concert I had tickets to the following week. Instead I woke up in a hospital bed hooked to oxygen and the symphony of a beeping heart monitor, connected to 27 IVs and two heart assist devices attached to each side of my heart. I woke in a medicated fog with my sister mentioning I was going to be having a heart transplant. I wondered if my situation was real or if I was dreaming and had been swept to a hospital located in Oz. The most positive and painful moments of my recovery and quest to get back home could sometimes be part of the same moment. There were excruciatingly painful moments as I balanced myself on a walker surrounded by a pit crew of nurses helping me balance all the IVs and an oxygen tank. One of the crew followed close behind me with a wheelchair if I should tire on my trek around the nurse’s station and should need a rest. Having not walked in weeks and weeks, each step was excoriatingly painful. My legs felt like a pair of wet flimsy noodles as I stood up for the first [End Page 120] time in a month and a half. My mind knew exactly what it was supposed to do, but the body wasn’t getting the message But as painful as these steps were (and they really were), I saw each step as one step closer to home. The staff at Cedars-Sinai were not just staff taking another patient on a walk—they made me feel like they were my crew with their reassuring and positive attitude as they guided me. I’ll be forever grateful to the nurse who, on one of my first brutally painful walks around the nurse’s station, lightheartedly told me that “today we walk, tomorrow we’ll dance.” I’ve known fewer moments as hopeful, humorous, and humanizing as that one. That mindset transferred onto me as we made our daily walks around the nursing station. Those walks became less and less painful with each passing day. I saw my progress as I graduated from walker, to cane, to being able to walk independently again. I have not stopped thinking of my donor and their family in the years since returning home from Cedars-Sinai, although I only know minimal details about them. I know they were 25 years old and a male. I have reached out to the family with written expressions of my enduring and unending gratitude over the years through the proper channels but have yet to hear back. When I sent out my initial note to the family, I was told that the odds were that I would likely not hear back as it can be an overwhelming emotional experience for donor families to meet the donor. This is more than understandable. My hope is only that my donor family found some small comfort and a sense of closure in my messages. I am often told by others what a journey I have been on. And it has been a journey...

Transplants: The One Hope.

The author is the father of a seven-year old child who was shot in an attempted robbery, whose organs and corneas were donated to seven people. He traces the impact of decisions to donate organs at a time when COVID-19 has brought an unprecedented level of stress on health services. He notes that, although most countries make it either difficult or impossible for donor families to communicate with their recipients, even if both sides want to, tens of thousands of families in the United States have written to each other, or even met face to face, with therapeutic results in the great majority of cases.

Qualitative and Quantitative Evaluation of Donor Corneal Tissue by Slit Lamp and Specular Microscopy.

BackgroundIn India, donor eye collection and promotion of eye banking are insufficient to meet the needs. By adequately evaluating donor corneas, eye banks can maximize the number of viable corneas for transplantation. This study evaluated donor corneal tissue based on age, lens status, and cause of death by their morphology and endothelial cell count via slit lamp and specular microscopy.MethodsWe conducted a prospective observational study of all eye bank donor corneas indicated for eye donation at a tertiary hospital and research center in Western Maharashtra between September 2019 to December 2021. We evaluated the corneoscleral discs by slit-lamp microscopy specular microscopy. We analyzed donor corneas quantitatively and qualitatively and graded them accordingly. We also collected blood samples for serological testing and the donor's behavioral and family medical histories.ResultsWe collected 94 eyes from 47 donors; the mean age of the donor population was 48.2 years, and most donors were aged 41 to 80 years. Thirty-one donors (65.96%) were male, and 16 were female (34.04%. For preservation, we used Cornisol (Aurolab, Madurai, India) in 36 cases (77%) and McCarey-Kaufman medium in 11 cases (23%). We found a mean endothelial cell density (ECD) of 2214.40/mm2, with hexagonality of 53.05%, and a coefficient of variation of 38.01. Further, we observed that ECD and hexagonality of cells in phakic donors were significantly greater than that of pseudophakic (PP) donors. Moreover, ECD and hexagonality significantly decreased in donors with the chronic disease compared to those who had a sudden, unexpected death.ConclusionCorneal grafts from younger donors, phakic donors, and donors who experienced an acute cause of death were qualitatively and quantitatively significantly better than those of older donors, PP donors, and donors who experienced sudden, unexpected death. Therefore, eye bank specular examination can improve tissue utilization and transplantation success. Therefore, we strongly recommend that eye bank personnel evaluate their donor tissue with a specular microscope to enhance the quality of eye care.

A Systematic Review on Improving the Family Experience After Consent for Deceased Organ Donation.

The demand for transplanted organs outweighs the supply and intensifies the need to improve care for donor families. Studies have shown inadequate care by hospital staff can increase posttraumatic stress disorder and complicated grief in these families but putting solutions into practice remains slow. This systematic review identified factors that relieve or contribute to distress for deceased organ donor families in the time since the decision to donate. Additionally, it provides insights into potential improvements at public health, educational, and health system levels to address these deficiencies. Search terms included organ don*, famil* or relati*, family-centered, grief, and experience*. The search covered original research articles, published in English, from 2014 to July 2021. Four key themes emerged among the studies. (a) Understanding factors that affect the emotional aftermath can help staff prevent posttraumatic stress disorder and complicated grief. (b) Improving communication by hospital staff includes: avoiding medical jargon, providing adequate audio and visual explanations, and understanding that the next of kin is struggling to comprehend the tragedy and the information they are being told. (c) End-of-life care such as memory making, bringing in palliative care resources, and parting ceremonies can assist with familial coping as well as staff interactions. (d) Families want more support in the months and years after the donation decision. Changes at multiple levels can improve the quality of care for families whose relative gave the gift of life, but more research and translation into practice are needed.