Donor Transplant Coordinators Research Articles

Professional burnout and its correlates in Polish donor transplant coordinators

Job demands-resources (JD-R) model of professional burnout states that job demands predict the feeling of exhaustion, and lack of job resources—disengagement from work. This research project investigated professional burnout and it correlates, including sex, death anxiety, and relationship status in 108 Polish donor transplant coordinators involved in organ, tissue, and cell transplantations. This study employed the Polish version of the Oldenburg Burnout Inventory which follows the JD-R model, the Psychosocial Working Conditions Questionnaire—a Polish instrument based on the model of job stress proposed by Karasek—and the Polish version of the Fear of Death and Dying Questionnaire. The results were suggestive of average levels of job stress and burnout in the studied population, with men being more disengaged than women. Participants who were in relationship had significantly higher levels of exhaustion than those who were single. Exhaustion was positively correlated with years of working as a transplant coordinator but not with participants’ age. Multiple negative correlations were detected between exhaustion/disengagement and different aspects of job control, social support, and well-being. Moreover, positive correlations between different components of fear of death and dying and exhaustion were detected. Our findings, linking fear of death and dying with some aspects of professional burnout in transplant coordinators, suggest that a pre-employment screening for the level of death anxiety in candidates for transplant coordinators could be useful as this job provides chronic exposure to mortality cues.

The role of specialist nurses for organ donation: A solution for maximising organ donation rates?

To explore the role that Donor Transplant Co-ordinators have played and the future potential of Specialist Nurses for Organ Donation (SN-ODs), within organ donation strategies in the UK and other countries. Organ donation and transplantation rates vary extensively around the world. However, there is a universal shortage of deceased donors, prompting different approaches to increase transplantation rates. Within the UK, the Clinical Lead for Organ Donation and Specialist Nurse in Organ Donation undertake a key role in the implementation of the Organ Donation Strategy. The Human Transplantation (Wales) Act 2015 is a recent development which facilities a deemed (presumed) consent approach to organ donation, the Specialist Nurse in Organ Donation undertakes a major role identifying the potential donor in this situation by confirming the deemed consent status of the donor and supporting bereaved relatives. UK governments in England and Scotland are currently seeking legislative changes to an opt-out system of organ donation, in line with the Wales change. This discursive paper explores the role from Donor Transplant Co-ordinator to Specialist Nurse in Organ Donation (SN-OD) within organ donation policy in different settings, but with a specific focus on the UK. The paper clarifies the current and future potential of nurses working with bereaved families when requesting authorisation for donation. The current scope and future potential of Donor Transplant Co-ordinator and Specialist Nurse in Organ Donation roles need better recognition. Little empirical data exist about the key role that these nurses play in the organ donation process, especially in relation to gaining authorisation to proceed to donation. There is a need to clarify the role of the Specialist Nurse in Organ Donation and their impact on improving rates of organ donation.

Activity of Hospital Transplant Coordinators in Malopolskie Province (Poland)

BackgroundIn Poland as well as in other European countries, the number of organs from deceased donors is too small to meet the needs of transplantation therapy. MethodsThis situation can be improved by increasing the number of hospital transplant coordinators in hospitals with potential of donation. Since 2010, 200 Polish hospitals have employed coordinators whose role is to recruit deceased organ donors, to monitor the potential of donation (quality assurance program), and to run the training courses. In Malopolskie Province, there are 26 hospitals in which organ procurement from brain-dead donors is possible. In 13 hospitals, donor transplant coordinators have been employed. The objective of this study was to evaluate the activity of hospitals in Malopolskie Province in the field of donor recruitment before and after employment of coordinators (19 months before and after). For the purpose of the study, the number of hospitals with positive effects and with no effects of coordinator employment was calculated, and several donation rates were compared in the period before and after employment of the coordinator. We also compared the number of deceased organ donors in 13 hospitals employing a coordinator and in 13 hospitals without a coordinator. ResultsThe desired impact of employment of coordinators in Malopolskie Province measured by improvement of organ donation rates was observed in half of the hospitals (7 of 13; 54%) with a transplant donor coordinator. The number of potential organ donors increased by 100% (from 24 to 48), and the number of actual organ donors increased by 113% (from 16 to 34). The percentage of family objections to organ donation decreased (from 17% to 8%). The best result of employing coordinators was observed at university hospitals and multidisciplinary hospitals and at hospitals in which the coordinator was a physician. The worst effect was recorded at county hospitals. ConclusionsThe employment of hospital transplant coordinators in Malopolskie Province has a global impact on the increase of the number of actual organ donors in that region and improvement of organ donation rates, but it is effective only in half of the hospitals with coordinators. It indicates that other measurements should also be undertaken to run donation programs.

Use of donor bladder tissues for in vitro research

To evaluate deceased non-heart beating (DNHB) donors and deceased heart beating (DHB) brain-stem dead donors, as sources of viable urological tissue for use in biomedical research. To identify sources of viable human bladder tissue as an essential resource for cell biological research aimed at understanding human diseases of the bladder and for developing new tissue engineering and regenerative medicine strategies for bladder reconstruction. Typically, normal human urinary tract tissue is obtained from adult or paediatric surgical patients with benign urological conditions, but few surgical procedures yield useful quantities of healthy bladder tissue for research. Research ethics committee approval was obtained for collection of donor bladder tissue. Consent for DHB donors was undertaken by the Donor Transplant Coordinators. Tissue Donor Coordinators were responsible for consent for DNHB donors and the retrieval of bladders was coordinated through the National Blood Service Tissue Banking Service. All retrievals were performed by practicing urologists and care was taken to maintain sterility and to minimise bacterial contamination. Two bladders were retrieved from DNHB donors and four were retrieved from DHB donors. By histology, DNHB donor bladder tissue exhibited marked urothelial tissue damage and necrosis, with major loss or absence of urothelium. No cell cultures could be established from these specimens, as the urothelial cells were not viable in primary culture. Bladder urothelium from DHB donors was intact, but showed some damage, including loss of superficial cells and variable separation from the basement membrane. All four DHB bladder specimens yielded viable urothelial cells that attached in primary culture, but cell growth was slow to establish and cultures showed a limited capacity to form a functional barrier epithelium and a propensity to senesce early. We have shown that normal human bladder urothelial cell cultures can be established and serially propagated from DHB donor bladders. However, our study suggests that rapid post-mortem changes to the bladder affect the quality and viability of the urothelium, rendering tissue from DNHB donors an inadequate source for urothelial cell culture. Our experience is that whereas patients are willing to donate surgical tissue for research, there is a barrier to obtaining consent from next of kin for retrieved tissues to be used for research purposes.

Donation after circulatory death – a new role for the anaesthetist?

Donation after circulatory death – a new role for the anaesthetist?

Recent changes in the role of the donor transplant coordinator

Tracy Rhodes explains how the role of transplant coordinator was first developed in the UK 30 years ago. In 2008, the Organ Donation Taskforce stated its main aim of increasing organ donation by 50% in the UK by 2013. Their recommendations resulted in changes to the role of donor transplant coordinator (DTC) and the emergence of the new role of specialist nurse-organ donation (SN-OD).

Organ Donation and Transplantation after Cardiac Death

Technical refinements, improved immunosuppression and long-term care have transformed transplantation from an experimental procedure to an established life-saving and life-prolonging treatment with good survival rates in both the short- and long-term. However, the issues surrounding organ donation remain one of the most difficult areas in transplantation and the shortage of donor organs is the major limiting factor, with growing numbers of patients on waiting lists world-wide. A variety of factors including improved road safety and changes in neurosurgical management have led to a decreased number of conventional heart-beating brain-stem-dead donors in some countries and has prompted a resurgence of interest in donation from donors after cardiac standstill - originally called ‘non heart beating’ donation but now more commonly referred to as ‘donation after cardiac death’ as in the title of this book. This volume is, therefore, extremely timely, addressing a rapidly developing field. Both editors have long track records in this area and they have chosen a wide range of international experts as contributors. On the whole, they have succeeded in covering the field comprehensively. Like any multi-author volume there is some degree of repetition of material from chapter to chapter but this leaves the virtue that chapters can be read as a complete source by those only wishing to dip into the volume for specific topics. Areas covered include techniques of retrieval, organ preservation, resuscitation after retrieval, organ assessment and the outcomes of transplantation in kidneys, livers and lungs retrieved from such donors. The commonest (but not the only) form of donation after cardiac death is retrieval of organs from patients where supportive treatment has been withdrawn in an intensive-care setting. Some of the thorniest issues in such donations arise in the management of these patients prior to their death and in the immediate period after cardiac standstill. These issues are remarkably well rehearsed and reviewed in the chapter on legal and ethical issues by Sam Shemie and Michael DeVita, who have managed to put together an impressive review of the situation and the relevant legal framework across the world. This book will be of interest and value to all working in the area of solid-organ transplantation. It contains information relevant to established consultants in transplantation, trainees and both recipient and donor-transplant co-ordinators.

Implementing minimum notification criteria for organ donation in an acute hospital's critical care units

To increase the number of donated organs through an effective donor identification and referral scheme in a large acute hospital's critical care units. The barrier to successful organ transplantation is a serious shortage of donated organs. In January 2008, the Department of Health officially endorsed all 14 recommendations presented by the Organ Donation Taskforce. Recommendation 5 from the Taskforce is that minimum notification criteria for potential organ donation should be introduced on a UK-wide basis. A hospital policy entitled Required Referral was implemented into a large hospital trust consisting of four critical care units. Support from the trust board was sought and it was agreed that the policy would be implemented as a 'pilot policy' in the first instance, then a formal review after a 6-month period. A rolling education programme was instituted to incorporate 170 clinical staff to ensure the policy was activated with the following criteria: If the plan is to perform brain stem death tests on a patient or a clinical decision is made to withdraw treatment, the on-call donor transplant co-ordinator is contacted for an assessment of suitability. A significant increase in potential donor referrals and a 200% increase in donated organs has been achieved with the policy in place. A retrospective audit for the 6-month period prior to the policy launch had shown four referrals from the pilot sites. The following 12 months as the policy was implemented revealed an impressive 121 referrals to the transplant co-ordinator. This has resulted in nine successful multi-organ donors. The required referral scheme has clearly shown an impressive increase in donation activity within the trust. Donation has been embraced as a normal part of end of life care.

Clinical Leads for Organ Donation: Making it Happen in Hospitals

The report from the Organ Donation Taskforce into the relatively poor rates of donation in the UK called for a complete overhaul of the processes that currently support the identification, referral and management of potential organ donors dying in our hospitals. Although some of the specific recommendations of the Taskforce refer to the responsibilities of national bodies such as the Department of Health or NHS Blood and Transplant, at the very heart of the Taskforce report are those recommendations that are concerned with how the option of donation is made available to patients when they die. Thus, the Taskforce recommended that donation should be a component of end-of-life care, that brainstem death should be diagnosed wherever possible and that potential donors should always be referred according to defined minimum criteria and regardless of apparent donation potential. However, it was recognised that this was unlikely to happen unless every hospital had a team to make it possible - the Donation Committee - that was chaired and driven by a non-clinical champion, enhanced by a donor transplant co-ordinator and lead by a clinician. This paper develops these themes and describes, by focusing on a collaborative relationship between donor transplant co-ordinators and clinical leads for organ donation, how real improvements in the number of organ donors might be achieved.

Transplant Coordinators and Communication With Potential Organ Donor Migrant Families in France: An Exploratory Qualitative Study

Donor transplant coordinators often face organ donation refusals by migrant families in France. A multidisciplinary Working Group was asked by “Fondation Greffe de Vie” and Roche Company, in collaboration with the French national agency “Agence de la Biomédecine,” to design a support program to improve communication between coordinators and families from other cultures upon the death of a family member who could be a potential donor. CerPhi was asked to conduct a survey of 30 coordinators in 22 French establishments. Most of the interviewed coordinators indicated that cultural differences complicate communication with families, leading to a higher proportion of organ donation refusals than among the local population. Coordinators are looking for a better knowledge of cultural and religious patterns as well as pertinent transcultural behaviors to improve their communication with families in the painful moment of raising the question of organ consent.

Effect of “collaborative requesting” on consent rate for organ donation: randomised controlled trial (ACRE trial)

Objective To determine whether collaborative requesting increases consent for organ donation from the relatives of patients declared dead by criteria for brain stem death.Design Unblinded multicentre randomised controlled trial using...

Results from a Questionnaire to ICU Clinicians and Donor Transplant Co-Ordinator Team Leaders on Collaborative Requesting for Organ Donation

Results from a Questionnaire to ICU Clinicians and Donor Transplant Co-Ordinator Team Leaders on Collaborative Requesting for Organ Donation

Non-Heart Beating Organ Donation: A Case Study

The aim of this case study is to discuss the clinical management of a non-heart beating organ donor. This case study will concentrate in particular on the clinical assessment of the potential donor patient undertaken by the donor transplant coordinator (DTC) and the donation process up to the time of transplantation. The author will also describe the differences between heart beating and non-heart beating donors and discuss how transplantation can benefit renal recipient patients.

POTENTIAL DONOR AUDIT

P137 Aims: As part of a series of measures to improve organ donation, UK Transplant (UKT) has established a potential donor audit (PDA). No large scale donor audits have been undertaken in the UK since the late 1980s and UKT’s PDA aims to provide an up-to-date assessment of the potential for organ donation from Intensive Care Units (ICUs) in the UK. Methods: Since January 2003, data have been and are currently being collected by donor liaison nurses in the 34 ICUs where they are in post, and by donor transplant co-ordinators and/or link nurses in all other units. An audit form developed in collaboration with other appropriate personnel is being used. One form is completed for each patient death in an ICU. Results: An evaluation of six months of data (April-September 2003) has shown that at the time of analysis, 273 hospitals (347 ICUs) had reported at least one patient death. Of the 10,390 audited patient deaths, death was diagnosed following brain stem death tests in 545 (5%) patients. In 64 (12%) of 545 families there was no record of any discussion of donation with relatives. Of the 481 patients for whom the possibility of solid organ donation was suggested to relatives, consent for donation was given for 275 (57%) and not given for 206 (43%) patients. Of the 275 patients for whom consent for donation was given, 250 (91%) became heartbeating solid organ donors. Although this analysis showed that the overall relative refusal rate was 43% (95% CI: 39%-47%), there was considerable variability in this rate over time. The relative refusal rate for April-June 2003 was 48%, for July-September 2003 it was 37%. Further analyses of the overall relative refusal rate by age, gender and ethnicity were performed. Age was categorised into six groups: 0-17, 18-24, 25-34, 35-49, 50-59 and 60+ years. Due to the small numbers of non-white patients, ethnicity was categorised into two groups: white and non-white. For age, there was no significant difference in the relative refusal rates across the age groups, but there was evidence to suggest that the relative refusal rate was significantly lower in the 18-24 year group. For ethnicity, there was a significant difference in the relative refusal rate (p<0.01) with 38% (95% CI: 33%-43%) of relatives refusing consent for white patients compared with 70% (95% CI: 54%-86%) for non-white patients. The relative refusal rates for male and female patients were 41% and 45%, respectively; there was no significant difference in these percentages. Conclusions: It is hoped that more in-depth analyses of these data will indicate the extent of variation across the UK in the relative refusal rate and the reasons for families not consenting to donation. In the meantime UKT hopes that the national PDA will continue to raise the profile of organ donation and heighten awareness of donation issues amongst all critical care staff. Most importantly, it will allow a realistic estimate to be made of the true potential for organ donation in the UK and the identification of both local and national obstacles to realising the potential.