Organ Transplant Coordinators Research Articles

Knowledge, Attitudes and Intention to Donate Organs among the Public, Health Sciences Students and Health Personnel: A Scoping Review with a Systematic Review of Malaysian Studies.

Various barriers lead to a shortage of organs for transplantation in Malaysia. One drive to improve the organ donation rate operates through future healthcare practitioners and practitioner advocacy. This scoping review was carried out to establish and summarise findings about organ donation-related articles among the public, health sciences students and health personnel. A further aim was to synthesise the latest data on knowledge and attitudes towards organ donation in the Malaysian population. PubMed, Scopus, Google Scholar and the Malaysian Medical Repository (MyMedR) were used for a search conducted up to May 2022. Relevant search terms included 'Organ donation' and 'Malaysia'. Journal articles related to knowledge, attitudes and intention were grouped under the general public and health science. Students and health personnel were included. Eligible studies were reviewed by two independent reviewers. Any disagreements were resolved by consensus with a third reviewer. The 31 included articles revealed an increased level of awareness among the public regarding organ donation. The analysis identified that nonrecognition of brainstem death (38.5%), no knowledge of how to contact the Organ Transplant Coordinator (82.3%) and never approaching the families of a potential donor (63.9%) led to a lack of confidence among healthcare practitioners to promote organ donation. The shortage of organ donors is the result of the failure to identify the expected donor, obtain consent and procure the organs due to the passivity of Malaysian health professionals in promoting the organ donation process.

Analysis of Personal and Cultural Beliefs Related to Organ Donation in Saudi Arabia

This article aimed to perceive and analyze the obstacles and demanding situations dealing with the organ donation manner in Saudi Arabia, and to observe how cultural factors affect society’s outlook and choices concerning organ donation, as organ donation contributes significantly to improving public health and saving the lives of people who be afflicted by Incurable sicknesses. Through using the experimental approach and the usage of the questionnaire as an examination tool among the residents of KSA during 2023, this cross-sectional study showed that lack of awareness and information are principle obstacles to organ donation in KSA. This is due to personal and cultural beliefs connected to habits and traditions, and we found that the doctor is responsible for the case of brain death and the organ transplant coordinator must be fully aware of these matters, as well as they must have a spirit of inquiry and good listening, and they must also have a sense of the non-verbal language of the brain-dead’s family that may be a major reason for their approval to donate the organs of the brain dead, and taking into consideration that organ donation awareness as one of the critical issues in transplantation centers.

Evaluation of patients diagnosed with brain death in the intensive care unit: 10 years of tertiary center experience in Istanbul.

Early and accurate diagnosis of brain death in intensive care units (ICU) is essential for organ transplantation. This study aimed to evaluate the cases diagnosed with brain death in the ICU of a tertiary center in Istanbul. The cases diagnosed as brain death in the ICU during the ten years between January 2013 and September 2022 were evaluated retrospectively. The demographic characteristics of the patients, the diagnosis of hospitalization in the ICU, the time from arrival to the ICU until the diagnosis of brain death, the somatic survival time after the diagnosis of brain death, the acceptance rate of organ donation by the families and the organs removed were evaluated. A total of 44 patients were diagnosed with brain death. The mean age of the cases was 39.7±17.4 years, and 63% were male. The most common hospitalization diagnosis was intracranial hemorrhage (81.8%). Traffic accidents, hypertensive and aneurysm-related hemorrhages, gunshot wounds, and falls from height were the most common causes of intracranial hemorrhage. Patients were admitted to the ICU most frequently from the emergency department (54%). The mean time to brain death was 7.9±6.2 days, and the somatic survival time was 1.9±1.9 days in patients who did not receive organ transplantation. While the apnea test was positive in 91% of the cases, the apnea test could not be completed in 9% of the cases. While relatives of 7% (n=3) of the cases accepted organ donation, a patient was not allowed to be an organ donor for medical reasons. Organ transplantation was performed in two patients (5%). As in the whole world, getting treatment as soon as possible for the patients waiting on the organ transplant list in Turkiye by increasing the number of organs to be obtained from cadavers. In cases with suspected brain death in the ICU, diagnosing brain death as soon as possible and conducting family interviews with trained organ transplant coordinators will increase the number of cadaver donors. However, we think policies should be developed to ensure that society is informed and encouraged about brain death and organ donation.

Manpower, task performance and analysis of organ transplantation coordinators in Korea

Manpower, task performance and analysis of organ transplantation coordinators in Korea

Care of the organ transplant receiver: Review

Organ transplantation is the process of replacing damaged/inoperative organs with healthy ones. Many parameters are considered in the decision-making process for this procedure. At first, compatibility parameters of the recipient individual and the donor should be evaluated. All laboratory values and tissue compatibility tests should be compared. The organ transplant coordinator shares the patient’s compliance information with the team. The recipient patient is informed of the match, and the process begins. Preparing the recipient for transplantation is as difficult as finding the appropriate organ. During the first stages, the individual is evaluated and meets with the entire transplant team. Everyone on the transplant team explains their roles and responsibilities. The patient can ask questions. Information is given about complications and negative care processes encountered after transplantation. Patients most often experience differences of opinion in religious and cultural dimensions. On the one hand, he/she wants to live; on the other hand, he/she thinks transplantation is a “sin”. These confusing thoughts can increase and be replaced by psychosocial issues. The transplant nurse initiates the patient’s rehabilitation process. This process is based on an immunosuppressive treatment plan to strengthen the patient’s immunity before transplantation. The transplantation plan provides guidance on transplant day, donor patient preparation, and organ safety. This review serves as a guide for recipient individual. This review study consists of specific sub-titles related to the subject.

Reflex and Spontaneous Movements in Pediatric Patients with Brain Death.

Reflex and spontaneous movements are not uncommon in brain death patients. However, most studies have been conducted in adults, while reports in infants and children are rare. Thus, we aimed to evaluate the frequency and characteristics of these movements in pediatric patients declared as brain death. Records of pediatric patients who were diagnosed as brain death from 15 hospitals in the Yeongnam region, South Korea, between January 2013 and September 2016 were analyzed. All body movements in patients who met the criteria for brain death as established by the Korea Medical Association were assessed by medical doctors and trained organ transplant coordinators. The frequency and characteristics of these movements were identified. Additionally, the demographic and clinical factors of the brain death patients with and without these movements were compared. A total of 31 patients who met the criteria for brain death were enrolled. Seven patients (22.6%) showed either reflex or spontaneous movements; six of them (85.7%) showed reflex movements only, and one patient (14.3%) showed both types of movements. The most common types of reflex movements were the flexor/extensor plantar response and isolated finger jerk. Four of seven patients (57.1%) showed a single movement pattern, while three (42.9%) showed two different movement patterns. It is essential for physicians who perform pediatric brain death examinations to recognize the frequency and characteristics of reflex and spontaneous movements, and this article may help in the accurate and prompt diagnosis of brain death.

Reflex and Spontaneous Movements in Pediatric Patients with Brain Death

Reflex and spontaneous movements are not uncommon in brain death patients. However, most studies have been conducted in adults, while reports in infants and children are rare. Thus, we aimed to evaluate the frequency and characteristics of these movements in pediatric patients declared as brain death. Records of pediatric patients who were diagnosed as brain death from 15 hospitals in the Yeongnam region, South Korea, between January 2013 and September 2016 were analyzed. All body movements in patients who met the criteria for brain death as established by the Korea Medical Association were assessed by medical doctors and trained organ transplant coordinators. The frequency and characteristics of these movements were identified. Additionally, the demographic and clinical factors of the brain death patients with and without these movements were compared. A total of 31 patients who met the criteria for brain death were enrolled. Seven patients (22.6%) showed either reflex or spontaneous movements; six of them (85.7%) showed reflex movements only, and one patient (14.3%) showed both types of movements. The most common types of reflex movements were the flexor/extensor plantar response and isolated finger jerk. Four of seven patients (57.1%) showed a single movement pattern, while three (42.9%) showed two different movement patterns. It is essential for physicians who perform pediatric brain death examinations to recognize the frequency and characteristics of reflex and spontaneous movements, and this article may help in the accurate and prompt diagnosis of brain death.

The System of Transplant Coordinators in Poland: Poltransplant Activity

One of the important tasks of a modern hospital, in addition to treatment, prevention, and education, is the activity in the field of donating organs from deceased and living donors. In July 2010, the Polish Transplantation Coordination Center Poltransplant (the national transplantation organization and the authority responsible for organ donation and transplantation), thanks to the funds of the Ministry of Health, under the National Program for the Development of Transplant Medicine, initiated the project of building a network of coordinators by employing hospital transplantation coordinators in selected hospitals, where it is possible to identify potential deceased donors, perform the brain death diagnostic procedure, and where the conditions are met and it is possible to collect organs (they have an intensive care unit and operating theater in their structures). In Poland, these conditions are met by 388 hospitals with a donation potential. The aim of the work is to present the functioning of the system of transplant coordinators in Poland. The work presents the system of employment and tasks of transplant coordinators at various levels: hospital coordinators for donating organs from deceased donors, living donation and transplant coordinators, coordinators of hematopoietic cell collection and transplantation, central coordinators of Poltransplant, and organ procurement and transplant coordinators associated with transplant centers.

Making it happen: data practices and the power of diplomacy among Danish organ transplant coordinators

Danish transplant coordinators handle all data and logistics involved with the removal and transfer of organs from the body of an organ donor into several recipients in other Scandinavian hospitals. This entails a wide range of data work, not only in relation to sudden organ donation cases, but also to documenting transplantations, providing feedback on donation outcomes, and facilitating the data needed by surgeons or other health professionals. This article investigates the data practices of organ transplant coordinators through the lens of diplomacy. Based on participant observation and interviews among Danish transplant coordinators, I focus on the cross-disciplinary relations and negotiations characterizing organ exchanges and show how datafication in itself is not enough to ensure smooth transplantation processes. Organ transplantation depends on the diplomatic social skills of the coordinator and the personal relationships between coordinators, surgeons and ICU staff. By bringing into focus the power of diplomacy, I conceptualize these structurally invisible efforts enabling organ donation and its associated data practices. Diplomacy enables us to recognize and understand the relational efforts and aspects of datafication, and the tremendous amount of work and social skill that go into producing and exchanging data in contemporary healthcare.

An investigation of ethical conflict, ethical competency and educational needs for the organ transplant coordinators

An investigation of ethical conflict, ethical competency and educational needs for the organ transplant coordinators

Burnout, compassion fatigue and work-related stressors among organ donation and transplantation coordinators: A qualitative study

AimOrgan and Tissue Donation Coordinators (OTDCs) are healthcare professionals who manage deceased organ donation cases. This study investigated the experiences and perceptions of OTDCs, pertaining to compassion fatigue, burnout, and resilience as it relates to their daily work. MethodologyA qualitative descriptive study was undertaken using semi-structured interviews conducted with a convenience sample of OTDCs. SettingA Canadian Organ Donation Organization. FindingsSeven out of the ten OTDCs contacted participated in this study. Coordinators all agreed that they work in a high-pressure and demanding environment and the constant exposure to work-related stress and grief has resulted in the majority of them experiencing signs and symptoms of burnout and compassion fatigue occurring throughout their career. Participants described that the emotional toll of work-related stressors and difficult cases led them to use a variety of defence strategies to protect and support their well-being. They also recognised that more strategies to help mitigate work-related stressors and to prevent burnout and compassion fatigue are needed and that management and institutions should lead the development of such interventions. ConclusionOur results describe how coordinators’ mental health is affected by their daily work. Further research is needed to comprehensively examine these work-related stressors and to generate additional data to support the development of interventions to mitigate burnout and compassion fatigue among OTDCs.

Role of Emotions in Curating Professional Identity:An interplay of Identity Work and Identity Play

In this study we study the identity formation and sustenance in case of nascent jobs where existing frames, expectations and ideal identities are absent. We conduct a narrative inquiry of thirty three Organ Transplant Coordinators (OTCs) in India. We propose a three staged model of Identity Progression consisting of Identity Probing, Identity Steadying and Identity Advocacy stages as the OTCs enter and sustain in their careers. The stages illustrate the interplay between identity play and identity work, emotional and cognitive salience and sensemaking and sense giving. Our paper contributes to research on the role of emotions in identity work and identity play in several ways. First, we propose that in nascent professions with underdeveloped or equivocal identity, identity play and identity work might not be mutually exclusive. In such situations, we posit that identity play and identity work proceed in a reflective and iterative process thereby creating a unique individual professional identity. Further, we examine the role of emotions in identity play and identity work by exploring the ways in which emotions not only affect identity work but also become an integral part of creating a new identity. Finally, we establish the critical role of context in identity work and identity play. We discuss practical implications for facilitating identity formation and sustenance processes in nascent professions.

Beyin Ölümü Tanısı Alan Hastaların Retrospektif Analizi

Amaç: Bu çalışmada beyin ölümü tanılı hastaların özellikleri, organ bağışı oranları ve uygulanan donör bakımının irdelenmesi amaçlanmıştır. Materyal ve Metot: 2013-2020 yılları arasında hastanemizde beyin ölümü tanısı alan hastaların dosyaları taranarak yaş, cinsiyet, yandaş hastalıkları, yatış tanısı, yatış zamanı, beyin ölümü zamanı, tanı testi yöntemleri, organ bağış oranı, nakledilen organların sayıları, donör bakımında uygulanan tedaviler ve kardiyak arrest süresi gibi veriler kaydedildi. Bulgular: Çalışmamızda 41 hastada beyin ölümü tanısı konulurken 6 (%14,6) hastada organ bağışına onay saptandı. Beyin ölümüne en sık yol açan nedenler travmatik beyin hasarı (n=17) ve serebrovasküler olay (n=17) idi. Hastaların yaş ortalamaları 46,73 ± 23,5 (6-80) iken bunların 6’sı çocuk, 21’i yetişkin ve 14’ü yaşlı hasta idi. Hastaların 12’si (%29,3) kadın, 29’u (%70,7) erkekti. Organ bağışı izni verilmeyen 35 hastada ortalama kardiyak arrest süresi 47,17 ± 38,8 (1-167) saat saptandı. Donör bakımında düşük doz dopamin infüzyonu (4 µg/kg/dk), metilprednizolon infüzyonu ve levotiroksin uygulandığı saptandı. Sonuç: Kadavradan organ transplantasyonu için beyin ölümü tanısının konulması önem arz etmektedir. Nörolojik prognozu kötü hastalar beyin ölümü ve potansiyel donör olmaları açısından yakın takip edilmelidir. Organ bağışını arttırmak için eğitimli ve deneyimli organ nakil koordinatörlerine ihtiyaç vardır. Nakledilen organların sayısını ve kalitesini arttırmak için güncel literatüre uygun donör bakımı protokolleri oluşturulmalıdır.

Evaluating the Relationship Between Burnout Levels and Compassion Fatigue, Emotional Intelligence, and Communication Skills of Organ Transplant Coordinators

AimThe aim was to determine the effects of compassion fatigue, emotional intelligence levels, and communication skills of organ transplant coordinators on burnout. MethodsThis descriptive correlational study included 104 organ transplant coordinators. Data were collected via a survey that consisted of demographic information, the Copenhagen Burnout Inventory, the Emotional Intelligence Scale, and the Compassion Fatigue Scale. FindingsA positive relationship was reported between burnout (mean, 39.42 [SD, 19.54]) and compassion fatigue (mean, 2.26 [SD, 0.86]) measurements of the organ transplant coordinators (r = 0.432) and a negative and significant relationship existed between burnout and emotional intelligence (mean, 3.53 [SD, 0.58]) measurements (r = −0.372). However, no correlation was found between communication skills (mean, 4.27 [SD, 0.52]) and burnout (r = −0.184; P > .05) except a negative correlation with client-related burnout measurements (r = −0.222; P < .05). As a result of the 2-step regression analysis, the regression-squared value predicted the joint effect of compassion fatigue and emotional intelligence on burnout (R2 = .285). ConclusionsOrgan transplant coordinators reported moderate levels of burnout and compassion fatigue and high levels of emotional intelligence and communication skills. Compassion fatigue caused burnout, while emotional intelligence decreased. Additionally, transplant coordinators’ communication skills were related to client-related burnout.

Reflex and Spontaneous Movements in Adult Patients during the Process of Determining Brain Death in Korea.

BackgroundBrain death is a clinical diagnosis that implies irreversible loss of function of the entire brain, including the brainstem and both hemispheres. Based on previous reports, it is not rare for reflex and spontaneous movements to occur in patients during the process of determining brain death. However, reports of the frequency and common types of these movements vary from study to study. Thus, we evaluated adult patients with impending brain death in Korea to determine the frequency and characteristics of reflex and spontaneous movements.MethodsBrain dead patients who were admitted to 15 hospitals in the Yeongnam region (Southeast) of Korea were recruited prospectively from January 2013 to September 2016. All patients met the criteria for brain death as established by the Korea Medical Association. All body movements occurred during the process of diagnosing brain death and were assessed by physicians and trained organ transplant coordinators. The frequency and characteristics of these movements were identified and the demographic and clinical factors of impending brain dead patients with and without these movements were compared.ResultsA total of 436 patients who met the criteria for brain death were enrolled during the study period. Of these patients, 74 (17.0%) exhibited either reflex or spontaneous movements. Of this subset, 45 (60.8%) exhibited reflex movements only, 18 (24.3%) exhibited spontaneous movements only, and 11 (14.9%) exhibited both reflex and spontaneous movements. The most common reflex movements were the flexor/extensor plantar response and spinal myoclonus. Of the 74 patients, 52 (70.3%) exhibited one movement of the same pattern and 22 (29.7%) exhibited two or more different movement patterns. In addition, 45 (60.8%) exhibited these movements only on a limited area of the body with the leg being most common (n = 26, 57.8%). Patients with hypoxic brain damage and a higher systolic blood pressure exhibited significantly more reflex or spontaneous movements.ConclusionMovements associated with brain dead patients are not rare and thus an awareness of these movements is important to brain death diagnosis. Physicians who perform brain death examinations should understand the frequency and characteristics of these movements to reduce delays in determining brain death.

Análisis del perfil de la enfermera coordinadora de procuramiento de órganos en Chile

RESUMEN Introducción: En Chile, los coordinadores de procuramiento son mayoritariamente enfermeras y la tasa de donación es muy baja respecto a su población. Objetivo: Analizar la coherencia entre el perfil del enfermero/a coordinador de procuramiento definido por el Ministerio de Salud y el observado en los coordinadores chilenos. Material y Método: Estudio descriptivo, cuantitativo, muestreo no probabilístico, de enfermeras que se desempeñaban cómo Coordinadores de Procuramiento en servicios asistenciales públicos y privados de Chile. Las Variables estudiadas fueron de carácter sociodemográficas, de caracterización profesional, de capacitación, estructura de la unidad de procuramiento, y de requisitos del cargo de coordinador. Datos recolectados en el mes de octubre del año 2017, en el III Encuentro Nacional de Coordinadores de Procuramiento y Trasplantes, a través de un cuestionario estructurado, que permitió contrastar el perfil obtenido con el perfil definido por el Ministerio de Salud (MINSAL) Resultados: Los coordinadores de procuramiento, son en un 82.4% de sexo femenino, promedio de edad de 36+ 11 años .El 90.2% se desempeña en un Hospital Público. El 100% tiene título enfermera acreditada, un 30 % entre 1 y 4 años de egresados, y un 37 % menos de 5 años de experiencia laboral. Sin experiencia clínica en cuidados de alta complejidad, como unidades de Urgencia (82.3%) o cuidados intensivos (58.8%). El 66,5% consideró que la formación inicial, fue suficiente para asumir el cargo. Conclusiones: En los aspectos estudiados, el perfil profesional de los enfermeros coordinadores locales difiere del perfil definido por la autoridad de salud.

Early identification and referral of organ donors in five private hospitals: A survey to determine the knowledge and views of critical care professional nurses pre and post a PowerPoint training intervention.

Internationally, the declining number of organ donors does not meet the rising demand for life-saving solid organ transplant operations. Critical care professional nurses play an important role in the identification of organ donors. A deeper understanding is needed of the missed opportunities of identification and referral of potential organ donors to organ transplant co-ordinators in the critical care environment. To describe the knowledge and views of critical care professional nurses (CCPNs) in South Africa concerning the early identification and referral of organ donors, and to describe the short-term effect of implementing a PowerPoint training intervention on nurses' knowledge in this domain. A mixed method, experimental, exploratory, descriptive study design was followed. Critical care professional nurses in seven intensive care units at five private hospitals completed a data collection instrument comprising 11 quantitative and three qualitative questions, before and after completing a PowerPoint training intervention. The post test was done directly after the training intervention due to the environment of nursing shift work. A total of 173 (79%) CCPNs participated, from a population of 218. The median (interquartile range) score for all participants increased from 60% (48 - 76) prior to the PowerPoint training intervention, to 96% (88 - 96) after the intervention (p<0.0001). Three main themes emerged from the qualitative questions: stress experienced by the CCPNs during the organ donor process (62%); inadequate collaboration between doctors and nurses (34%); and the need for a policy (9%) to guide the donor referral process. CCPNs' knowledge regarding the early identification and referral of potential organ donors increased significantly following a targeted PowerPoint training intervention. The identified themes suggest that CCPNs require support in order to effectively communicate with the donor's family and medical staff. The findings of this study will contribute to the increase in organ donor referrals. Increased education of critical care professional nurses and doctors on effective communication, and the early identification and referral of organ donors, will expectedly help to resolve the critical barriers in the organ donor process.

P.146: The investigation of the effect of Bursa region’s organ transplantation coordinators’ working conditions to the rates of family donation.

P.146: The investigation of the effect of Bursa region’s organ transplantation coordinators’ working conditions to the rates of family donation.

Our Brain Death and Organ Donation Experience: Over 12 Years

PurposeNowadays, as the number of patients waiting for organ transplant is increasing, it is important to diagnose brain death in intensive care units and to provide good donor care. We aimed to share our experience of donor care with the diagnosis of brain death in our clinic. Material and methodOne hundred and fifty-one patients diagnosed in our clinic with brain death between June 2006 to 2018 were studied retrospectively. FindingsThe mean age of the 151 patients was 46.6 (1–89) years. Fifty-seven (37.7%) of the 151 patients’ families accepted donation. Ten out of 57 patients could not be organ donors for medical reasons. Eighty-four kidneys, 7 hearts, and 40 livers were transplanted to the patients. When the diagnosis at admission to the intensive care unit was examined, it was found that the most common diagnosis was intracranial hemorrhage (36.8%), followed by head trauma (21.05%), drowning in water (3.5%), and firearm injury (3.5%). The apnea test was applied to all cases, but 17 patients could not complete the apnea test. In order to support the diagnosis of brain death, in 63% of patients (n = 95) radiological methods were performed. Cranial computed tomography angiography was performed as a radiological method. All cases were found to have received at least 1 inotropic support. We used dopamine in 41 patients, noradrenaline in 36 patients, dobutamine in 8 patients, and adrenaline in 3 patients. During the 12 months when the organ transplant coordinator was not on duty, there were no organ donors. It is important to maintain an organ and tissue transplant coordinator and an intensive care unit team for organ donation. ConclusionIn order to increase the cadaver donor pool, it is necessary to increase the number of brain death diagnoses and decrease the rate of family rejection. Therefore, patients with poor neurologic prognosis should be carefully monitored for brain death. Successful family discussions by an experienced and trained organ transplant coordinator should try to increase donation rates by emphasizing the importance of organ donation and the fact that brain death is a real death.

Reasons Why Organs From Deceased Donors Were Not Accepted for Transplantation

IntroductionThe rate of organ donations from deceased donors in Turkey is among the lowest in the world. We analyzed the reasons why some potential donors whose families had given consent did not become actual solid organ donors. MethodsWe retrospectively reviewed the organ donation, retrieval, and transplantation registries of 102 potential donors from the Ministry of Health Organ and Tissue Transplant Coordination Centre of Istanbul Region from the year 2015. ResultsCardiac arrest occurred in 8 of the potential donors while waiting for organ procurement or during surgery. The organ specific suitability ratio was 83% for kidneys, 82% for livers, 72% for hearts, and 75% for lungs. Of these suitable organs, the transplantation rates were as follows: kidneys 88%, livers 70%, hearts 30%, and lungs 13%. Medical reasons (donor unsuitable) (14%–24%) and poor organ function (2%–24%) were the reasons most organs were not accepted for transplant. These reasons included diabetes insipidus, electrolyte imbalance caused by neuro-humoral changes, inotrope/vasopressor requirement for hemodynamic instability, hypoperfusion, and myocardial dysfunction after brain death. ConclusionThe mismatch between organ donation and demand is a major problem worldwide. In addition to low organ donation rates, late diagnosis of potential donors or inappropriate management of the pathophysiological consequences of brain death reduce the number of transplantable organs even more in our country. In order to overcome these setbacks, we need education programs to improve quality and decrease donor losses in an intensive care unit goal-directed protocol for the management of potential donors.