Organ Donation Process Research Articles

Understanding the Influence of Inter-Professional Relational Networks within Organ Donation Programs in Ontario

Background To optimize organ donation performance the nature and impact of complex factors need to be understood. Some factors are well known and might not be modifiable (contra-indications for transplant, age limit of organ donor, etc), but others (collaboration and relationships) that contribute to variations among similar hospitals in the same province, are poorly understood. Thus, the overall aim of this research is to understand the nature and impact of relationships within the organizational context of organ donation programs in Ontario. Methods We will employ an exploratory, prospective, diagnostic study consisting of three approaches: (1) to describe the characteristics of social networks of health care professionals of the organ donation programs (Social Network Analysis) and (2) to describe the organizational attributes and processes of on organ donation programs (Multiple Case-Study), and (3) to compare the influence of social networks and organizational attributes on the performance of organ donation programs (Network Comparison). The study sites will include Ontario hospitals designated as type A based on trauma centre level (Public Hospitals Act classification); and hospitals partners of the Ontario’s Organ Procurement Organization. At least five sites will be purposely selected to capture the greatest variability of settings possible. Expected/Preliminary Outcomes Understanding the influences of informal networks on organ donation outcomes is essential to the development and informing of interventions to optimize performance. This research will increase organ donation rates in Ontario by providing to the scientific community a novel measure of organ donation programs’ performance and by identifying successful collaboration paths during organ donation processes. We will present the development process of the research as well as preliminary findings.

Implementation of a Quality Management System on Organ Donation in the Kingdom of Saudi Arabia (KSA)

Introduction World Health Organization (WHO) is advocating for the development of self-sufficiency in Donation and Transplantation (D&T) in all countries, as a practical alternative to combat transplant tourism and commercialism around the world. KSA is a Middle East country with 27.448.000 population. In 2016, 92 deceased donors (3.07 pmp) were reported. Therefore, 265 organ transplantations (9.6 pmp) were performed. Organ shortage represents a major obstacle preventing a further increase of transplantation in KSA. In 2017, the Ministry of Health of KSA launched a 3-year project coordinated by DTI foundation with the support of the Saudi Center for Organ Transplantation (SCOT). The project aims to improve the D&T rates by implementing an organ donation quality management system based on the implementation of the most successful models in organ donation (SEUSA) and quality systems (ODEQUS). Materials and Methods Through the use of SEUSA and ODEQUS methodologies (already described previously by us), as valuable and replicable international collaborative strategies to improve organ donation worldwide, the project methodology includes: a) Competence Authorities involvement; b) Diagnosis of the current situation (national, regional and hospital level) using ODDS (Organ Donation Diagnostic Surveys) and developing in situ expert’s visits; c) Detection of all brain and cardiac deaths in the hospitals implementing the DAS (Decease Alert System); d) implementation of the ODEQUS quality indicators (pilot phase); e) Knowledge exchange activities; f) External hospital audits. Continuous monitoring was performed to allow data collection and analysis. Results and Discussion The pilot phase linked 5 hospitals from different background in Riyadh and Jeddah. D&T healthcare professionals were trained in the application of the quality indicators. An IT tool beta version was created to collect data derived from the clinical donation activity. A 3-year plan was developed to expand the project up to 25 hospitals and to increase the D&T rates of the country. The project allowed to broaden SCOT’s geographical representation with the result of KSA becoming a reference model in D&T in the Middle East region. Conclusion SEUSA and ODEQUS methodologies have shown, to be a good option to consolidate D&T systems. Its use has allowed to homogenize the organ donation process creating a methodology to evaluate the organ procurement performance and defining improvement strategies enhancing the efficiency of transplant systems in KSA.

The Weekend Effect

Introduction A US study suggested donation rates were poorer on weekends. We investigated the effect of day-of-week of donor referral on organ donation in Australia. We also investigated whether any weekend effect resulted in fewer referrals for donation on weekends compared to weekdays. Methods In Australia, potential donor referrals are made to a state-based Donation Service, who then simultaneously seek family consent for donation and assess the medical suitability of the referral for donation. Referrals do not proceed without family consent, or if deemed medically unsuitable. In Australia, organ retrieval occurs when utilisation is almost certain, hence discard rates are extremely low. We retrospectively reviewed all New South Wales referral logs from January 2010 to March 2016. Our outcomes were actual donation (when a referral proceeded to organ retrieval), family consent, and medical suitability. We used logistic regression with random effects adjusting for clustering of referral hospitals. We used mortality data from the Australian Institute of Health and Welfare to compare donation referrals to the background mortality rate by day of the week. We compared donor referrals to all-cause mortality, and specifically to motor vehicle accident (MVA) deaths, as these deaths more typically result in donor referrals. Results Of 2,832 potential donors referred for consideration, 603 (21%) became actual donors.Donation rates were higher for weekend compared to weekday referrals (24% vs. 20%), however this was not statistically significant (p=0.1). We found no evidence of reduced donation (adjusted OR: 1.10; 95% CI 0.88 – 1.38; p=0.4), consent (adjusted OR 1.14; 95% CI 0.88-1.48; p=0.3), or medical suitability (adjusted OR 1.26; 95% CI 0.98-1.62; p=0.07) among weekend referrals.While all-cause mortality was relatively uniform over the week, referrals appeared to drop on Saturdays and Sundays.MVA deaths were more common on weekends (Saturday and Sunday), while the number of referrals from MVA deaths was relatively stable over the week.Compared to all-cause mortality rates by day of the week, the rate of donor-referral on weekends was lower than during the week (p<0.001). We also found that MVA referrals were less common on weekends compared to all MVA deaths (24% vs. 35%; p=0.03). Conclusion There was no association between day-of-the-week or weekend referrals and actual donation, family consent, or medical suitability. Our study suggests the Australian organ donation process is operating consistently even during transient periods of diminished resource or higher caseload, typically experienced during the weekend. These results stand in contrast to the findings from the US. There was some indirect evidence that donor referrals may be more selective at weekends. Further research could explore different stages of the donation pathway (e.g. progression from donor-identification to referral, and progression from actual donation to transplantation)

First Series of Brain Death Organ Donors in United Arab Emirates - SEUSA Program Implementation

Introduction The Middle East region faces some common challenges regarding organ donation and transplantation, like lack integrated approach across (private-public) healthcare systems, poor knowledge and awareness among public and professionals and lack of full regulatory frameworks. In the region deceased donor per million population (pmp) rate is low despite very good medical infrastructure and availability of medical experts compared to European average of donors pmp in 2016 of 21.5 dpmp. Two separate populations studies showed positive public attitudes for donation with 60-68 % surveyed wishing to donate their organs after death. In 2016 UAE issued a new Transplant law and addressed the legal requirement for deceased donation and the Ministry of Health and Prevention issued additional needed guiding documents for its implementation. In order to design a self-sufficient DD program and improve the skills of the health care professionals in the field, the UAE national Transplant committee in UAE and DTI Foundation have been working together to implement SEUSA tools. Methodology The SEUSA methodology is based on application of the tools from the most successful models in organ donation (OD), Spain, Europe and USA, and by implementing specialized trainings for health professionals based on the model of transplant procurement management TPM trainings. Since 2015, 3 yearly intermediate TPM training courses have been conducted for physicians and nurses on every step of the organ donation process. Visits form UAE professionals to Barcelona for educational purposes and experience interchange have also been performed. From 2017, visits from DTI international experts to UAE hospitals have been organized. During the hospital visits, interviews were conducted with local healthcare professionals, recommendations were provided about the establishment of in-hospital organ procurement units and a deceased alert system was defined for possible donor identification. Prior to the visits, ODDS (Organ Donation Diagnostic Surveys) were completed to assess the donor potentiality of each hospital. Results 128 healthcare professionals, mainly from the 10 leading hospitals, have been trained as Transplant Procurement Managers. Between July 2017 and February 2018, a total of 6 potential donors have become actual brain-dead organ donors. 19 organs have been recovered allowing the beginning of deceased cardiac, liver and lung transplantation and expansion of living related kidney transplantation programs in the UAE and full activation of organ sharing model between UAE and the Kingdom of Saudi Arabia. Conclusion Adequate in-hospital structure, organ donation training, and international collaboration alongside institutional and regulatory support from government has proven to be key for the establishment of deceased organ donation in the UAE. SEUSA program continues its implementation in UAE during 2018.

A multicentre investigation of organ and tissue donation education for critical care residents.

To describe critical care medicine residents' training, expertise, and skills regarding organ and tissue donation processes and procedures. We undertook a qualitative multicentre study and employed a purposive sample of program directors, physicians, nurses, residents, and organ donation leaders from all nine academic intensive care unit (ICU) training centres (five adult, four pediatric) in Ontario (n = 71). Interviews, conducted by telephone between December 2015 and March 2016, were audio-recorded and transcribed verbatim. Data collection and analysis were performed using an iterative process and continued until saturation was achieved. Five main themes were identified: 1) gaps in residents' knowledge for both neurologic determination of death (NDD) and circulatory determination of death (DCD) cases; 2) commitment to the provision of organ and tissue donation training; 3) limited experiential learning (NDD and DCD); 4) challenges related to the provision of training on organ donation and need for a standardized curriculum; and 5) communication with family members. Overall, this study showed system-level gaps in training resulting from the lack of a standardized provincial curriculum on organ donation. Qualitative data corroborated that residents need more exposure to clinical cases, especially regarding DCD donors. A standardized education curriculum would be beneficial for all residents within the ICU. Developing a better shared understanding of the donation process will improve team communication and performance, translate into a better end-of-life experience for families, and potentially result in increased donation rates.

A Qualitative Study of Turning Points or Aha! Moments in Older Adults' Discussions About Organ Donation.

Older adults (50-70 years old) have lower organ donor registration rates than younger adults. Older adults have different informational needs and donor registration behavior than younger age groups. The objective of this qualitative study was to understand insights of older adults about organ donation to effectively address the barriers to becoming an organ donor. This study identified turning points as "Aha!" moments that occurred during a dialogue intervention where older adults discussed benefits, barriers, and process to organ donation. Dialogues were held with small groups of older adults in 11 communities in a Midwestern organ procurement organization service area. Participants were positive to organ donation, but not registered as an organ donor. Methods/Approach: Qualitative analysis of verbatim comments from the dialogue and a follow-up survey were used to examine turning points or "Aha!" moments of participants' decision-making about organ donation and organ donor registration. Twenty-one separate in-depth dialogues were conducted with 198 participants, with mean age of 60.57 years. There were 2757 separate comments coded with 465 of the comments (17%) identified as providing Aha! moments during the dialogue. Three themes include benefits of organ donation (30%), barriers about organ donation (39%), and organ donation process (31%). The research identified moments in the dialogue where possible learning about organ donation may have occurred. After participation in the dialogue process, there was an increase in intent to register to be an organ donor, organ donation discussion with family and friends, and organ donor registration.

P146: Organ and tissue donation from poisoned patients in the emergency department: a Canadian perspective

Introduction: Screening for organ and tissue donation is an essential skill for emergency physicians. In 2015, 4564 individuals were on a waiting list for organ transplant and 242 died while waiting. As Canadas donation rates are less than half that of other comparable countries, it is crucial to ensure we are identifying all potential donors. Patients deceased from poisoning are a source that may not be considered for referral as often as those who die from other causes. This study aims to identify if patients dying from poisoning represent an under-referred group and determine what physician characteristics influence referral decisions. Methods: In this cross-sectional unidirectional survey study, physician members of the Canadian Association of Emergency Physicians were invited to participate. Participants were presented with 20 organ donation scenarios that included poisoned and non-poisoned deaths, as well as one ideal scenario for organ or tissue donation used for comparison. Participants were unaware of the objective to explore donation in the context of poisoning deaths. Following the organ donation scenarios, a range of follow-up questions and demographics were included to explore factors influencing the decision to refer or not refer for organ or tissue donation. Results were reported descriptively and associations between physician characteristics and decisions to refer were assessed using odds ratios and 95% confidence intervals. Results: 208/2058 (10.1%) physicians participated. 25% did not refer in scenarios involving a drug overdose (n=71). Specific poisonings commonly triggering the decision to not refer included palliative care medications (n=34, 18%), acetaminophen (n=42, 22%), chemical exposure (n=48, 27%) and organophosphates (n=87, 48%). Factors associated with an increased likelihood to refer potential donors following overdose included previous organ and tissue donation training (OR=2.6), having referred in the past (OR=4.3), available donation support (OR=3.9), greater than 10 years of service (OR=2.1), large urban center (OR=3.8), holding emergency medicine certification (OR=3.6), male gender (OR=2.2, CI), and having indicated a desire to be a donor on government identification (OR=5.8). Conclusion: Scenarios involving drug overdoses were associated with under-referral for organ and tissue donation. As poisoning is not a contraindication for referral, this represents a potential source of donors. By examining characteristics that put clinicians at risk for under-referral of organ or tissue donors, becoming aware of potential biases, improving transplant knowledge bases, and implementing support and training programs for the organ and tissue donation processes, we have the opportunity to improve these rates and reduce morbidity and mortality for Canadians requiring organ or tissue donation.

Attitudes of intensive care and emergency physicians in Australia with regard to the organ donation process: A qualitative analysis.

Specialized hospital physicians have direct capacity to impact Australia's sub-optimal organ donation rates because of their responsibility to identify and facilitate donation opportunities. Australian physicians' attitudes toward this responsibility are examined. A total of 12 intensive care unit and three emergency department physicians were interviewed using a constructionist grounded theory and situational analysis approach. A major theme emerged, related to physicians' conflicts of interest in maintaining patients'/next-of-kin's best interests and a sense of duty-of-care in this context. Two sub-themes related to this main theme were identified as follows: (1) discussions about organ donation and who is best to carry these out and (2) determining whether organ donation is part of end-of-life care; including the avoidance of non-therapeutic ventilation; and some reluctance to follow clinical triggers in the emergency department. Overall, participants indicated strong support for organ donation but would not consider it part of end-of-life care, representing a major obstacle to the support of potential donation opportunities. Findings have implications for physician education and training. Continued efforts are needed to integrate the potential for organ donation into end-of-life care within intensive care units and emergency departments.

Bereaved relatives' decision about deceased organ donation: An integrated psycho-social study conducted in Spain

RationaleFamily refusal to organ donation of a deceased relative represents one of the most important barriers to organ transplantation. Although a large literature about family decisions has amassed, the existing evidence needs further integration and structuring. ObjectiveThis study seeks to analyse relationships between bereaved relatives’ decisions and a wide range of factors that converge in the family decision process, including interactions and complex relationship patterns, and taking psychosocial theoretical frameworks as reference to conceptualize empirical findings. MethodThis observational study examined 16 Spanish hospitals during a 36-month period. Transplant coordination teams collected data of 421 cases of family decision processes about donation (338 donations/83 refusals) through a previously validated instrument. Indicators of the following factors were collected: deceased's characteristics; circumstances of death; bereaved relatives' characteristics, beliefs, and expressions; behaviour of health and coordination staff; and family's emotional responses. Three global hypotheses related to bivariate and multivariate relations of factors with family decisions and relationships/interactions among factors were tested. ResultsRelatives' beliefs about the deceased's wishes concerning donation are the strongest predictor of family decisions. However, family decisions are also related to the deceased's characteristics, relatives' characteristics, satisfaction with medical attention, satisfaction with personal treatment and relatives' emotional responses, and other factors. Relatives' emotional reactions are related to satisfaction with health-staff interventions and condition family decision, even if deceased's will concerning donation is known and positive. Relatives' beliefs about deceased's wishes concerning donation vary as a function of deceased's characteristics and according to relatives' characteristics. ConclusionsUnderstanding of family decisions underlying organ donation may greatly benefit from a more complex, integrated, and theoretically based approach. Educational efforts should stress the need to register or simply communicate own willingness to donate organs. However, an adequate training and performance of the health-staff involved in the organ donation process may generate substantive differences in consent rates.

Importance for the Elderly of Discussion in the Family and Society About Attitude Toward Organ Donation

BackgroundThe aging of the population has changed some of the approaches to the organ donation and transplant (ODT) process, such as considering elderly people as potential donors. We aimed to assess social and family discussions among the elderly about ODT and its effect on their attitude toward organ donation. MethodsA study was carried out at 2 publicly-funded social centers for the elderly. Contact was made with individuals >65 years of age (n = 120) to seek their participation in the study. A questionnaire was distributed to them with questions about ODT. A descriptive assessment was performed with the Student t test and χ2 test used for statistical analysis. ResultsThe completion rate was 87% (n = 104). Of the respondents with a partner and children, 48% had discussed the topic of ODT. It was found that talking about the subject with one's partner, children, or friends had a favorable influence on attitude compared with when this was not done (93%, 86%, and 83% vs 19%, 30%, and 31%, respectively; P < .001). In addition, the opinion of one's partner and children toward ODT also had an influence; if favorable, the respondent's attitude was more favorable, compared with when they did not know their opinion (92% to 88% vs 58% to 37%, respectively; P < .001). Other ODT-related variables did not affect their attitude (P > .05). ConclusionsAlmost half of the elderly people had discussed ODT socially or with their family. This discourse has a favorable influence on their attitude toward organ donation and, therefore, it is important to encourage social and family dialog among this group.

Organ donation and transplantation: Awareness and roles of healthcare professionals-A systematic literature review.

To examine the role of healthcare professionals in the organ donation and transplantation process. Globally, there remains a perennial disequilibrium between organ donation and organ transplantation. Several factors account for this disequilibrium; however, as healthcare professionals are not only strategically positioned as the primary intermediaries between organ donors and transplant recipients, but also professionally situated as the implementers of organ donation and transplantation processes, they are often blamed for the global organ shortage. Mixed-method systematic review using the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols 2015 checklist. Databases were searched including CINAHL, MEDLINE, Web of Science and EMBASE using the search terms "organ donation," "healthcare professionals," "awareness" and "roles" to retrieve relevant publications. Thirteen publications met the inclusion criteria. The global organ shortage is neither contingent upon unavailability of suitable organs nor exclusively dependent upon healthcare professionals. Instead, the existence of disequilibrium between organ donation and transplantation is necessitated by a web of factors. These include the following: healthcare professionals' attitudes towards, and experience of, the organ donation and transplantation process, underpinned by professional education, specialist clinical area and duration of professional practice; conflicts of interests; ethical dilemmas; altruistic values towards organ donation; and varied organ donation legislations in different legal jurisdictions. This review maintains that if this web of factors is to be adequately addressed by healthcare systems in different global and legal jurisdictions, there should be sufficient organs voluntarily donated to meetall transplantation needs. There is a suggestion that healthcare professionals partly account for the global shortage in organ donation, but there is a need to examine how healthcare professionals' roles, knowledge, awareness, skills and competencies might impact upon the organ donation and transplantation process.

Organ donation in the ICU: A document analysis of institutional policies, protocols, and order sets

ObjectiveTo better understand how local policies influence organ donation rates. Research methodology/designWe conducted a document analysis of our ICU organ donation policies, protocols and order sets. We used a systematic search of our institution’s policy library to identify documents related to organ donation. We used Mindnode software to create a publication timeline, basic statistics to describe document characteristics, and qualitative content analysis to extract document themes. SettingDocuments were retrieved from Hamilton Health Sciences, an academic hospital system with a high volume of organ donation, from database inception to October 2015. FindingsWe retrieved 12 active organ donation documents, including six protocols, two policies, two order sets, and two unclassified documents, a majority (75%) after the introduction of donation after circulatory death in 2006. Four major themes emerged: organ donation process, quality of care, patient and family-centred care, and the role of the institution. These themes indicate areas where documented institutional standards may be beneficial. ConclusionFurther research is necessary to determine the relationship of local policies, protocols, and order sets to actual organ donation practices, and to identify barriers and facilitators to improving donation rates.

Perception of Healthcare Workers about Barriers Impacting Organ Donation in Qatar: A Focus Group Study

Objectives: To understand perception of healthcare workers about factors acting as barriers to organ donation and transplantation process in Qatar.Subjects and Methods: A phenomenological approach with the help of focus group discussions was used to fulfill the objectives of the research. Participants were healthcare workers working as volunteers in organ donation campaigns or playing a crucial role in the process of organ donation or transplantation in Qatar. They were selected purposively to participate in the discussions. Open-ended questions were asked during the audio-recorded discussions. Transcripts were coded and assessed using NVivo software. Results were analyzed based on the Theory of Planned Behavior to explore intentions shaping an individual’s donation decision.Results: Lack of awareness and information about the process of organ donation were found to be the root cause barriers for both deceased and living organ donation in Qatar whereas; family, religious and community influences, and an incongruous attitude towards organ donation are the main factors influencing organ donation registration and family consent for deceased donation.Conclusion: Improving awareness and accurate information about organ donation could play significant in increasing deceased and living organ donation in Qatar. However, factors impacting family consent, which was found to be the most prominent reason for gap between availability and utilization of organs, need to be further researched.

Awareness, knowledge, and attitude regarding organ donation among final year students of medical, Dental, Engineering, and Arts and Science Colleges in Thiruvallur and Chennai City, India

Background: Organ donation (OD) is the process of surgically removing an organ or tissue from one person (donor) and placing it into another person (recipient). Of the overall deaths occurring annually in India, nearly one lakh deaths occur due to organ failure. Shortage of donor organs can be resolved by raising awareness and educating the youth about various aspects of OD since they comprise of the majority of the population. The purpose of our study is to determine the level of awareness, knowledge and attitude regarding OD among pupils related to both medical and non-medical fields. Objective: To assess the awareness, knowledge, and attitude regarding OD among final year students of medical, dental, engineering, and arts and science students in Thiruvallur and Chennai. Materials and Methods: A cross-sectional study was conducted among 486 undergraduate students belonging to medical, dental, engineering, and arts and science from various colleges in Thiruvallur and Chennai. A 30 item self administered English questionnaire was given which assessed levels of awareness from Q1-Q7, knowledge from Q8- Q20 and attitude from Q21-Q30 among the study population regarding organ donation. Results: A total of 486 students participated in the study, out of which 183 (37.7%) were males and 303 (62.3%) were females. Among the study population, 455 (94%) were aware and 31 (6.4%) were not aware of the term OD. A total of 261 (54%) students were aware and 225 (46%) were not aware of the “organ transplantation act”. A total of 240 (49.4%) students had the knowledge about the risks involved in OD. A total of 329 (68%) students felt the need for laws to govern the process of OD. Knowledge about the human donor card was observed among 169 (35%) students among the study population. Three hundred and eight (63.4%) wanted to be a part of any OD group and also motivate others for OD. Conclusion: A well-organized approach is required to raise awareness among the youth about various aspects of OD which is necessary to eliminate the setbacks that affect the rate of availability of donor organs. Motivational messages and facts are some of the means of intervention to bring about changes regarding perceptions and intentions about OD among the students.

Knowledge and Attitude regarding organ Donation among Health Professionals of Selected Colleges of Anand District

The current study aims “A study to assess knowledge and attitude regarding organ donation among health professionals of selected colleges of Anand District” Life is too precious to be lost to an organ failure. But millions have lost their lives when a vital organ failed to function in their body. Health professionals who are more concerned related to educate students in health sectors so every health rofessionalsneed to know all aspect of organ donation process including legal aspects of organ donation to save precious lives from being lost before their time.

THE POSSIBLE EFFECT OF THE PROTECTION OF PERSONAL INFORMATION ACT 4 OF 2013 ON ORGAN AND TISSUE DONATIONS

Organ donation for purposes of a transplant is an altruistic act that lends itself to the ethical principle of beneficence. Available evidence indicates that in the transplant process information or data sharing is of the utmost importance. The Constitution of the Republic of South Africa, 1996 and other legislative frameworks like the National Health Act 61 of 2003, facilitates participation in support of this principle. Section 12(2) of the Constitution states that “Everyone has the right to bodily and psychological integrity, which includes the right – … (b) to security in and control over their body; and (c) not to be subjected to medical or scientific experiments without informed consent.” Section 27(1) and (2) provide that everyone has the right to have access to health care services... The same section immediately prompts the state to “take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of each of these rights”.The NHA in sections 14–17 applies a safeguard on how the principle of beneficence in respect of organ donations should be achieved. These sections address the issues of confidentiality, access to and the protection of health records. The guarantees in the Constitution and the NHA are not absolute but may be limited in one way or another, especially in cases where the donor is declared brain dead and therefore deceased. In such a case the Protection of Personal Information Act 4 of 2013 does make provision for instances where the protection of personal information may be limited. Although it is feared that the POPI Act might negatively influence the organ donation process, an analysis of the Act and its possible influence on the transplantation scenario seems unfounded if a few precautionary measures are put in place.

Acceptance of post-mortem organ donation in Germany : Representative cross-sectional study

The German post-mortem organ donation rate has dropped by one third since 2010. Furthermore, 958 patients died in 2015 in Germany while waiting for an organ. To decrease organ shortage, an amendment of the transplantation law was established in 2012. An information package including an organ donor card is sent to all German citizens via the postal service. Avoluntary national transplantation register was introduced in 2016 to improve transparency in the organ donation process. The influence of several transplantation scandals starting in 2012 on organ donation rates is in question. Therefore, the objective of this article is to discuss approval and objections to post-mortem organ donation among the next of kin of potential donors and the general public in Germany. Binary logistic regression of data from the 2014 survey by the Federal Centre for Health Education on attitudes towards organ and tissue donation in Germany was conducted, aiming to identify influencing factors on the likelihood of organ donor card possession. Additionally, data of the German Organ Transplantation Foundation on post-mortem organ donations in Germany in 2014 were studied to highlight reasons for approval and objections by next of kin of potential and explanted post-mortem organ donors. Methods of documentation of the deceased's will according to data of the German Organ Transplantation Foundation were analyzed. Male gender and lack of knowledge about organ donation decrease the likelihood of having an organ donor card. Of the respondents in the survey of the Federal Centre for Health Education 71.0% would donate their own organs, whereas only one third possess an organ donor card. Health insurances and physicians are the most important providers of organ donor cards in Germany. An increase in the percentage of organ donor card possession following the amendment of the transplantation law could not be observed by 2016. Fear of organ trade and unjust organ allocation are the main reasons for rejecting organ donation among the general public. Previous transplantation scandals are aprimary reason for anegative change in attitudes. Main reasons for objection among the next of kin of potential organ donors are known objections of the deceased and the lack of knowledge about the will of the deceased. In addition, only 58.1% of all explanted organ donors documented their will in written or verbal form. Education on organ donation can be ameans to increase organ donation rates. The effects of the change in legislation and the establishment of the transplant register need to be evaluated. Further research regarding the influence of religion, especially among religious minorities, on organ donation rates in Germany needs to be conducted to identify possible obstacles. Moreover, the use of social networks to address potential organ donors has proven to increase registration numbers and could easily be implemented in Germany.

Nurses’ knowledge about and attitudes toward organ donation in state and private hospitals in Johannesburg, South Africa

Background . Nurses are intricately involved in organ donation; however, the referral of donors appears to be declining in Johannesburg, South Africa (SA). This may be due to barriers in the referral process. Objectives . The objectives of this study were to explore nurses’ knowledge of the organ donation process and to explore personal beliefs and attitudes around organ donation. Methods . A quantitative, self-administered questionnaire was completed by nurses in Johannesburg, SA. Results. A total of 273 nurses participated, of whom most were female and <50 years old. The majority of participants (64.2%) reported positive attitudes, and 63.2% stated that their personal beliefs about organ donation did not influence the advice they gave to patients. However, only 36.8% felt confident referring potential donors and 35.8% felt that referral was within their scope of practice. Most participants (84.5%) felt that it was the doctor’s responsibility to refer donors, but 80.3% noted that they would refer donors themselves if there was a mandatory referral protocol. Only 61% of nurses were aware that there was access to a transplant procurement coordinator through their hospitals; however, there was uncertainty regarding the role of the coordinator. Conclusion . There is an urgent need to clarify the role of nurses in the process of organ donor referral in SA. Although nurses felt positive about organ donation, they expressed uncertainties about referring potential donors. However, if a clear protocol for referral was introduced, the majority of nurses noted that they would willingly follow it. We advocate for the development and implementation of a nationally endorsed protocol for donor referral and for the training of nurses in organ donation in SA.

Are Transplant Recipients Human Subjects When Research Is Conducted on Organ Donors?

Interventional research on deceased organ donors and donor organs prior to transplant holds the promise of reducing the number of patients who die waiting for an organ by expanding the pool of transplantable organs and improving transplant outcomes. However, one of the key challenges researchers face is an assumption that someone who receives an organ that was part of an interventional research protocol is always a human subject of that same study. The consequences of this assumption include the need for oversight by an institutional review board and for research-level informed consent from transplant recipients, all within the complex practical realities of the organ donation and transplantation process in the United States. The current national focus on this issue provides an opportunity to think critically about the policy goals of the human subjects regulations and their application to the nascent field of deceased organ donor intervention research. We propose that for donor research where the transplant recipient does not fall under the definition of human subject, the clinical consent model-rather than the consent model used for human research subjects-best facilitates the policy objectives of balancing clinical innovation, transparency, and protection of patients in an ethically responsible and legally compliant manner.

Success in Organ Donation Program in Thailand

Introduction The Thai Red Cross Organ Donation Centre has been involved effectively and consistently in several parts of organ donation process for more than 23 years. Although there are many stakeholders in organ donation process, we described success factors for increase total numbers of deceased donors. Material and methods A retrospective study of data from The Thai Red Cross Organ Donation Center from 1st January 2006 - 31st December 2016. We collected the data of deceased donors in Thailand over the last decade, and also various related activities and programs involving in organ donation. Results There was an increased in deceased donors from 1.03 to 3.33 per million population. The total number of donors was 1,433, number of donors increased 244 %, annual rate increased 14 % on average. The donors were 1,153 males (80.5%) and 280 females (19.5%). Over 9,398 organs and tissue had been transplanted including 2,477 kidneys; 601 livers; and 112 hearts. During the same period, there were 245 training activities. The majority of activities were visiting provincial hospitals (61.6%). The rest of them were transplant coordination training courses (14.7%), Transplant Procurement Management International training courses (1.2%), Walk Rally for nurse and medical students (15.9%), courses for retrieval team training with Soft Cadaver (0.8%) and other courses (5.7%). There were other activities to provide knowledge to the public in order to promote organ donation such as music video, songs, video clip in YouTube, organ donation roadshows, organ donation project celebrating the 84 th birthday anniversary of Her Majestry Queen Sirikit, the 60th anniversary of His Majesty the King's accession to the throne and 60th birthday anniversary of Her Royal Highness Princess Maha Chakri Sirindhorn. Moreover, the Ministry of Public Health (MOPH) strategies and policy during 2013–2016 has played the important roles. MOPH has set the organ donation process as Key Performance Indicators for the government hospitals. Conclusion Although all factors have favored the increase in organ donation, a great impact was in the last 4 year since MOPH has launched strategies and policy. The Thai Red Cross Organ Donation Centre helped donor and transplant hospitals to set their own local network of organ donation, not only by materials support but also useful comprehensive guidance. However, continuing public awareness campaign for a better understanding is still necessary.