Transplant Coordinators Research Articles

Evaluating Organ Donation Decision in ICU Patients' Families by Analytic Network Process Approach.

The imbalance between supply and demand for organs has been a global crisis, despite the efforts of transplant coordinators from healthcare institutions to promote donor registration. Because the patient's family has legal rights over the patient's remains, they can easily undermine any efforts spent on organ procurement by simply refusing the patient's consent before death in practice. Most related studies seldom mention the decision-making on organ donation from patients' families. The objectives of this study are to find what are the priorities of those factors acting as the pillars of organ donation by patients' families. This study applied the analytic network process (ANP) to the prioritization factors contributing toward the willingness of families to donate organs of intensive care unit patients. The purposive sampling method used structured questionnaires and ANP questionnaires to enroll 180 patients' families from five intensive care units who met the criteria in the regional teaching hospital of southern Taiwan. Through the ANP analysis, it was found that when family members made organ donation decisions, the weights of the four domains are as follows: psychology—47.6%, externality—20.3%, spirituality—19.7%, and physiology—12.3%. The main decision-making factors that influenced the weighting factors were “attitude” (31.5%), “physician's experience” (0.88%), “religion” (19.3%), and “organ selection” (31.9%). These results could assist organ donation teams to take the best strategies for persuading people to agree with organ donation and formulating an individual organ donation plan.

Clinical Decision Support to Identify Care Gaps and Improve Efficiency of Health Maintenance Documentation for Heart Transplant Recipients

<h3>Purpose</h3> Cardiac transplant recipients have a unique set of health maintenance tasks that must be performed in a timely manner to avoid graft failure as well as infection- and malignancy-related complications. Monitoring adherence to these tasks at every outpatient visit in separate clinical notes can be repetitive, time-consuming, and can lead to errors in documentation and follow up. <h3>Methods</h3> The electronic health record in our health system (Epic) provides a health maintenance activity to provide clinical decision support for the general adult population. We modified the health maintenance tab by adding the tests, labs, and protocols unique to heart transplant recipients. We also created a text macro for these tests to expedite documentation of these results and also provide reminders for outstanding tests. <h3>Results</h3> These interventions were adopted by 100% of cardiac transplant providers and coordinators at our institution (N=10). <h3>Conclusion</h3> The health maintenance section within the electronic medical record can be modified to suit the unique needs of heart transplant recipients. Furthermore, these data can be the basis of process measures for future QI efforts focused on gaps in care.

Organ Donation and the Medicolegal Aspects

Context: In India, the majority of brain-dead organ donors are victims of road traffic accidents, thereby making them entities in medicolegal cases (MLC). This places an additional burden and complicates the organ donation process, as an inquest must be conducted by the police station closest to the accident spot before the possibility of organ donation is considered. Following organ retrieval and donation, a postmortem is required before the body is handed back to the police. These procedures cause delays in the organ donation process and subsequently in families receiving the body of their loved ones. The problem is compounded by the fact that there are variations in the inquest and postmortem procedures in different states. Aim: The study aims to comprehensively enumerate the medicolegal protocols followed by the states having an active deceased organ donation program. Design and Methods: A survey, using a structured questionnaire, was conducted among the senior Transplant Coordinators (key stakeholders in the organ donation process) of eight states. Their experiences handling MLC and the state protocols adhered to were captured. Results: It was found that there were differences in protocols followed by the states with respect to medicolegal organ donation cases. Significant variations were observed in the police inquest and postmortem procedures. A need for training of the police personnel in the medicolegal aspects of the organ donation process is evident from the survey responses. Conclusions: The undue delays lead to difficulties in completing the donation and also cause distress among the family members who have said yes to organ donation despite their grief. The study recommends the need for uniformity in protocols to ease pain points in this program. This is of paramount importance in instances of interstate-organ donation cases.

The urgent need to achieve an optimal strategic stock of human allogeneic skin graft materials in case of a mass disaster in Poland.

A burn is a sudden injury which immediate or long-term consequences may be life-threatening for the patient. A mass disaster event may involve large numbers of severely burned patients. Patients of this type typically have a limited area of healthy, unburned skin from which an autologous split thickness skin graft could be collected. In a clinical situation of this type, it is necessary to use a particular skin substitute. Non-viable allogeneic human skin graft materials might be considered as the most suitable skin substitutes in the treatment of such patients. At present, Poland does not have a sufficient supply of human allogeneic skin graft materials to meet the needs arising from a sudden and unforeseen mass disaster. This study involved an analysis of selected mass disasters. From this an estimate was made from a verified casualty profile of the necessary minimum stock of human allogeneic skin graft materials. An insufficient amount of skin results from an inadequate number of skin donors, which in turn results from the current tissue donation system. Therefore, a proposal has been made for the organizational, legal and systemic changes required to improve the situation in Polish transplantology, with particular emphasis on skin donation. In order to achieve a strategic stock of human skin grafts, a tissue collecting transplantation team should be organized. The rights and obligations of the non-physician transplant team member should be extended. Proposals have been made for awareness campaigns (adverts, posters etc.) and educational schemes (educational video, lectures during transplant coordinator training, etc.). Finally, a proposal has been made for possible methods to deal with the logistic management of the allogeneic skin stock. The required, essential stock of human allogeneic skin in the event of a mass disaster has been estimated at 600,000 cm2.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10561-022-10001-z.

Challenges of the LGBT Community in Health Care: Focus on Heart Failure

When one of our heart transplant patients began rescheduling her appointments, an atypical practice for her, it caused concern for the transplant coordinator who had followed the patient before and after the heart transplantation. Fortunately, because of the well-established relationship between the two, the experienced coordinator was able to convince the patient to return for her routine follow-up appointment. Upon entry into the examination room, the patient's anxiety was undeniable; she avoided eye contact, her voice was tremulous, and her hands were restless.

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.

Usability assessment of an interactive health technology for kidney living donors: protocol for a prospective cross-sectional survey

IntroductionSeveral web portals for kidney patients are available, but assessments of their performance are scarce. A crucial aspect of living donation is to provide standardised information about the risks of...

Deception and deceit in living kidney transplant program

In India, the majority of kidney transplants are living donor transplants. The transplant law in India only permits donation from first degree relatives, spouses, grandparents and altruistic donation without any commercial intent. Donation that happens other than first degree relative require to go through the process of authorization by a committee that determines their intent of donation. In spite of the requirements that are clearly laid down in the Act, fake and fraudulent activities have been reported to make donations happen with a commercial intent. This paper is an attempt to inform and empower clinicians and transplant coordinators and give them the requisite skills that would help them to identify fraudulent relationships, detect discrepancies in the documents and help ensure that the hospital and the doctors follow the law of the land and not fall prey to fake documentation that has a commercial intent of donation. Sample cases have been studied based on their coordination and different ways of approaches to detect falsification of documents and tutoring of the donors by the family members or broker. It was seen that with the right approach that included thorough donor-recipient interrogation, close scrutinization of documents and keenly observing the donor-recipient relationship including their body language and attire, various discrepancies could be identified. All transplant teams should include a well-trained Transplant Coordinator who is alert to every case of a living donor recipient pair and makes a thorough assessment of the relationship by observing, interviewing and scrutinizing the documents of relationship to exclude fraud. Some recommendations have also been drawn up to minimize the risk of fraud.

Family support for pediatric organ donation experienced at our hospital- served as both a medical social worker and a hospital transplant coordinator

Family support for pediatric organ donation experienced at our hospital- served as both a medical social worker and a hospital transplant coordinator

The role of the recipient transplant coordinator in promoting cooperation among transplant providers for a liver transplant recipient with central pontine myelinolysis in the early postoperative period

The role of the recipient transplant coordinator in promoting cooperation among transplant providers for a liver transplant recipient with central pontine myelinolysis in the early postoperative period

The Structure of Distress and Related Factors of Recipient Transplant Coordinators in Ethical Situations of Organ Transplant Nursing

The Structure of Distress and Related Factors of Recipient Transplant Coordinators in Ethical Situations of Organ Transplant Nursing

Understanding Patients' and Living Donors' Kidney Paired Donation Educational Experiences and Recommendations for Improvement.

Educating potential kidney patients and living donors about the risks and benefits of kidney paired donation to ensure they make informed decisions is complex. This study aimed to increase understanding of patients' and donors' decision-making about donation, the educational content they received, and their recommendations for educational improvements. We conducted a mixed methods study, including semistructured interviews and quantitative surveys, with 43 participants (25 living donors; 18 kidney recipients). Participants reported that the benefits of paired donation motivated them to participate (ie, helping multiple people, receiving a transplant sooner, flexible timing of donation). Although deciding to participate in paired donation was a systematic, logical, and carefully considered process for some. For most, it was a quickly made, often emotion-based decision. Paired donation educational content on different topics varied, with recipients reporting receiving less information than donors about donor protections and processes to ameliorate the challenges faced, such as broken swaps and chains, and delays in matching. Those who faced challenges requested more information about donor protections and support during and after paired donation. Although many acknowledged their transplant coordinators' helpfulness, participants also recommended being more proactive in learning about kidney paired donation and speaking to former donors and recipients beforehand. Standardized, health literate educational content addressing the gaps and variability in education received may help increase paired donation informed decision-making.

Liver Transplantation in Malaysia: Needs, Obstacles, and Opportunities.

Liver Transplantation in Malaysia: Needs, Obstacles, and Opportunities.

Work-related problems faced by coordinators of organ, cell, and tissue transplantations in Poland and possible ways of ameliorating them

In recent years in Poland, the numbers of reported potential cadaveric donors of organs, tissues, and cells, and the numbers of transplantations being carried out seem to be low in the context of the size of the country population and the presumed consent legal principle which rules transplantations. This research project was carried out on 109 Polish transplant coordinators by means of a questionnaire created specifically for this study. The goal of the project was to detect problems specific to transplant coordinators working in Poland which, when properly addressed, might improve the efficacy of transplantation network within the Polish health care system. The results suggest that Polish transplant coordinators face a variety of issues in their work. It appears that the most important interventions which could improve working conditions for in this population and—as a result—also improve the efficacy of transplantation network in Poland could include: (1) a variety of training programs for transplant coordinators; (2) a social campaign promoting transplantations and spreading awareness of the transplantation-related legislation; and (3) introduction of changes in the regulations pertaining to medical professions in Poland.

Sequential Therapy with Fitcy Preparative Regimen for Patients with Primary Refractory AML - a Single Center Retrospective Analysis

Introduction - primary refractory AML is associated with a dismal prognosis. Only 30% of patients will respond to salvage chemotherapy and continue to allogeneic hematopoietic cell transplantation (HCT) with a 10-20% long- term overall survival. Following from the FLAMSA protocol, we implemented a modified RIC regimen - FITCy (fludarabine, cytarabine +/- idarubicin and 4 Gy TBI) in all primary refractory patients with a donor available for transplant.Methods - all patients who were admitted with AML, were identified by the transplantation coordinator nurse and underwent donor evaluation within 2 days from diagnosis. Patients who received induction chemotherapy had a day 14 marrow examination and where leukaemia blasts were identified, donor search was prioritized. These patients went on to have a day 28 bone marrow examination to confirm refractory disease. Patients who were treated with azacitidine ±venetoclax had a 2-month BM evaluation and donor search was prioritized in case of refractory disease. All consecutive patients, diagnosed with primary refractory AML, underwent HCT with the FITCy regimen in the Tel Aviv Sourasky Medical Center. Patients who underwent sequential therapy for relapsed disease (either chemosensitive or refractory) or a second HCT were excluded from this analysis. The protocol was amended on January 2018 to include ATG for all patients after interim analysis showed a high rate of GVHD.Results - Between January 2014 and June 2021, 48 patients were identified with primary refractory disease and were eligible for the protocol. Median age was 63 (range, 22-75) years (Table). Median follow-up for surviving patients was 33 (range, 1-81) months. Prior to HCT, 12 (25%) patients had ongoing documented infections (either microbiology or clinically). Median days to engraftment of neutrophils (>500/dL) and to complete engraftment of platelets (>20000/dL) were 10 (range, 7-20) days, and 16 (9-35) days, respectively. 7 patients with early progression/non relapse mortality were not evaluated for this outcome. No patient had primary/secondary graft rejection. Severe mucositis was observed in only 7 patients (15%) and was mostly observed in the upper gut. 18 patients (38%) developed microbiology documented infections during the neutropenic period and in 7 (40%) this directly contributed to mortality. Only 2 patients (4%) developed sinusoidal obstruction syndrome. Complete remission was documented on day 30, in all but 1 patient with a median whole marrow donor chimerism of 98% (range, 73-100%).Cumulative incidences of grade 2-4 and 3-4 acute GVHD at day 100 were 55% and 15%, respectively. Cumulative incidences of overall chronic GVHD and moderate-severe chronic GVHD at 1 year after HCT were 64% and 24%, respectively. Cumulative incidences of relapse at 1 year and 2 years post HCT were 24% and 30%, respectively. Non-relapse mortality rates, at 30 days, 100 days and 1 year post HCT were 13%, 20%, and 32%, respectively. Cumulative incidences of 1, 2, and 3 years overall survival were 50%, 42%, and 42%, Figure. Cox regression analysis for overall survival identified increased time from diagnosis (HR-1.03, p=.046), mismatched donor (HR-1.4, p=.05) and the use of ATG (HR=.33, p=.006) to impact survival, while age, sex and comorbidity index were not predictive.Conclusions - Sequential therapy in patients with primary refractory AML provides a remarkable anti- leukemic effect. A timely donor search program is essential for the succession of this approach. Nevertheless, infection control and GVHD prophylaxis is still suboptimal and future protocols should focus on these domains while preserving graft vs. leukemia function. [Display omitted] DisclosuresMoshe: AbbVie: Membership on an entity's Board of Directors or advisory committees, Other: Lectures; Astellas: Membership on an entity's Board of Directors or advisory committees, Other: Lectures; Novartis: Membership on an entity's Board of Directors or advisory committees, Other: Lectures. Avivi: Novartis: Speakers Bureau; Kite, a Gilead Company: Speakers Bureau. Ram: Novartis: Honoraria; Gilead: Honoraria. OffLabel Disclosure:Off label Cellcepet for prophylaxis of GVHD

The Diagnosis of Brain Death

Organ transplantation is impossible without donation which is performed both intra vitam and posthumously. Each case of multi-organ collection provides help to 4 to 6 patients. We believe that presentation of modern algorithms for diagnosing brain death is quite feasible, and such information can be useful not only for anesthesiologists, but also for doctors of other specialties. This paper presents materials related to organ donation. Diagnostic criteria for human brain death, as well as the procedure for ascertaining human brain death and the actions of doctors of healthcare institutions in relation to persons who are in these institutions and who have clinical indications for the diagnosis of brain death, are determined by "The procedure for cancellation of active measures to maintain the patient's life…". Active measures (ventilation, infusion therapy and vasopressor support, etc.) to support the patient's life are cancelled after the patient's brain death is ascertained, except for cases where the deceased person is considered a potential donor. Verification of the human brain death is carried out by the case management team of the healthcare institution involving, if necessary, members of consultative and diagnostic mobile team, specialists of other healthcare institutions. The head of the healthcare institution is responsible for timely and proper engagement and work of the case management team. The responsible person determines the membership of the case management team by making an appropriate entry in the case record and is responsible for its work.&#x0D; An anesthesiologist and a neurologist (neurosurgeon) who have at least 5 years of practical experience in the specialty are engaged in the case management team to ascertain brain death in persons over 18 years of age.&#x0D; Physicians involved in the removal of human anatomical materials and transplantation thereof, as well as transplant coordinator, may not be included in the case management team.

Building a bridge between patients and transplant healthcare professionals - a descriptive study.

This article describes a pathway for collaboration between transplant healthcare professionals and organ recipients. Under the umbrella of the European Society for Organ Transplantation (ESOT) a joint initiative started from three Sections and Committees of ESOT: EDTCO (European Donation and Transplant Coordination Organisation), ETHAP (European Transplant Allied Healthcare Professionals) and ELPAT (Ethical, Legal and Psycho-social Aspects of Transplantation). The formal 'kick-off' of the Advisory Board Meeting of the European Transplant Patient Organisation (ETPO) was during the ESOT congress in 2019. The aim was to produce a series of statements to serve as a path to dialogue between patients and transplant professionals and to define the next steps towards giving a voice to the patient network. To include the patients' perspectives, two surveys have been performed. The results identified the unmet needs and lead to a proposal for future plans. Educational activities have since started leading to a patient learning workstream. All initiatives taken have one purpose: to include patients, give them a voice and build a foundation for collaboration between patients and transplant professionals. ESOT has created a platform for mutual understanding, learning and a collaborative partnership between ETPO and European donation and transplant professionals.

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

Роль трансплант-координатора: беседа с семьей потенциального донора

В статье представлены основные принципы ведения диалога с семьей трансплантат-донора, уделяется внимание ключевым моментам, обеспечивающим наиболее высокое количество согласий на эксплантацию органов и тканей.

Is Age an Exclusive Factor for Accepting Liver Donors?

The aims of this study were to assess the viability of livers from older donors ≥80 years of age and to study the evolution of both the graft and the recipient during a minimum follow-up period of 6 months. This was a retrospective study (January 2011 to July 2019), including older liver donors, offered by the National Transplant Organization to the Transplant Coordination Team of our hospital. We compared livers excluded exclusively because of donor's age to those that were implanted. The following variables were studied: age, sex, body mass index, cardiovascular risk factors, toxic habits, comorbidities, natremia, use of vasoactive drugs, development of diabetes insipidus, use of antibiotics and length of stay in the intensive care unit. We also conducted a 6-month minimum follow-up of recipients, assessing graft and patient survival. During the period, 130 livers were offered. Of these, 102 (78%) livers were rejected. In 62 (47%), the reason for rejection was age exclusively. Twenty-eight (21%) livers ≥80 years of age were implanted; 2 needed retransplantation. There were no statistically significant differences between livers that were rejected and implanted in the variables detailed above, except for the number of comorbidities, which were lower in the rejected group. During the follow-up period, 7 deaths were registered. In our series, liver rejection due exclusively to age was frequent. Recipients of livers that came from older donors had an evolution that is similar to what has been previously described for younger livers. Patients an older age should be evaluated carefully as liver donors before excluding them based exclusively on age criteria.