Transplant Coordinators Research Articles

Solid Organ Transplantation in Kazakhstan: A Review on Current Situation and Challenges

Transplantation is one of the important strategic directions of medicine in Kazakhstan, which has been intensively developing in recent years. Noteworthy progress is observed in the implementation of advanced transplantation technologies aligned with global standards within scientific institutions and regional clinics across the country. However, there are certain problems in this field associated with the shortage of organs, transplantation for individuals in advanced disease stages, the growing need for re-transplantation, and adverse effects associated with immunosuppressive therapy. In this review, we aim to summarize the current situation of solid organ transplantation in Kazakhstan and the challenges hindering transplantation in the country. A literature search encompassing the Cochrane Library, Medline, and EMBASE, spanning until December 2023, was conducted. Search was done manually and using the following keywords: transplantation in Kazakhstan, liver transplantation, kidney transplantation, heart transplantation, coordination centers, and immunosuppression. For the effective work of the transplant coordination service and the provision of donors to the population, an integrated approach is needed, including organization of educational campaigns to disseminate information among the population, expanding the network of transplant coordination centers, creating a donation model based on the presumption of consent, and eliminating the free disposal of human organs.

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.

Conceptual model of regional system of organ donation and transplantation

Annotation. The aim – to substantiate the conceptual organizational and functional model of the regional system of organ donation and transplantation. In order to solve the problem of development of transplant medical care for the population of the region, an attempt was made to develop an organizational and functional model of the regional system of organ donation and transplantation. The study uses general scientific methods of analysis, synthesis, generalization, modeling, interpretation of scientific data, as well as systemic and structural-functional approaches. The developed model of the regional system of organ donation and transplantation is represented by a comprehensive regional system of engaged in the field of donation and transplantology, which integrates the activities of health care institutions that have the status of territorial donor bases and that are regional centers for organ transplantation. From the point of view of a systemic approach, this model provides transplant coordination of the activities of the health centers that are part of it, a clear algorithmization of actions at the stages of the donor process, organizational and methodological support of the donor bases and an interdisciplinary approach aimed at involving a number of regional organizations to assist the regional system of organ donation and transplantation in matters that depend from their competences. The conceptual model of the regional system of organ donation and transplantation is patient-oriented and aims to ensure the availability of highly specialized transplant medical care for the population of the region. The regional system of organ donation and transplantation model is presented as a system, a complex of interconnected regional health centers in the field of organ donation and transplantation, united in an effective regional system, the combined interaction of which provides a synergistic effect.

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

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

Review of the allocation criteria for heart transplant in Spain in 2023. SEC-Heart Failure Association/ONT/SECCE consensus document

Heart transplant (HT) remains the best therapeutic option for patients with advanced heart failure (HF). The allocation criteria aim to guarantee equitable access to HT and prioritize patients with a worse clinical status. To review the HT allocation criteria, the Heart Failure Association of the Spanish Society of Cardiology (HFA-SEC), the Spanish Society of Cardiovascular and Endovascular Surgery (SECCE) and the National Transplant Organization (ONT), organized a consensus conference involving adult and pediatric cardiologists, adult and pediatric cardiac surgeons, transplant coordinators from all over Spain, and physicians and nurses from the ONT. The aims of the consensus conference were as follows: a) to analyze the organization and management of patients with advanced HF and cardiogenic shock in Spain; b) to critically review heart allocation and priority criteria in other transplant organizations; c) to analyze the outcomes of patients listed and transplanted before and after the modification of the heart allocation criteria in 2017; and d) to propose new heart allocation criteria in Spain after an analysis of the available evidence and multidisciplinary discussion. In this article, by the HFA-SEC, SECCE and the ONT we present the results of the analysis performed in the consensus conference and the rationale for the new heart allocation criteria in Spain.

122.4: Breaking barriers in transplant coordination training: A developing country's experience with online education initiative.

122.4: Breaking barriers in transplant coordination training: A developing country's experience with online education initiative.

312.4: Annual visiting educational programs for in-hospital procurement transplant coordinators held by the Japanese Society for Organ Preservation and Biology.

312.4: Annual visiting educational programs for in-hospital procurement transplant coordinators held by the Japanese Society for Organ Preservation and Biology.

STRUCTURING ORGANIZATIONAL PROBLEMS AND TASKS IN TRANSPLANTOLOGY IN THE REGIONS OF UKRAINE

Purpose: to structure the organizational problems of regional organ donation and transplantation systems and identify key tasks for their optimization. Materials and Methods. To achieve the stated objective, this study employed general scientific methods such as analysis, synthesis, generalization, interpretation of scientific data, as well as systemic and structural-functional approaches. Results. Transplantation is a critically important part of treating individuals with damaged or dysfunctional organs or tissues. It holds global medical and social significance. The primary challenge in transplantation is the shortage of donor organs The main issue in organ transplantation, the problem of an adequate supply of optimal donor organs, can be addressed through effective organization of the donation process. The progress of transplantology is directly dependent on the level of organization of the transplantation process, and therefore, the best results in transplant activity are achieved by countries that have managed to establish an efficient transplant coordination system. Transplantology serves as a growth point for the entire healthcare system. The conducted research has shown that the key problems defining the directions for optimizing the regional organ donation and transplantation system include the following. In the systemic regional model of organ donation and transplantation, it is important to establish a mechanism for patient transfer from donor bases of regional transplantation centers, control organ allocation, and introduce modern medical technology standards at all stages of the donation process to optimize the diagnostic and therapeutic process. Conclusions. The article presents the structured key problems of optimizing the organ donation and transplantation system in the regions of Ukraine and defines optimization tasks as a framework for building a modern regional system. The identified problems confirmed that the conditions in which health care providers conduct transplants work, increasing the volume of transplants that contribute to the preservation of public health, and often life, is problematic. The study contributed to the formation of priority are as for the development of regional health care providers conducting organ transplantation.

Revisión de los criterios de distribución de trasplante cardiaco en España en 2023. Documento de consenso SEC-Asociación de Insuficiencia Cardiaca/ONT/SECCE

Heart transplant (HT) remains the best therapeutic option for patients with advanced heart failure (HF). The allocation criteria aim to guarantee equitable access to HT and prioritize patients with a worse clinical status. To review the HT allocation criteria, the Heart Failure Association of the Spanish Society of Cardiology (HFA-SEC), the Spanish Society of Cardiovascular and Endovascular Surgery (SECCE) and the National Transplant Organization (ONT), organized a consensus conference involving adult and pediatric cardiologists, adult and pediatric cardiac surgeons, transplant coordinators from all over Spain, and physicians and nurses from the ONT. The aims of the consensus conference were as follows: a) to analyze the organization and management of patients with advanced HF and cardiogenic shock in Spain; b) to critically review heart allocation and priority criteria in other transplant organizations; c) to analyze the outcomes of patients listed and transplanted before and after the modification of the heart allocation criteria in 2017; and d) to propose new heart allocation criteria in Spain after an analysis of the available evidence and multidisciplinary discussion. In this article, by the HFA-SEC, SECCE and the ONT we present the results of the analysis performed in the consensus conference and the rationale for the new heart allocation criteria in Spain.

Multidisciplinary and multidimensional approaches to transplantation in children with rare genetic kidney diseases.

In this review, we describe the multidisciplinary, multidimensional care required to optimize outcomes for pediatric transplant recipients with rare genetic kidney diseases. Transplant success, recipient survival, and improvement in quality of life depend on collaboration between patients, families, and a team of specialists with medical, as well as nonmedical expertise. A multidisciplinary transplant team composed of experts from medicine, surgery, nursing, nutrition, social services, transplant coordination, psychology, and pharmacology, is now standard in most transplant centers and is critical to the success of a transplant. In addition to these professionals, other specialists, such as cardiologists, urologists, geneticists, metabolic disease specialists, occupational therapists, case management, child life, chaplain, and palliative care services, have a crucial role to play in the preparation, surgery, and follow-up care, especially when a pediatric patient has a rare genetic disorder leading to renal involvement, and the need for transplantation. In order to describe this multidisciplinary care, we divide the genetic renal diseases into five subgroups-metabolic and tubular disorders, glomerular diseases, congenital anomalies of the kidney and urinary tract, ciliopathies including cystic diseases, and miscellaneous renal conditions; and describe for each, the need for care beyond that provided by the standard transplant team members.

State transplant coordinators’ views on influencing factors of the performance of organ donation and transplantation services in Brazil: a qualitative study

State transplant coordinators’ views on influencing factors of the performance of organ donation and transplantation services in Brazil: a qualitative study

#3143 MEASURING CLINICAL JUDGEMENT IN PROSPECTIVE KIDNEY TRANSPLANT RECIPIENTS: A FEASIBILITY STUDY

Abstract Background and Aims Exercising clinical judgement is becoming more challenging in the context of ageing populations, increasing prevalence of multimorbidity and frailty, and insufficient evidence regarding how best to manage increasing complexity in clinical practice. Measures of clinical judgement are surprisingly absent from health information systems despite their clear importance and the potential costs of poor decisions. Suitability for kidney transplantation is a high-stake clinical judgement, requiring consideration of complex biopsychosocial patient and organ-utilisation factors. This study aimed to test if it is feasible to assess clinical judgement quantitatively from routine clinical documentation in kidney transplant recipients. Method Participants were identified from a regional register of patients on haemodialysis, who underwent deceased donor kidney transplantation (KTR) and had at least 1 year of follow-up. We identified 15 KTR who had poor outcomes, defined as more than 6 hospital admissions or death within one-year of transplantation. Fifteen KTR controls were matched using the United Kingdom Renal Recipient Index (UKRRI: a composite score of age, dialysis requirement at listing, wait time on dialysis and diabetes status). Six blinded raters (two nephrologists, two transplant surgeons and two kidney transplant coordinators) scored clinical letters written at the time of transplant assessment across four domains (Clinician Belief of Appropriateness [CBA] for perceived suitability, perceived benefit, predicted short-term harm, predicted long-term harm: from 1 = worst, to 5 = best). The total CBA score was calculated as the mean score across the 4 domains. CBA scores were compared between raters using the intra-class correlation coefficient (ICC: for two-way agreement). Logistic regression models tested odds of poor outcome by CBA scores across 4 domains. Results Practicing clinicians were eager to participate, suggesting this type of research will be worthwhile and feasible. Among 30 KTR, the median total CBA transplant suitability score was 3 (IQR 3-4, range 1-5). Overall agreement was moderate (ICC for the total CBA score: 0.63, 95% CI 0.51-0.74; p < 0.001), but with substantial variation in CBA scores across the domains and between raters (Figure 1). In 3 of the 4 domains (perceived suitability: OR 0.91, 95% CI 0.48-1.73; predicted short-term: OR 0.70, 95% CI 0.33-1.51; and predicted long-term harms: OR 0.82, 95% CI 0.35-1.91), CBA scores adjusted for UKRRI were associated with poor outcome after transplantation in the expected direction. For predicted benefit, the point estimate was not in the expected direction; individuals with greater predicted benefits were more likely to have poor outcomes (OR 1.46, 95% CI 0.28-7.47). Unsurprisingly, given the small numbers in this pilot and the substantial influence of the donor organ on outcomes in kidney transplantation, all the confidence intervals were wide and crossed the null, indicating considerable uncertainty. Conclusion In patients undergoing assessment for kidney transplantation, measuring clinical judgement retrospectively is feasible, though subject to variability across domains and between raters. We did not identify any clear associations between retrospective assessment of CBA and outcome after kidney transplantation in this small pilot. In future work, we will develop and validate measures of clinical judgement, collect these measures prospectively, and examine the relationship of measured clinical judgement with health outcomes.

Pediatric Organ and Tissue Donation—A 10-Year Retrospective Study in Portugal

Organ and tissue donation can transform lives. One donor can ensure the survival of up to 8 people through their organs and improve the quality of life for dozens more through tissue donation. Portugal has an excellent transplantation rate, but deaths still occur while waiting for an organ. The study aimed to analyze pediatric organ and tissue donors nationally and evaluate brain deaths in a pediatric intensive care unit (PICU) over the past 10 years to identify any potential lost donors. We conducted a retrospective descriptive study of pediatric organ and tissue donors and diagnosed brain deaths from January 2011 to December 2021. Demographic and clinical data were analyzed, including those provided by the National Transplant Coordination. Over the past 10 years in Portugal, 121 pediatric donors (11.7 per million population) were collected, and 569 organs and tissues were collected. During the same period in the PICU, there were 125 deaths, including 20 brain deaths. Of this group, 4 were organ and tissue donors. In the non-donor group (n=16), a potential lost donor case stands out. Pediatric specialists need to be more familiar with the donation process, which would enable the identification and optimization of all potential donors, thus minimizing the number of potentially lost organs.

POSTHUMOUS DONATION AND ORGAN TRANSPLANTATION IN UKRAINE DURING THE WAR

One of the leading directions of the development of Ukrainian medicine during the last few years is organ transplantation, because it is a treatment method that remains the last hope when all other methods are already ineffective. However, despite the successes in this area, there are also problematic moments, the main of which is the lack of donor organs. And the reason for this shortage is considered to be the disapproval of relatives for the removal of organs, due to the low level of awareness of the procedure for establishing brain death. But, despite this, as well as in spite of the difficult working conditions during the war, Ukrainian transplantology is constantly developing, as evidenced by the data of the Ministry of Health and the Ukrainian Center for Transplant Coordination. A significant success in the field of transplantology is the second lung transplant recently carried out in Ukraine and the first carried out independently by Ukrainian doctors.

Self-Assessment Tool and Clinical Audits: A Way to Manage Organ Donation and Transplantation in Hospital Settings

The self-assessment tool (SAT) of hospital management in donation and transplantation is a systematic instrument that allows reaching a situation status on Procurement and Transplantation with emphasis on the management and cultural change of Health Personnel in each care center.The SAT allows reflection on institutionalization, achievements, and the cultural change generated by donation and transplantation in Health Personnel. It also allows the evaluation of the culture of hospital donation and the formulation of plans and goals for the future.The SAT evaluates 5 components (Logistics, Education, Communication, Donation Culture, and Results Evaluation) with 30 questions and reflects the core aspects of the hospital donation process.The answers to the SAT are numbered and based on the total score. We can classify the management and its results as insufficient, basic, intermediate, and advanced.The SAT was applied in 8 hospitals whose donation results are externally audited, and their results were compared with the result of the self-assessment.The SAT was useful in supporting and guiding the work of the intra-hospital transplant coordinator; it allows the classification of the hospital, taking into account the main aspects of donation and transplant management and, based on this, generating a package of measures for improvement.

Kidney Donation after circulatory death: The Veneto Region experience in Italy

Donation after circulatory death (DCD) is a promising strategy for increasing organ supply worldwide. The Italian current legislative framework has represented a major barrier to the implementation of such program, given the 20-minute no-touch period required for donor death declaration.In this study, we describe DCD reporting activity in Veneto, number of procurements and kidney transplants performed from DCD donors since the beginning of its application, in 2017. We considered donor characteristics (DCD Maastricht category, age, sex) and number of kidney grafts retrieved and transplanted for each donor.All the procured kidney grafts underwent ex situ hypothermic perfusion and pre-implantation kidney biopsy according to Karpinski-Remuzzi score. Perfusion parameters were monitored in order to predict functional recovery after transplantation and the histological evaluation focused on evaluating the extension of the ischemic injury. In the Veneto experience, histological data and hypothermic perfusion have proven to be very useful tools to make a decision concerning whether a kidney is suitable for transplantation.Considering logistical, clinical, ethical and technical issues related to DCD donor program in Italy, many resources had to be dedicated in Veneto to build adequate technical expertise and to develop dedicated care pathways. The Veneto Region Transplant Coordination has encouraged and supported the development of DCD activity, increasing kidney transplantation from DCD donors.

106 - Improving Electronic Communication for Transplant and Cellular Therapy Calendar Coordination: Collections, Admissions, Product Arrivals and Infusions

106 - Improving Electronic Communication for Transplant and Cellular Therapy Calendar Coordination: Collections, Admissions, Product Arrivals and Infusions

Overcoming Challenges of Deceased Organ Donation in Indian Private Hospitals.

Overcoming Challenges of Deceased Organ Donation in Indian Private Hospitals.

Factors influencing kidney transplantation rates: a study from the ERA Registry.

Large international differences exist in kidney transplantation (KT) rates. We aimed to investigate which factors may explain the total, deceased donor and living donor KT rates over the last decade. KT experts from 39 European countries completed the Kidney Transplantation Rate Survey on measures and barriers and their potential effect on the KT rate in their country. In the analyses, countries were divided into low, middle and high KT rate countries based on the KT rate at the start of study period in 2010. Experts from low KT rate countries reported more frequently that they had taken measures regarding staff, equipment and facilities to increase the total KT rate compared with middle and high KT rate countries. For donor type-specific KT, the largest international differences in measures taken were reported for deceased donor KT, with middle and high KT rate countries taking more measures, such as the use of expanded criteria donor kidneys, the presence of transplantation coordinators and (inter)national exchange of donor kidneys. Once a measure was taken, experts' opinion on its success was similar across the low, middle and high KT rate countries. Experts from low KT rate countries more often reported potential barriers, such as patients' lack of knowledge and distrust in the healthcare system. Particularly in low KT rate countries, the KT rate might be stimulated by optimizing staff, equipment and facilities. In addition, all countries may benefit from measures specific to deceased and living donors.

1298. Donor Call Simulation: A Novel Medical Education Tool to Evaluate Trainees’ Clinical Decision-Making in Transplant Infectious Disease

Abstract Background Simulation is a useful education tool for high-stakes clinical skills and decision-making. Recommending whether to accept or reject an organ for transplantation based on infection risk is a critical core competency in Transplant Infectious Disease (ID), however there are no published data that learners have opportunities to practice this during training. We created a novel simulation to expose learners to this real-life clinical scenario and evaluated their clinical decision-making in these situations. Methods We created 6 simulations with common ID consult questions about whether to accept or reject an organ for transplant based on infection risk (Table 1). During learners’ Transplant ID rotations, faculty periodically texted or paged them with the simulation cases as though they were the transplant coordinator. Learners had 15 minutes to ask follow up questions before deciding to accept or reject the organ and explain their decision-making process in a survey. Learners completed a survey 1 month after the simulation experience to evaluate its effectiveness. Results Between October 2021 and April 2022, 16 learners from 7 medical centers participated in the simulation (Table 2) and 94% (15/16) completed the follow up survey. Eighty-seven percent (13/15) of ID learners reported that the simulation was effective in teaching them when to accept or reject organs and 80% (12/15) felt more prepared to make these decisions in practice. Most learners correctly identified acceptable organs for transplant during the simulations (Figure 1). Of the 100 clinical reasoning decisions made during the activity, 19% were discordant, where the learner correctly decided to accept or decline the organ but with incorrect or incomplete reasoning for this decision (Figure 2). Conclusion ID learners perceived our transplant ID simulation as an effective educational tool to learn when to accept or reject an organ for transplant. By evaluating the clinical reasoning behind these decisions our simulation provides ID educators with nuanced insight into their learners' thought process and allows for targeted coaching to correct deficits in reasoning. Disclosures Rebecca Kumar, MD, Gilead: Grant/Research Support|Regeneron: Grant/Research Support Jonathan Hand, MD, GlaxoSmithKline: Grant/Research Support|Janssen: Grant/Research Support|Pfizer: Grant/Research Support Roderick Go, DO, Aptose Biosciences: Stocks/Bonds|Bristol Meyers Squibb: Stocks/Bonds|Cytodyn Inc.: Stocks/Bonds|Scynexis: Grant/Research Support Erica J. Stohs, MD, MPH, bioMerieux: Grant/Research Support.