UK Donors Research Articles

More Giving or More Givers? The Effects of Tax Incentives on Charitable Donations in the UK

This paper estimates the intensive and extensive-margin tax-price elasticities of giving using UK administrative tax return data, exploiting variation from a large tax reform. Using a variety of estimation methods and new instruments for the tax-price of giving, we find an intensive-margin elasticity of about -0.25 and an extensive-margin elasticity of -0.1, yielding a total elasticity of about -0.35. These estimates mask considerable heterogeneity: high-income individuals respond more on the intensive margin, while the extensive-margin response is stronger for low-income taxpayers. We then derive new conditions to evaluate the welfare consequences of changes in the subsidy to donations. This analysis shows that these elasticities can only be rationalized as being optimal if the UK government places a large enough value on providing warm-glow opportunities for UK donors.

Secrets and disclosure in donor conception

This article considers the disclosure, sharing and exchange of information on being donor conceived within families, drawing on data from a study undertaken with donor-conceived adults registered with UK Donor Link (a voluntary DNA-linking register). This paper considers the narratives of how respondents found out they were donor-conceived and what events triggered disclosure of this information. This paper then goes on to examine the role secrecy played in their family life and uses the concept of 'display' to explore how secrecy affected their relationships with their immediate and extended family. Secrets are notoriously 'leaky' and we found complex patterns of knowing and uncertainty about whom in the family knew that the person was donor-conceived. We argue that what is kept secret and from whom provides insights into the multifaceted web of social relationships that can be created by donor-conception, and how knowledge can be managed and controlled in attempts to display and maintain family narratives of biogenetic connection.

Standards in reporting cryopreserved donor sperm characteristics: should they be reported post-thaw or post-wash?

An increase in the reliance on imported donor samples has been the consequence of a continued shortage of UK donors. Disputes can arise between suppliers and purchasers if the sperm quality is not as expected, yet there appears to be no requirement for the standardization of methods for sperm processing or analysis. Following analysis of 102 donor intrauterine insemination cycles, this study demonstrates that the motile sperm concentration is significantly (P < 0.05) reduced after the necessary removal of cryoprotectant before insemination. Suppliers of donor spermatozoa should therefore provide information on standards used for sperm assessment and whether analysis is performed before or after washing in order that purchasers are better informed about the quality of the end product they are committed to buying.

Getting personal with blood donors-the rationale for, methodology of and an overview of participants in the UK blood donor survey.

To design and pilot a survey of UK blood donors to assess, on a large scale, their understanding of and compliance with the donor selection guidelines (DSG). Compliance with the DSG is important for maintaining blood safety, however, little is currently known about the extent of this among UK donors. The online, unlinked survey was based on the donor health check form with a focus on behaviours associated with blood borne infections, sexual contact, drug use and travel. The survey materials were reviewed by a donor focus group and the survey was piloted among 2982 UK donors. Percentage responses were calculated, complaints monitored and answers to questions reviewed. The survey went live in 2013; 225 091 donors were invited via email to participate followed by two reminders. The survey was well received by the focus group, with little concern about the sensitive and personal questions. Their feedback led to important refinement in the survey materials. In the pilots, 21·0% (627/2982) responded, a reminder was necessary to achieve this. Among responders, there was evidence of non-compliance and test seeking behaviour, and no evidence that intention to donate again was affected. In the live survey, 29% (65 439) responded; responders were generally representative of donors overall. A large scale survey of donor compliances is feasible, acceptable and effective in ascertaining appropriate information; involving donors and the blood services in the development stages through a focus group and pilots was important to achieve this.

Short Term Outcomes of Recipients Transplanted With Machine Perfused Kidneys From Elderly Donors After Circulatory Death (DCD).

Background: The use of the elderly (age>60 years) DCD donors in UK is rising in recent years. Hypothermic pulsatile machine perfusion of donor kidneys results in lower incidence as well as duration of DGF. The use and potential benefit of machine perfusion of kidneys retrieved from elderly DCD donors is not well established. Aim: To investigate the impact of hypothermic pulsatile machine perfusion on short term outcome of recipient transplanted with kidneys from elderly DCD donors. Material and methods: From 10/2009 to 06/2013 sixty patients were transplanted with kidneys from DCD donors which were machine perfused prior the implantation. Recipients were grouped in two groups. Group A: donor age< 60 years and Group B: donor age>60years. Donor and recipient characteristics, renal function, 1 year patient and graft survival and perfusion characteristics were compared between the two groups. Continuous variables were compared using student's t-test and categorical variables using Fisher's exact test. Results: The overall DGF rate in patients transplanted with kidneys from DCD donors decreased to 28% compare to 40% prior the machine perfusion era.Table: No Caption available.Summary: The overall DGF rate is decreased using machine perfusion to 28%. The short term results of recipients transplanted with kidneys from elderly and younger donors are comparable. The beneficial effect of machine perfusion on donor kidneys retrieved from elderly DCD donors is worth future studies.

Population screening for variant Creutzfeldt-Jakob disease using a novel blood test: diagnostic accuracy and feasibility study.

Our study indicates a prototype blood-based variant Creutzfeldt-Jakob disease (vCJD) assay has sufficient sensitivity and specificity to justify a large study comparing vCJD prevalence in the United Kingdom with a bovine spongiform encephalopathy-unexposed population. In a clinical diagnostic capacity, the assay's likelihood ratios dramatically change an individual's pretest disease odds to posttest probabilities and can confirm vCJD infection. To determine the diagnostic accuracy of a prototype blood test for vCJD and hence its suitability for clinical use and for screening prion-exposed populations. Retrospective, cross-sectional diagnostic study of blood samples from national blood collection and prion disease centers in the United States and United Kingdom. Anonymized samples were representative of the US blood donor population (n = 5000), healthy UK donors (n = 200), patients with nonprion neurodegenerative diseases (n = 352), patients in whom a prion disease diagnosis was likely (n = 105), and patients with confirmed vCJD (n = 10). Presence of vCJD infection determined by a prototype test (now in clinical diagnostic use) that captures, enriches, and detects disease-associated prion protein from whole blood using stainless steel powder. The assay's specificity among the presumed negative American donor samples was 100% (95% CI, 99.93%-100%) and was confirmed in a healthy UK cohort (100% specificity; 95% CI, 98.2%-100%). Of potentially cross-reactive blood samples from patients with nonprion neurodegenerative diseases, no samples tested positive (100% specificity; 95% CI, 98.9%-100%). Among National Prion Clinic referrals in whom a prion disease diagnosis was likely, 2 patients with sporadic CJD tested positive (98.1% specificity; 95% CI, 93.3%-99.8%). Finally, we reconfirmed but could not refine our previous sensitivity estimate in a small blind panel of samples from unaffected individuals and patients with vCJD (70% sensitivity; 95% CI, 34.8%-93.3%). In conjunction with the assay's established high sensitivity (71.4%; 95% CI, 47.8%-88.7%), the extremely high specificity supports using the assay to screen for vCJD infection in prion-exposed populations. Additionally, the lack of cross-reactivity and false positives in a range of nonprion neurodegenerative diseases supports the use of the assay in patient diagnosis.

(428) - Marginal Donors: Improvement in Quality of Hearts Transplanted and Mid-Term Survival By Echo-Stress Evaluation

“scouted” donors versus 63% of “non-scouted” donors (p= 0.0298). The conversion rate from offer to heart transplantation was 47% for the “scouted” donors versus 30% for the “non-scouted” donors (p= 0.1314). During this period, 39% of hearts offered from UK donors were transplanted compared with 28% for the equivalent period in the previous year (p= 0.0587). Conclusion: Initial results for the UK retrieval team ‘scout’ pilot programme suggest that early interventions by a team experienced in donor management may lead to an increased conversion rate for cardiac donors. Detailed information is being collated on scout attendance over a longer time period to investigate the association between scout attendance and the substantial observed overall increase in UK heart transplants since April 2013.

Equality Of Access To Transplant For Ethnic Minority Patients Through Use Of Cord Blood and Haploidentical Transplants

It is well accepted that patients of ethnic minorities who lack a sibling donor are poorly represented on the international unrelated donor panels. As recently as 2000, only 30% of such patients were able to find an unrelated donor suitable for transplantation. Historically these patients would have either not been transplanted, or would receive transplants from unrelated donors with two or more HLA mismatches. Continued expansion of the international donor inventory, and the advent of cord blood and haploidentical transplantation has improved the prospects for transplantation for such patients and, through the expertise of search staff within donor registries and histocompatibility laboratories, transplant centres are increasingly able to identify early on those patients who are unlikely to find a well-matched unrelated adult donor. Surprisingly, however, few contemporary data have been published to show the impact of these search strategies and alternative stem cell sources on provision of transplant to those of non-white Northern European origin.We consecutively enrolled and prospectively followed up (from search request to last contact or death) 332 patients referred by four UK transplant centres to the Anthony Nolan Graft Identification and Advisory Service (GIAS) for identification of an unrelated adult donor or cord blood unit. Of these, 248 (74.7%) were of white Northern European (WNE) descent, and 84 (25.3%) non-WNE. The underlying disease did not differ significantly between ethnicities. The median number of UK donors listed on the search report was 8 (range 0 to 3395) and 0 (0 to 42) respectively, and on BMDW 127 (0 to 38245) and 5.5 (0 to 380) respectively. 69.3% of WNE and 20.5% of non-WNE patients found a 10/10 HLA-matched donor at confirmatory typing (CT) (p<0.001); 96.3% of WNE and 61.4% of non-WNE found at least a 9/10 HLA-matched donor (p<0.001). Non-WNE patients had more cord blood transplants (21.3% vs 3.8%, p<0.001) and more haploidentical transplants (10.6% vs 1.3%, p<0.001). There was no significant difference in the number of patients reaching transplant (WNE 63.3%, non-WNE 56.0%, p=0.185) when considering all of the graft sources. Patients of non-WNE background had a significantly slower time from first CT request to identification of an unrelated donor for transplant (median 27 days vs 33.5 days, p= 0.02), and from search request to transplant with any graft source (median 110 days vs 132 days, p=0.03). However, when the cumulative incidence of transplantation with death as a competing risk was considered, there was no difference between ethnic groups (log rank p=0.185, see figure). The median time from search request to transplant by graft source was 120.5 days for adult unrelated donors (n=179), 143 days for cord blood (n=16) and 91 days for haploidentical donors (n=6) (p=0.626). [Display omitted] These data show that the chance of receiving a transplant for patients of a non-WNE descent has improved considerably compared to historical literature. The majority of non-WNE patients were able to find a 9 or 10/10 matched donor, and many of those who could not were afforded the option of a cord blood or haploidentical donor transplant within a similar timescale. Whilst times to transplant do remain slightly longer for non-WNE patients, mainly due to a more protracted CT stage, they now stand an equal chance of reaching transplant. However, whether survival following transplant is similar between ethnic groups remains to be seen. Disclosures:No relevant conflicts of interest to declare.

App to reality: snapshot validation of the US Pancreas Donor Risk Index in a UK center

BackgroundA pancreas donor risk index (PDRI) has been derived by Axelrod et al. to inform organ acceptance and developed into a smartphone app by Marc Melcher. This paper aims to validate the app for use in a single UK transplant center through a snapshot of donors and outcomes during one calendar year. MethodsDonor details for all pancreas transplants performed in 2011 were collected from a prospectively maintained clinical database to calculate a PDRI using the Pancreas Transplant Donor Risk Index smartphone app. ResultsNinety pancreas transplants were included in the analysis (72 simultaneous pancreas kidney [SPK], 18 pancreas transplant alone [PTA]). PDRI scores were found to be positively skewed compared with donors described in the US literature. The PDRI was predictive of poorer 1-y graft outcome in the SPK group but not in the PTA group. PDRI was not predictive of time to failure or failure cause. ConclusionValidation of the PDRI app against data from our center shows that it can be used as a tool to predict poorer graft outcome in the SPK group. However, it was not predictive in the PTA group, and differences in US and UK donor characteristics were evident. Development of a UK-specific PDRI may overcome these limitations.

Acceptability of blood and blood substitutes

Alternatives to donor blood have been developed in part to meet increasing demand. However, new biotechnologies are often associated with increased perceptions of risk and low acceptance. This paper reviews developments of alternatives and presents data, from a field-based experiment in the UK and Holland, on the risks and acceptance of donor blood and alternatives (chemical, genetically modified and bovine). UK groups perceived all substitutes as riskier than the Dutch. There is a negative association between perceived risk and acceptability. Solutions to increasing acceptance are discussed in terms of implicit attitudes, product naming and emotional responses.

P55 The Management of Blood Samples to be Used in Assessing Tests for vCJD in Donor Blood.

There are presently 161 reported cases of vCJD in the UK, with three cases associated with the receipt of blood components. However, there is currently no routine large‐scale screening test for vCJD in humans. The NHSBT considers that it is essential to be in a position to validate emerging tests for vCJD as quickly as possible, to ensure that suitable tests can be implemented in a timely manner, if required by the DoH. NHSBT is proactively preparing a panel of samples that will be used in assessing tests, to determine if they are operationally fit for purpose. This work is being undertaken in a specifically designed Test Assessment Facility (TAF) at Manchester Blood Centre, which went live in November 2005. To manage the panel, the Thermo Nautilus Laboratory Information Management System (LIMS) has been installed. Nautilus is a highly configurable LIMS, capable of handling large amounts of data. Irreversible anonymisation, integration with robotic equipment, and the ability to interrogate other data systems and retrieve information, are key features. Whole blood donations are received into the TAF and are logged into the LIMS, which retrieves basic donor demographic information, then irreversibly anonymises it. Red cell, buffy coat and plasma components are then prepared, and robot sample handlers sub‐aliquot them. The LIMS then references a data output file, and processes the sub‐aliquot information, creating a detailed inventory. Wireless technology is used for plate storage. The LIMS underwent extensive validation, including the use of designated test scripts to challenge and validate all aspects of the system, plus verification of compliance with GMP and GAMP regulations. The panel builds at a rate of around 125 donations per week, equating to 18,000 individual sub‐aliquots, all managed by the LIMS. The panel will take 2 years to complete, when it will consist of samples from 10,000 donations(5000 from UK donors and 5000 from US donors), producing a panel size of 1,440,000 sub‐aliquots. The use of Nautilus LIMS in the TAF has proved invaluable to the project, and has contributed to its successful implementation. Furthermore, it will continue to manage the panel, and all associated activities.

P41 Anti‐Cra , Pegnancy and Transfusion Support

The managemet of a patient with anti‐Cra presents a challenge as it is impossible to locate Cr(a‐) blood from the UK donors. The data regarding haemolytic transfusion reactions (HTR) in association with anti‐Cra is very flimsy. Patients with anti‐Cra have been transfused with Cr(a+) blood uneventfully, some have provided Cr(a‐) units when red cell survival studies demonstrated shorten survival. UK guidelines (Daniels et al) recommended that weak Cr antibodies are not considered clinically significant, and Cr(a‐) blood is not indicated. There is no firm evidence that anti‐Cra causes HTR, but has been suggested to provide Cr(a‐) units for those with strong antibodies. Anti‐Cra is unique as the antibody may diminish or even disappear during the course of the pregnancy. Weber et al have demonstrated that the decrease in anti‐Cra during pregnancy is due to sequestration by the placenta. This protects the fetus from developing HDN. There were only four reported cases of anti‐Cra during pregnancy. We report our experience in planning transfusion support for a pregnant patient with anti‐Cra. Anti‐Cra (IAT titre 32) was identified in the booking sample of a 31‐year‐old Somalian woman. Her blood typed as O,R1R1 At 28 weeks gestation antibody titre dropped to four. Plan for transfusion support was discussed with the obstetricians. Previous pregnancies were uneventful and the patient did not require any transfusion. In view of the significant drop in antibody level, instead of searching for rare Cr(a‐) blood, we advised transfusing group O, R1R1, K‐ rbcs if the patient required a transfusion. It was planned to deliver by vaginal route. The patient was seen again at 35 weeks gestation. By that time, the IAT titre had further dropped to 1. The healthy baby was delivered by vaginal route during the weekend. There was no clinical evidence of HDN. Delivery was uneventful and the mother did not require blood transfusion. Both the mother and baby were discharged the next day. Attempts to obtain cord and post delivery infant's sample was unsuccessful. Anti‐Cra has not been reported causing HDN, therefore the patient with anti‐Cra does not require close monitoring.The purpose of the serial antibody titration study in our case is to demonstrate the drop or disappearance of antibody. This assisted in making a final decision for selection of suitable blood for the patient.

P34 Management of Pregnancy Complicated by Anti‐hrB and/or Anti‐HrB.

Anti‐hrB and anti‐HrB are rare alloantibodies, so far found exclusively in people of Black African descent. There is no data available regarding haemolytic transfusion reactions in association with anti‐hrB, and precise information is limited. Anti‐HrB may cause transfusion reactions, but no data is available. Selection of blood for transfusion support for patients with these alloantibodies imposes a special challenge in the UK, as, in the case of anti‐hrB (if accompanied with anti‐D) it is difficult to locate suitable antigen negative blood, whilst HrB‐ blood is almost unknown amongst the UK donor population. Two antenatal cases are reported, one with anti‐hrB, and one with anti‐HrB. Weak anti‐D was also identified in the serum in both cases. For the former case, r“r” ( dcE/dcE) units were provided to cover the delivery. The baby was delivered by vaginal route. Cord sample DAT was negative, with no evidence of haemolytic disease of the newborn (HDN). The patient did not require transfusion. The patient was known to have anti‐hrB in her previous pregnancy, and there was no evidence of HDN in that pregnancy. Anti‐HrB may cause haemolytic transfusion reaction. In the latter case, there are two options: either to import extremely rare D‐, HrB blood from South Africa or to provide rare Rhnull units. The patient received two Rhnull units to cover for Caesarean Section and transfusion was uneventful. Although the cord sample DAT was positive (Anti‐IgG 2+, ‐C3d1+) the infant's delivery Hb level was 15.2 g dL‐1 and bilirubin was within the normal range. No therapy was required. A literature search confirms that there is not much data available regarding the clinical significance of anti‐hrB and anti‐HrB. The few previous reports indicate that both anti‐hrB and anti‐HrB appear not to cause HDN. Our cases supported that HDN is not associated with both anti‐hrB and anti‐HrB. The cases reported here illustrate the complexity in providing transfusion support for these patients. Further case reports are warranted to establish the clinical relevance of these rare antibodies.

Does Compassion Bring Results? a critical Perspective on Faith and Development

This article explores the relationship between the Christian concept of compassion and the work of Non Governmental Organisations (NGOs) in the Developing World. The article focuses on the work of a UK donor, NGO whose members express a Christian faith. The membership of this NGO is highly motivated and they have maintained a long-term commitment to the communities they help in rural Rajasthan. However, the success of this NGO is constrained by their construction of a poor underdeveloped Other who is the focus of their prayers and towards whom all interventions are directed. This image of the suffering Rajasthani villager is fictitious and blocks the emergence of a complex picture of life in this region. This article stresses that whilst faith has much to offer development practice it can also render people blind to the experiences and needs of others.

Is It Possible To Recruit Gamete Donors Who Are Both Altruistic and Identifiable?

To provide an analysis of responses from British gamete donors to a Department of Health survey on the possible implications of removing donor anonymity. A questionnaire designed by the Department of Health distributed to egg and sperm donors via licensed infertility treatment centres The questionnaire sought information from donors on: The centre at which they were/had been a donor The type of their donation Their response to the future removal of donor anonymity Their willingness to donate should donor anonymity be removed Their knowledge of other potential donors Their perception of the main issues or questions Their suggestions for recruiting identifiable donors 135 anonymously completed questionnaires were accessed by the researchers and analysed using SPSS. Two questionnaires were excluded from the analysis as it was unclear whether these respondents were donors. 16 centres were identified; five respondents did not specify a centre; 74% (99) identified just four centres and one centre was identified by 38% (50) 75 respondents (57%) were egg donors, 43 (32%) were sperm donors. 12 respondents (9%) identified themselves as egg share donors. There were no embryo donors. Three respondents did not make clear the type of donation in which they had engaged. Just over a third (47) of respondents asserted that they would become concerned about the future removal of donor anonymity. 48 (36%) were either not worried about, or positively welcomed, the removal of donor anonymity. The remaining quarter was unsure. 4 respondents did not respond to this question. Almost half of the respondents (20 sperm donors, 38 egg donors and 8 egg share donors) indicated they would still donate if anonymity were removed. This includes virtually all respondents who indicated that they were either not worried about, or positively welcomed, the removal of donor anonymity, and nearly half of those who were “unsure”. Very few who had expressed concern (3) would continue to donate. Only 15% (20) said they knew of a potential donor. While some concern was expressed about the physical and psychological health of donor-conceived children, most “main issues or questions” were concerned with possible implications for the donor of the removal of anonymity, including financial responsibility, emotional liability, moral obligations and fears of general personal involvement. Related issues focused on legal aspects, donors’ rights - including access to information about the recipients or any resulting child (or indeed any information about the outcome of their donation), the personal security of donors, and the potential impact on family members - in particular the donor’s spouse - if the resulting child ever wished to make contact with the donor. Suggestions made for recruiting identifiable donors included: education of others; providing a financial incentive (since currently UK donors are generally not compensated); ensuring that that the legal issues were considered and that donors had protection from legal responsibility, and use of the media/publicity. The survey indicates that approximately half of existing donors would continue to donate if anonymity were removed. In addition evidence is provided of the need for donors to have more information about the legal and social implications of gamete donation and greater opportunities for discussion.

Efficiency is a Legitimate Consideration in Equitable Distribution of Cadaveric Transplants: Development of an Efficiency-Equality Model of Equity

It is proposed that equity is a trade-off, or compromise, between equality and efficiency. The kidney transplant allocation algorithm currently used in the United Kingdom (NAT) was tested in the efficiency-equity model. In an exercise of 2000 past UK donors and a dynamic waiting list of 5000 potential recipients, 4000 transplants were allocated according either by NAT, by equal allocation (EQ) (a lottery), or by efficiency (EF). Diabetic recipients received 7.4% of transplants in NAT, 8.6% in EQ, and 0% in EF; paediatric recipients received 6.8% in NAT, 0.6% in EQ, and 0.7% in EF model. For HLA matching, there were 77.9% favourable or 000 matches in NAT, 3.0% in EQ, and 53.1% in EF. Predicted survival showed better outcomes in EF versus NAT ( P < .0001) and in NAT versus EQ ( P = .05). The NAT allocation system favours paediatric recipients and does not deny diabetics the chance of a transplant, broadly in line with published public and professional opinions. The NAT scheme achieves better HLA matching than the EF model, and this suggests that the rationale for allocation based primarily on HLA matching could be reexamined.

EFFICIENCY IS A LEGITIMATE CONSIDERATION IN EQUITABLE DISTRIBUTION OF CADAVERIC TRANSPLANTS: DEVELOPMENT OF AN EFFICIENCY-EQUALITY MODEL OF EQUITY

It is proposed that equity is a trade-off, or compromise, between equality and efficiency. The kidney transplant allocation algorithm currently used in the United Kingdom (NAT) was tested in the efficiency-equity model. In an exercise of 2000 past UK donors and a dynamic waiting list of 5000 potential recipients, 4000 transplants were allocated according either by NAT, by equal allocation (EQ) (a lottery), or by efficiency (EF). Diabetic recipients received 7.4% of transplants in NAT, 8.6% in EQ, and 0% in EF; paediatric recipients received 6.8% in NAT, 0.6% in EQ, and 0.7% in EF model. For HLA matching, there were 77.9% favourable or 000 matches in NAT, 3.0% in EQ, and 53.1% in EF. Predicted survival showed better outcomes in EF versus NAT (P < .0001) and in NAT versus EQ (P = .05). The NAT allocation system favours paediatric recipients and does not deny diabetics the chance of a transplant, broadly in line with published public and professional opinions. The NAT scheme achieves better HLA matching than the EF model, and this suggests that the rationale for allocation based primarily on HLA matching could be reexamined.

Malaria Screening of Blood Donors in Saudi Arabia

Transfusion-associated malaria is a potentially serious complication that continues to pose risks in blood bank settings. There is a need for effective malaria screening of blood donations to improve on the current exclusion policies of potentially infected carriers on the basis of clinical and travel history. We evaluated the potential usefulness of ELISA screening for malaria antibody and P. falciparum antigen among Saudi blood donors. A total of 1756 donors were studied, 1100 from the malaria endemic Southern Region and 656 donors from the known malaria-free Riyadh area. The overall antibody prevalence for the antibody was 7.6%, in comparison to only 0.17% for the antigen. In the endemic region, the antibody positivity rate of 9.1% was almost double the rate in the non-endemic area (4.8%). There was no difference in the antigen prevalence rates; 0.18% in endemic and 0.15% in nonendemic areas. In malaria endemic countries like Saudi Arabia, excluding antibody-positive donations would result in too much wastage of blood units. However, antigen malaria testing appears to offer a potential utility, as only few donations would be rejected.

The management of coumarin-induced over-anticoagulation Annotation.

The management of coumarin-induced over-anticoagulation Annotation.

Variations in cardiac transplantation: comparisons between the United Kingdom and the United States

Background: International practice variations have been documented in various health care specialties. This study compares cardiac transplantation in the UK with practice in the US. Methods UK data were from an ongoing multi-center prospective study, the UK Cardiothoracic Transplant Audit. The UK population comprised 620 listings and 463 transplants. US data were obtained from UNOS and comprised 3946 listings and 4704 transplants. Results There was a mean of 14 transplants per center per year in the US compared with 34 in the UK. Notable differences in practice include rarity of listing in the UK of patients > 65 years (0.2% vs 4.1% in US) and patients with previous transplants (UK 0.9%, US 3.2%). Patients listed in the US were more likely to be on ventricular assist devices (odds ratio 8.0, 95% CI 3.0–21.7) or inotropes (odds ratio 4.9, 95% CI 3.7–6.4). Living donor (domino) transplants, although comprising 7% of transplants in the UK, are virtually non-existent in the US (1 domino in 4704 transplants). Heterotopic transplants were more common in the UK (4.4% vs 0.5%). Indications for transplant were similar (except retransplantation). The donor age was >35 years in 43% of UK donors vs 33% of US donors. Conclusion This study reveals substantial practice differences between the UK and US. Further studies are required to examine the reasons for these practice differences, the influence on transplant outcome, and their ethical and economic implications.