Patients with end stage liver disease may become critically ill prior to LT requiring admission to the intensive care unit ICU. The high acuity patients may be thought too ill to transplant; however, often LT is the only therapeutic option. Choosing the correct liver allograft for these patients is often difficult and it is imperative that the allograft work immediately. Donation after cardiac death DCD donors provide an important source of livers, however, DCD graft allocation remains a controversial topic, in critically ill patients.
After retransplant cases and multiorgan transplants were excluded, 8 recipients of DCD grafts and 42 recipients of DBD grafts were included in this study. While there were differences in graft and survival between DCD and DBD groups at 4 month and 1 year time points, the differences did not reach statistical significance. The graft and patient survival rates were similar among the groups at 3-year time point.
There is need for other large liver transplant programs to report their outcomes using liver grafts from DCD and DBD donors. We believe that the experience of the surgical, medical and critical care team is important for successfully using DCD grafts for critically ill patients.
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The PSD Specialized programs are believed to cultivate stronger relationships with students, which lead to stronger alumni relationships and increased donations. This research tests this empirically by examining relationship perceptions and donation…. Kidney paired donation KPD strategies have facilitated compatible living-donor kidney transplants for end-stage renal disease patients with willing but incompatible living donors.
Success has inspired further innovations that expand opportunities for kidney-paired donation. Two such innovations are the advanced donation strategy in which a donor provides a kidney before their recipient is matched, or even in need of, a kidney transplant, and deceased donor initiated chains in which chains are started with deceased donors rather than altruistic living donors.
Although these innovations may expand KPD, they raise several ethical issues. Specific concerns raised by advanced donation include the management of uncertainty, the extent of donor and recipient consent, the scope of the obligation that the organization has to the kidney exchange paired recipient, the naming of alternative recipients, and the potential to unfairly advantage the recipient.
Use of deceased donors for chain-initiating kidneys raises ethical issues concerning the consent process for each involved party, the prioritization of deceased donor kidneys, the allocation of chain ending kidneys, and the value of a living donor kidney versus a deceased donor kidney. We outline each ethical issue and discuss how it can be conceptualized and managed so that these KPD innovations programs are ultimately successful.
Family communication coordination: a program to increase organ donation.
To improve organ donation performance, the Medical College of Virginia Hospitals implemented a comprehensive family support and communication program , consisting of a standard family communications protocol, a hospital-based team from the Department of Pastoral Care, targeted staff education, and an ongoing quality assurance measuring and monitoring system. The 3 best-demonstrated request practices, private setting, "decoupling," and collaboration in the request between the organ procurement organization and hospital staff, were incorporated into the program.
During the second year, there was also a positive correlation between "decoupling," appropriate requestor, and the consent rate. Implementation of a hospital-based team and a standard protocol facilitated the clarification of roles and responsibilities toward clearer and more consistent family communication and support. Data suggest that staff experience is a major contributor to a positive donation outcome. Process and barriers to organ donation and causes of brain death in northeast of Iran. Organ transplantation is the treatment of choice for some diseases.
However, the need for cadaveric organ donation has either plateaued or is on a decreasing trend in some countries, especially in developed ones. In this study, we aimed to identify the barriers to organ donation in brain dead patients, who were referred to the organ procurement organizations OPO in northeast Iran. In this cross-sectional study during to , data were collected from medical records of brain dead patients.
Demographic information, cause of brain death, the process of obtaining informed consent, and the reasons for declining organ donation were obtained from the OPO records. The data were analyzed using chi-square test by SPSS 13 software. Of brain dead patients, cases The rate of organ donation increased during the course of the study; medical and legal reasons as well as family refusal to authorize donation were the main barriers to the process.
Based on the pattern of mortality, the need for living donors in developing countries, such as Iran and other countries in the Mediterranean region, can be reduced by improving the quality of healthcare, efficient identification of brain death, and obtaining consent with appropriate strategies. Care pathways for organ donation after brain death: guidance from available literature? A discussion of the literature concerning the impact of care pathways in the complex and by definition multidisciplinary process of organ donation following brain death.
Enhancing the quality and safety of organs for transplantation has become a central concern for governmental and professional organizations. At the local hospital level, a donor coordinator can use a range of interventions to improve the donation and procurement process. Care pathways have been proven to represent an effective intervention in several settings for optimizing processes and outcomes. A discussion paper. Each paper was reviewed to investigate the effects of existing care pathways for donation after brain death. An additional search for unpublished information was conducted.
Although literature supports care pathways as an effective intervention in several settings, few studies have explored its use and effectiveness for complex care processes such as donation after brain death. Nurses should be aware of their role in the donation process. Care pathways have the potential to support them, but their effectiveness has been insufficiently explored. Further research should focus on the development and standardization of the clinical content of a care pathway for donation after brain death and the identification of quality indicators.
These should be used in a prospective effectiveness assessment of the proposed pathway. Satisfaction with the organ donation process of brain dead donors' families in Korea. The purpose of this study was to investigate the satisfaction of the families of brain dead donors with regard to donation processes as well as their emotions after the donation.
Donor willingness and desire in life was the most frequent reason organs were donated Satisfaction with the organ donation processes was 4. In each category, the satisfaction with the decision of donation was the highest 4. Moreover, Because donors' own willingness is the most common reason that families choose donation , it is necessary to remind the public of the importance of organ donation through education and public relations using mass communication approaches. Additionally, because the families felt grief and guilt as well as missing their loved ones and pride regarding their dead loved ones after organ donation , continuous and systematic supports are needed to promote their psychological stability.
Published by Elsevier Inc. Administrative processing by the police may affect the process involved in organ donation in the event of an accidental brain injury. The purpose of this study was to evaluate the knowledge and attitude of police toward brain -dead donors and organ donation. This was a descriptive research study using a item questionnaire. As of July 19, , 11 police stations in Seoul had collected questionnaires completed by police officers.
Data were analyzed using SAS version 9. It is necessary to understand and cooperate with the police when processing brain death organs from accidents.
Education about organ donation can enhance the information and knowledge of the police and can also help to establish a positive attitude about organ donation. Two hundred seventy-six organs were transplanted from the 81 donors that transitioned from DCD to actual DBD, including 24 heart, 70 liver, 12 single and 14 bilateral lung, and 12 pancreas transplants. When patients with devastating brain injury admitted to the intensive care units are registered donors, the Organ Procurement Organization staff should share the patient's donation decision with the health care team and the patient's family, as early as possible after the comfort measures only discussion has been initiated.
Outcomes of organ donation in brain -dead patient's families: Ethical perspective. The families of brain -dead patients have a significant role in the process of decision making for organ donation. Organ donation is a traumatic experience. The ethical responsibility of healthcare systems respecting organ donation is far beyond the phase of decision making for donation.
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The principles of donation -related ethics require healthcare providers and organ procurement organizations to respect donor families and protect them against any probable harm. Given the difficult and traumatic nature of donation -related experience, understanding the outcomes of donation appears crucial. The aim of this study was to explore the outcomes of organ donation for the families of brain -dead patients. This was a qualitative descriptive study to which a purposeful sample of 19 donor family members were recruited. Data were collected through holding in-depth semi-structured interviews with the participants.
The main category of the data was "Decision to organ donation : a challenge from conflict to transcendence. The general categories were "challenging outcomes," "reassuring outcomes," and "transcending outcomes. The ethical principles of informed consent, confidentiality, and non-identification were used. Donor families experience different challenges which range from conflict and doubtfulness to confidence, satisfaction, and transcendence.
Healthcare providers and organ procurers should not discontinue care and support provision to donor families after obtaining their consent to donate because the post-decision phase is also associated with different complexities and difficulties with which donor families may not be able to cope effectively. In order to help donor families achieve positive outcomes from.
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The quality assurance program of organ donation in Tuscany. Constant monitoring is paramount in order to detect the criticalities and improve the results of the deceased donation process. Concomitant with the institution of a regional transplantation service authority--Organizzazione Toscana Trapianti--in , Tuscany adopted a program of quality assurance of the deceased donation process by compulsory reporting of all encephalic deaths from local intensive care units to the regional transplant office in Florence.
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Data were collected prospectively, stratified by regional hospital consortia Aziende Sanitarie Locali and compared with international benchmarks. In the period the mean efficiency of DD identification was Further strategies are favored to address this. An overview of the roles and responsibilities of Chinese medical colleges in body donation programs.
The use of human tissue is critical for gross anatomy education in the health professions. Chinese medical colleges have faced a shortage of anatomical specimens over the past decade. While body donation plays an important role in overcoming this gap, this practice has only recently been introduced in China, and the donation rate is relatively low and fraught with a number of difficulties. In the past, traditional Chinese culture focused on preserving the human body intact, which often limited body donation.
In recent years, the public has become more open toward body donation. At Nanjing Medical University, only 20 bodies were donated in After the university became involved in an organized body donation program , this number increased to 70 donated bodies per year to This article describes and reviews Chinese medical colleges as a special case study among body donation programs , particularly in terms of the multiple responsibilities and roles that such institutions must assume in the course of adopting these programs.