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Kaplan A, Aby ES, Scott S, Sonnenday C, Fox A, Mathur A, Olthoff K, Heimbach J, Ladin K, Emamaullee J. Financial toxicity in living donor liver transplantation: A call to action for financial neutrality. Am J Transplant 2024:S1600-6135(24)00337-X. [PMID: 38763318 DOI: 10.1016/j.ajt.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/22/2024] [Accepted: 05/14/2024] [Indexed: 05/21/2024]
Abstract
After 2 decades of limited growth, living donor liver transplant (LDLT) has been increasingly accepted as a promising solution to the growing organ shortage in the US. With experience, LDLT offers superior graft and patient survival with low rates of rejection. However, not all waitlisted patients have equal access to LDLT, with financial toxicity representing a substantial barrier. Potential living liver donors face indirect, direct, and opportunity costs associated with donation as well as insurance-based discrimination and variable employer leave policies. There are multiple potential national, local, and patient-centered solutions to address some of the cost-related issues associated with living LDLT. These include standardization of employer leave policies, creation of federal and state-led tax relief programs, optimization of National Living Donor Assistance Center use, engagement of independent living donor advocates, creation of financial toolkits, and encouragement of recipient or donor-led fundraising. In this piece, members of the North American Living Liver Donation Group, a consortium of 37 LDLT programs, explore these financial challenges and discuss solutions to achieve financial neutrality, where individuals can donate free from financial constraints or gains. As a community, it is imperative that we confront factors driving financial toxicity to improve equity and access to LDLT.
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Affiliation(s)
- Alyson Kaplan
- Department of Gastroenterology and Hepatology, Transplant Institute, Tufts University Medical Center, Boston, Massachusetts, USA
| | - Elizabeth S Aby
- Department of Gastroenterology and Hepatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sonia Scott
- Department of Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York, USA
| | | | - Alyson Fox
- Department of Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York, USA
| | - Amit Mathur
- Department of Transplant Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Kim Olthoff
- Department of Transplant Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julie Heimbach
- Department of Transplant Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Keren Ladin
- Department of Gastroenterology and Hepatology, Transplant Institute, Tufts University Medical Center, Boston, Massachusetts, USA
| | - Juliet Emamaullee
- Department of Transplant Surgery, University of Southern California, Los Angeles, California, USA.
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2
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Cignarella A, Marshall A, Ranse K, Opdam H, Buckley T, Hewitt J. Identity Disclosure Between Donor Family Members and Organ Transplant Recipients: A Description and Synthesis of Australian Laws and Guidelines. JOURNAL OF BIOETHICAL INQUIRY 2023:10.1007/s11673-023-10287-y. [PMID: 38060147 DOI: 10.1007/s11673-023-10287-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 07/20/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION The disclosure of information that identifies deceased organ donors and/or organ transplant recipients by organ donation agencies and transplant centres is regulated in Australia by state and territory legislation, yet a significant number of donor family members and transplant recipients independently establish contact with each other. AIM To describe and synthesize Australian laws and guidelines on the disclosure of identifying information. METHOD Legislation and guidelines relevant to organ donation and transplantation were obtained following a search of government and DonateLife network websites. Information about the regulation of identity disclosure was extracted and synthesised using a process guided by Walt and Gilson's (1994) policy analysis framework. FINDINGS Nineteen documents were examined. Six guidelines refer to and were consistent with current legislation. Four documents did not address identity disclosure. All jurisdictions prohibit healthcare professionals from disclosing identifying information. In three states, the prohibition extends to all members of the public including donor family members and transplant recipients. CONCLUSION Restrictions on identity disclosure have implications for public promotion of donation and transplantation where sharing of stories and images of organ donors and transplant recipients is common. Further research is required to understand the perspective of donor family members, transplant recipients, and healthcare professionals impacted by the current laws.
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Affiliation(s)
- Anthony Cignarella
- School of Nursing and Midwifery, Griffith University, 1 Parklands Drive Southport, Gold Coast, QLD, 4222, Australia.
- Peninsula Health, Frankston Hospital, Learning Hub, 2 Hastings Road Frankston, Melbourne, VIC, 3084, Australia.
| | - Andrea Marshall
- School of Nursing and Midwifery, Griffith University, 1 Parklands Drive Southport, Gold Coast, QLD, 4222, Australia
| | - Kristen Ranse
- School of Nursing and Midwifery, Griffith University, 1 Parklands Drive Southport, Gold Coast, QLD, 4222, Australia
| | - Helen Opdam
- Intensive Care Unit, Austin Health, The Austin Hospital, 145 Studley Road Heidelberg, Melbourne, VIC, 3084, Australia
- Australian Organ and Tissue Authority, 14 Childers Street Level 3, Canberra City, ACT, 2601, Australia
| | - Thomas Buckley
- School of Nursing and Midwifery, The University of Sydney, Susan Wakil Health Building Level 8, D-18 Western Avenue Camperdown, Sydney, NSW, 2006, Australia
| | - Jayne Hewitt
- School of Nursing and Midwifery, Griffith University, 1 Parklands Drive Southport, Gold Coast, QLD, 4222, Australia
- Law Futures Centre, Griffith University Law School, 170 Kessels Road, Nathan, QLD, 4111, Australia
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3
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van Dijk N, Shaw D, Shemie S, Wiebe K, van Mook W, Bollen J. Directed Organ Donation After Euthanasia. Transpl Int 2023; 36:11259. [PMID: 37324219 PMCID: PMC10262997 DOI: 10.3389/ti.2023.11259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/11/2023] [Indexed: 06/17/2023]
Abstract
Organ donation after euthanasia is performed in Belgium, the Netherlands, Canada and Spain. Directed deceased organ donation is currently possible under strict conditions in a limited number of countries, while it is currently not possible to opt for directed donation following euthanasia. While organ donation after euthanasia is a deceased donation procedure, directed organ donation after euthanasia could be seen as a deceased donation procedure with a living donation consent process. Therefore, directed organ donation after euthanasia is feasible on medical and ethical grounds. Strict safeguards should be in place, including the requirement of a pre-existing familial or personal relationship with the proposed recipient, without any evidence of coercion or financial gain.
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Affiliation(s)
- Nathalie van Dijk
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
| | - David Shaw
- Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Sam Shemie
- Division of Critical Care, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
- Canadian Blood Services, Ottawa, ON, Canada
| | - Kim Wiebe
- Medical Assistance in Dying, Shared Health Services, Winnipeg, MB, Canada
| | - Walther van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Jan Bollen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands
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4
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Meena P, Kute VB, Bhargava V, Mondal R, Agarwal SK. Social Media and Organ Donation: Pros and Cons. Indian J Nephrol 2023; 33:4-11. [PMID: 37197042 PMCID: PMC10185012 DOI: 10.4103/ijn.ijn_158_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/06/2022] [Accepted: 07/14/2022] [Indexed: 12/28/2022] Open
Abstract
Shortage of organ donors is the most important obstacle standing in the way of lifesaving organ transplantation in a myriad of patients suffering from end-stage organ failure. It is vital that the transplant societies and associated appropriate authorities develop strategies to overcome the unmet needs for organ donation. The power of prominent social media (SoMe) platforms such as Facebook, Twitter, and Instagram, which reach millions of people, can increase awareness, provide education, and may ameliorate the pessimism toward organ donation among the general population. Additionally, public solicitation of organs may be helpful for waitlisted candidates for organ transplantation, who cannot find a suitable donor among near relations. However, the use of SoMe for organ donation has several ethical issues. This review attempts to highlight the advantages and limitations of using social media in the context of organ donation for transplantation. Some suggestions on the best utilization of social media platforms for organ donation while balancing ethical considerations have been highlighted here.
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Affiliation(s)
- Priti Meena
- Department of Nephrology, All India Institute of Medical Sciences Bhubaneswar, Odisha, India
| | - Vivek B. Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
| | - Vinant Bhargava
- Institute of Renal Science, Sir Gangaram Hospital, New Delhi, India
| | - Rishita Mondal
- Department of Nephrology, All India Institute of Medical Sciences Bhubaneswar, Odisha, India
| | - Sanjay K. Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
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Nishio-Lucar AG, Hunt HF, Booker SE, Cartwright LA, Larkin L, Gonzalez SA, Spiers JA, Srinivas T, Ahmad MU, Levan ML, Singh P, Wertin H, McAdams C, Lentine KL, Schaffer R. Utilizing Social Media to Identify Potential Living Donors: Learning from US Living Donor Programs. CURRENT TRANSPLANTATION REPORTS 2022; 9:318-327. [PMID: 36466961 PMCID: PMC9684893 DOI: 10.1007/s40472-022-00382-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 11/24/2022]
Abstract
Abstract
Purpose of Review
Living donor transplantation provides the best possible recipient outcomes in solid organ transplantation. Yet, identifying potential living donors can be a laborious and resource intensive task that heavily relies on the recipient’s means and social network. Social media has evolved to become a key tool in helping to bring recipients and potential living donors together given its ease of utilization, widespread access, and improved recipient’s comfort with public solicitation. However, in the USA, formal guidelines to direct the use of social media in this context are lacking.
Recent Findings
To better inform the landscape and opportunities utilizing social media in living donation, the OPTN Living Donor Committee surveyed US transplant programs to explore programs’ experiences and challenges when helping patients use social media to identify potential living donors (September 2019). A large majority of survey participants (N = 125/174, 72%) indicated that their program provided education to use social media to identify potential living donors and most programs tracking referral source confirmed an increase utilization over time. The use of social media was compounded with program and recipient’s challenges including concerns about privacy, inadequate technology access, and knowledge gaps. In this review, we discuss the results of this national survey and recent literature, and provide suggestions to inform program practices and guidance provided to patients wishing to use social media to identify potential living donors.
Summary
Transplant programs should become competent in the use of social media for potential living donor identification to empower patients interested in using this tool. Social media education should be provided to all patients regardless of voiced interest and, when appropriate, revisited at multiple time points. Programs should consider developing a “team of experts” that can provide focused education and support to patients embarking in social media living donor campaigns. Care should be taken to avoid exacerbating disparities in access to living donor transplantation. Effective and timely guidance to patients in the use of social media could enhance the identification of potential living donors.
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Gong F, Jia Y, Zhang J, Cao M, Jia X, Sun X, Wu Y. Media use and organ donation willingness: A latent profile analysis from Chinese residents. Front Public Health 2022; 10:1000158. [PMID: 36324440 PMCID: PMC9618944 DOI: 10.3389/fpubh.2022.1000158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/26/2022] [Indexed: 01/26/2023] Open
Abstract
Background Previous studies have paid attention to media as an important channel for understanding organ donation knowledge and have not divided groups according to the degree of media use to study their differences in organ donation. Therefore, the purpose of this study is to explore the influence of media use on organ donation willingness and the influencing factors of organ donation willingness of people with different media use levels. Methods A cross-sectional study of residents from 120 cities in China was conducted by questionnaire survey. Using Mplus 8.3 software, the latent profile analysis of seven media usage related items was made, and multiple linear regression was performed to analyze the influence of varying levels of media use on organ donation willingness of different population. Results All the interviewees were divided into three groups, namely, "Occluded media use" (9.7%), "Ordinary media use" (67.1%) and "High-frequency media use" (23.2%). Compared with ordinary media use, high-frequency media population (β = 0.06, P < 0.001) were positively correlated with their willingness to accept organ donation, residents who used media occlusion (β = -0.02, P < 0.001) were negatively correlated with their willingness to accept organ donation. The influencing factors of residents' accept willingness to organ donation were different among the types of occluded media use, ordinary media use and high-frequency media use. Conclusion It is necessary to formulate personalized and targeted dissemination strategies of organ donation health information for different media users.
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Affiliation(s)
- Fangmin Gong
- School of Literature and Journalism Communication, Jishou University, Jishou, China
| | - Yuhan Jia
- School of Literature and Journalism Communication, Jishou University, Jishou, China,Yuhan Jia
| | - Jinzi Zhang
- School of Humanities and Social Sciences, Harbin Medical University, Harbin, China
| | - Meiling Cao
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaocen Jia
- School of Public Health, Qingdao University, Qingdao, China
| | - Xinying Sun
- School of Public Health, Peking University, Beijing, China
| | - Yibo Wu
- School of Public Health, Peking University, Beijing, China,*Correspondence: Yibo Wu
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7
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Cignarella A, Ranse K, Hewitt J, Opdam H, Romero L, Marshall A. Identity disclosure between donor families and organ transplant recipients: an integrative review of the international literature. PSYCHOL HEALTH MED 2022:1-23. [PMID: 35272546 DOI: 10.1080/13548506.2022.2050272] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Anonymity of deceased organ donation is a legal requirement in many international jurisdictions where legislation prohibits health professionals from disclosing identifiable information about donors, recipients or their families. Written correspondence between donor families and transplant recipients that is coordinated by healthcare professionals must remain anonymous. Internationally, an increasing number of donor families and transplant recipients have advocated for law reform and policy amendment to enable the exchange of identifiable written correspondence and/or face-to-face meetings. This paper aims to synthesise and critically evaluate published, peer-reviewed literature on the perceptions, benefits and challenges of identifiable communication or anonymity between donor families and organ transplant recipients in the international context. Analysis of the findings revealed two major themes: (1) views held by donor families, transplant recipients and healthcare professionals towards identity disclosure in the context of organ donation are diverse across and within groups (2) there are benefits and burdens associated with connecting donor families and transplant recipients through written correspondence. Less is known about the impact of face-to-face meetings between donor families and transplant recipients. However, what is known is that for some donor families, meeting with the transplant recipient(s) may provide a range of positive emotions.
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Affiliation(s)
- Anthony Cignarella
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,The Alfred Hospital, Alfred Health, Nursing Education, Melbourne, Victoria, Australia.,The Alfred Hospital, Alfred Health, Intensive Care Unit, Melbourne, Victoria, Australia
| | - Kristen Ranse
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Jayne Hewitt
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Griffith Law School, Griffith University, Gold Coast, Queensland, Australia
| | - Helen Opdam
- Australian Organ and Tissue Authority, Canberra, NSW, Australia.,The Austin Hospital, Austin Health, Intensive Care Unit, Melbourne, Victoria, Australia
| | - Lorena Romero
- The Alfred Hospital, Alfred Health, Melbourne, Victoria, Australia
| | - Andrea Marshall
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Nursing and Midwifery Education and Research Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia
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8
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Abstract
BACKGROUND Living donor liver transplants (LDLTs) including those from nondirected donors (NDDs) have increased during the past decade, and center-level variations in LDLTs have not yet been described. We sought to quantify changes in the volume of NDD transplants over time and variation in NDD volume between transplant centers. We further examined characteristics of living liver donors and identified factors potentially associated with receiving an NDD liver transplant. METHODS Using Scientific Registry of Transplant Recipients data between March 01, 2002, and December 31, 2020, we compared 173 NDDs with 5704 DLDs and 167 NDD recipients with 1153 waitlist candidates. RESULTS NDDs increased from 1 (0.4% of LDLTs) in 2002 to 58 (12% of LDLTs) in 2020. Of 150 transplant centers, 35 performed at least 1 NDD transplant. Compared with waitlist candidates, adult NDD recipients were less frequently males (39% versus 62%, P < 0.001), had a lower model for end-stage liver disease (16 versus 18, P = 0.01), and spent fewer days on the waitlist (173 versus 246, P = 0.02). Compared with waitlist candidates, pediatric NDD recipients were younger (50% versus 12% age <2 y, P < 0.001) and more often diagnosed with biliary atresia (66% versus 41%, P < 0.001). Compared with DLDs, NDDs were older (40 versus 35 y, P < 0.001), college educated (83% versus 64%, P < 0.001), White (92% versus 78%, P < 0.001), and more frequently donated left-lateral segment grafts (32.0% versus 14%, P < 0.001). CONCLUSIONS Liver NDD transplants continue to expand but remain concentrated at a few centers. Graft distribution favors female adults and pediatric patients with biliary atresia. Racial inequities in adult or pediatric center-level NDD graft distribution were not observed.
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9
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Doshi MD, Singh N, Hippen BE, Woodside KJ, Mohan P, Byford HL, Cooper M, Dadhania DM, Ainapurapu S, Lentine KL. Transplant Clinician Opinions on Use of Race in the Estimation of Glomerular Filtration Rate. Clin J Am Soc Nephrol 2021; 16:1552-1559. [PMID: 34620650 PMCID: PMC8499001 DOI: 10.2215/cjn.05490421] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/13/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Current race-based eGFR calculators assign a higher eGFR value to Black patients, which could affect the care of kidney transplant candidates and potential living donors. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a survey of staff at adult kidney transplant centers in the United States (December 17, 2020 to February 28, 2021) to assess opinions on use of race-based eGFR equations for waitlisting and living donor candidate evaluation, availability of serum cystatin C testing and measured GFR, and related practices. RESULTS Respondents represented 57% (124 of 218) of adult kidney transplant programs, and the responding centers conducted 70% of recent kidney transplant volume. Most (93%) programs use serum creatinine-based eGFR for listing candidates. However, only 6% of respondents felt that current race-based eGFR calculators are appropriate, with desire for change grounded in concerns for promotion of health care disparities by current equations and inaccuracies in reporting of race. Most respondents (70%) believed that elimination of race would allow more preemptive waitlisting for Black patients, but a majority (79%) also raised concerns that such an approach could incur harms. More than one third of the responding programs lacked or were unsure of availability of testing for cystatin C or measured GFR. At this time, 40% of represented centers did not plan to remove race from eGFR calculators, 46% were planning to remove, and 15% had already done so. There was substantial variability in eGFR reporting and listing of multiracial patients with some Black ancestry. There was no difference in GFR acceptance thresholds for Black versus non-Black living donors. CONCLUSIONS This national survey highlights a broad consensus that extant approaches to GFR estimation are unsatisfactory, but it also identified a range of current opinions.
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Affiliation(s)
| | - Neeraj Singh
- Willis Knighton Health System, Shreveport, Louisiana
| | | | | | - Prince Mohan
- Geisinger Medical Center, Danville, Pennsylvania
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10
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Febrero B, Almela-Baeza J, Ros I, Pérez-Sánchez MB, Pérez-Manzano A, Cascales P, Martínez-Alarcón L, Ramírez P. The impact of information and communications technology and broadcasting on YouTube for improving attitude toward organ donation in secondary education with the creation of short films. PATIENT EDUCATION AND COUNSELING 2021; 104:2317-2326. [PMID: 33658142 DOI: 10.1016/j.pec.2021.02.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 01/15/2021] [Accepted: 02/17/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE There is a lack of awareness about organ donation among teenagers, a fact that could decrease future donation rates. The objective is to analyze the impact of an educational proposal based on the creation of short films. METHODS Fifteen schools were randomly selected: ten for the experimental group (EG), and five for the control group (CG). In both groups all students from the selected classes participated (EG: n = 543, CG: n = 320). An intervention was undertaken in the EG, providing a website to make a short film about organ donation and transplantation (ODT) to be broadcast on YouTube. The students completed a questionnaire before and after the proposal. STATISTICS Mann-Whitney test was conducted to compare the pre-test data, McNemar test compare the pre and post test results of each group, and Chi-square test to compare the change in responses between the two groups. RESULTS The change to a more favorable response was greater in the EG in all variables. The YouTube channel received 104,912 viewings. CONCLUSIONS An innovative educational intervention has a positive influence on teenage attitude and knowledge about ODT; it also has important social repercussions. PRACTICE IMPLICATIONS Implementing this educational proposal about ODT could help improve future donation rates.
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Affiliation(s)
- Beatriz Febrero
- General Surgery Service, Virgen de la Arrixaca University Hospital, Instituto Murciano de Investigaciones Biosanitarias (IMIB), Murcia, Spain; Department of Surgery, Pediatrics, Gynecology and Obstetrics, School of Medicine, University of Murcia, Spain
| | | | - Inmaculada Ros
- Department of Surgery, Pediatrics, Gynecology and Obstetrics, School of Medicine, University of Murcia, Spain
| | - Mª Belén Pérez-Sánchez
- Department of Statistics, Mathematics and Informatics, University of Miguel Hernández, Elche, Spain
| | | | - Pedro Cascales
- General Surgery Service, Virgen de la Arrixaca University Hospital, Instituto Murciano de Investigaciones Biosanitarias (IMIB), Murcia, Spain; Department of Surgery, Pediatrics, Gynecology and Obstetrics, School of Medicine, University of Murcia, Spain
| | - Laura Martínez-Alarcón
- General Surgery Service, Virgen de la Arrixaca University Hospital, Instituto Murciano de Investigaciones Biosanitarias (IMIB), Murcia, Spain
| | - Pablo Ramírez
- General Surgery Service, Virgen de la Arrixaca University Hospital, Instituto Murciano de Investigaciones Biosanitarias (IMIB), Murcia, Spain; Department of Surgery, Pediatrics, Gynecology and Obstetrics, School of Medicine, University of Murcia, Spain
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11
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Thomas R, Consolo H, Oniscu GC. Have we reached the limits in altruistic kidney donation? Transpl Int 2021; 34:1187-1197. [PMID: 34008872 DOI: 10.1111/tri.13921] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 01/05/2023]
Abstract
Altruistic donation (unspecified donation) is an important aspect of living donor kidney transplantation. Although donation to a stranger is lawful and supported in many countries, it remains uncommon and not actively promoted. Herein, we ask the question if we have reached the limit in altruistic donation. In doing so, we examine important ethical questions that define the limits of unspecified donation, such as the appropriate balance between autonomous decision-making and paternalistic protection of the donor, the extent of outcome uncertainty and risk-benefit analyses that donors should be allowed to accept. We also consider the scrutiny and acceptance of donor motives, the potential for commercialization, donation to particular categories of recipients (including those encountered through social media) and the ethical boundaries of active promotion of unspecified kidney donation. We conclude that there is scope to increase the number of living donation kidney transplants further by optimizing existing practices to support and promote unspecified donation. A number of strategies including optimization of the assessment process, innovative approaches to reach potential donors together with reimbursement of expenses and a more specific recognition of unspecified donation are likely to lead to a meaningful increase in this type of donation.
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Affiliation(s)
- Rachel Thomas
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK
| | | | - Gabriel C Oniscu
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK.,Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK
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12
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Lentine KL, Peipert JD, Alhamad T, Caliskan Y, Concepcion BP, Forbes R, Schnitzler M, Chang SH, Cooper M, Bloom RD, Mannon RB, Axelrod DA. Survey of Clinician Opinions on Kidney Transplantation from Hepatitis C Virus Positive Donors: Identifying and Overcoming Barriers. ACTA ACUST UNITED AC 2020; 1:1291-1299. [PMID: 33251523 DOI: 10.34067/kid.0004592020] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Transplant practices related to use of organs from Hepatitis C virus infected donors (DHCV+) is evolving rapidly. Methods We surveyed U.S. kidney transplant programs by email and professional society listserv postings between 7/19-1/20 to assess attitudes, management strategies, and barriers related to use of viremic (nucleic acid testing (NAT)+) donor organs in HCV uninfected recipients. Results Staff at 112 unique programs responded, representing 54% of U.S. adult kidney transplant programs and 69% of adult deceased donor kidney transplant volume in 2019. Most survey respondents were transplant nephrologists (46%) or surgeons (43%). Among responding programs, 67% currently transplant DHCV antibody+/NAT- organs under a clinical protocol or as standard of care. By comparison, only 58% offer DHCV NAT+ kidney transplant to HCV- recipients, including 35% under clinical protocols, 14% as standard of care, and 9% under research protocols. Following transplant of DHCV NAT+ organs to uninfected recipients, 53% start direct acting antiviral agent (DAA) therapy after discharge and documented viremia. Viral monitoring protocols after DHCV NAT+ to HCV uninfected recipient kidney transplantation varied substantially. 56% of programs performing these transplants report having an institutional plan to provide DAA treatment if declined by the recipient's insurance. Respondents felt a mean decrease in waiting time of ≥18 months (range 0-60) justifies the practice. Program concerns related to use of DHCV NAT+ kidneys include insurance coverage concerns (72%), cost (60%), and perceived risk of transmitting resistant infection (44%). Conclusions Addressing knowledge about safety and logistical/financial barriers related to use of DHCV NAT+ kidney transplantation for HCV uninfected recipients may help reduced discards and expand the organ supply.
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Affiliation(s)
- Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, MO
| | - John D Peipert
- Northwestern University, Feinberg School of Medicine, Chicago, IL.,Northwestern University Transplant Outcomes Research Core, Chicago, IL
| | | | - Yasar Caliskan
- Saint Louis University Center for Abdominal Transplantation, St. Louis, MO
| | | | | | - Mark Schnitzler
- Saint Louis University Center for Abdominal Transplantation, St. Louis, MO
| | | | | | - Roy D Bloom
- University of Pennsylvania, Philadelphia, PA
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Lentine KL, Vest LS, Schnitzler MA, Mannon RB, Kumar V, Doshi MD, Cooper M, Mandelbrot DA, Harhay MN, Josephson MA, Caliskan Y, Sharfuddin A, Kasiske BL, Axelrod DA. Survey of US Living Kidney Donation and Transplantation Practices in the COVID-19 Era. Kidney Int Rep 2020; 5:1894-1905. [PMID: 32864513 PMCID: PMC7445484 DOI: 10.1016/j.ekir.2020.08.017] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The scope of the impact of the coronavirus disease 2019 (COVID-19) pandemic on living donor kidney transplantation (LDKT) practices is not well defined. METHODS We surveyed US transplant programs to assess practices, strategies, and barriers to living LDKT during the COVID-19 pandemic. After institutional review board approval, the survey was distributed from 9 May 2020 to 30 May 2020 by e-mail and postings to professional society list-servs. Responses were stratified based on state COVID-19 cumulative incidence levels. RESULTS Staff at 118 unique centers responded, representing 61% of US living donor recovery programs and 75% of LKDT volume in the prepandemic year. Overall, 66% reported that LDKT surgery was on hold (81% in "high" vs. 49% in "low" COVID-19 cumulative incidence states). A total of 36% reported that evaluation of new donor candidates had paused, 27% reported that evaluations were very much decreased (>0% to <25% typical), and 23% reported that evaluations were moderately decreased (25% to <50% typical). Barriers to LDKT surgery included program concerns for donor (85%) and recipient (75%) safety, patient concerns (56%), elective case restrictions (47%), and hospital administrative restrictions (48%). Programs with higher local COVID-19 cumulative incidence reported more barriers related to staff and resource diversion. Most centers continuing donor evaluations used remote strategies (video, 82%; telephone, 43%). As LDKT resumes, all programs will screen for COVID-19, although timeframe and modalities will vary. Recommendations for presurgical self-quarantine are also variable. CONCLUSION The COVID-19 pandemic has had broad impacts on LDKT practice. Ongoing research and consensus building are needed to reduce barriers, to guide optimal practices, and to support safe restoration of LDKT across centers.
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Affiliation(s)
- Krista L. Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri, USA
| | - Luke S. Vest
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri, USA
| | - Mark A. Schnitzler
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri, USA
| | - Roslyn B. Mannon
- Department of Medicine, University of Nebraska, Omaha, Nebraska, USA
| | - Vineeta Kumar
- University of Alabama Comprehensive Transplant Center, Birmingham, Alabama, USA
| | - Mona D. Doshi
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew Cooper
- Medstar Georgetown Transplant Institute, Washington, DC, USA
| | - Didier A. Mandelbrot
- Comprehensive Transplant Program, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA
| | - Meera N. Harhay
- Department of Medicine, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Yasar Caliskan
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri, USA
| | - Asif Sharfuddin
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Bertram L. Kasiske
- Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - David A. Axelrod
- Organ Transplant Center, University of Iowa, Iowa City, Iowa, USA
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14
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Lentine KL, Motter JD, Henderson ML, Hays RE, Shukhman E, Hunt J, Al Ammary F, Kumar V, LaPointe Rudow D, Van Pilsum Rasmussen SE, Nishio-Lucar AG, Schaefer HM, Cooper M, Mandelbrot DA. Care of international living kidney donor candidates in the United States: A survey of contemporary experience, practice, and challenges. Clin Transplant 2020; 34:e14064. [PMID: 32808320 DOI: 10.1111/ctr.14064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/08/2020] [Accepted: 08/13/2020] [Indexed: 12/25/2022]
Abstract
The evaluation and care of non-US citizen, non-US residents who wish to come to the United States to serve as international living kidney donors (ILKDs) can pose unique challenges. We surveyed US transplant programs to better understand practices related to ILKD care. We distributed the survey by email and professional society list-servs (Fall 2018, assessing 2017 experience). Eighty-five programs responded (36.8% program response rate), of which 80 considered ILKD candidates. Only 18 programs had written protocols for ILKD evaluation. Programs had a median of 3 (range: 0,75) ILKD candidates who initiated contact during the year, from origin countries spanning 6 continents. Fewer (median: 1, range: 0,25) were approved for donation. Program-reported reasons for not completing ILKD evaluations included visa barriers (58.6%), inability to complete evaluation (34.3%), concerns regarding follow-up (31.4%) or other healthcare access (28.6%), and financial impacts (21.4%). Programs that did not evaluate ILKDs reported similar concerns. Staff time required to evaluate ILKDs was estimated as 1.5-to-3-times (47.9%) or >3-times (32.9%) that needed for domestic candidates. Among programs accepting ILKDs, on average 55% reported successful completion of 1-year follow-up. ILKD evaluation is a resource-intensive process with variable outcomes. Planning and commitment are necessary to care for this unique candidate group.
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Affiliation(s)
- Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri, USA
| | - Jennifer D Motter
- Johns Hopkins Comprehensive Transplant Center, Baltimore, Maryland, USA
| | - Macey L Henderson
- Johns Hopkins Comprehensive Transplant Center, Baltimore, Maryland, USA
| | - Rebecca E Hays
- University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA
| | - Ellen Shukhman
- Cedars-Sinai Comprehensive Transplant Center, Los Angeles, California, USA
| | - Julia Hunt
- Recanati/Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Fawaz Al Ammary
- Johns Hopkins Comprehensive Transplant Center, Baltimore, Maryland, USA
| | - Vineeta Kumar
- University of Alabama Comprehensive Transplant Center, Birmingham, Alabama, USA
| | | | | | | | | | - Matthew Cooper
- MedStar Georgetown Transplant Institute, Washington, District of Columbia, USA
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15
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Henderson ML, Herbst L, Love AD. Social Media and Kidney Transplant Donation in the United States: Clinical and Ethical Considerations When Seeking a Living Donor. Am J Kidney Dis 2020; 76:583-585. [DOI: 10.1053/j.ajkd.2020.03.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/24/2020] [Indexed: 11/11/2022]
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16
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Wightman A, Freeman M. An Organ for My Child: Public Appeals for Limited Resources. Pediatrics 2020; 146:S42-S47. [PMID: 32737231 DOI: 10.1542/peds.2020-0818i] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2020] [Indexed: 11/24/2022] Open
Abstract
The case of Jamie Fiske and subsequent public appeals for particular children by President Ronald Reagan represent classic cases in pediatric bioethics in which parents or others publicly appealed for a donor organ for a particular child. These raise questions about the appropriate boundaries for public appeals for a limited resource for a particular child and how the press and medical community should respond to such appeals. Public appeals by parents to advocate for their child to receive a limited resource above others promote rationing by morally irrelevant factors and shift the public focus from the national shortage of organs for transplant to the needs of a particular child. Yet these appeals are understandable and will likely continue. Recognizing this, we consider appropriate responses by the media, transplant community, hospitals, and individual clinicians.
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Affiliation(s)
- Aaron Wightman
- Divisions of Nephrology and Bioethics, Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington; .,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital Research Institute, Seattle Washington; and
| | - Michael Freeman
- Division of Pediatric Nephrology and Hypertension, Department of Pediatrics, College of Medicine, Penn State, Hershey, Pennsylvania
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17
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Schmidt S, Ghouzi A, Petrov G, Hofmann N, Boergel M, Sixt SU. Cornea donation in Germany: Obtaining consent. Clin Transplant 2020; 34:e13895. [DOI: 10.1111/ctr.13895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/08/2020] [Accepted: 04/25/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - George Petrov
- Department of Anesthesiology University Hospital of Duesseldorf Duesseldorf Germany
| | - Nicola Hofmann
- German Society for Tissue Transplantation Hannover Germany
| | - Martin Boergel
- German Society for Tissue Transplantation Hannover Germany
| | - Stephan Urs Sixt
- German Society for Tissue Transplantation Hannover Germany
- Department of Anesthesiology University Hospital of Duesseldorf Duesseldorf Germany
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18
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Is There Decreasing Public Interest in Renal Transplantation? A Google Trends TM Analysis. J Clin Med 2020; 9:jcm9041048. [PMID: 32272783 PMCID: PMC7231300 DOI: 10.3390/jcm9041048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/29/2020] [Accepted: 04/06/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Renal transplantation is the preferred form of renal replacement therapy for the majority of patients with end stage renal disease (ESRD). The Internet is a key tool for people seeking healthcare-related information. This current work explored the interest in kidney transplantation based on Internet search queries using Google TrendsTM. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS We performed a Google TrendsTM search with the search term "kidney transplantation" between 2004 (year of inception) and 2018. We retrieved and analyzed data on the worldwide trend as well as data from the United Network for Organ Sharing (UNOS), the Organización Nacional de Trasplantes (ONT), the Eurotransplant area, and the National Health Service (NHS) Transplant Register. Google TrendsTM indices were investigated and compared to the numbers of performed kidney transplants, which were extracted from the respective official websites of UNOS, ONT, Eurotransplant, and the NHS. RESULTS During an investigational period of 15 years, there was a significant decrease of the worldwide Google TrendsTM index from 76.3 to 25.4, corresponding to an absolute reduction of -50.9% and a relative reduction by -66.7%. The trend was even more pronounced for the UNOS area (-75.2%), while in the same time period the number of transplanted kidneys in the UNOS area increased by 21.9%. Events of public interest had an impact on the search queries in the year of occurrence, as shown by an increase in the Google TrendsTM index by 39.2% in the year 2005 in Austria when a person of public interest received his second live donor kidney transplant. CONCLUSIONS This study indicates a decreased public interest in kidney transplantation. There is a clear need to raise public awareness, since transplantation represents the best form of renal replacement therapy for patients with ESRD. Information should be provided on social media, with a special focus on readability and equitable access, as well as on web pages.
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19
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Caulfield T, Murdoch B, Sapir-Pichhadze R, Keown P. Policy Challenges for Organ Allocation in an Era of "Precision Medicine". Can J Kidney Health Dis 2020; 7:2054358120912655. [PMID: 32231786 PMCID: PMC7088188 DOI: 10.1177/2054358120912655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/29/2020] [Indexed: 12/27/2022] Open
Abstract
There is increasing interest in the use of precision medicine tools and evidence-based outcome measures for donor-recipient matching to optimize transplant outcomes. Although the shift toward greater precision can provide health and resource benefits, it may be perceived as conflicting with both established equity-focused organ allocation norms and the legal and ethical obligations of health care providers and related institutions. With increasing evidence that various forms of human leukocyte antigen (HLA) mismatch and/or prognostic biomarkers can affect outcomes, the tension between maximizing utility and ensuring equity seems likely to intensify. In Canada, health care providers are generally required by law to put the interests of their patient, such as access to an organ, above the needs of the health care system and other patients. In addition, transplantation right of access lawsuits, which have been successful in the past, could affect the implementation of precision approaches. These legal tensions could be further heightened by media representations, which have historically favored strong rights of access. When implementing new precision technologies in organ allocation, there will be a recurrent need for policymakers to revisit the balance of equity and utility and to assess how to craft rules that reflect our society’s conception of a fair allocation system.
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Affiliation(s)
- Timothy Caulfield
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, Canada
| | - Blake Murdoch
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, Canada
| | | | - Paul Keown
- Faculty of Medicine, The University of British Columbia, Vancouver, Canada
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20
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Pol SJ, Snyder J, Anthony SJ. "Tremendous financial burden": Crowdfunding for organ transplantation costs in Canada. PLoS One 2019; 14:e0226686. [PMID: 31860656 PMCID: PMC6924656 DOI: 10.1371/journal.pone.0226686] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 11/24/2019] [Indexed: 11/23/2022] Open
Abstract
Online crowdfunding platforms such as GoFundMe are used to raise funds for health-related expenses associated with medical conditions such as organ transplantation. By investigating crowdfunding in Canadian organ transplantation, this study aimed to increase understanding of the motivations and outcomes of organ transplantation crowdfunding. Canadian liver and kidney transplantation campaigns posted to GoFundMe between May 30 & 31 2018 were identified and after exclusion, 258 kidney and 171 liver campaigns were included in study. These campaigns were coded for: worthiness of the campaign recipient, requested financial and non-monetary contributions, how monetary donations would be spent, and comments on the Canadian health system, among others. Results suggest Canadian organ donors, transplant candidates, recipients, and their families and caregivers experience significant financial difficulties not addressed by the public health system. Living and medication costs, transportation and relocation expenses, and income loss were the expenses most commonly highlighted by campaigners. Liver campaigns raised nearly half their goal while kidney campaigns received 11.5% of their requested amount. Findings highlight disease burden and the use of crowdfunding as a response to the extraordinary costs associated with organ transplantation. Although crowdfunding reduces some financial burden, it does not do so equitably and raises ethical concerns.
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Affiliation(s)
- Sarah J. Pol
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Jeremy Snyder
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Samantha J. Anthony
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
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21
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Public Solicitation and The Canadian Media: Two Cases of Living Liver Donation, Two Different Stories. Transplant Direct 2019; 5:e508. [PMID: 32095503 PMCID: PMC7004592 DOI: 10.1097/txd.0000000000000950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/19/2019] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text. Background . Two stories of public solicitation for living liver donors received substantial Canadian media attention in 2015: The Wagner family, with twin toddlers, each needing transplants, and Eugene Melnyk, wealthy owner of a professional hockey team. This study compared the print media coverage of these 2 stories to understand how public solicitation was portrayed and whether coverage differed depending on the individual making the plea. Methods. We conducted a content analysis on 155 relevant Canadian newspaper articles published between January 1, 2015 and December 31, 2016. Articles were analyzed for their description of public solicitation, benefits and issues associated with public solicitation, and overall tone with respect to public solicitation. Results. The foregrounding of public solicitation and associated ethical issues featured heavily in articles focused on Melnyk but were largely absent when discussing the Wagner family. The fairness of Melnyk's solicitation was the most prominent ethical issue raised. Laws and policies surrounding public solicitation also featured in the Melnyk story but not in articles focused on the Wagners. Public solicitation was portrayed more negatively in the Melnyk articles, but overall, was portrayed positively in relation to both Melnyk and the Wagner family. Conclusions. Public solicitation was generally portrayed as a positive phenomenon in Canadian print media, yet there were stark differences in how these cases were presented. The Wagner story was largely portrayed as a human-interest piece about a family in dire circumstances, whereas Melnyk's wealth, status, and influence raised questions of the fairness of his transplant.
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22
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Existing and Evolving Bioethical Dilemmas, Challenges, and Controversies in Vascularized Composite Allotransplantation: An International Perspective From the Brocher Bioethics Working Group. Transplantation 2019; 103:1746-1751. [DOI: 10.1097/tp.0000000000002606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Jiang X, Jiang W, Cai J, Su Q, Zhou Z, He L, Lai K. Characterizing Media Content and Effects of Organ Donation on a Social Media Platform: Content Analysis. J Med Internet Res 2019; 21:e13058. [PMID: 30860489 PMCID: PMC6434401 DOI: 10.2196/13058] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/11/2019] [Accepted: 03/03/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The lack of organ donors has become a barrier for the development of organ transplantation programs, and many countries are currently facing a severe shortage of deceased organs. Media campaigns on social media have the potential to promote organ donation. However, little is known about what kind of media content is the most appropriate for this purpose. OBJECTIVE This study aimed to analyze media posts regarding organ donation on Weibo, a social media platform, and to identify the media themes that are most advantageous in promoting public awareness and attitudes concerning organ donation. METHODS Based on 16 million social media users' posts randomly extracted from January 1 to December 31, 2017, 1507 reposts of 141 distinct media posts relevant to organ donation were found. We analyzed the media posts' themes and examined their effects in promoting public awareness about organ donation by comparing the number of reposts and comments they prompted. The themes' impact on attitude toward organ donation was gauged using the comments indicating support and intentions for organ donation. RESULTS Overall, 5 major themes were identified from the media posts, among which "organ donation behaviors" constituted the highest proportion (58/141, 41.13%). However, themes of "statistical descriptions of organ donation" and "meaningfulness of donation" were the most influential in promoting awareness on organ donation: approximately 3 of 10 commenters for the former theme and 2 of 10 commenters for the latter expressed intentions to become organ donors. These two themes, along with "meaningfulness of organ donation for society," a subtheme of "meaningfulness of donation," were the most effective for evoking support and intentions for donation. CONCLUSIONS A discrepancy was revealed between the media themes that were the most salient on the media agenda and those that were the most effective in increasing organ donation awareness and intentions on social media. These findings provide guidance for campaigns on organ donation. The results also suggest the potential of campaigns on social media for promoting prosocial health behaviors and highlight the importance of strategic message design for serving this goal.
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Affiliation(s)
- Xiaoya Jiang
- School of Communication and Design, Sun Yat-Sen University, Guangzhou, China
| | - Wenshi Jiang
- Intelligence Sharing for Life Science Research Institute, Shenzhen, China
| | - Jiawei Cai
- Intelligence Sharing for Life Science Research Institute, Shenzhen, China
| | - Qingdong Su
- 923 Hospital of Chinese People's Liberation Army, Nanning, China
| | - Zhigang Zhou
- The First People's Hospital of Kunming, Kunming, China
| | - Lingnan He
- School of Communication and Design, Sun Yat-Sen University, Guangzhou, China.,Guangdong Key Laboratory for Big Data Analysis and Simulation of Public Opinion, Guangzhou, China
| | - Kaisheng Lai
- School of Journalism and Communication, Jinan University, Guangzhou, China
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24
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Henderson ML, Adler JT, Van Pilsum Rasmussen SE, Thomas AG, Herron PD, Waldram MM, Ruck JM, Purnell TS, DiBrito SR, Holscher CM, Haugen CE, Alimi Y, Konel JM, Eno AK, Garonzik Wang JM, Gordon EJ, Lentine KL, Schaffer RL, Cameron AM, Segev DL. How Should Social Media Be Used in Transplantation? A Survey of the American Society of Transplant Surgeons. Transplantation 2019; 103:573-580. [PMID: 29684002 PMCID: PMC6196114 DOI: 10.1097/tp.0000000000002243] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Social media platforms are increasingly used in surgery and have shown promise as effective tools to promote deceased donation and expand living donor transplantation. There is a growing need to understand how social media-driven communication is perceived by providers in the field of transplantation. METHODS We surveyed 299 members of the American Society of Transplant Surgeons about their use of, attitudes toward, and perceptions of social media and analyzed relationships between responses and participant characteristics. RESULTS Respondents used social media to communicate with: family and friends (76%), surgeons (59%), transplant professionals (57%), transplant recipients (21%), living donors (16%), and waitlisted candidates (15%). Most respondents (83%) reported using social media for at least 1 purpose. Although most (61%) supported sharing information with transplant recipients via social media, 42% believed it should not be used to facilitate living donor-recipient matching. Younger age (P = 0.02) and fewer years of experience in the field of transplantation (P = 0.03) were associated with stronger belief that social media can be influential in living organ donation. Respondents at transplant centers with higher reported use of social media had more favorable views about sharing information with transplant recipients (P < 0.01), increasing awareness about deceased organ donation (P < 0.01), and advertising for transplant centers (P < 0.01). Individual characteristics influence opinions about the role and clinical usefulness of social media. CONCLUSIONS Transplant center involvement and support for social media may influence clinician perceptions and practices. Increasing use of social media among transplant professionals may provide an opportunity to deliver high-quality information to patients.
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Affiliation(s)
- Macey L. Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD
| | - Joel T. Adler
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | - Alvin G. Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Madeleine M. Waldram
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jessica M. Ruck
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tanjala S. Purnell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Sandra R. DiBrito
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Christine E. Haugen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yewande Alimi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jonathan M. Konel
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ann K. Eno
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Elisa J. Gordon
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Krista L. Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO
| | | | - Andrew M. Cameron
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
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25
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Ruck JM, Henderson ML, Eno AK, Van Pilsum Rasmussen SE, DiBrito SR, Thomas AG, Li R, Singer L, Massie I, Waldram MM, Konel JM, Helfer DR, Garonzik Wang JM, Purnell TS, Mogul DB, Lentine KL, Waterman AD, Segev DL. Use of Twitter in communicating living solid organ donation information to the public: An exploratory study of living donors and transplant professionals. Clin Transplant 2018; 33:e13447. [PMID: 30421841 DOI: 10.1111/ctr.13447] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 11/01/2018] [Accepted: 11/06/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND As transplant centers start leveraging Twitter for information dissemination and public engagement, it is important to understand current living solid organ donation-related Twitter use. METHODS We identified public Twitter profiles available in 01/2017 that referenced living organ donation and analyzed the use of donation-related Twitter handles, names, or profile information. Tweets were manually abstracted and qualitatively analyzed for common themes. Social media influence of those tweeting about living donation was evaluated using Klout score. RESULTS We identified 93 donors, 61 professionals, 12 hospitals, and 19 organizations that met eligibility criteria. Social media influence was similar across these groups (P = 0.4). Donors (16%) and organizations (23%) were more likely than professionals (7%) or hospitals (0%) to include transplant-related educational information in their profiles (P = 0.007). Living donation-related tweets were most commonly donation stories (33%), news reports (20%), reports about new transplant research (15%), and sharing transplant candidates' searches for donors (14%). CONCLUSIONS This exploratory study of living donors and transplant professionals, hospitals, and organizations on Twitter provides insight into how the social media platform may be used to communicate about and disseminate information about living donation.
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Affiliation(s)
- Jessica M Ruck
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, Maryland
| | - Ann K Eno
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Sandra R DiBrito
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alvin G Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rebecca Li
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lauren Singer
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Indraneel Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Madeleine M Waldram
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan M Konel
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David R Helfer
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Tanjala S Purnell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Douglas B Mogul
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University, St. Louis, Missouri
| | - Amy D Waterman
- Department of Nephrology, University of California Los Angeles, Los Angeles, California
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
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26
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Durand WM, Peters JL, Eltorai AEM, Kalagara S, Osband AJ, Daniels AH. Medical crowdfunding for organ transplantation. Clin Transplant 2018; 32:e13267. [PMID: 29683220 DOI: 10.1111/ctr.13267] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2018] [Indexed: 11/29/2022]
Abstract
An increasing number of patients and families are utilizing online crowdfunding to support their medical expenses related to organ transplantation. The factors influencing the success of crowdfunding campaigns are poorly understood. Crowdfunding campaigns were abstracted from a popular crowdfunding web site. Campaigns were included if they were actively accepting donations to fund medical expenses related to transplantation of selected organs. The primary outcome measure was total amount raised among successful campaigns receiving at least one donation. Bivariate and multivariate analyses were performed on various campaign characteristics. A total of 850 campaigns were analyzed. Kidney transplant campaigns were most common (40.5%), followed by liver (33.3%), lung (12.2%), heart (11.3%), and multiorgan (2.7%). 69.1% of campaigns received any donation, and among these, the mean amount raised was $3664 (median $1175). The following factors were significantly associated with amount raised: more positive emotional sentiment in the campaign description (+2.6% per AFINN unit, P < .001), longer campaign description length (+2.4% per 100 characters, P = .001), higher goal amount (+0.6% per $1000 of goal amount, P = .004), and third-person description perspective (+131% vs first person, P < .001). Physicians will likely encounter medical crowdfunding with increasing frequency as it continues to grow in popularity among their patients.
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Affiliation(s)
- Wesley M Durand
- Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Jillian L Peters
- Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Adam E M Eltorai
- Brown University Warren Alpert Medical School, Providence, RI, USA
| | | | - Adena J Osband
- Division of Transplant Surgery, Department of Surgery, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Alan H Daniels
- Division of Spine Surgery, Department of Orthopedics, Brown University Warren Alpert Medical School, Providence, RI, USA
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27
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Henderson ML. Social Media in the Identification of Living Kidney Donors: Platforms, Tools, and Strategies. CURRENT TRANSPLANTATION REPORTS 2018; 5:19-26. [PMID: 29805956 PMCID: PMC5963285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE OF REVIEW Living donor transplantation offers patients with end-stage renal disease faster access to transplant and better survival and quality of life than waiting for a deceased donor or remaining on dialysis. While many people state they would be willing to help someone in need through kidney donation, there are education and communication barriers to donor candidate identification. These barriers might be mitigated by technological innovations, including the use of social media. RECENT FINDINGS This article describes the state of contemporary evidence regarding use of social media tools and interventions to increase access to living donor transplantation, as reported in peer-reviewed medical literature, as well as programs that have not yet been formally evaluated. SUMMARY As social media platforms continue to grow and expand, a commitment to understanding and facilitating the use of social media by the transplant community may support patients who are interested in using social media as a tool to find a living kidney donor.
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Affiliation(s)
- Macey L. Henderson
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins University School of Nursing, Baltimore, Maryland
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28
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Hunt HF, Rodrigue JR, Dew MA, Schaffer RL, Henderson ML, Bloom R, Kacani P, Shim P, Bolton L, Sanchez W, Lentine KL. Strategies for Increasing Knowledge, Communication, and Access to Living Donor Transplantation: an Evidence Review to Inform Patient Education. CURRENT TRANSPLANTATION REPORTS 2018; 5:27-44. [PMID: 30873335 DOI: 10.1007/s40472-018-0181-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Purpose of review Inadequate knowledge of the benefits, risks and opportunities for living donation is an important, potentially modifiable barrier to living donor transplantation. We assessed the current state of the evidence regarding strategies to increase knowledge, communication and access to living donor transplantation, as reported in peer-reviewed medical literature. Recent Findings Nineteen studies were reviewed, categorized as programs evaluated in randomized controlled trials (8 studies) and programs supported by observational (non-randomized) studies (11 studies). Content extraction demonstrated that comprehensive education about living donation and living donor transplantation involves multiple learners - the transplant candidate, potential living donors, and social support networks - and requires communicating complex information about the risks and benefits of donation, transplantation and alternative therapies to these different audiences. Transplant centers can help transplant patients learn about living donor transplantation through a variety of formats and modalities, including center-based, home-based and remote technology-based education, outreach to dialysis centers, and social media. Evaluation of these strategies and program themes informed a new Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) public education brochure. Summary Increasing transplant candidate knowledge and comfort in talking about living donation and transplantation can reduce educational barriers to pursuit of living donor transplants. Ongoing efforts are needed to develop, refine and disseminate educational programs to help improve transplant access for more patients in need of organ donors.
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Affiliation(s)
- Heather F Hunt
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,LIVE ON Organ Donation, Inc., Longmeadow, MA
| | - James R Rodrigue
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,Beth Israel Deaconess Transplant Institute, Boston, MA
| | - Mary Amanda Dew
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
| | - Randolph L Schaffer
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,Scripps Clinic, La Jolla, CA
| | - Macey L Henderson
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,Johns Hopkins University, Transplant Center & School of Nursing, Baltimore, MD
| | - Randee Bloom
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA
| | - Patrick Kacani
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA
| | - Pono Shim
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA
| | - Lee Bolton
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA
| | - William Sanchez
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,Mayo Clinic, Rochester, MN
| | - Krista L Lentine
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,Saint Louis University School of Medicine & Transplant Center, St. Louis, MO
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29
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Social Media in the Identification of Living Kidney Donors: Platforms, Tools, and Strategies. CURRENT TRANSPLANTATION REPORTS 2018. [DOI: 10.1007/s40472-018-0179-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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