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Lee LA, Martin DA, Mahoney M, James L, Avitzur Y, Carroll A, Piggott B, Tomlinson C, Urschel S, Hamiwka L. Organ Donation in Canadian PICUs: A Cross-Sectional Survey, 2021-2022. Pediatr Crit Care Med 2024; 25:416-424. [PMID: 37966310 PMCID: PMC11060061 DOI: 10.1097/pcc.0000000000003404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
OBJECTIVES To understand contemporary pediatric organ donation programs in Canadian PICUs, including: policies and practices, data collection and reporting, and system and process barriers. DESIGN A cross-sectional survey carried out 2021-2022. SETTING Canadian PICUs affiliated with a donor physician network. SUBJECTS Pediatric intensivists identified as the donation program lead, or most knowledgeable about donation for their institution. MEASUREMENTS AND MAIN RESULTS A 19-item survey was developed through collaboration with stakeholders from the organ donation and transplantation community within Canada. Domains and items were generated and reduced iteratively during an in-person workshop. Pretesting and pilot testing were completed to ensure readability, flow, clinical sensibility, and construct validity. Fifteen of 16 (94%) invited Canadian PICUs from seven provinces completed the survey representing 88% (15/18) of all noncardiac Canadian PICUs. Surveys were completed between June 2021 and September 2022. All units support donation after death by neurologic criteria (DNC); 14 of 15 indicated donation policies were in place and 1 of 15 indicated no policy but the ability to facilitate donation. Thirteen of 15 units (87%) support donation after death by circulatory criteria (DCC) with policies in place, with 11 of 13 of these indicating routine support of donation opportunities. The majority (13/15) of units identified a donation champion. Of the 16 identified champions across these centers, 13 were physicians and were registered nurses or nurse practitioners. Eight of 13 units (62%) with donation champions had positions supported financially, of which 5 units came from the Organ Donation Organization and the other 3 came from the provincial health authority. Finally, only 3 of 15 PICU donation programs have a pediatric donation committee with family involvement. Variability exists in identification (including determination of death practices), referral, and approach for donation between units. CONCLUSIONS Although all Canadian PICUs support donation after DNC donation, and most support donation after DCC, variability exists in the identification, referral, and approach of potential donors. There is a notable lack of family involvement in pediatric donation programs. There are many opportunities for standardization of PICU donation programs which may result in improved rates of pediatric organ donation in Canada.
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Affiliation(s)
- Laurie A Lee
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada
- Canadian Blood Services, Ottawa, ON, Canada
- Division of Gastroenterology, Hepatology and Nutrition, SickKids Hospital, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
- University of Alberta, Edmonton, AB, Canada
| | - Dori-Ann Martin
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Meagan Mahoney
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada
| | - Lee James
- Canadian Blood Services, Ottawa, ON, Canada
| | - Yaron Avitzur
- Division of Gastroenterology, Hepatology and Nutrition, SickKids Hospital, Toronto, ON, Canada
| | - Allison Carroll
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - Christopher Tomlinson
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - Simon Urschel
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- University of Alberta, Edmonton, AB, Canada
| | - Lorraine Hamiwka
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Silva AR, Rochon A, Hornby L, Lotherington K, James L, Webster R, Sucha E, Sarti A, Dhanani S, Silva E Silva V. Resilience among organ donation coordinators: a Canadian mixed-methods study. Front Public Health 2024; 12:1367546. [PMID: 38560430 PMCID: PMC10978649 DOI: 10.3389/fpubh.2024.1367546] [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: 01/08/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Background Organ and Tissue Donation Coordinators (OTDCs) are key to the success of deceased organ donation processes. However, reduced resilience can leave them susceptible to the incidence of work-related issues and decrease the quality of the care provided. Therefore, this study aimed to examine the extent of resilience and influencing aspects among OTDCs in Canada. Methods Mixed-method (QUAN-qual) explanatory sequential design. Quantitative data was collected using an online cross-sectional survey approach with demographic data and the validated scales and analyzed using descriptive and inferential statistics. Qualitative data was collected using a descriptive approach with a semi-structured interview guide and analyzed using content analysis. Results One hundred twenty participants responded to the survey, and 39 participants were interviewed. Most participants from the survey were female (82%), registered nurses (97%) and on average 42 years old. The quantitative data revealed that OTDCs had a high level of perceived compassion satisfaction (ProQOL-CS = 36.3) but a resilience score (CD-RISC = 28.5) lower than other groups of healthcare professionals. OTDCs with over a year of experience in the role were more likely to have higher levels of resilience. The qualitative data identified that participants saw resilience as crucial for their work-related well-being. Although coping strategies were identified as a key factor that enhance resilience, many OTDCs reported difficulty in developing healthy coping strategies, and that the use of unhealthy mechanisms (e.g., alcohol and smoking) can result in negative physical consequences (e.g., weight gain) and reduced resilience levels. Conclusion Participants reported using a series of coping and protective strategies to help build resilience, but also difficulty in developing healthy mechanisms. The lack of healthy coping strategies were seen as contributing to negative work-related issues (e.g., burnout). Our findings are being used to develop tailored interventions to improve resilience and healthy coping strategies among organ donor coordinators in Canada.
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Affiliation(s)
- Amina R Silva
- Department of Nursing, Brock University, St. Catharines, ON, Canada
| | - Andrea Rochon
- Department of Nursing, St. Lawrence College, Kingston, ON, Canada
| | | | | | - Lee James
- Canadian Blood Services, Ottawa, ON, Canada
| | - Richard Webster
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Ewa Sucha
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Aimee Sarti
- Department of Critical Care, The Ottawa Hospital, Ottawa, ON, Canada
| | - Sonny Dhanani
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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Krmpotic K, Dirk J, Gallant J, Hancock J, Isenor C, James L, Landry A, Laybolt A, Tennankore K, Weiss MJ, Beed S. Development of the Nova Scotia Potential Donor Audit (PDA) Tool and 2020 Historic Performance Database: Lessons Learned From the First 1000 Medical Record Reviews. Transplant Direct 2023; 9:e1545. [PMID: 37876919 PMCID: PMC10593262 DOI: 10.1097/txd.0000000000001545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/26/2023] [Accepted: 08/21/2023] [Indexed: 10/26/2023] Open
Abstract
Background Legislation and accountability frameworks are key components of high-performing deceased-donation systems. In 2021, Nova Scotia (NS), Canada, became the first jurisdiction in North America to enact deemed consent legislation and concurrently implemented mandatory referral legislation similar to that found in other Canadian provinces. Frontline financial resources were provided by the government to support the development of program infrastructure, including implementation of means to evaluate system performance. Methods The Organ Donation Program (ODP), in collaboration with other stakeholders, developed a Potential Donor Audit (PDA) tool and database for referral intake and manual performance audits. Medical record reviews of deaths in the year before legislative change were conducted to pilot and revise the PDA and evaluate missed donation opportunities. Results The NS PDA was piloted on 1028 patient deaths. Of 518 patients (50.4%) who met clinical triggers for referral to the ODP, 72 (13.9%) were referred (86.1% missed referral rate). One hundred sixty-three patients met the NS definition of a potential donor; 53 (32.5%) were referred (110 missed potential donors). Referral consent rates reached 71.7% (n = 38 of 53 approaches). The actualized donation rate reported by Canadian Blood Services was 29.9 donors per million population (n = 34 donors). Discussion We documented high rates of missed referrals and missed potential donors before the enactment of mandatory referral and deemed consent legislation. Conclusions The ODP has intentionally broadened clinical criteria for referral to shift the responsibility of identifying medically suitable potential donors from bedside clinicians to organ donation specialists. Lessons learned from our experience developing a PDA include the importance of early involvement of multiple stakeholders and ongoing modification of fields and workflow based on data availability and utility for clinical, educational, research, and reporting purposes.
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Affiliation(s)
- Kristina Krmpotic
- Department of Critical Care, Dalhousie University, Halifax, NS, Canada
- Legacy of Life Provincial Organ Donation, Nova Scotia Health, Halifax, NS, Canada
| | - Jade Dirk
- Legacy of Life Provincial Organ Donation, Nova Scotia Health, Halifax, NS, Canada
- Department of Research and Innovation, Nova Scotia Health, Halifax, NS, Canada
| | - Julien Gallant
- Department of Pediatric Critical Care, IWK Health, Halifax, NS, Canada
| | - Jennifer Hancock
- Department of Critical Care, Dalhousie University, Halifax, NS, Canada
- Legacy of Life Provincial Organ Donation, Nova Scotia Health, Halifax, NS, Canada
| | | | - Lee James
- Canadian Blood Services, Vancouver, BC, Canada
| | - Alain Landry
- Legacy of Life Provincial Organ Donation, Nova Scotia Health, Halifax, NS, Canada
| | | | | | - Matthew-John Weiss
- Transplant Québec, Montreal, QC, Canada
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Centre, Trauma-Emergency-Critical Care Medicine, Université Laval, QC, Canada
| | - Stephen Beed
- Department of Critical Care, Dalhousie University, Halifax, NS, Canada
- Legacy of Life Provincial Organ Donation, Nova Scotia Health, Halifax, NS, Canada
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Kazzaz YM, Maghrabi F, Alkhathaami RA, Alghannam RF, Alonazi NM, Alrubaiaan AA, Alkadeeb NA, Antar M, Babakr R. Paediatric organ donation following neurological determinants of death in intensive care units in Saudi Arabia: a retrospective cross-sectional study. BMJ Open 2023; 13:e072073. [PMID: 37586859 PMCID: PMC10432649 DOI: 10.1136/bmjopen-2023-072073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 08/03/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVES The aim of this retrospective cross-sectional study was to assess the performance of paediatric organ donation in intensive care units following neurological determinants of death in Saudi Arabia. DESIGN Retrospective cross-sectional study. SETTING Paediatric intensive care units at three tertiary centres over 5 years. PARTICIPANTS 423 paediatric deaths (<14 years) from January 2017 to December 2021. PRIMARY OUTCOME Patients were identified as either possible, potential, eligible, approached, consented or actual donors based on organ donation definitions from the WHO, Transplantation Society and UK potential donor audit. SECONDARY OUTCOME Secondary outcome was causative mechanisms of brain injury in possible donors. Demographics of the study cohort (age, sex, hospital length of stay (LOS), paediatric intensive care unit LOS, pre-existing comorbidities, admission type and diagnosis category) were compared between possible and non-possible donors. Demographics were also compared between patients who underwent neurological determination of death and patients who did not. RESULTS Among the 423 paediatric deaths, 125 (29.6%) were identified as possible donors by neurological criteria (devastating brain insult with likelihood of brain death, Glasgow Coma Score of 3 and ≥2 absent brainstem reflexes). Of them, 41 (32.8%) patients were identified as potential donors (neurological determination of death examinations initiated by the treating team), while only two became actual donors. The eligible death conversion rate was 6.9%. The reporting rate to organ procurement organisation was 70.7% with a consent rate of 8.3%. The most common causes of brain insult causing death were cardiac arrest (44 of 125 patients, 35.2%), followed by traumatic brain injury and drowning (31 of 125 patients, 24.8%), and intracranial bleeding (13 of 125 patients, 11.4%). CONCLUSION Major contributors to low actual donation rate were consent, donor identification and donor referral.
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Affiliation(s)
- Yasser Mohammed Kazzaz
- Department of Pediatrics, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Fidaa Maghrabi
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Raghad Ali Alkhathaami
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Rahaf Fahad Alghannam
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nora Mohammad Alonazi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Nayla Anwar Alkadeeb
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohannad Antar
- Department of Pediatrics, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Razan Babakr
- Department of Pediatrics, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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de Oliveira Restier RB, Knihs NDS, Salum NC, Pontes DO, Magalhães ALP, Dos Santos EG, Walendowsky ASSDR, Pessoa JLE, Roza BDA, Ramos SF. Interventions to Improve the Quality in the Organ and Tissue Donation Process. Transplant Proc 2023; 55:1346-1351. [PMID: 37537077 DOI: 10.1016/j.transproceed.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/19/2023] [Accepted: 06/22/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Map Interventions is capable of supporting the multidisciplinary team that works in organ and tissue donation to disseminate quality in this process. METHODS A scoping review study that was conducted through the steps proposed by the Joanna Briggs Institute. RESULTS Fifty-six studies made up the sample. 2018 (no. 07, 12.5%) had the highest number of publications. The country that published the most was the United States (no. 16, 28.56%). The database with the most publications was the Cumulative Index to Nursing and Allied Health Literature - CINAHL (no. 15, 26.78%). The most used interventions, which had the most significant impact on the improvement of results and quality, were the use of indicators in all stages of the organ and tissue donation process; the use of real goals that can be achieved; frequent audits, validation of instruments to track opportunities for improvement; as well as methodologies to implement quality and education among professionals who work in this process. Such interventions reveal important changes in the organ donation process, especially in the notification of potential and effective donors, as well as providing an opportunity for safety in the stages of the organ and tissue donation process. CONCLUSION The interventions tracked suggest the implementation of a set of actions formed by the continuous use of auditing, indicators, continuing education with the team that works in the process of organ and tissue donation, combined with the management of the results obtained through the indicators, where it is generated from these data, actions that have a direct impact on the weaknesses identified.
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Affiliation(s)
| | | | | | | | | | | | | | - João Luis Erbs Pessoa
- State Transplant Center; Secretary of Health of the state of São Paulo, São Paulo, Brazil
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Williment C, Beaulieu L, Clarkson A, Gunderson S, Hartell D, Escoto M, Ippersiel R, Powell L, Kirste G, Nathan HM, Opdam H, Weiss MJ. Organ Donation Organization Architecture: Recommendations From an International Consensus Forum. Transplant Direct 2023; 9:e1440. [PMID: 37138552 PMCID: PMC10150918 DOI: 10.1097/txd.0000000000001440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 05/05/2023] Open
Abstract
This report contains recommendations from 1 of 7 domains of the International Donation and Transplantation Legislative and Policy Forum (the Forum). The purpose is to provide expert guidance on the structure and function of Organ and Tissue Donation and Transplantation (OTDT) systems. The intended audience is OTDT stakeholders working to establish or improve existing systems. Methods The Forum was initiated by Transplant Québec and co-hosted by the Canadian Donation and Transplantation Program partnered with multiple national and international donation and transplantation organizations. This domain group included administrative, clinical, and academic experts in OTDT systems and 3 patient, family, and donor partners. We identified topic areas and recommendations through consensus, using the nominal group technique. Selected topics were informed by narrative literature reviews and vetted by the Forum's scientific committee. We presented these recommendations publicly, with delegate feedback being incorporated into the final report. Results This report has 33 recommendations grouped into 10 topic areas. Topic areas include the need for public and professional education, processes to assure timely referral of patients who are potential donors, and processes to ensure that standards are properly enforced. Conclusions The recommendations encompass the multiple roles organ donation organizations play in the donation and transplantation process. We recognize the diversity of local conditions but believe that they could be adapted and applied by organ donation organizations across the world to accomplish their fundamental objectives of assuring that everyone who desires to become an organ donor is given that opportunity in a safe, equitable, and transparent manner.
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Affiliation(s)
- Claire Williment
- Organ Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
| | | | - Anthony Clarkson
- Organ Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
| | | | - David Hartell
- Organ and Tissue Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
| | - Manuel Escoto
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Richard Ippersiel
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Linda Powell
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Gunter Kirste
- Albert Ludwigs University Freiburg, Medical Center, Freiburg, Germany
| | | | - Helen Opdam
- Australian Organ and Tissue Authority, Canberra, Australia
| | - Matthew J. Weiss
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Gift of Life Donor Program, Philadelphia, PA
- Transplant Québec, Montréal, QC, Canada
- Division of Critical Care, Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, QC, Canada
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Liapakis A, Jesse MT, Pillai A, Bittermann T, Dew MA, Emre S, Hunt H, Kumar V, Locke J, Mohammad S, Olthoff K, Verna EC, Lentine KL. Living donor liver transplantation: A multi-disciplinary collaboration towards growth, consensus, and a change in culture. Clin Transplant 2023:e14953. [PMID: 36890717 DOI: 10.1111/ctr.14953] [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: 12/28/2022] [Revised: 02/14/2023] [Accepted: 02/26/2023] [Indexed: 03/10/2023]
Abstract
INTRODUCTION Living donor liver transplantation (LDLT) reduces liver transplant waitlist mortality and provides excellent long-term outcomes for persons with end stage liver disease. Yet, utilization of LDLT has been limited in the United States (US). METHODS In October 2021, the American Society of Transplantation held a consensus conference to identify important barriers to broader expansion of LDLT in the US, including data gaps, and make recommendations for impactful and feasible mitigation strategies to overcome these barriers. Domains addressed encompassed the entirety of the LDLT process. Representation from international centers and living donor kidney transplantation were included for their perspective/experience in addition to members across disciplines within the US liver transplantation community. A modified Delphi approach was employed as the consensus methodology. RESULTS The predominant theme permeating discussion and polling results centered on culture; the beliefs and behaviors of a group of people perpetuated over time. CONCLUSIONS Creating a culture of support for LDLT in the US is key for expansion and includes engagement and education of stakeholders across the spectrum of the process of LDLT. A shift from awareness of LDLT to acknowledgement of benefit of LDLT is the primary goal. Propagation of the maxim "LDLT is the best option" is pivotal.
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Affiliation(s)
- AnnMarie Liapakis
- Yale School of Medicine and Yale New Haven Transplant Center, New Haven, Connecticut, USA
| | - Michelle T Jesse
- Transplant Institute, Henry Ford Health System, Detroit, Michigan, USA
| | - Anjana Pillai
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | | | - Mary Amanda Dew
- University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sukru Emre
- Ege University School of Medicine, Izmir, Turkey
| | - Heather Hunt
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, Virginia, USA
| | - Vineeta Kumar
- Department of Medicine, Division of Nephrology/Transplant, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jayme Locke
- Department of Medicine, Division of Nephrology/Transplant, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Saeed Mohammad
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kim Olthoff
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Elizabeth C Verna
- Center for Liver Disease and Transplantation, Columbia University, New York, USA
| | - Krista L Lentine
- Saint Louis University Transplant Center, St. Louis, Missouri, USA
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Silva E Silva V, Schirmer J, de Aguiar Roza B, Sarti A, Hickey M, Dhanani S, Almost J, Schafer M, Tranmer J. Understanding organ donation processes and structures in ontario: A social network analysis approach. Soc Sci Med 2022; 310:115243. [PMID: 36027760 DOI: 10.1016/j.socscimed.2022.115243] [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: 01/23/2022] [Revised: 06/17/2022] [Accepted: 07/23/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Transplant rates in Ontario rose steeply in the decade prior to the COVID-19 pandemic. Reasons for that increase remain unclear, but the inter-organizational arrangement of organ donation programs may have contributed. However, there is a paucity of literature investigating these inter-organizational arrangements, with a limited understanding of how communication facilitates organ donation. Understanding these arrangements may help to re-establish rising organ donation rates post-pandemic. OBJECTIVE To describe interprofessional interactions of Organ and Tissue Donation Coordinators (OTDCs) during organ donation cases, within organ donation programs in Ontario, from an organizational perspective (describing structure, context, process). METHODS Mixed-method social network analysis (SNA) approach analyzing 14 organ donation cases just before the COVID-19 pandemic. RESULTS Structure: Social network graphs depict the joint work performed by hospital staff and OTDCs, with a great part of the communication being processed through the OTDC. CONTEXT Network density ranged from 0.05 to 0.24 across cases, and health care professionals perceived an atmosphere of shared vision and trust among team members. PROCESS Most networks had a degree centralization <0.50 suggesting a decentralized information flow, and participants perceived decisions being jointly made. The characteristic path length of cases ranged from 1.6 to 3.2, suggesting potential for rapid information diffusion. Overall, data reinforced the OTDC role of intermediator within the communication process, and hospital staff perceived OTDCs as central players. Hospital staff and OTDCs reported frustration with some aspects of the flow of information during the organ allocation processes. CONCLUSION Findings from this study provide a network map of communications within organ donation cases and reinforce the importance of the OTDC role. Opportunities for quality improvement within these processes are identified.
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Affiliation(s)
- Vanessa Silva E Silva
- Brock University, Department of Nursing, 1812 ir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada; Queen's Univeristy, School of Nursing, 92 Barrie Street Kingston, Ontario, K7L 3N6, Canada.
| | | | | | - Aimee Sarti
- University of Ottawa, Faculty of Medicine, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON, K1H 8M5, Canada
| | - Michael Hickey
- University of Ottawa, Faculty of Medicine, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON, K1H 8M5, Canada
| | - Sonny Dhanani
- University of Ottawa, Faculty of Medicine, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON, K1H 8M5, Canada
| | - Joan Almost
- Queen's Univeristy, School of Nursing, 92 Barrie Street Kingston, Ontario, K7L 3N6, Canada
| | - Markus Schafer
- Department of Sociology, Baylor University, Waco, TX, United States
| | - Joan Tranmer
- Queen's Univeristy, School of Nursing, 92 Barrie Street Kingston, Ontario, K7L 3N6, Canada
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Knihs NDS, Silva AMD, Santos JD, Silva RMD, Paim SMS, Silva VSE, Dietrich MA, Bellaguarda MLDR. MORTE ENCEFÁLICA: VIVÊNCIA DA EQUIPE DE SAÚDE JUNTO AOS PAIS DE CRIANÇAS E ADOLESCENTES. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2022-0151pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RESUMO Objetivo: compreender a vivência da equipe de saúde junto aos pais de crianças e adolescentes durante as etapas do protocolo de morte encefálica. Método: pesquisa exploratória de abordagem qualitativa desenvolvida em duas instituições de saúde de alta complexidade e referência no atendimento a crianças e adolescentes com politrauma. Os participantes foram profissionais de saúde das unidades de pacientes críticos. A coleta de dados ocorreu entre os meses de outubro e dezembro de 2019 por meio de entrevistas semiestruturadas. Para análise de conteúdo, utilizou-se como apoio o software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires. Resultados: participaram do estudo 21 profissionais (médicos, enfermeiros e técnicos de enfermagem). O corpus geral foi constituído por 21 textos, separados em 123 segmentos, emergindo quatro classes. O estudo mostra sentimentos de apoio e compaixão em todas as etapas do protocolo de morte encefálica. Na etapa da abertura do protocolo, as emoções da equipe estão voltadas às ações de clarificar e transparecer informações deste processo. Além de apontar a necessidade de a equipe detalhar o passo a passo dos exames a serem realizados. Na etapa da comunicação da morte, a sensação de estar, cuidar e acolher a família se conecta com outros sentimentos experimentados por eles. Conclusão: o estudo revela que a equipe de saúde vivencia sentimentos únicos durante o protocolo de morte encefálica na realidade de crianças e adolescentes. Revela também a preocupação de a equipe em estar com a família, atentar e cuidar ante a dor da perda.
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Knihs NDS, Silva AMD, Santos JD, Silva RMD, Paim SMS, Silva VSE, Dietrich MA, Bellaguarda MLDR. BRAIN DEATH: HEALTH TEAM’S EXPERIENCE WITH PARENTS OF CHILDREN AND ADOLESCENTS. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2022-0151en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
ABSTRACT Objective to understand the health team’s experience with parents of children and adolescents during the brain death protocol stages. Method a qualitative and exploratory research developed in two health institutions of high complexity and reference in the care of children and adolescents with polytrauma. Participants were health professionals from critical patient units. Data collection took place between October and December 2019 through semi-structured interviews. For content analysis, we used the software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires as support. Results twenty-one professionals (physicians, nurses and nursing technicians) participated in the study. The general corpus consisted of 21 texts, separated into 123 segments, with the emergence of four classes. The study shows feelings of support and compassion at all brain death protocol stages. In the protocol opening stage, the team’s emotions are focused on the actions of clarifying and revealing information in this process, in addition to pointing out the need for the team to detail the step by step of the exams to be performed. In the communication of death stage, the feeling of being, caring for and welcoming the family relates to other feelings experienced by them. Conclusion the study reveals that the health team experiences unique feelings during the brain death protocol in the reality of children and adolescents, revealing the team’s concern with being with the family, paying attention and caring for the pain of loss.
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