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Padela AI, Titi M, Keval A, Abdelrahim MT. Muslims, Islam, and Organ Donation: Righting Social Narratives and Designing Ethically Balanced Educational Interventions. EXP CLIN TRANSPLANT 2022; 20:885-894. [DOI: 10.6002/ect.2022.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Padela AI, Duivenbode R, Saunders MR, Quinn M, Koh E. The impact of religiously tailored and ethically balanced education on intention for living organ donation among Muslim Americans. Clin Transplant 2020; 34:e14111. [PMID: 33063912 DOI: 10.1111/ctr.14111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 01/02/2023]
Abstract
We tested the efficacy of religiously tailored and ethically balanced education upon living kidney organ donation intent among Muslim Americans. Pre-post changes in participant stage of change, preparedness, and likelihood judged efficacy. Among 137 participants, mean stage of change toward donation appeared to improve (0.59; SD ± 1.07, P < .0001), as did the group's preparedness to make a donation decision (0.55; SD ± 0.86, P < .0001), and likelihood to donate a kidney (0.39; SD ± 0.85, P < .0001). Mean change in likelihood to encourage a loved one, a co-worker, or a mosque community member with ESRD to seek a living donor also increased (0.22; SD ± 0.84, P = .0035, 0.23; SD ± 0.82, P = .0021, 0.33; SD ± 0.79, P < .0001 respectively). Multivariate ordered logistic regression models revealed that gains in biomedical knowledge regarding organ donation increased odds for positive change in preparedness (OR = 1.20; 95% CI 1.01-1.41, P = .03), while increasing age associated with lower odds of positive change in stage of change (OR = 0.98, 95% CI 0.96-0.998, P = .03), and prior registration as an organ donor lowered odds for an increase in likelihood to donate a kidney (OR = 0.22; 95% CI 0.08-0.60, P = .003). Our intervention appears to enhance living kidney donation-related intent among Muslim Americans [Clinicaltrials.gov number: NCT04443114].
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Affiliation(s)
- Aasim I Padela
- Initiative on Islam and Medicine, University of Chicago, Chicago, IL, USA.,Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Rosie Duivenbode
- Initiative on Islam and Medicine, University of Chicago, Chicago, IL, USA
| | - Milda R Saunders
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Michael Quinn
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Elizabeth Koh
- Initiative on Islam and Medicine, University of Chicago, Chicago, IL, USA
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Gao W, Plummer V, McKenna L. Using metaphor method to interpret and understand meanings of international operating room nurses' experiences in organ procurement surgery. J Clin Nurs 2020; 29:4604-4613. [PMID: 32956510 DOI: 10.1111/jocn.15496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/29/2020] [Accepted: 09/06/2020] [Indexed: 11/30/2022]
Abstract
AIMS To demonstrate how metaphor method can be employed in health care research, through a rainbow metaphor to conceptualise lived experiences, and represent a sense of verisimilitude, in a phenomenological study of international nurses' experiences of organ procurement procedures. BACKGROUND International operating room nurses are likely to form unique attitudes towards multi-organ procurement. Phenomenology is used to focus on discovering human experiences and the meanings of certain phenomena. Phenomenological writing can mediate people's reflections and actions, measure people's thoughtfulness and help people to see and show lived experiences from their lifeworlds. DESIGN Metaphor was used to interpret meanings of international operating room nurses' experiences in organ procurement surgery. The meanings were identified through a phenomenological approach informed by the work of van Manen. METHODS A metaphor method was used to interpret and understand the lived experiences of eighteen international OR nurses recruited from nine different countries. Thematic data analysis was used to portray their lived experiences in organ procurement procedure. RESULTS Using a rainbow as metaphor, a vivid picture was portrayed reflecting international OR nurses' experiences and organ procurement journey in Australia as challenging, with mixed feelings. According to the relationship between certain colours and emotions, four essential themes evolved into the concept of a four-colour rainbow to signify the meanings of international OR nurses' experiences in organ procurement procedures. The essential themes represented by these four colours were as follows: Orange-"The surreality of experiencing death," Red-"Personal and professional challenges," Green-"Becoming stronger" and Purple-"My beliefs, my wishes." CONCLUSION Interpreting the meanings of their organ procurement experiences using metaphor method provided valuable insights about what personal and professional challenges these nurses faced, how they coped and managed their challenges, what support and care they required from others, and suggestions for future practice. RELEVANCE TO CLINICAL PRACTICE Operating room nurses in practice needed a range of workplace supports and the rainbow metaphor provides a suitable approach for reflection and understanding of their experiences in organ procurement, with a focus on international, newly graduated and less experienced nurses. Practice improvement is a likely outcome when nurses have a better understanding of their experiences and the experiences of others in their team and this will assist in identifying their knowledge and professional support needs. The method demonstrates how metaphor can be applied to understand clinical nursing situations.
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Affiliation(s)
- Weili Gao
- School of Nursing and Midwifery, Monash University, Frankston, Vic., Australia
| | - Virginia Plummer
- School of Nursing & Health Care Professions, Federation University, Berwick, Vic., Australia
| | - Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Melbourne, Vic., Australia
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Moloney G, Upcroft L, Rienks S, Sutherland M, Bowling A, Walker I. Respect, Interaction, and Immediacy: Addressing the Challenges Associated With the Different Religious and Cultural Approaches to Organ Donation in Australia. EXP CLIN TRANSPLANT 2020; 18:43-53. [PMID: 32758119 DOI: 10.6002/ect.rlgnsymp2020.l7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Australia is a multicultural society of just over 25 million people, with approximately 310 different ancestries, 300 languages, and 150 religions. This diversity suggests that Australia's people might hold a multiplicity of beliefs regarding organ donation. Research shows that most people in Australia have a strong, positive perception of organ donation; they believe that organ donation helps others and benefits society. However, the current rate of 21.6 donors per million population is below expectations and below the demand for organs needed for transplantation. This has led us to ask whether donation consent rates are differentiated by religious and cultural affiliation. We present a case study of New South Wales, Australia, to address this issue. New South Wales is the most populous state in Australia and is also religiously and culturally diverse. Donation consent data (2016-2019) by ethnicity and by religion show that donation consent rates have improved but not across all groups. Initiatives to increase awareness and support for organ and tissue donation among culturally and linguistically diverse and Aboriginal and Torres Strait Islander communities are discussed. Research is also presented that investigates whether registration rates on the Australian Organ Donor Register can be increased and the implications of this for increasing consent for donation. This research underscores the importance of respecting the diversity of beliefs held regarding organ donation, both positive and negative; offering all people a face-to-face interaction opportunity to consider their beliefs about organ donation, ask questions, and raise concerns without judgment; and providing people with an immediate opportunity to register their donation decision on the Australian Organ Donor Register. The challenges associated with adopting these initiatives are considered along with the role of religious and cultural leaders within the context of organ donation and registration; the unspoken concerns of cultural and religious groups are also addressed. In conclusion, we propose that the rich diversity of Australian society is more of a backdrop than a barrier to organ donation.
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Affiliation(s)
- Gail Moloney
- From the Psychology Department, School of Health and Human Sciences, Southern Cross University, Coffs Harbour NSW Australia
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Gan Kim Soon P, Lim SK, Rampal S, Su TT. A qualitative examination of barriers and solutions to renal transplantation in Malaysia: Key-informants' perspective. PLoS One 2019; 14:e0220411. [PMID: 31404075 PMCID: PMC6690507 DOI: 10.1371/journal.pone.0220411] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/15/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION End-stage renal disease (ESRD) is increasing globally, and renal transplantation (RT) is the preferred renal replacement therapy to treat ESRD. Internationally, there are only a few countries with RT rates above 50 per million population (pmp), while most of the countries have RT rates between 30-40 pmp. The low- and middle-income countries (LMIC) makes up the majority for the RT rates below 20 pmp in which Malaysia belongs to despite its increasing ESRD rates. There is a need to explore the barriers to access RT with targeted solutions to improve the RT rates and service in LMIC. Thus, a qualitative study was undertaken in Malaysia to address this issue. METHOD A qualitative methodological approach was performed between March-May 2018. Semi-structured interviews were used to explore current RT policy and service availability. Key-informants were identified from a detailed stakeholder analysis of RT system in Malaysia. Interviews were digitally audio-recorded, transcribed verbatim, coded with ATLAS.ti software and underwent thematic analysis thoroughly. RESULTS Eight key-informants participated in the study. Barriers and related solutions were classified using the socio-ecological model (SEM). As reported, the barriers and solutions of RT in Malaysia are the results of a complex interplay of personal, cultural, and environmental factors. Key barriers are linked to public's attitude and perception towards RT and the unaccommodating practices in the healthcare fraternity for RT. Key-informants provided a systematic solution that shed light on how RT could be improved at each SEM level via effective communication, education and inter-agency collaboration. CONCLUSION The SEM provided a framework to foster a better understanding of current practice, barriers, and solutions to RT in Malaysia. This study is the first to explore the barriers and related solutions to RT comprehensively as a whole. Implications of these findings could prompt a policy change for a better RT service delivery model not just for Malaysia but also for other LMIC. Further stakeholder engagement and evaluation of the systems are required to provide insight into best practices that will help to improve the RT rates and service in Malaysia.
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Affiliation(s)
- Peter Gan Kim Soon
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Soo Kun Lim
- Nephrology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sanjay Rampal
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Tin Tin Su
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- South East Asia Community Observatory (SEACO), Jeffery Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
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Martínez-Alarcón L, Ríos A, Santainés-Borredá E, Agras-Suarez MC, Cañadas-De la Fuente GA, Hurtado-Pardos B, Bárcena-Calvo C, Alorda-Terrasa C, Morillo-Velázquez JM, Martí-García C, Redin-Areta MD, Alconero-Camarero AR, Jiménez-Navascues ML, Gutierrez-Izquierdo MI, Chamorro-Rebollo E, de Las Nieves Merchán-Felipe M, Barandiaran-Lasa M, Martín-Espinosa N, Gala-León FJ, Oter-Quintana C, Benbunan-Bentata B, Tirado-Altamirano F, Fernández-Vallhonrat MB, Ramírez-Rodrigo J, Maciá-Soler L, Saez A, Sánchez Á, López-Navas A, Ramírez P, Parrilla P. Student nurses at Spanish universities and their attitude toward xenotransplantation. Xenotransplantation 2019; 26:e12507. [PMID: 30963648 DOI: 10.1111/xen.12507] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/27/2019] [Accepted: 03/07/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Recent immunological and transgenic advances are a promising alternative using limited materials of human origin for transplantation. However, it is essential to achieve social acceptance of this therapy. OBJECTIVE To analyze the attitude of nursing students from Spanish universities toward organ xenotransplantation (XTx) and to determine the factors affecting their attitude. MATERIALS AND METHODS Type of study: A sociological, multicentre, and observational study. STUDY POPULATION Nursing students enrolled in Spain (n = 28,000). SAMPLE SIZE A sample of 10 566 students estimating a proportion of 76% (99% confidence and precision of ±1%), stratified by geographical area and year of study. Instrument of measurement: A validated questionnaire (PCID-XenoTx-RIOS) was handed out to every student in a compulsory session. This survey was self-administered and self-completed voluntarily and anonymously by each student in a period of 5-10 min. STATISTICAL ANALYSIS descriptive analysis, Student's t test, the chi-square test, and a logistic regression analysis. RESULTS A completion rate: 84% (n = 8913) was obtained. If the results of XTx were as good as in human donation, 74% (n = 6564) would be in favor and 22% (n = 1946) would have doubts. The following variables affected this attitude: age (P < 0.001); sex (P < 0.001); geographical location (P < 0.001); academic year of study (P < 0.001); attitude toward organ donation (P < 0.001); belief in the possibility of needing a transplant (P < 0.001); discussion of transplantation with one's family (P < 0.001) and friends (P < 0.001); and the opinion of one's partner (P < 0.001). The following variables persisted in the multivariate analysis: being a male (OR = 1.436; P < 0.001); geographical location (OR = 1.937; P < 0.001); an attitude in favor of donation (OR = 1.519; P < 0.001); belief in the possibility of needing a transplant (OR = 1.497; P = 0.036); and having spoken about the issue with family (OR = 1.351; P < 0.001) or friends (OR = 1.240; P = 0.001). CONCLUSIONS The attitude of nursing students toward organ XTx is favorable and is associated with factors of general knowledge about organ donation and transplantation and social interaction.
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Affiliation(s)
- Laura Martínez-Alarcón
- Department of Surgery, Transplant Unit, Virgen de la Arrixaca Univeristy Hospital, El Palmar, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), El Palmar, Spain.,"International Collaborative Donor Project", El Palmar, Spain
| | - Antonio Ríos
- Department of Surgery, Transplant Unit, Virgen de la Arrixaca Univeristy Hospital, El Palmar, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), El Palmar, Spain.,"International Collaborative Donor Project", El Palmar, Spain
| | - Elena Santainés-Borredá
- Departamento de Enfermería, Facultad de Enfermeria, Universidad de Valencia, Valencia, Spain
| | | | | | | | - Carmen Bárcena-Calvo
- Departamento de Enfermería y Fisioterapia-Área de Enfermería, Facultad de Ciencias de la Salud, Universidad de León, León, Spain
| | - Carme Alorda-Terrasa
- Departamento de Enfermeria y Fisioterapia, Universidad de las Islas Baleares, Baleares, Spain
| | - Juan Manuel Morillo-Velázquez
- Departamento de Ciencias de la Salud, Escuela Universitaria de Enfermería y Fisioterapia "San Juan de Dios", Universidad Pontificia Comillas, Madrid, Spain
| | - Celia Martí-García
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, Spain
| | | | | | | | | | - Elena Chamorro-Rebollo
- Facultad de Enfermería y Fisioterapia Salus Infirmorum, Universidad Pontificia de Salamanca, Madrid, Spain
| | | | - Maite Barandiaran-Lasa
- Facultad de Medicina y Enfermería, Departamento de Enfermería II Donostia, Sección Donostia UPV/EHU, Gipuzkoa, Spain
| | - Noelia Martín-Espinosa
- Escuela Universitaria de Enfermería y Fisioterapia de Toledo, Universidad de Castilla la Mancha, Toledo, Spain
| | | | | | - Bibinha Benbunan-Bentata
- Departamento de Personalidad, evaluación y tratamiento psicológico, Universalidad de Granada, Melilla, Spain
| | | | | | - Jesús Ramírez-Rodrigo
- Departamento de Enfermería, Facultad de Ciencias de la Salud de Ceuta, Universidad de Granada, Ceuta, Spain
| | - Loreto Maciá-Soler
- Departamento de Enfermería, Facultad de Ciencias de la salud, Universidad de Alicante, Alicante, Spain
| | - Aida Saez
- Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), El Palmar, Spain
| | - Álvaro Sánchez
- "International Collaborative Donor Project", El Palmar, Spain
| | - Ana López-Navas
- Departmento de Psicología, Universidad Católica San Antonio Murcia, Murcia, Spain
| | - Pablo Ramírez
- Department of Surgery, Transplant Unit, Virgen de la Arrixaca Univeristy Hospital, El Palmar, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), El Palmar, Spain.,"International Collaborative Donor Project", El Palmar, Spain
| | - Pascual Parrilla
- Department of Surgery, Transplant Unit, Virgen de la Arrixaca Univeristy Hospital, El Palmar, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), El Palmar, Spain
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DuBay DA, Ivankova NV, Herbey I, Redden DT, Holt C, Siminoff L, Fouad MN, Su Z, Morinelli TA, Martin MY. A quantitative appraisal of African Americans' decisions to become registered organ donors at the driver's license office. Clin Transplant 2018; 32:e13402. [PMID: 30179271 DOI: 10.1111/ctr.13402] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 08/28/2018] [Accepted: 08/30/2018] [Indexed: 11/27/2022]
Abstract
African American (AA) organ donation registration rates fall short of national objectives. The goal of the present study was to utilize data acquired from a quantitative telephone survey to provide information for a future Department of Motorized Vehicles (DMV) intervention to increase AA organ donor registration at the DMV. AAs (n = 20 177) that had visited an Alabama DMV office within a 3-month period were recruited via direct mailing to participate in a quantitative phone survey. Data from 155 respondents that participated in the survey were analyzed. Of those respondents deciding to become a registered organ donor (ROD; n = 122), one-third made that decision at the time of visiting the DMV. Of those who chose not to become a ROD (n = 33), one-third made the decision during the DMV visit. Almost 85% of all participants wanted to learn more about organ donation while waiting at the DMV, preferably via TV messaging (digital signage), with the messaging delivered from organ donors, transplant recipients, and healthcare experts. Altruism, accurate organ donation information, and encouragement from family and friends were the most important educational topics to support AAs becoming a ROD. These data provide a platform to inform future interventions designed to increase AAs becoming a ROD at the DMV.
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Affiliation(s)
- Derek A DuBay
- Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Nataliya V Ivankova
- Department of Health Services Administration, School of Health Professions and Department of Acute, Chronic and Continuing Care, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ivan Herbey
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
| | - David T Redden
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Cheryl Holt
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland
| | - Laura Siminoff
- College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Mona N Fouad
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
| | - Zemin Su
- Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Thomas A Morinelli
- Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Michelle Y Martin
- Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee
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Sehgal NKR, Sullivan C, Figueroa M, Pencak JA, Einstadter D, Thornton JD. A Standardized Donor Designation Ratio to Assess the Performance of Driver's License Agencies. Transplant Proc 2018; 49:1211-1214. [PMID: 28735982 DOI: 10.1016/j.transproceed.2017.01.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 01/24/2017] [Indexed: 11/29/2022]
Abstract
Evaluating Department of Motor Vehicles (DMV) locations based on the percent of patrons who register as donors does not account for individual characteristics that may influence willingness to donate. We reviewed the driver's licenses of 2997 randomly selected patients at an urban medical system to obtain donor designation, age, gender, and DMV location and linked patient addresses with census tract data on race, ethnicity, income, and education. We then developed a Standardized Donor Designation Ratio (SDDR) (ie, the observed number of donors at each DMV divided by the expected number of donors based on patient demographic characteristics). Overall, 1355 (45%) patients were designated as donors. Donor designation was independently associated with younger age, female gender, nonblack race, and higher income. Across 18 DMVs, the proportion of patients who were donors ranged from 30% to 68% and SDDRs ranged from 0.82 to 1.17. Among the 6 facilities in the lowest tertile by SDDR, 3 were in the lowest tertile by percent donation. In conclusion, there is a great deal of variation across DMVs in rates of organ donor designation. SDDRs that adjust for DMV patron characteristics are distinct measures that may more accurately describe the performance of DMVs in promoting organ donation.
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Affiliation(s)
| | - C Sullivan
- Center for Reducing Health Disparities, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio, USA
| | - M Figueroa
- Center for Reducing Health Disparities, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio, USA
| | - J A Pencak
- Center for Reducing Health Disparities, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio, USA
| | - D Einstadter
- Center for Health Care Research and Policy, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio, USA; Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Internal Medicine, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio, USA
| | - J D Thornton
- Center for Reducing Health Disparities, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio, USA; Department of Internal Medicine, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio, USA.
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Sehgal NK, Sullivan C, Figueroa M, Pencak JA, Thornton JD. Stability of Organ Donor Designations on Driver's Licenses. Transplant Proc 2016; 48:1907-10. [PMID: 27569920 DOI: 10.1016/j.transproceed.2016.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 04/27/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Little is known about the stability of decisions that people make to be organ donors. We sought to determine the rate of stability of organ donor designations on driver's licenses. METHODS With the use of a cross-sectional study design, we reviewed the health records of 2500 randomly selected primary-care patients at a large urban safety-net medical system to obtain their demographic and medical characteristics. We also examined the two most recent unique driver's licenses, state identification cards, or learner's permits that were scanned into electronic health records as part of the patient registration process. We obtained organ donor designations from these documents for each patient. RESULTS Of all patients, 1174 (47%) had two driver's licenses, identification cards, or permits in their electronic medical records. The two documents were issued an average of 3.5 years apart. Overall, 114 (10%) patients had differing organ donor designations on their two documents. Among the 502 patients who were designated as organ donors on the first document, 32 (6%) were not designated as organ donors on the second document. Among the 672 patients who were not designated as organ donors on the first document, 82 (12%) were designated as organ donors on the second document. There was little relationship between stability of organ donor designations and patient demographic and medical characteristics. CONCLUSIONS About 1 of every 10 patients changed their organ donor designation, but stability was not associated with any demographic or medical factors. Further work is needed to understand why individuals change their organ donor designation.
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Sehgal NKR, Sullivan C, Scallan C, Figueroa M, Pencak JA, Kirkland J, Scott K, Thornton JD. Is Signature Size Associated With Organ Donor Designation on Driver's Licenses? Transplant Proc 2017; 48:1911-5. [PMID: 27569921 DOI: 10.1016/j.transproceed.2016.02.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 02/16/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Previous studies suggest that large signature size is associated with narcissistic characteristics. By contrast, organ donation is an indicator of altruism. Because altruism and narcissism may be viewed as opposites, we sought to determine if smaller signature size is associated with willingness to be an organ donor. METHODS Using a cross-sectional study design, we reviewed the health records of 571 randomly selected primary care patients at a large urban safety-net medical system to obtain their demographic and medical characteristics. We also examined driver's licenses that were scanned into electronic health records as part of the patient registration process. We measured signature sizes and obtained the organ donor designation from these driver's licenses. RESULTS Overall, 256 (45%) patients were designated as donors on their driver's licenses. Signature size averaged 113.3 mm(2) but varied greatly across patients (10th percentile 49.1 mm(2), 90th percentile 226.1 mm(2)). On multivariate analysis, donor designation was positively associated with age 18-34 years, non-black race, having private insurance, and not having any comorbid conditions. However, signature size was not associated with organ donor designation. CONCLUSIONS Signature size is not associated with verified organ donor designation. Further work is needed to understand the relationship between personality types and willingness to be an organ donor.
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Affiliation(s)
- N K R Sehgal
- University School, Chagrin Falls, Ohio, United States
| | - C Sullivan
- Center for Reducing Health Disparities, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio, United States
| | - C Scallan
- Department of Internal Medicine, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio, United States
| | - M Figueroa
- Center for Reducing Health Disparities, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio, United States
| | - J A Pencak
- Center for Reducing Health Disparities, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio, United States
| | - J Kirkland
- Case Western Reserve University, Cleveland, Ohio, United States
| | - K Scott
- Center for Reducing Health Disparities, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio, United States
| | - J D Thornton
- Center for Reducing Health Disparities, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio, United States; Department of Internal Medicine, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio, United States; Division of Pulmonary, Critical Care, and Sleep Medicine, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio, United States.
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Sehgal NKR, Scallan C, Sullivan C, Cedeño M, Pencak J, Kirkland J, Scott K, Thornton JD. The Relationship Between Verified Organ Donor Designation and Patient Demographic and Medical Characteristics. Am J Transplant 2016; 16:1294-7. [PMID: 26603147 PMCID: PMC4803538 DOI: 10.1111/ajt.13608] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 10/20/2015] [Accepted: 10/31/2015] [Indexed: 01/25/2023]
Abstract
Previous studies on the correlates of organ donation consent have focused on self-reported willingness to donate and on self-reported medical suitability to donate. However, these may be subject to social desirability bias and inaccurate assessments of medical suitability. The authors sought to overcome these limitations by directly verifying donor designation on driver's licenses and by abstracting comorbid conditions from electronic health records. Using a cross-sectional study design, they reviewed the health records of 2070 randomly selected primary care patients at a large urban safety-net medical system to obtain demographic and medical characteristics. They also examined driver's licenses that were scanned into electronic health records as part of the patient registration process for donor designation. Overall, 943 (46%) patients were designated as a donor on their driver's license. On multivariate analysis, donor designation was positively associated with age 35-54 years, female sex, nonblack race, speaking English or Spanish, being employed, having private insurance, having an income >$45 000, and having fewer comorbid conditions. These demographic and medical characteristics resulted in patient subgroups with donor designation rates ranging from 21% to 75%. In conclusion, patient characteristics are strongly related to verified donor designation. Further work should tailor organ donation efforts to specific subgroups.
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Affiliation(s)
| | - Ciaran Scallan
- Department of Internal Medicine, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
| | - Catherine Sullivan
- Center for Reducing Health Disparities, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
| | - Maria Cedeño
- Center for Reducing Health Disparities, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
| | - Julie Pencak
- Center for Reducing Health Disparities, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
| | | | - Karen Scott
- Center for Reducing Health Disparities, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
| | - J. Daryl Thornton
- Department of Internal Medicine, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio,Center for Reducing Health Disparities, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio,Division of Pulmonary, Critical Care, and Sleep Medicine, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
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Ríos A, López-Navas A, López-López A, Gómez FJ, Iriarte J, Herruzo R, Blanco G, Llorca FJ, Asunsolo A, Sánchez P, Gutiérrez PR, Fernández A, de Jesús MT, Martínez Alarcón L, Lana A, Fuentes L, Hernández JR, Virseda J, Yelamos J, Bondía JA, Hernández A, Ayala MA, Ramis G, Ramírez P, Parrilla P. The level of acceptance of spanish medical students of the transplantation of solid organs from animals: a stratified and multicentre study. Xenotransplantation 2015; 22:476-86. [PMID: 26602493 DOI: 10.1111/xen.12208] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 10/15/2015] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Research into the transplantation of solid organs from animals (xenotransplantation) is generating interest and curiosity given that this could be a way of resolving the shortage in transplant organs. However, the fact is that currently xenotransplantation is far from becoming a clinical practice. OBJECTIVE To analyse the attitude of medical students from Spanish universities towards the donation of organs from animals and to determine the factors affecting their attitudes. MATERIAL AND METHODS TYPE OF STUDY A sociological, interdisciplinary, observational and multicentre study in Spain. STUDY POPULATION Students enrolled on the medical degree in Spain (n = 34 000). SAMPLE SIZE A sample of 9598 students (a confidence level of 99% and precision of ± 1%) stratified by geographical area and academic year. Instrument of measurement: A validated questionnaire of attitude towards organ xenotransplantation (PCID-XenoTx RIOS) which was self-administered and completed anonymously. RESULTS A completion rate of 95.7% (n = 9275) was obtained. If the results of xenotransplantation were as good as in human donation, 81% (n = 7491) would be in favour, 3% (n = 308) against and 16% (n = 1476) undecided. The following variables affected this attitude: sex (P < 0.001); academic year (P < 0.001); discussion of transplantation with one's family (P < 0.001) and friends (P < 0.001); the opinion of one's partner (P < 0.001); the respondent's attitude towards organ donation (P < 0.001); religion (P < 0.001); and participation in altruistic activities (P < 0.001). The following variables persisted in the multivariate analysis: (1) being a female (OR = 1.794; P < 0.001); (2) academic year (OR = 2.487; P < 0.001); (3) having spoken about the issue with one's family (OR = 1.200; P = 0.019); (4) the favourable opinion of one's partner (OR = 1.526; P = 0.028); (5) an attitude in favour of donation (OR = 2.087; P < 0.001); (6) being an atheist/agnostic, (OR = 2.5; P < 0.001); and (7) a belief that one's religion is in favour of transplantation (OR = 1.317; P = 0.005). CONCLUSIONS Spanish medical students have a favourable attitude towards xenotransplantation. This willingness and interest could be a decisive platform for the development and strengthening of research, both for centres with a pre-clinical xenotransplantation programme and new healthcare centres.
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Affiliation(s)
- Antonio Ríos
- International Collaborative Donor Project ("Proyecto Colaborativo Internacional Donante"), Murcia, Spain.,Department of Surgery, Paediatrics, Obstetrics and Gynaecology, University of Murcia, Murcia, Spain.,Transplant Unit, Surgery Service, IMIB - Virgen de la Arrixaca University Hospital, Murcia, Spain.,Regional Transplant Centre, Consejería de Sanidad y Consumo de la Región de Murcia, Murcia, Spain
| | - Ana López-Navas
- International Collaborative Donor Project ("Proyecto Colaborativo Internacional Donante"), Murcia, Spain.,Department of Psychology, Universidad Católica San Antonio (UCAM), Murcia, Spain
| | - Ana López-López
- Department of Urology, San Juan University Hospital of Alicante, Alicante, Spain
| | | | | | | | - Gerardo Blanco
- Servicio de Cirugía HBP y Trasplante Hepático, Complejo Hospitalario Universitario de Badajoz, Hospital Infanta Cristina, Badajoz, Spain
| | | | - Angel Asunsolo
- Departamento de Cirugía, Ciencias Médicas y Sociales, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá Campus Científico-Tecnológico, Alcala de Henares, Madrid, Spain
| | - Pilar Sánchez
- Facultad de Medicina, Universidad de Málaga, Málaga, Spain
| | - Pedro Ramón Gutiérrez
- Servicio de Urología (Complejo Hospitalario Universitario de Canarias, CHUC) y Departamento de Cirugía (Universidad de La Laguna, ULL) San Cristóbal de La Laguna, Tenerife, Spain
| | - Ana Fernández
- Departamento de Ciencias Biomédicas Básicas, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Madrid, Spain
| | | | - Laura Martínez Alarcón
- International Collaborative Donor Project ("Proyecto Colaborativo Internacional Donante"), Murcia, Spain.,Transplant Unit, Surgery Service, IMIB - Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Alberto Lana
- Facultad de Medicina y Ciencias de la Salud, Área de Medicina Preventiva y Salud Pública, Universidad de Oviedo, Oviedo, Spain
| | - Lorena Fuentes
- Departamento de Farmacología y Fisiología Facultad de Ciencias de la Salud y del Deporte, Universidad de Zaragoza, Huesca, Spain
| | | | | | - José Yelamos
- Department of Immunology, Hospital del Mar, Barcelona, Spain
| | | | - Antonio Hernández
- Endocrinology and Nutrition Service, Unidad de Docencia y Formación Continuada, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Servicio Murciano de Salud, El Palmar, Spain
| | - Marco Antonio Ayala
- Hospital Regional de Alta Especialidad del Bajío, León, Mexico.,HGSZ No. 10 del Instituto Mexicano del Seguro Social Delegación Guanajuato, Guanajuato, Mexico
| | | | - Pablo Ramírez
- International Collaborative Donor Project ("Proyecto Colaborativo Internacional Donante"), Murcia, Spain.,Department of Surgery, Paediatrics, Obstetrics and Gynaecology, University of Murcia, Murcia, Spain.,Transplant Unit, Surgery Service, IMIB - Virgen de la Arrixaca University Hospital, Murcia, Spain.,Regional Transplant Centre, Consejería de Sanidad y Consumo de la Región de Murcia, Murcia, Spain
| | - Pascual Parrilla
- Department of Surgery, Paediatrics, Obstetrics and Gynaecology, University of Murcia, Murcia, Spain.,Transplant Unit, Surgery Service, IMIB - Virgen de la Arrixaca University Hospital, Murcia, Spain
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Marck CH, Neate SL, Skinner MR, Dwyer BM, Hickey BB, D'Costa R, Weiland TJ, Jelinek GA. Factors relating to consent for organ donation: prospective data on potential organ donors. Intern Med J 2015; 45:40-7. [DOI: 10.1111/imj.12628] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 09/28/2014] [Indexed: 11/28/2022]
Affiliation(s)
- C. H. Marck
- Emergency Practice Innovation Centre; St Vincent's Hospital Melbourne; Melbourne Victoria Australia
| | - S. L. Neate
- Emergency Department; St Vincent's Hospital Melbourne; Melbourne Victoria Australia
| | | | - B. M. Dwyer
- Organ and Tissue Authority; Canberra Australian Capital Territory Australia
| | - B. B. Hickey
- Intensive Care Unit; St Vincent's Hospital Melbourne; Melbourne Victoria Australia
| | - R. D'Costa
- Intensive Care Unit; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - T. J. Weiland
- Emergency Practice Innovation Centre; St Vincent's Hospital Melbourne; Melbourne Victoria Australia
| | - G. A. Jelinek
- Emergency Practice Innovation Centre; St Vincent's Hospital Melbourne; Melbourne Victoria Australia
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Robinson DH, Gerbensky Klammer SM, Perryman JP, Thompson NJ, Jacob Arriola KR. Understanding African American's religious beliefs and organ donation intentions. J Relig Health 2014; 53:1857-72. [PMID: 24553774 PMCID: PMC4139473 DOI: 10.1007/s10943-014-9841-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
African Americans are overrepresented on the organ transplant waiting list and underrepresented among organ and tissue donors. One of the most highly noted reasons for lack of donation is the perception that donation is contrary to religious beliefs. The purpose of this cross-sectional study is to explore the complexities of religion (beliefs, religiosity, and religious involvement) and its association with willingness to donate and the written expression of donation intentions. Findings from a sample of 505 African American participants suggest that religion is a multidimensional construct and results differ depending on how the construct is measured and operationalized.
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Affiliation(s)
- Dana H.Z. Robinson
- Rollins School of Public Health, Emory University, Department of Behavioral Sciences and Health Education, Atlanta, Georgia
| | - Susan M. Gerbensky Klammer
- Rollins School of Public Health, Emory University, Department of Behavioral Sciences and Health Education, Atlanta, Georgia
| | - Jennie P. Perryman
- Emory Transplant Center, Emory Healthcare, Department of Policy and Outcomes Management, Atlanta, Georgia
| | - Nancy J. Thompson
- Rollins School of Public Health, Emory University, Department of Behavioral Sciences and Health Education, Atlanta, Georgia
| | - Kimberly R. Jacob Arriola
- Rollins School of Public Health, Emory University, Department of Behavioral Sciences and Health Education, Atlanta, Georgia
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Abstract
Racial disparities in transplantation rates and outcomes have not been investigated in detail for NZ, a country with unique demographics. We studied a retrospective cohort of 215 patients <18 yr who started renal replacement therapy in NZ 1990-2012, using the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). Primary outcomes were time to first kidney transplant, death-censored graft survival, and retransplantation after loss of primary graft. Europeans and Asians were most likely to receive a transplant (92% and 91% transplanted within five yr, respectively), and Pacific and Māori patients were less likely to receive a transplant than Europeans (51% and 46%, respectively), reflecting disparities in live donor transplantation. Pacific patients were more likely to have glomerulonephritis and FSGS. Pacific patients had five-yr death-censored graft survival of 31%, lower than Māori (61%) and Europeans (88%). No Pacific patients who lost their grafts were re-transplanted within 72 patient-years of follow-up, whereas 14% of Māori patients and 36% of European and Asian patients were retransplanted within five yr. Current programs to improve live and deceased donation within Māori and Pacific people and management of recurrent kidney disease are likely to reduce these disparities.
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Affiliation(s)
- Blair S Grace
- Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), Adelaide, SA, Australia; Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
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Weiss J, Coslovsky M, Keel I, Immer FF, Jüni P. Organ donation in Switzerland--an analysis of factors associated with consent rate. PLoS One 2014; 9:e106845. [PMID: 25208215 PMCID: PMC4160222 DOI: 10.1371/journal.pone.0106845] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/09/2014] [Indexed: 11/18/2022] Open
Abstract
Background and Aim Switzerland has a low post mortem organ donation rate. Here we examine variables that are associated with the consent of the deceased’s next of kin (NOK) for organ donation, which is a prerequisite for donation in Switzerland. Methods and Analysis During one year, we registered information from NOK of all deceased patients in Swiss intensive care units, who were approached for consent to organ donation. We collected data on patient demographics, characteristics of NOK, factors related to the request process and to the clinical setting. We analyzed the association of collected predictors with consent rate using univariable logistic regression models; predictors with p-values <0.2 were selected for a multivariable logistic regression. Results Of 266 NOK approached for consent, consent was given in 137 (51.5%) cases. In multivariable analysis, we found associations of consent rates with Swiss nationality (OR 3.09, 95% CI: 1.46–6.54) and German language area (OR 0.31, 95% CI: 0.14–0.73). Consent rates tended to be higher if a parent was present during the request (OR 1.76, 95% CI: 0.93–3.33) and if the request was done before brain death was formally declared (OR 1.87, 95% CI: 0.90–3.87). Conclusion Establishing an atmosphere of trust between the medical staff putting forward a request and the NOK, allowing sufficient time for the NOK to consider donation, and respecting personal values and cultural differences, could be of importance for increasing donation rates. Additional measures are needed to address the pronounced differences in consent rates between language regions.
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Affiliation(s)
- Julius Weiss
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
| | - Michael Coslovsky
- CTU Bern, Department of Clinical Research and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Isabelle Keel
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
| | - Franz F. Immer
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
- * E-mail:
| | - Peter Jüni
- CTU Bern, Department of Clinical Research and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Irving MJ, Jan S, Tong A, Wong G, Craig JC, Chadban S, Rose J, Cass A, Allen RD, Howard K. What factors influence people's decisions to register for organ donation? The results of a nominal group study. Transpl Int 2014; 27:617-24. [DOI: 10.1111/tri.12307] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/08/2014] [Accepted: 03/05/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Michelle J. Irving
- Sydney School of Public Health; The University of Sydney; Sydney NSW Australia
- Centre for Kidney Research; The Children's Hospital Westmead; Sydney NSW Australia
| | - Stephen Jan
- The George Institute for Global Health; Camperdown Sydney NSW Australia
| | - Allison Tong
- Sydney School of Public Health; The University of Sydney; Sydney NSW Australia
- Centre for Kidney Research; The Children's Hospital Westmead; Sydney NSW Australia
| | - Germaine Wong
- Sydney School of Public Health; The University of Sydney; Sydney NSW Australia
- Centre for Kidney Research; The Children's Hospital Westmead; Sydney NSW Australia
| | - Jonathan C. Craig
- Sydney School of Public Health; The University of Sydney; Sydney NSW Australia
- Centre for Kidney Research; The Children's Hospital Westmead; Sydney NSW Australia
| | - Steven Chadban
- Central Clinical School; Bosch Institute; The University of Sydney; Sydney NSW Australia
- Department of Renal Medicine; Royal Prince Alfred Hospital; Camperdown Sydney NSW Australia
| | - John Rose
- Institute for Transport and Logistics Studies; The University of Sydney; Sydney NSW Australia
- Institute for Choice; University of South Australia; Adelaide Australia
| | - Alan Cass
- The George Institute for Global Health; Camperdown Sydney NSW Australia
- Menzies School of Health Research; Casuarina NT Australia
| | - Richard D. Allen
- Department of Renal Medicine; Royal Prince Alfred Hospital; Camperdown Sydney NSW Australia
| | - Kirsten Howard
- Sydney School of Public Health; The University of Sydney; Sydney NSW Australia
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Grace BS, Kennedy SE, Clayton PA, McDonald SP. Racial disparities in paediatric kidney transplantation. Pediatr Nephrol 2014; 29:125-32. [PMID: 23928908 DOI: 10.1007/s00467-013-2572-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 07/04/2013] [Accepted: 07/09/2013] [Indexed: 01/12/2023]
Abstract
BACKGROUND Transplantation is the preferred treatment for children with end-stage kidney disease (ESKD). Pre-emptive transplants, those from live donors and with few human leukocyte antigen (HLA) mismatches provide the best outcomes. Studies into disparities in paediatric transplantation to date have not adequately disentangled different transplant types. METHODS We studied a retrospective cohort of 823 patients aged <18 years who started renal replacement therapy (RRT) in Australia 1990-2011, using the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). The primary outcomes were time to first kidney transplant and kidney donor type (deceased or living), analysed using competing risk regression. RESULTS Caucasian patients were most likely to receive any transplant, due largely to disparities in live donor transplantation. No Indigenous patients received a pre-emptive transplant. Indigenous patients were least likely to receive a transplant from a live donor (sub-hazard ratio 0.41, 95 % confidence interval 0.20-0.82, compared to Caucasians). Caucasian recipients had fewer HLA mismatches, were less sensitised and were more likely to have kidney diseases that could be diagnosed early or progress slowly. CONCLUSIONS Caucasian paediatric patients are more likely to receive optimum treatment--a transplant from a living donor and fewer HLA mismatches. Further work is required to identify and address barriers to live donor transplantation among minority racial groups.
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Abstract
Today, the frequency and the rate of success resulting from advances in medicine have made organ transplantations an everyday occurrence. Still, organ transplantations and donations modify the subjective experience of human beings as regards the image they have of themselves, of body, of life and of death. If the concern of the quality of life and the survival of the patients is a completely human phenomenon, the fact remains that the possibility of organ transplantation and its justification depend a great deal on the culture in which we live. The exploration of the philosophical tradition allows for a reconsideration of organ transplantation. If we listen to people who have experienced the decline of one of their organs and their own rebirth through the organ of someone else, we arrive at the conclusion that they went through an extreme experience in which nothing appeared as before. All those experiences intensify philosophical questionings on the meaning of life with respect to self fulfilment. The concept of nature as the experience of others can be an authentic source from which to nourish our thoughts about organ transplantation. However, and this is our hypothesis, we need something more if we are to decide something about our own life. We need a hermeneutical stance in relation to ourselves and to our world. Philosophical counselling, as a long established tradition originating with Pythagoras and later reframed by the German philosopher Achenbach could be useful in inspiring a reflection on the good life, chiefly as it takes the form of a Socratic dialogue.
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Affiliation(s)
- Jacques Quintin
- Université de Sherbrooke, 97 Heneker, Sherbrooke, QC J1J 3G2, Canada.
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Abstract
OBJETIVO: Avaliação das causas de recusa familiar para a doação de órgãos e tecidos. MÉTODOS: Trata-se de um estudo transversal correlacional sobre as causas de recusa familiar para a doação de órgãos e tecidos. Para análise dos dados foi utilizado o teste Qui-Quadrado e o t-Student. RESULTADOS: A pesquisa destacou que os principais motivos de recusa relacionados são: não compreensão do diagnóstico de morte encefálica (21%), religiosidade (19%), falta de competência técnica da equipe (19%), tempo longo processo (10%), falecido não era doador (9%), medo da mutilação (5,2%), enterrado como veio ao mundo (3,4%), qualidade do atendimento (3,4%), decisão de um único membro da família (3,4%), experiência negativa em outro processo de doação (1,7%), transferência do corpo (1,7%). CONCLUSÃO: As causas de recusa familiar estão ligadas a não compreensão do diagnostico da morte encefálica pelos familiares, aspectos ligados a religião, despreparo do profissional que realizou a entrevista.
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