1
|
Isenor C, Weiss MJ, Beed S, Urquhart R, Tennankore K, Lucas A, Tomblin-Murphy G, Krmpotic K, Dhanani S, Sullivan V, West Oc LJ, Gongal P, Hartell D, Simpson C, James L, Landry A, Dirk J. Development of a consortium to examine organ donation legislative and system reforms: A report from the LEADDR consortium. Healthc Manage Forum 2023; 36:357-363. [PMID: 37253083 DOI: 10.1177/08404704231175024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In April 2019, the province of Nova Scotia became the first jurisdiction in North America to pass legislation that incorporated deemed consent for deceased organ donation. The reform included many other important updates, including the hierarchy for consent, enabled donor and recipient contact, and mandatory referral of potential deceased donors. Additionally, system reforms were implemented to improve the deceased donation system in Nova Scotia. A collection of national colleagues identified the magnitude of the opportunity to develop a comprehensive strategy to measure and evaluate the impact of the legislative and system reforms. This article describes the successful development of a consortium from both national and provincial jurisdictions that included experts from a variety of backgrounds and clinical and administrative disciplines. In describing the creation of this group, we hope to offer our case example as a model for the evaluation of other health system reforms from a multidisciplinary perspective.
Collapse
Affiliation(s)
- Cynthia Isenor
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Matthew J Weiss
- Transplant Québec, Montréal, Québec, Canada
- CHU de Québec-Université Laval Research Center, Laval, Québec, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Stephen Beed
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robin Urquhart
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Karthik Tennankore
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | - Kristina Krmpotic
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Sonny Dhanani
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | | | - Lori J West Oc
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
- University of Alberta, Edmonton, Alberta, Canada
| | - Patricia Gongal
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
- University of Alberta, Edmonton, Alberta, Canada
| | - David Hartell
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Christy Simpson
- Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Lee James
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Alain Landry
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Jade Dirk
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| |
Collapse
|
2
|
Edwards L, Bentley C, Burgess M, Sapir-Pichhadze R, Hartell D, Keown P, Bryan S. Adding epitope compatibility to deceased donor kidney allocation criteria: recommendations from a pan-Canadian online public deliberation. BMC Nephrol 2023; 24:165. [PMID: 37296384 PMCID: PMC10255937 DOI: 10.1186/s12882-023-03224-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The widening supply-demand imbalance for kidneys necessitates finding ways to reduce rejection and improve transplant outcomes. Human leukocyte antigen (HLA) epitope compatibility between donor and recipient may minimize premature graft loss and prolong survival, but incorporating this strategy to deceased donor allocation criteria prioritizes transplant outcomes over wait times. An online public deliberation was held to identify acceptable trade-offs when implementing epitope compatibility to guide Canadian policymakers and health professionals in deciding how best to allocate kidneys fairly. METHODS Invitations were mailed to 35,000 randomly-selected Canadian households, with over-sampling of rural/remote locations. Participants were selected for socio-demographic diversity and geographic representation. Five two-hour online sessions were held from November-December 2021. Participants received an information booklet and heard from expert speakers prior to deliberating on how to fairly implement epitope compatibility for transplant candidates and governance issues. Participants collectively generated and voted on recommendations. In the final session, kidney donation and allocation policymakers engaged with participants. Sessions were recorded and transcribed. RESULTS Thirty-two individuals participated and generated nine recommendations. There was consensus on adding epitope compatibility to the existing deceased donor kidney allocation criteria. However, participants recommended including safeguards/flexibility around this (e.g., mitigating declining health). They called for a transition period to epitope compatibility, including an ongoing comprehensive public education program. Participants unanimously recommended regular monitoring and public sharing of epitope-based transplant outcomes. CONCLUSIONS Participants supported adding epitope compatibility to kidney allocation criteria, but advised safeguards and flexibility around implementation. These recommendations provide guidance to policymakers about incorporating epitope-based deceased donor allocation criteria.
Collapse
Affiliation(s)
- Louisa Edwards
- School of Population & Public Health, University of British Columbia (UBC), 717 - 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada.
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada.
| | | | - Michael Burgess
- School of Population & Public Health, University of British Columbia (UBC), 717 - 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada
- W. Maurice Young Centre for Applied Ethics, UBC, Vancouver, Canada
| | - Ruth Sapir-Pichhadze
- Division of Nephrology, Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Vancouver, Canada
| | | | - Paul Keown
- Department of Medicine, UBC, Vancouver, Canada
- Immune Centre of BC, Vancouver Coastal Health, Vancouver, Canada
| | - Stirling Bryan
- School of Population & Public Health, University of British Columbia (UBC), 717 - 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
| |
Collapse
|
3
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
4
|
Ibrahim B, Dawson R, Chandler JA, Goldberg A, Hartell D, Hornby L, Simpson C, Weiss MJ, Wilson LC, Wilson TM, Fortin MC. The COVID-19 pandemic and organ donation and transplantation: ethical issues. BMC Med Ethics 2021; 22:142. [PMID: 34674700 PMCID: PMC8528937 DOI: 10.1186/s12910-021-00711-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 10/13/2021] [Indexed: 12/24/2022] Open
Abstract
Background The COVID-19 pandemic has had a significant impact on the health system worldwide. The organ and tissue donation and transplantation (OTDT) system is no exception and has had to face ethical challenges related to the pandemic, such as risks of infection and resource allocation. In this setting, many Canadian transplant programs halted their activities during the first wave of the pandemic. Method To inform future ethical guidelines related to the COVID-19 pandemic or other public health emergencies of international concern, we conducted a literature review to summarize the ethical issues. Results This literature review identified three categories of ethical challenges. The first one describes the general ethical issues and challenges reported by OTDT organizations and transplantation programs, such as risks of COVID-19 transmission and infection to transplant recipients and healthcare professionals during the transplant process, risk of patient waitlist mortality or further resource strain where transplant procedures have been delayed or halted, and resource allocation. The second category describes ethical challenges related to informed consent in the context of uncertainty and virtual consent. Finally, the third category describes ethical issues related to organ allocation, such as social considerations in selecting transplant candidates. Conclusion This literature review highlights the salient ethical issues related to OTDT during the current COVID-19 pandemic. As medical and scientific knowledge about COVID-19 increases, the uncertainties related to this disease will decrease and the associated ethical issues will continue to evolve.
Collapse
Affiliation(s)
| | | | - Jennifer A Chandler
- Faculty of Law, University of Ottawa, Ottawa, ON, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Aviva Goldberg
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.,Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | - Laura Hornby
- Canadian Blood Services, Ottawa, ON, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Christy Simpson
- Canadian Blood Services, Ottawa, ON, Canada.,Faculty of Medicine, Department of Bioethics, Dalhousie University, Halifax, NS, Canada
| | - Matthew-John Weiss
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.,CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, Quebec, QC, Canada.,Transplant Québec, Montreal, QC, Canada
| | | | - T Murray Wilson
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Marie-Chantal Fortin
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada. .,Centre de Recherche du CHUM, Room R12-418, 900 rue St-Denis, Montreal, QC, H2X 0A9, Canada. .,Faculté de Médecine, Université de Montreal, Montreal, QC, Canada.
| |
Collapse
|
5
|
Aubert O, Yoo D, Zielinski D, Cozzi E, Cardillo M, Dürr M, Domínguez-Gil B, Coll E, Da Silva MI, Sallinen V, Lemström K, Midtvedt K, Ulloa C, Immer F, Weissenbacher A, Vallant N, Basic-Jukic N, Tanabe K, Papatheodoridis G, Menoudakou G, Torres M, Soratti C, Hansen Krogh D, Lefaucheur C, Ferreira G, Silva HT, Hartell D, Forsythe J, Mumford L, Reese PP, Kerbaul F, Jacquelinet C, Vogelaar S, Papalois V, Loupy A. COVID-19 pandemic and worldwide organ transplantation: a population-based study. Lancet Public Health 2021; 6:e709-e719. [PMID: 34474014 PMCID: PMC8460176 DOI: 10.1016/s2468-2667(21)00200-0] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [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: 05/09/2021] [Revised: 08/02/2021] [Accepted: 08/16/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Preliminary data suggest that COVID-19 has reduced access to solid organ transplantation. However, the global consequences of the COVID-19 pandemic on transplantation rates and the effect on waitlisted patients have not been reported. We aimed to assess the effect of the COVID-19 pandemic on transplantation and investigate if the pandemic was associated with heterogeneous adaptation in terms of organ transplantation, with ensuing consequences for waitlisted patients. METHODS In this population-based, observational, before-and-after study, we collected and validated nationwide cohorts of consecutive kidney, liver, lung, and heart transplants from 22 countries. Data were collected from Jan 1 to Dec 31, 2020, along with data from the same period in 2019. The analysis was done from the onset of the 100th cumulative COVID-19 case through to Dec 31, 2020. We assessed the effect of the pandemic on the worldwide organ transplantation rate and the disparity in transplant numbers within each country. We estimated the number of waitlisted patient life-years lost due to the negative effects of the pandemic. The study is registered with ClinicalTrials.gov, NCT04416256. FINDINGS Transplant activity in all countries studied showed an overall decrease during the pandemic. Kidney transplantation was the most affected, followed by lung, liver, and heart. We identified three organ transplant rate patterns, as follows: countries with a sharp decrease in transplantation rate with a low COVID-19-related death rate; countries with a moderate decrease in transplantation rate with a moderate COVID-19-related death rate; and countries with a slight decrease in transplantation rate despite a high COVID-19-related death rate. Temporal trends revealed a marked worldwide reduction in transplant activity during the first 3 months of the pandemic, with losses stabilising after June, 2020, but decreasing again from October to December, 2020. The overall reduction in transplants during the observation time period translated to 48 239 waitlisted patient life-years lost. INTERPRETATION We quantified the impact of the COVID-19 pandemic on worldwide organ transplantation activity and revealed heterogeneous adaptation in terms of organ transplantation, both at national levels and within countries, with detrimental consequences for waitlisted patients. Understanding how different countries and health-care systems responded to COVID-19-related challenges could facilitate improved pandemic preparedness, notably, how to safely maintain transplant programmes, both with immediate and non-immediate life-saving potential, to prevent loss of patient life-years. FUNDING French national research agency (INSERM) ATIP Avenir and Fondation Bettencourt Schueller.
Collapse
Affiliation(s)
- Olivier Aubert
- Université de Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France; Kidney Transplant Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Daniel Yoo
- Université de Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France
| | - Dina Zielinski
- Université de Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France
| | - Emanuele Cozzi
- Transplant Immunology Unit, Department of Cardio-Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy; Italian National Transplant Center, Istituto Superiore di Sanità, Rome, Italy
| | - Massimo Cardillo
- Italian National Transplant Center, Istituto Superiore di Sanità, Rome, Italy
| | - Michael Dürr
- Division of Nephrology and Internal Intensive Care Medicine, Charité-Universitätsmedizin, Berlin, Germany
| | | | | | | | - Ville Sallinen
- Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Karl Lemström
- Department of Cardiothoracic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Karsten Midtvedt
- Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Camilo Ulloa
- Nephrology Department, Clínica Alemana de Santiago-UDD, Santiago, Chile
| | | | - Annemarie Weissenbacher
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Natalie Vallant
- Department of Transplant Surgery, Faculty of Medicine, Imperial College London, London, UK
| | - Nikolina Basic-Jukic
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | | | | | - Martin Torres
- Instituto Nacional Central Único Coordinador de Ablación e Implante (INCUCAI), Buenos Aires, Argentina
| | - Carlos Soratti
- Instituto Nacional Central Único Coordinador de Ablación e Implante (INCUCAI), Buenos Aires, Argentina
| | - Daniela Hansen Krogh
- Instituto Nacional Central Único Coordinador de Ablación e Implante (INCUCAI), Buenos Aires, Argentina
| | - Carmen Lefaucheur
- Université de Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France; Department of Nephrology and Kidney Transplantation, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gustavo Ferreira
- Department of Medicine, Santa Casa de Juiz de Fora, Juiz de Fora, Brazil
| | - Helio Tedesco Silva
- Division of Nephrology, Hospital do Rim, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - John Forsythe
- NHS Blood and Transplant, Stoke Gifford, Bristol, UK
| | - Lisa Mumford
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, UK
| | - Peter P Reese
- Université de Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France; Department of Medicine, Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Serge Vogelaar
- Eurotransplant International Foundation, Leiden, Netherlands
| | - Vassilios Papalois
- Department of Surgery, Faculty of Medicine, Imperial College London, London, UK
| | - Alexandre Loupy
- Université de Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France; Kidney Transplant Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
| |
Collapse
|
6
|
Weiss MJ, Lalani J, Patriquin-Stoner C, Dieudé M, Hartell D, Hornby L, Shemie SD, Wilson L, Mah A. Summary of International Recommendations for Donation and Transplantation Programs During the Coronavirus Disease Pandemic. Transplantation 2021; 105:14-17. [PMID: 33141806 DOI: 10.1097/tp.0000000000003520] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The COVID-19 pandemic has disrupted all aspects of the international organ donation and transplantation (ODT) system. Multiple organizations have developed guidance, but to date, no comparative summary has emerged to understand differences in existing recommendations. METHODS We developed and applied a comparative methodology to a convenience sample of recommendations available on The Transplantation Society website. Document types were classified according to characteristics such as type of organization (eg, governing body or professional society) and geographic region. Recommendations were grouped according to content, and summaries were posted on a public website. This process is ongoing and will be updated as new recommendations become available. RESULTS Eighteen documents were extracted in the initial review. All documents were based on expert opinion, and none described a formal literature review or adherence with clinical guideline development processes. Recommendation categories included screening of potential donors, risk assessment of potential recipients, posttransplant risk, living/paired donation, protection of ODT professionals, and ethics/logistics. While many documents included similar recommendations, such as the need to screen and test patients who are potential donors, there was variation on some topics. Type of recommended laboratory testing varied with 64% recommending nasopharyngeal swabs, 43% oropharyngeal, and 24% bronchial aspirates. Updated results are available at https://cdtrp.ca/en/covid-19-international-recommendations-for-odt/. CONCLUSIONS The current state of COVID-19 ODT recommendations is limited to expert opinion. Substantial variation exists regarding recommendations, which are based on emerging but currently low-quality evidence. This summary of existing recommendations will serve to inform priorities for evidence-based recommendations.
Collapse
Affiliation(s)
- Matthew J Weiss
- Transplant Québec, Montréal, QC, Canada
- CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, Québec, QC, Canada
- Canadian Donation and Transplantation Research Program (CDTRP), Ottawa, ON, Canada
- System Development-Organ and Tissue Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
| | - Jehan Lalani
- System Development-Organ and Tissue Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
| | | | - Mélanie Dieudé
- Canadian Donation and Transplantation Research Program (CDTRP), Ottawa, ON, Canada
- Faculty of Medicine, University of Montreal, Montréal, QC, Canada
| | - David Hartell
- System Development-Organ and Tissue Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
| | - Laura Hornby
- Canadian Donation and Transplantation Research Program (CDTRP), Ottawa, ON, Canada
- System Development-Organ and Tissue Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
- Pediatric Critical Care, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Sam D Shemie
- Canadian Donation and Transplantation Research Program (CDTRP), Ottawa, ON, Canada
- System Development-Organ and Tissue Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
- Division of Critical Care, Montréal Children's Hospital, McGill University Health Centre and Research Institute, Montréal, QC, Canada
| | - Lindsay Wilson
- System Development-Organ and Tissue Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
| | - Allison Mah
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
7
|
Weiss MJ, English SW, D'Aragon F, Lauzier F, Turgeon AF, Dhanani S, McIntyre L, Carvalho LP, Yu M, Shemie SD, Knoll G, Fergusson DA, Anthony SJ, Haj-Moustafa A, Hartell D, Mohr J, Chassé M. Survey of Canadian critical care physicians' knowledge and attitudes towards legislative aspects of the deceased organ donation system. Can J Anaesth 2020; 67:1349-1358. [PMID: 32696225 DOI: 10.1007/s12630-020-01756-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE We surveyed Canadian critical care physicians who may care for patients who are potential organ donors to understand their attitudes and knowledge of legislation governing the deceased organ donation system. METHODS We used a web-based, self-administered survey that included questions related to opt-out consent and mandatory referral legislation. Potential participants were identified through membership lists of professional societies and manual searches. We designed our survey using standardized methods and administered it in February and March 2018. RESULTS Fifty percent (263/529) of potential participants completed the questionnaire. A majority (61%; 144/235) supported a change towards an opt-out consent model, and 77% (181/235) stated they believe it would increase donation rates. Asked if opt-out consent would change their practices, 71% (166/235) stated an opt-out model would not change how or if they approach families to discuss donation. Fifty-six percent (139/249) supported mandatory referral laws, while only 42% (93/219) of those working in provinces with mandatory referral correctly stated that such laws exist in their province. Respondents gave variable responses on who should be accountable when patients are not referred, and 16% (40/249) believed no one should be held accountable. CONCLUSIONS While a majority of critical care physicians supported opt-out consent and mandatory referral, many were neutral or against it. Many were unaware of existing laws and had variable opinions on how to ensure accountability. Efforts to increase understanding of how legislative models influence practice are required for any law to achieve its desired effect.
Collapse
Affiliation(s)
- Matthew J Weiss
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, Québec, QC, Canada.
- Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada.
- Transplant Québec, Montréal, QC, Canada.
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada.
| | - Shane W English
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Frederick D'Aragon
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - François Lauzier
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, Québec, QC, Canada
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, QC, Canada
- Department of Medicine, Université Laval, Québec, QC, Canada
| | - Alexis F Turgeon
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, Québec, QC, Canada
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, QC, Canada
| | - Sonny Dhanani
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Division of Critical Care, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Lauralyn McIntyre
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Livia P Carvalho
- Carrefour de l'innovation, Centre de Recherche du CHUM, Montréal, QC, Canada
| | - Michael Yu
- Carrefour de l'innovation, Centre de Recherche du CHUM, Montréal, QC, Canada
| | - Sam D Shemie
- Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
- Division of Critical Care, Montréal Children's Hospital, Montréal, QC, Canada
- McGill University Health Centre and Research Institute, Montréal, QC, Canada
| | - Gregory Knoll
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Dean A Fergusson
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Samantha J Anthony
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Adnan Haj-Moustafa
- Carrefour de l'innovation, Centre de Recherche du CHUM, Montréal, QC, Canada
| | - David Hartell
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
| | - Jim Mohr
- Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
| | - Michaël Chassé
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Carrefour de l'innovation, Centre de Recherche du CHUM, Montréal, QC, Canada
- Division of Critical Care, Department of Medicine, Centre Hospitalier de L'Université de Montréal, Montréal, QC, Canada
- Department of Medicine, Université de Montréal, Montréal, QC, Canada
| |
Collapse
|
8
|
Janaudis-Ferreira T, Mathur S, Tansey CM, Blydt-Hansen T, Hartell D. Disseminating Knowledge to Providers on Exercise Training After Solid Organ Transplantation. Prog Transplant 2020; 30:125-131. [DOI: 10.1177/1526924820913506] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Introduction: The objectives of our dissemination project were (1) to disseminate the evidence supporting exercise training in solid organ transplantation to exercise professionals, health-care professionals, physicians, and directors of transplant programs in order to enhance their ability to apply evidence to practice and (2) to build a community of exercise professionals and researchers across Canada. Methods: We used the 5-step Patient-Centered Outcomes Research Institute model for knowledge translation to guide our project: (1) evidence assessment, (2) audience and partner identification, (3) dissemination, (4) implementation, and (5) evaluation. After meeting with experts in the field, conducting a literature review, and identifying an appropriate audience, we took our presentations on the road across Canada. Results: We visited 10 transplant centers and held interactive knowledge translation sessions in each center. To provide sustainability and to facilitate the adoption of the research evidence, we founded the Canadian Network for Rehabilitation and Exercise for Solid Organ Transplant Optimal Recovery network and created its website. Conclusions: Our project raised awareness of the importance of exercise among many health professionals in Canada and built a community of exercise professionals and researchers in the field of transplantation through the rehabilitation network. It also led to the creation of online resources that will facilitate the implementation of rehabilitation programs in transplant centers.
Collapse
Affiliation(s)
- Tania Janaudis-Ferreira
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
- Centre for Health Outcomes Research (CORE) Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Sunita Mathur
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Catherine M. Tansey
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Tom Blydt-Hansen
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Hartell
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| |
Collapse
|
9
|
Weiss MJ, English SW, D'Aragon F, Lauzier F, Turgeon AF, Dhanani S, McIntyre L, Shemie SD, Knoll G, Fergusson DA, Anthony SJ, Haj-Moustafa A, Hartell D, Mohr J, Chassé M. Survey of Canadian intensivists on physician non-referral and family override of deceased organ donation. Can J Anaesth 2020; 67:313-323. [PMID: 31768789 DOI: 10.1007/s12630-019-01538-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/08/2019] [Accepted: 09/04/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Intensive care physicians play an important role in the identification and referral of potential organ donors in Canada. Nevertheless, little is known about intensivists' attitudes or behaviours in situations where families override previously expressed consent to donate; nor why physicians elect not to refer patients who are potential donors to provincial organ donation organizations (physician non-referral). METHODS We integrated questions regarding family override and physician non-referral into an online, self-administered survey of Canadian intensivists. We report results descriptively. RESULTS Fifty percent of targeted respondents (n = 550) participated. Fifty-five percent reported having witnessed family override situations and 44% reported having personally not referred patients who were potential donors. Fifty-six percent of respondents stated they would not pursue donation in the face of family override; 2% stated they would continue with the donation process. Fear of loss of trust in the donation system (81%) and obligation to respect the grief and desires of surrogate decision makers (71%) were frequently reported reasons to respect family override requests. Respondents who chose not to refer patients often did so based on organ dysfunction they assumed would preclude donation (59%), or a perception that the family was too distressed to consider donation (42%). No respondents reported that personally held beliefs against organ donation influenced their decision. CONCLUSION Physicians caring for patients who are potential organ donors commonly encounter both family override and physician non-referral situations. Knowledge translation of optimal practices in identification and referral could help ensure that physician practices align with legal requirements and practice recommendations.
Collapse
Affiliation(s)
- Matthew J Weiss
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, Québec, QC, Canada.
- Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada.
- Transplant Québec, Montréal, QC, Canada.
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada.
| | - Shane W English
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Frederick D'Aragon
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - François Lauzier
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, Québec, QC, Canada
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, QC, Canada
- Department of Medicine, Université Laval, Québec, QC, Canada
| | - Alexis F Turgeon
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, Québec, QC, Canada
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, QC, Canada
| | - Sonny Dhanani
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Division of Critical Care, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Lauralyn McIntyre
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sam D Shemie
- Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
- Division of Critical Care, Montréal Children's Hospital, McGill University Health Centre and Research Institute, Montreal, QC, Canada
- McGill University, Montréal, QC, Canada
| | - Gregory Knoll
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Dean A Fergusson
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Samantha J Anthony
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Adnan Haj-Moustafa
- Carrefour de l'Innovation, Centre de Recherche du CHUM, Montréal, QC, Canada
| | - David Hartell
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
| | - Jim Mohr
- Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
| | - Michaël Chassé
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Carrefour de l'Innovation, Centre de Recherche du CHUM, Montréal, QC, Canada
- Division of Critical Care, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Department of Medicine, University of Montréal, Montréal, QC, Canada
| |
Collapse
|
10
|
Allard J, Ballesteros F, Anthony SJ, Dumez V, Hartell D, Knoll G, Wright L, Fortin MC. What does patient engagement mean for Canadian National Transplant Research Program Researchers? Res Involv Engagem 2018; 4:13. [PMID: 29657835 PMCID: PMC5890351 DOI: 10.1186/s40900-018-0096-0] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 02/20/2018] [Indexed: 05/26/2023]
Abstract
PLAIN ENGLISH SUMMARY In recent years, the importance of involving patients in research has been increasingly recognized because it increases the relevance and quality of research, facilitates recruitment, enhances public trust and allows for more effective dissemination of results. The Canadian National Transplant Research Program (CNTRP) is an interdisciplinary research team looking at a variety of issues related to organ and tissue donation and transplantation. The aim of this study was to gather the perspectives of CNTRP researchers on engaging patients in research.We conducted interviews with 10 researchers who attended a national workshop on priority-setting in organ donation and transplant research. The researchers viewed patient engagement in research as necessary and important. They also considered that patients could be engaged at every step of the research process. Participants in this study identified scientific language, time, money, power imbalance, patient selection and risk of tokenism as potential barriers to patient engagement in research. Training, adequate resources and support from the institution were identified as facilitators of patient engagement.This study showed a positive attitude among researchers in the field of organ donation and transplantation. Further studies are needed to study the implementation and impact of patient engagement in research within the CNTRP. ABSTRACT Background Involving patients in research has been acknowledged as a way to enhance the quality, relevance and transparency of medical research. No previous studies have looked at researchers' perspectives on patient engagement (PE) in organ donation and transplant research in Canada. Objective The aim of this study was to gather the perspectives of Canadian National Transplant Research Program (CNTRP) researchers on PE in research. Methods We conducted semi-structured interviews with ten researchers who attended a national workshop on priority-setting in organ donation and transplant research. The interviews were digitally recorded and transcribed verbatim, and the transcripts were subjected to qualitative thematic and content analyses. Results The researchers viewed PE in research as necessary and important. PE was a method to incorporate the voice of the patient. They also considered that patients could be engaged at every step of the research process. The following were identified as the main barriers to PE in research: (i) scientific jargon; (ii) resources (time and money); (iii) tokenism; (iv) power imbalance; and (v) patient selection. Facilitating factors included (i) training for patients and researchers, (ii) adequate resources and (iii) institutional support. Conclusion This study revealed a favourable attitude and willingness among CNTRP researchers to engage and partner with patients in research. Further studies are needed to assess the implementation of PE strategy within the CNTRP and its impact.
Collapse
Affiliation(s)
- Julie Allard
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), 900 Saint-Denis St., Room 12-454, Montréal, QC, H2X 0A9 Canada
- Canadian National Transplant Research Program, Edmonton, Canada
| | - Fabián Ballesteros
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), 900 Saint-Denis St., Room 12-454, Montréal, QC, H2X 0A9 Canada
- Canadian National Transplant Research Program, Edmonton, Canada
| | - Samantha J. Anthony
- Canadian National Transplant Research Program, Edmonton, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Vincent Dumez
- Direction collaboration et partenariat patient, Faculty of Medicine, Université de Montréal, Montréal, Canada
- Centre of Excellence on Partnership with Patients and the Public, Université de Montréal, Montréal, Canada
| | - David Hartell
- Canadian National Transplant Research Program, Edmonton, Canada
| | - Greg Knoll
- Canadian National Transplant Research Program, Edmonton, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Linda Wright
- Canadian National Transplant Research Program, Edmonton, Canada
- Department of Surgery and Joint Centre for Bioethics, University of Toronto, Toronto, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), 900 Saint-Denis St., Room 12-454, Montréal, QC, H2X 0A9 Canada
- Canadian National Transplant Research Program, Edmonton, Canada
- Université de Montréal, Montréal, Canada
| |
Collapse
|
11
|
Leblanc J, Subrt P, Paré M, Hartell D, Sénécal L, Blydt-Hansen T, Cardinal H. Practice Patterns in the Treatment and Monitoring of Acute T Cell-Mediated Kidney Graft Rejection in Canada. Can J Kidney Health Dis 2018; 5:2054358117753616. [PMID: 29479453 PMCID: PMC5818088 DOI: 10.1177/2054358117753616] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 09/21/2017] [Indexed: 01/11/2023] Open
Abstract
Background One of the goals of the Canadian National Transplant Research Program (CNTRP) is to develop novel therapies for acute rejection that could positively affect graft outcomes with greater efficacy or less toxicity. To develop innovative management strategies for kidney graft rejection, new modalities need to be compared with current clinical practices. However, there are no standardized practices concerning the management of acute T cell-mediated rejection (TCMR). Objectives To describe clinicians' practice patterns in the diagnosis, treatment, and monitoring of acute TCMR in Canada. Design Survey. Setting Patients/Participants Canadian transplant nephrologists and transplant surgeons involved in the management of acute TCMR. Methods and Measurements We developed an anonymous, web-based survey consisting of questions related to the diagnosis, treatment, and monitoring of TCMR. The survey was disseminated on 3 occasions between June and October 2016 through the Canadian Society of Transplantation (CST) kidney group electronic mailing list. Results Forty-seven respondents, mostly transplant nephrologists (97%), originating from at least 18 of the 25 Canadian centers offering adult or pediatric kidney transplantation, participated in the study. Surveillance biopsies were used by 28% of respondents to screen for kidney graft rejection. High-dose steroids were used by most of the respondents to treat clinical and subclinical Banff grade 1A and 1B rejections. Nine percent (95% confidence interval [CI]: 1-17) of practitioners used lymphocyte-depleting agents as the first-line approach for the treatment of Banff grade 1B acute rejection. Eighteen percent (95% CI: 7-29) and 36% (95% CI: 8-65) of respondents reported that they would not use high-dose steroids for treating clinical and subclinical borderline rejections, respectively. Seventy percent (95% CI: 54-83) of respondents answered that there was no indication to assess histological response to treatment independent of the change in kidney function. Limitations The limitations of this study are its limited sample size and the low representation of pediatric specialists. Conclusions There is heterogeneity regarding the use of surveillance biopsies, treatment of borderline rejection, and modalities to monitor treatment response among transplant physicians. Our results illustrate the current state of practice patterns across Canada and can be used to inform the design of future trials.
Collapse
Affiliation(s)
- Julie Leblanc
- Division of Internal Medicine, Department of Medicine, Université de Montréal, Québec, Canada
| | - Peter Subrt
- Canadian National Transplant Research Program, Montreal, Québec, Canada
| | - Michèle Paré
- Institut de recherche en santé publique de l'Université de Montréal, Québec, Canada
| | - David Hartell
- Canadian National Transplant Research Program, Montreal, Québec, Canada
| | - Lynne Sénécal
- Canadian National Transplant Research Program, Montreal, Québec, Canada.,Division of Nephrology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Montreal, Québec, Canada
| | - Tom Blydt-Hansen
- Canadian National Transplant Research Program, Montreal, Québec, Canada.,Division of Pediatric Nephrology, University of British Columbia, Vancouver, Canada
| | - Héloïse Cardinal
- Canadian National Transplant Research Program, Montreal, Québec, Canada.,Division of Nephrology, Centre hospitalier de l'Université de Montréal, Québec, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| |
Collapse
|
12
|
Allard J, Durand C, Anthony SJ, Dumez V, Hartell D, Hébert MJ, West LJ, Wright L, Fortin MC. Perspectives of Patients, Caregivers and Researchers on Research Priorities in Donation and Transplantation in Canada: A Pilot Workshop. Transplant Direct 2017; 3:e127. [PMID: 28361111 PMCID: PMC5367744 DOI: 10.1097/txd.0000000000000639] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 11/04/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND It is vitally important to seek input from key stakeholders to increase the quality and relevance of health-related research and accelerate its adoption into practice. Patients and caregivers have rarely been involved in setting research priorities in the transplantation and donation field. The objectives of this explorative study are: (i) to discuss research priorities within the Canadian National Transplant Research Program during a priority-setting exercise with patients, caregivers, organ donors and researchers and (ii) to compare the identified priorities with research published in 2 prestigious transplantation journals. METHODS A pilot workshop attended by 10 patients and caregivers and 5 researchers was held in Montréal (Quebec, Canada) in August 2014 to identify research priorities. Priorities were identified using a thematic analysis of the workshop transcription conducted by multiple coders. These priorities were compared with the topics of research articles published in 2 major transplantation journals between 2012 and 2014. RESULTS The themes of the 10 research priorities identified by study participants were related to different research domains: social, cultural, and environmental health factors (4); biomedical or clinical (4); and research about health systems and services (2). 26.7% of the research articles published were related to the identified priorities. Thirteen percent looked at ways to improve graft survival and 8.5% looked at the development of tolerance, 2 priorities identified by participants. Fewer than 5% examined the other 8 research priorities identified as important by workshop participants. CONCLUSIONS This is the first study reporting patients' and researchers' priorities in the field of transplantation and donation in Canada. There is a discrepancy between topics that key stakeholders find important and research published in 2 major transplantation journals. The research priorities identified during our initial workshop will be validated through a national survey and workshop.
Collapse
Affiliation(s)
- Julie Allard
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
- Canadian National Transplant Research Program, Canada
| | - Céline Durand
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
| | - Samantha J. Anthony
- Canadian National Transplant Research Program, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Canada
| | - Vincent Dumez
- Canadian National Transplant Research Program, Canada
- Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - David Hartell
- Canadian National Transplant Research Program, Canada
| | - Marie-Josée Hébert
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
- Canadian National Transplant Research Program, Canada
- Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Lori J. West
- Canadian National Transplant Research Program, Canada
- Alberta Transplant Institute, University of Alberta, Edmonton, Canada
| | - Linda Wright
- Canadian National Transplant Research Program, Canada
- Department of Surgery and Joint Centre for Bioethics, University of Toronto, Toronto, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
- Canadian National Transplant Research Program, Canada
- Faculty of Medicine, Université de Montréal, Montréal, Canada
| |
Collapse
|
13
|
Fortin MC, Buchman D, Wright L, Chandler J, Delaney S, Fairhead T, Gallaher R, Grant D, Greenberg R, Hartell D, Holdsworth S, Landsberg D, Paraskevas S, Tibbles LA, Young K, West L, Humar A. Public Solicitation of Anonymous Organ Donors. Transplantation 2017; 101:17-20. [DOI: 10.1097/tp.0000000000001514] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|