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Loban K, Fadel E, Nugus P, Przybylak-Brouillard A, Badenoch H, Robert JT, Bugeja A, Gill J, Fortin MC, Rodriguez C, Sandal S. Living kidney donors' health care needs, experiences, and perspectives across their entire donation trajectory: a semistructured, in-depth interview study. Kidney Int 2024; 105:251-258. [PMID: 38008162 DOI: 10.1016/j.kint.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/27/2023] [Accepted: 11/10/2023] [Indexed: 11/28/2023]
Affiliation(s)
- Katya Loban
- Metabolic Disorders and Complications Program (MEDIC), Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Elie Fadel
- Division of Nephrology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Peter Nugus
- Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Antoine Przybylak-Brouillard
- Metabolic Disorders and Complications Program (MEDIC), Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Heather Badenoch
- Patient Partner, Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Jorane-Tiana Robert
- Metabolic Disorders and Complications Program (MEDIC), Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Ann Bugeja
- Division of Nephrology, Department of Medicine, the Ottawa Hospital, Ottawa, Ontario, Canada; Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Justin Gill
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Division of Nephrology, Department of Medicine, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Charo Rodriguez
- Patient Partner, Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Shaifali Sandal
- Metabolic Disorders and Complications Program (MEDIC), Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Nephrology, Department of Medicine, McGill University, Montreal, Quebec, Canada.
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2
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Affdal A, Ballesteros F, Malo MF, Sancho C, Cochran-Mavrikakis SL, Bryan S, Keown P, Sapir-Pichhadze R, Fortin MC. Canadian Kidney Transplant Professionals' Perspectives on Precision Medicine and Molecular Matching in Kidney Allocation. Transplant Direct 2024; 10:e1565. [PMID: 38111837 PMCID: PMC10727564 DOI: 10.1097/txd.0000000000001565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/29/2023] [Accepted: 10/20/2023] [Indexed: 12/20/2023] Open
Abstract
Background Antibody-mediated rejection is an important cause of kidney transplant loss. A new strategy requiring application of precision medicine tools in transplantation considers molecular compatibility between donors and recipients and holds the promise of improved immunologic risk, preventing rejection and premature graft loss. The objective of this study was to gather Canadian transplant professionals' perspectives on molecular compatibility in kidney transplantation. Methods Seventeen Canadian transplant professionals (14 nephrologists, 2 nurses, and 1 surgeon) participated in semistructured interviews in 2021. The interviews were digitally recorded, transcribed, and analyzed using the qualitative description approach. Results Participants identified fair access to transplantation as the most important principle in kidney allocation. Molecular compatibility was viewed as a promising innovation. However, participants were concerned about increased waiting times, negative impact on some patients, and potential problems related to the adequacy of information explaining this new technology. To mitigate the challenges associated with molecular matching, participants suggested integrating a maximum waiting time for molecular-matched kidneys and expanding the program nationally/internationally. Conclusions Molecular matching in kidney transplantation is viewed as a promising technology for decreasing the incidence of antibody-mediated rejection and improving graft survival. Further studies are needed to determine how to ethically integrate this technology into the kidney allocation algorithm.
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Affiliation(s)
- Aliya Affdal
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Bioethics Program, École de santé publique de l’Université de Montréal, Montréal, Canada
| | - Fabian Ballesteros
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Canada
| | - Marie-Françoise Malo
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Bioethics Program, École de santé publique de l’Université de Montréal, Montréal, Canada
| | - Carina Sancho
- Bioethics Program, École de santé publique de l’Université de Montréal, Montréal, Canada
| | | | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, Vancouver,Canada
| | - Paul Keown
- Division of Nephrology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Ruth Sapir-Pichhadze
- Canadian Donation and Transplantation Research Program, Canada
- Division of Nephrology, Faculty of Medicine, McGill University, Montréal, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Canadian Donation and Transplantation Research Program, Canada
- Division of Nephrology, Faculty of Medicine, Université de Montréal, Montréal, Canada
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Sauthier N, Bouchakri R, Carrier FM, Sauthier M, Mullie LA, Cardinal H, Fortin MC, Lahrichi N, Chassé M. Automated screening of potential organ donors using a temporal machine learning model. Sci Rep 2023; 13:8459. [PMID: 37231073 DOI: 10.1038/s41598-023-35270-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/15/2023] [Indexed: 05/27/2023] Open
Abstract
Organ donation is not meeting demand, and yet 30-60% of potential donors are potentially not identified. Current systems rely on manual identification and referral to an Organ Donation Organization (ODO). We hypothesized that developing an automated screening system based on machine learning could reduce the proportion of missed potentially eligible organ donors. Using routine clinical data and laboratory time-series, we retrospectively developed and tested a neural network model to automatically identify potential organ donors. We first trained a convolutive autoencoder that learned from the longitudinal changes of over 100 types of laboratory results. We then added a deep neural network classifier. This model was compared to a simpler logistic regression model. We observed an AUROC of 0.966 (CI 0.949-0.981) for the neural network and 0.940 (0.908-0.969) for the logistic regression model. At a prespecified cutoff, sensitivity and specificity were similar between both models at 84% and 93%. Accuracy of the neural network model was robust across donor subgroups and remained stable in a prospective simulation, while the logistic regression model performance declined when applied to rarer subgroups and in the prospective simulation. Our findings support using machine learning models to help with the identification of potential organ donors using routinely collected clinical and laboratory data.
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Affiliation(s)
- Nicolas Sauthier
- Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Rima Bouchakri
- Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | | | - Michaël Sauthier
- Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada
| | | | - Héloïse Cardinal
- Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | | | | | - Michaël Chassé
- Centre Hospitalier de l'Université de Montréal, Montreal, Canada.
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4
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Horton A, Loban K, Nugus P, Fortin MC, Gunaratnam L, Knoll G, Mucsi I, Chaudhury P, Landsberg D, Paquet M, Cantarovich M, Sandal S. Health System-Level Barriers to Living Donor Kidney Transplantation: Protocol for a Comparative Case Study Analysis. JMIR Res Protoc 2023; 12:e44172. [PMID: 36881454 PMCID: PMC10031444 DOI: 10.2196/44172] [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: 12/31/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Living donor kidney transplantation (LDKT) is the best treatment option for patients with kidney failure and offers significant medical and economic advantages for both patients and health systems. Despite this, rates of LDKT in Canada have stagnated and vary significantly across Canadian provinces, the reasons for which are not well understood. Our prior work has suggested that system-level factors may be contributing to these differences. Identifying these factors can help inform system-level interventions to increase LDKT. OBJECTIVE Our objective is to generate a systemic interpretation of LDKT delivery across provincial health systems with variable performance. We aim to identify the attributes and processes that facilitate the delivery of LDKT to patients, and those that create barriers and compare these across systems with variable performance. These objectives are contextualized within our broader goal of increasing rates of LDKT in Canada, particularly in lower-performing provinces. METHODS This research takes the form of a qualitative comparative case study analysis of 3 provincial health systems in Canada that have high, moderate, and low rates of LDKT performance (the percentage of LDKT to all kidney transplantations performed). Our approach is underpinned by an understanding of health systems as complex adaptive systems that are multilevel and interconnected, and involve nonlinear interactions between people and organizations, operating within a loosely bounded network. Data collection will comprise semistructured interviews, document reviews, and focus groups. Individual case studies will be conducted and analyzed using inductive thematic analysis. Following this, our comparative analysis will operationalize resource-based theory to compare case study data and generate explanations for our research question. RESULTS This project was funded from 2020 to 2023. Individual case studies were carried out between November 2020 and August 2022. The comparative case analysis will begin in December 2022 and is expected to conclude in April 2023. Submission of the publication is projected for June 2023. CONCLUSIONS By investigating health systems as complex adaptive systems and making comparisons across provinces, this study will identify how health systems can improve the delivery of LDKT to patients with kidney failure. Our resource-based theory framework will provide a granular analysis of the attributes and processes that facilitate or create barriers to LDKT delivery across multiple organizations and levels of practice. Our findings will have practice and policy implications and help inform transferrable competencies and system-level interventions conducive to increasing LDKT. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44172.
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Affiliation(s)
- Anna Horton
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Katya Loban
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Peter Nugus
- Department of Family Medicine and the Institute of Health Sciences Education, McGill University, Montreal, QC, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Division of Nephrology, Department of Medicine, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Lakshman Gunaratnam
- Matthew Mailing Centre for Translational Transplant Studies, Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
- Division of Nephrology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Greg Knoll
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Istvan Mucsi
- Ajmera Transplant Center and Division of Nephrology, University Health Network, Toronto, ON, Canada
- Division of Nephrology, University of Toronto, Toronto, ON, Canada
| | - Prosanto Chaudhury
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - David Landsberg
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Michel Paquet
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Division of Nephrology, Department of Medicine, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Marcelo Cantarovich
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Shaifali Sandal
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
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5
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Affdal A, Malo MF, Blum D, Ballesteros F, Beaubien-Souligny W, Caron ML, Nadeau-Fredette AC, Vasilevsky M, Rios N, Suri RS, Fortin MC. Lived Experiences of Hemodialysis Health Care Workers during the COVID-19 Pandemic: A Qualitative Study from the Quebec Renal Network. Kidney360 2023; 4:188-197. [PMID: 36821610 PMCID: PMC10103388 DOI: 10.34067/kid.0004252022] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022]
Abstract
Key Points Hemodialysis workers' well-being and work were affected by the COVID-19 pandemics. Effective communication strategies and taking into account psychological distress are ways to mitigate the challenges faced by health care workers. Background The COVID-19 pandemic has disrupted health systems and created numerous challenges in hospitals worldwide for patients and health care workers (HCWs). Hemodialysis centers are at risk of COVID-19 outbreaks given the difficulty of maintaining social distancing and the fact that hemodialysis patients are at higher risk of being infected with COVID-19. During the COVID-19 pandemic, HCWs have had to face many challenges and stressors. Our study was designed to gain HCWs' perspectives on their experiences of the impacts of the COVID-19 pandemic in hemodialysis units. Methods Semistructured interviews were conducted with 22 HCWs (nurses, nephrologists, pharmacists, social workers, patient attendants, and security agents) working in five hemodialysis centers in Montreal, between November 2020 and May 2021. The content of the interviews was analyzed using thematic analysis. Results Four themes were identified during the interviews. The first was the impact of COVID-19 on work organization, regarding which participants reported an increased workload, a need for a consistent information strategy, and positive innovations such as telemedicine. The second theme was challenges associated with communicating and caring for dialysis patients during the pandemic. The third theme was psychological distress experienced by hemodialysis staff and the psychosocial impact of COVID-19 on their personal lives. The fourth theme was recommendations made by participants for future public health emergencies, such as maintaining public health measures, ensuring an adequate supply of protective equipment, and developing a consistent communication strategy. Conclusions During the first and second waves of the COVID-19 pandemic, HCWs working in hemodialysis units faced multiple challenges that affected their well-being and their work. To minimize challenges for HCWs in hemodialysis during a future pandemic, the health care system should provide an adequate supply of protective equipment, develop effective communication strategies, and take into account the psychological distress related to HCWs' professional and personal lives.
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Affiliation(s)
- Aliya Affdal
- Bioethics Program, École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Françoise Malo
- Bioethics Program, École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada
| | - Dan Blum
- Division of nephrology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Fabian Ballesteros
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - William Beaubien-Souligny
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Faculté de médecine de l'Université de Montréal, Montreal, Quebec, Canada
- Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Line Caron
- Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Annie-Claire Nadeau-Fredette
- Faculté de médecine de l'Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | | | - Norka Rios
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Rita S. Suri
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Faculté de médecine de l'Université de Montréal, Montreal, Quebec, Canada
- Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
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Horton A, Loban K, Fortin MC, Charbonneau S, Nugus P, Pâquet MR, Chaudhury P, Cantarovich M, Sandal S. Living Donor Kidney Transplantation in Quebec: A Qualitative Case Study of Health System Barriers and Facilitators. Can J Kidney Health Dis 2023; 10:20543581221150675. [PMID: 36704234 PMCID: PMC9871975 DOI: 10.1177/20543581221150675] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/05/2022] [Indexed: 01/21/2023] Open
Abstract
Background Patients with kidney failure represent a major public health burden, and living donor kidney transplantation (LDKT) is the best treatment option for these patients. Current work to optimize LDKT delivery to patients has focused on microlevel interventions and has not addressed interdependencies with meso and macro levels of practice. Objective We aimed to learn from a health system with historically low LDKT performance to identify facilitators and barriers to LDKT. Our specific aims were to understand how LDKT delivery is organized through interacting macro, meso, and micro levels of practice and identify what attributes and processes of this health system facilitate the delivery of LDKT to patients with kidney failure and what creates barriers. Design We conducted a qualitative case study, applying a complex adaptive systems approach to LDKT delivery, that recognizes health systems as being made up of dynamic, nested, and interconnected levels, with the patient at its core. Setting The setting for this case study was the province of Quebec, Canada. Participants Thirty-two key stakeholders from all levels of the health system. This included health care professionals, leaders in LDKT governance, living kidney donors, and kidney recipients. Methods Semi-structured interviews with 32 key stakeholders and a document review were undertaken between February 2021 and December 2021. Inductive thematic analysis was used to generate themes. Results Overall, we identified strong links between system attributes and processes and LDKT delivery, and more barriers than facilitators were discerned. Barriers that undermined access to LDKT included fragmented LDKT governance and expertise, disconnected care practices, limited resources, and regional inequities. Some were mitigated to an extent by the intervention of a program launched in 2018 to increase LDKT. Facilitators driven by the program included advocacy for LDKT from individual member(s) of the care team, dedicated resources, increased collaboration, and training opportunities that targeted LDKT delivery at multiple levels of practice. Limitations Delineating the borders of a "case" is a challenge in case study research, and it is possible that some perspectives may have been missed. Participants may have produced socially desirable answers. Conclusions Our study systematically investigated real-world practices as they operate throughout a health system. This novel approach has cross-disciplinary methodological relevance, and our findings have policy implications that can help inform multilevel interventions to improve LDKT.
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Affiliation(s)
- Anna Horton
- Research Institute of the McGill
University Health Centre, Montreal, QC, Canada
| | - Katya Loban
- Research Institute of the McGill
University Health Centre, Montreal, QC, Canada,Division of Nephrology, Department of
Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du Centre
hospitalier de l’Université de Montréal, QC, Canada,Division of Nephrology, Department of
Medicine, Centre hospitalier de l’Université de Montréal, QC, Canada
| | | | - Peter Nugus
- Department of Family Medicine and
Institute of Health Sciences Education, McGill University, Montreal, QC,
Canada
| | - Michel R. Pâquet
- Centre de recherche du Centre
hospitalier de l’Université de Montréal, QC, Canada,Division of Nephrology, Department of
Medicine, Centre hospitalier de l’Université de Montréal, QC, Canada
| | - Prosanto Chaudhury
- Research Institute of the McGill
University Health Centre, Montreal, QC, Canada,Department of Surgery, McGill
University Health Centre, Montreal, QC, Canada
| | - Marcelo Cantarovich
- Research Institute of the McGill
University Health Centre, Montreal, QC, Canada,Division of Nephrology, Department of
Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Shaifali Sandal
- Research Institute of the McGill
University Health Centre, Montreal, QC, Canada,Division of Nephrology, Department of
Medicine, McGill University Health Centre, Montreal, QC, Canada,Shaifali Sandal, Research Institute of the
McGill University Health Centre, Royal Victoria Hospital Glen Site, D05-7176,
1001 boul Decarie, Montreal, QC H4A 3J1, Canada.
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Horton A, Loban K, Nugus P, Fortin M, Gunaratnam L, Knoll G, Mucsi I, Chaudhury P, Landsberg D, Paquet M, Cantarovich M, Sandal S. Health System–Level Barriers to Living Donor Kidney Transplantation: Protocol for a Comparative Case Study Analysis (Preprint).. [DOI: 10.2196/preprints.44172] [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] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
Abstract
BACKGROUND
Living donor kidney transplantation (LDKT) is the best treatment option for patients with kidney failure and offers significant medical and economic advantages for both patients and health systems. Despite this, rates of LDKT in Canada have stagnated and vary significantly across Canadian provinces, the reasons for which are not well understood. Our prior work has suggested that system-level factors may be contributing to these differences. Identifying these factors can help inform system-level interventions to increase LDKT.
OBJECTIVE
Our objective is to generate a systemic interpretation of LDKT delivery across provincial health systems with variable performance. We aim to identify the attributes and processes that facilitate the delivery of LDKT to patients, and those that create barriers and compare these across systems with variable performance. These objectives are contextualized within our broader goal of increasing rates of LDKT in Canada, particularly in lower-performing provinces.
METHODS
This research takes the form of a qualitative comparative case study analysis of 3 provincial health systems in Canada that have high, moderate, and low rates of LDKT performance (the percentage of LDKT to all kidney transplantations performed). Our approach is underpinned by an understanding of health systems as complex adaptive systems that are multilevel and interconnected, and involve nonlinear interactions between people and organizations, operating within a loosely bounded network. Data collection will comprise semistructured interviews, document reviews, and focus groups. Individual case studies will be conducted and analyzed using inductive thematic analysis. Following this, our comparative analysis will operationalize resource-based theory to compare case study data and generate explanations for our research question.
RESULTS
This project was funded from 2020 to 2023. Individual case studies were carried out between November 2020 and August 2022. The comparative case analysis will begin in December 2022 and is expected to conclude in April 2023. Submission of the publication is projected for June 2023.
CONCLUSIONS
By investigating health systems as complex adaptive systems and making comparisons across provinces, this study will identify how health systems can improve the delivery of LDKT to patients with kidney failure. Our resource-based theory framework will provide a granular analysis of the attributes and processes that facilitate or create barriers to LDKT delivery across multiple organizations and levels of practice. Our findings will have practice and policy implications and help inform transferrable competencies and system-level interventions conducive to increasing LDKT.
INTERNATIONAL REGISTERED REPORT
DERR1-10.2196/44172
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Malo MF, Affdal A, Blum D, Ballesteros F, Beaubien-Souligny W, Caron ML, Nadeau-Fredette AC, Vasilevsky M, Rios N, Fortin MC, Suri RS. Lived Experiences of Patients Receiving Hemodialysis during the COVID-19 Pandemic: A Qualitative Study from the Quebec Renal Network. Kidney360 2022; 3:1057-1064. [PMID: 35845331 PMCID: PMC9255873 DOI: 10.34067/kid.0000182022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/21/2022] [Indexed: 01/10/2023]
Abstract
Background Hemodialysis patients have faced unique challenges during the COVID-19 pandemic. They face high risk of death if infected and have unavoidable exposure to others when they come to hospital three times weekly for their life-saving treatments. The objective of this study was to gain a better understanding of the scope and magnitude of the effects of the pandemic on the lived experience of patients receiving in-center hemodialysis. Methods We conducted semi-structured interviews with 22 patients who were undergoing dialysis treatments in five hemodialysis centers in Montreal from November 2020 to May 2021. Interviews were transcribed and then analyzed using thematic content analysis. Results Most participants reported no negative effects of the COVID-19 pandemic on their hemodialysis care. Several patients had negative feelings related to forced changes in their dialysis schedules, and this was especially pronounced for indigenous patients in a shared living situation. Some patients were concerned about contracting COVID-19, especially during public transportation, whereas others expressed confidence that the physical distancing and screening measures implemented at the hospital would protect them and their loved ones. Some participants reported that masks negatively affected their interactions with health care workers, and for many others, the pandemic was associated with feelings of loneliness. Finally, some respondents reported some positive effects of the pandemic, including use of telemedicine and creating a sense of solidarity. Conclusions Patients undergoing hemodialysis reported no negative effects on their medical care but faced significant disruptions in their routines and social interactions due to the COVID-19 pandemic. Nevertheless, they showed great resilience in their ability to adapt to the new reality of their hemodialysis treatments. We also show that studies focused on understanding the lived experiences of indigenous patients and patients from different ethnic backgrounds are needed in order reduce inequities in care during public health emergencies.
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Affiliation(s)
- Marie-Françoise Malo
- Bioethics Program, École de santé publique de l’Université de Montréal, Montreal, Canada
| | - Aliya Affdal
- Bioethics Program, École de santé publique de l’Université de Montréal, Montreal, Canada
| | - Dan Blum
- Division of nephrology, Jewish General Hospital, Montreal, Canada
| | - Fabian Ballesteros
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Canada
| | - William Beaubien-Souligny
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Canada,Faculté de médecine de l’Université de Montréal, Montreal, Canada,Centre hospitalier de l’Université de Montréal, Montreal, Canada
| | - Marie-Line Caron
- Centre hospitalier de l’Université de Montréal, Montreal, Canada
| | - Annie-Claire Nadeau-Fredette
- Faculté de médecine de l’Université de Montréal, Montreal, Canada,Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Canada
| | | | - Norka Rios
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Canada,Faculté de médecine de l’Université de Montréal, Montreal, Canada,Centre hospitalier de l’Université de Montréal, Montreal, Canada
| | - Rita S. Suri
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Canada,Faculty of Medicine, McGill University, Montreal, Canada,Research Institute of the McGill University Health Centre, Montreal, Canada
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9
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Horton A, Nugus P, Fortin MC, Landsberg D, Cantarovich M, Sandal S. Health system barriers and facilitators to living donor kidney transplantation: a qualitative case study in British Columbia. CMAJ Open 2022; 10:E348-E356. [PMID: 35440483 PMCID: PMC9022938 DOI: 10.9778/cmajo.20210049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In patients with kidney failure, living donor kidney transplantation (LDKT) is the best treatment option; yet, LDKT rates have stagnated in Canada and vary widely across provinces. We aimed to identify barriers and facilitators to LDKT in a high-performing health system. METHODS This study was conducted using a qualitative exploratory case study of British Columbia. Data collection, conducted between October 2020 and January 2021, entailed document review and semistructured interviews with key stakeholders, including provincial leadership, care teams and patients. We recruited participants via purposive sampling and snowballing technique. We generated themes using thematic analysis. RESULTS After analysis of interviews conducted with 22 participants (5 representatives from provincial organizations, 7 health care providers at transplant centres, 8 health care providers from regional units and 2 patients) and document review, we identified the following 5 themes as facilitators to LDKT: a centralized infrastructure, a mandate for timely intervention, an equitable funding model, a commitment to collaboration and cultivating distributed expertise. The relationship between 2 provincial organizations (BC Transplant and BC Renal Agency) was identified as key to enabling the mandate and processes for LDKT. Five barriers were identified that arose from silos between provincial organizations and manifested as inconsistencies in coordinating LDKT along the spectrum of care. These were divided accountability structures, disconnected care processes, missed training opportunities, inequitable access by region and financial burden for donors and recipients. INTERPRETATION We found strong links between provincial infrastructure and the processes that facilitate or impede timely intervention and referral of patients for LDKT. Our findings have implications for policy-makers and provide opportunities for cross-jurisdictional comparative analyses.
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Affiliation(s)
- Anna Horton
- Research Institute of the McGill University Health Centre (Horton, Cantarovich, Sandal); Department of Family Medicine and Institute of Health Sciences Education (Nugus), McGill University; Division of Nephrology (Fortin), Department of Medicine, Centre hospitalier de l'Université de Montréal; Centre de recherche du Centre hospitalier de l'Université de Montréal (Fortin), Montréal, Que.; Department of Medicine (Landsberg), University of British Columbia, Vancouver, BC; Division of Nephrology (Cantarovich, Sandal), Department of Medicine, McGill University Health Centre, Montréal, Que
| | - Peter Nugus
- Research Institute of the McGill University Health Centre (Horton, Cantarovich, Sandal); Department of Family Medicine and Institute of Health Sciences Education (Nugus), McGill University; Division of Nephrology (Fortin), Department of Medicine, Centre hospitalier de l'Université de Montréal; Centre de recherche du Centre hospitalier de l'Université de Montréal (Fortin), Montréal, Que.; Department of Medicine (Landsberg), University of British Columbia, Vancouver, BC; Division of Nephrology (Cantarovich, Sandal), Department of Medicine, McGill University Health Centre, Montréal, Que
| | - Marie-Chantal Fortin
- Research Institute of the McGill University Health Centre (Horton, Cantarovich, Sandal); Department of Family Medicine and Institute of Health Sciences Education (Nugus), McGill University; Division of Nephrology (Fortin), Department of Medicine, Centre hospitalier de l'Université de Montréal; Centre de recherche du Centre hospitalier de l'Université de Montréal (Fortin), Montréal, Que.; Department of Medicine (Landsberg), University of British Columbia, Vancouver, BC; Division of Nephrology (Cantarovich, Sandal), Department of Medicine, McGill University Health Centre, Montréal, Que
| | - David Landsberg
- Research Institute of the McGill University Health Centre (Horton, Cantarovich, Sandal); Department of Family Medicine and Institute of Health Sciences Education (Nugus), McGill University; Division of Nephrology (Fortin), Department of Medicine, Centre hospitalier de l'Université de Montréal; Centre de recherche du Centre hospitalier de l'Université de Montréal (Fortin), Montréal, Que.; Department of Medicine (Landsberg), University of British Columbia, Vancouver, BC; Division of Nephrology (Cantarovich, Sandal), Department of Medicine, McGill University Health Centre, Montréal, Que
| | - Marcelo Cantarovich
- Research Institute of the McGill University Health Centre (Horton, Cantarovich, Sandal); Department of Family Medicine and Institute of Health Sciences Education (Nugus), McGill University; Division of Nephrology (Fortin), Department of Medicine, Centre hospitalier de l'Université de Montréal; Centre de recherche du Centre hospitalier de l'Université de Montréal (Fortin), Montréal, Que.; Department of Medicine (Landsberg), University of British Columbia, Vancouver, BC; Division of Nephrology (Cantarovich, Sandal), Department of Medicine, McGill University Health Centre, Montréal, Que
| | - Shaifali Sandal
- Research Institute of the McGill University Health Centre (Horton, Cantarovich, Sandal); Department of Family Medicine and Institute of Health Sciences Education (Nugus), McGill University; Division of Nephrology (Fortin), Department of Medicine, Centre hospitalier de l'Université de Montréal; Centre de recherche du Centre hospitalier de l'Université de Montréal (Fortin), Montréal, Que.; Department of Medicine (Landsberg), University of British Columbia, Vancouver, BC; Division of Nephrology (Cantarovich, Sandal), Department of Medicine, McGill University Health Centre, Montréal, Que.
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10
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Sandal S, Horton A, Fortin MC. Advancing a Paradigm Shift to Approaching Health Systems in the Field of Living-Donor Kidney Transplantation: An Opinion Piece. Can J Kidney Health Dis 2022; 9:20543581221079486. [PMID: 35237443 PMCID: PMC8882925 DOI: 10.1177/20543581221079486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/20/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Shaifali Sandal
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
- The Metabolic Disorders and Complications Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Anna Horton
- The Metabolic Disorders and Complications Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Marie-Chantal Fortin
- Division of Nephrology, Department of Medicine, Centre hospitalier de l’Université de Montréal, QC, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, QC, Canada
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11
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Khalili M, Cardinal H, Ballesteros F, Fortin MC. Kidney transplant candidates' and recipients' perspectives on the decision-making process to accept or refuse a deceased donor kidney offer: Trust and graft survival matter. Clin Transplant 2022; 36:e14604. [PMID: 35099833 DOI: 10.1111/ctr.14604] [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: 07/26/2021] [Revised: 01/13/2022] [Accepted: 01/26/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The decision to accept a kidney from a deceased donor can be a difficult one. This study aims to capture the perspectives of transplant candidates (TCs) and kidney transplant recipients (KTRs) on the decision-making process when a deceased kidney is offered. METHODS We conducted six focus groups with KTRs and TCs. The content of the focus groups was analyzed using the qualitative thematic method. RESULTS KTRs reported that the experience of being offered a kidney could be difficult because of the circumstances of the offer and unpreparedness to participate in the discussion. Both KTRs and TCs trusted the medical expertise. Age and having experience with dialysis could influence the decision to accept an offer. In order to engage in the discussion, patients wanted to obtain estimates of expected graft survival. Patients did not express interest for a web-based calculator for patient use, but expected transplant physicians to summarize and explain the information that would impact graft survival time. CONCLUSION TCs and KTRs wanted to be involved in the decision to accept a deceased donor kidney. Tools that can help physicians communicate the risks and benefits of accepting an offer could improve patient participation in the decision-making process.
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Affiliation(s)
- Myriam Khalili
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Héloïse Cardinal
- Faculty of Medicine, Université de Montréal, Montreal, Canada.,Department of Medicine, Centre de recherche du CHUM, Montreal, Canada.,Department of Medicine, Canadian Donation and Transplantation Research Program, Edmonton, Canada
| | | | - Marie-Chantal Fortin
- Faculty of Medicine, Université de Montréal, Montreal, Canada.,Department of Medicine, Centre de recherche du CHUM, Montreal, Canada.,Department of Medicine, Canadian Donation and Transplantation Research Program, Edmonton, Canada
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12
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Laneuville L, Ballesteros F, Affdal A, Malo MF, Brassard L, Gagnon Chainey B, Millot P, Mavrikakis C, Harel S, Fortin MC. Perspectives of Kidney Transplant Recipients, Transplant Candidates, and Living Kidney Donors on the Role of Patients’ Self-Narratives and Experiences of Creative Writing Workshops: A Qualitative Study. Can J Kidney Health Dis 2022; 9:20543581221132742. [PMID: 36353517 PMCID: PMC9638699 DOI: 10.1177/20543581221132742] [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: 05/10/2022] [Accepted: 09/14/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Kidney transplantation is the best treatment for kidney failure but is
associated with medical, psychological, and existential challenges for
patients. Patients’ experiential knowledge can help other patients facing
these challenges. Patients’ self-narratives and creative writings are ways
to operationalize this experiential knowledge. Creative writing has been
described as a therapeutic tool for patients with chronic disease. Over the
past year, we conducted creative writing workshops with kidney transplant
recipients (KTRs), living kidney donors (LKDs), kidney transplant candidates
(KTCs), and professional writers. During these workshops, patients were
invited to explore different aspects of their experiences of their
transplant or donation journey through narrative-writing, poetry, comic art,
and screenwriting. Objective: The objectives of this study were to gather the perspectives of KTRs, KTCs,
and LKDs on the role of patients’ self-narratives and creative writing, and
to collect patients’ experiences of the creative writing workshops. Design: Focus groups and individual interviews. Setting: The Center hospitalier de l’Université de Montréal (CHUM) kidney transplant
program. Participants: KTRs, LKDs, and KTCs attending the CHUM kidney transplant clinic between
February 2020 and January 2021. Methods: We conducted 2 focus groups and 8 semi-structured individual interviews with
7 KTRs, 8 LKDs, and 5 KTCs from the CHUM between June and November 2020,
before the creative writing workshops. We also conducted 10 semi-structured
interviews with 5 KTRs, 1 KTC, and 4 LKDs in March 2021, after their
participation in the creative writing workshops. The interviews were
recorded and transcribed. Thematic and content analyses were conducted. Results: KTRs, LKDs, and KTCs had multiple significant moments to share from their
transplant/donation journey. These moments were highly emotional and marked
by uncertainty. The creative writing workshops were described as therapeutic
by participants, because they offered a safe space for group-facilitated
reflection, including a discovery and learning process, and normalization,
relativization, and appreciation of the transplant/donation experience. The
creative writing workshops also provided an opportunity to give back to
others (helping other patients, promoting kidney donation and continuing
this process in the future through the web platform). Limitations: Our participants came from a single French-speaking urban transplant center
in Quebec and were highly educated. Conclusion: The study set out to capture the perspectives of KTRs, LKDs, and KTCs through
the sharing of self-narratives and their participation in creative writing
workshops related to their transplant or donation journey. A website was set
up to publish patients’ creative writings (https://recitsdudonetdelavie.lorganon.ca/les-recits/).
Further study is needed to assess the website’s impact on other
patients. Trial registration: Not registered.
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Affiliation(s)
- Laurence Laneuville
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | | | - Aliya Affdal
- Bioethics Program, École de santé publique de l’Université de Montréal, QC, Canada
| | - Marie-Françoise Malo
- Bioethics Program, École de santé publique de l’Université de Montréal, QC, Canada
| | - Léonore Brassard
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
| | - Benjamin Gagnon Chainey
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
| | - Pascale Millot
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
- Département des littératures de langues française, Faculté des arts et des sciences, Université de Montréal, QC, Canada
| | - Catherine Mavrikakis
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
- Département des littératures de langues française, Faculté des arts et des sciences, Université de Montréal, QC, Canada
| | - Simon Harel
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
- Département de littératures et de langues du monde, Faculté des arts et des sciences, Université de Montréal, QC, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du CHUM, Montréal, QC, Canada
- Bioethics Program, École de santé publique de l’Université de Montréal, QC, Canada
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
- Faculté de médecine, Université de Montréal, QC, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
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13
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Fortin MC, Gill J, Allard J, Ballesteros Gallego F, Gill J. Compatible Donor and Recipient Pairs' Perspectives on Participation in Kidney Paired Donation Programs: A Mixed-Methods Study. Can J Kidney Health Dis 2021; 8:20543581211058932. [PMID: 34868609 PMCID: PMC8641119 DOI: 10.1177/20543581211058932] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/23/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Compatible pair participation in kidney paired donation (KPD) may increase the likelihood of finding suitable matches for all registered pairs. Retrospective studies have shown variable enthusiasm for participating in KPD in compatible pairs. Objective: The study objective was to gather potential living donor (PLD) and transplant candidate (TC) perspectives on compatible pair participation in KPD. Design: Surveys and qualitative interviews. Setting: Three transplant programs in Canada: Centre hospitalier de l’Université de Montréal in Montreal (Québec), Vancouver General Hospital, and St. Paul’s Hospital in Vancouver (British Columbia). Patients: Both PLDs and TCs undergoing evaluation for donation/transplantation between 2016 and 2018 at 3 transplant programs in Canada. Methods: Descriptive statistical analysis was performed for the results of the survey and thematic and content analysis method was used for the content of the qualitative interviews. Results: A total of 116 PLDs and 111 TCs completed surveys and an additional 18 PLDs and 17 TCs underwent semi-directed interviews. Of those surveyed, 61.2% of PLDs and 76.6% of TCs reported a willingness to participate in KPD as a compatible pair. The possibility of a more optimally matched kidney for the TC and policies ensuring prioritization of the TC for repeat transplantation in the event of early graft failure increased willingness to participate in KPD. Major concerns expressed during the interviews included the desire to retain the emotional bond of directed donation, the fear of chain breaks or donor reneging, delays in transplantation, and additional travel associated with participation in KPD. Limitation: The limitations of this study are that it was conducted in only 3 Canadian transplant programs and that the interviews and surveys were in French and in English. As a consequence, the results may not be reflective of the views of individuals not living in these 2 provinces and from ethnic minority populations. Conclusion: Most of the compatible PLDs and TCs surveyed were willing to participate in KPD. Ensuring timely transplantation and a more optimal match for TCs and offering a policy of reciprocity to ensure timely repeat transplantation for compatible recipients if their allograft fails post KPD transplant may further increase compatible pair participation in KPD.
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Affiliation(s)
- Marie-Chantal Fortin
- Centre de recherche du Centre hospitalier de l'Université de Montréal, QC, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.,Faculty of Medicine, Université de Montréal, QC, Canada
| | - John Gill
- Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Julie Allard
- Centre de recherche du Centre hospitalier de l'Université de Montréal, QC, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Fabián Ballesteros Gallego
- Centre de recherche du Centre hospitalier de l'Université de Montréal, QC, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Jagbir Gill
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.,Faculty of Medicine, The University of British Columbia, Vancouver, Canada
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14
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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.
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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.
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15
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Greenberg R, Goldberg A, Anthony S, Buchman DZ, Delaney S, Gruben V, Holdsworth S, Le Foll B, Leung M, Lien D, Lynch MJ, Selzner N, Chandler JA, Fortin MC. Canadian Society of Transplantation White Paper: Ethical and Legal Considerations for Alcohol and Cannabis Use in Solid Organ Listing and Allocation. Transplantation 2021; 105:1957-1964. [PMID: 33587429 PMCID: PMC8376271 DOI: 10.1097/tp.0000000000003618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/20/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 11/26/2022]
Abstract
Alcohol and cannabis use as a contraindication to organ transplantation is a controversial issue. Until recently, patients in Canada with alcohol-associated liver disease were required to demonstrate abstinence for 6 mo to receive a liver transplant. There is no equivalent rule that is applied consistently for cannabis use. There is some evidence that alcohol and cannabis use disorder pretransplant could be associated with worse outcomes posttransplantation. However, early liver transplantation for patients with alcohol-associated liver disease in France and in the United States has led to challenges of the 6-mo abstinence rule in Canada in the media. It has also resulted in several legal challenges arguing that the rule violates human rights laws regarding discrimination in the provision of medical services and that the rule is also unconstitutional (this challenge is still before the court). Recent legalization of cannabis use for adults in Canada has led to questions about the appropriateness of limiting transplant access based on cannabis use. The ethics committee of the Canadian Society of Transplantation was asked to provide an ethical analysis of cannabis and alcohol abstinence policies. Our conclusions were as follows: neither cannabis use nor the 6-mo abstinence rule for alcohol use should be an absolute contraindication to transplantation, and transplant could be offered to selected patients, further research should be conducted to ensure evidence-based policies; and the transplant community has a duty not to perpetuate stigma associated with alcohol and cannabis use disorders.
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Affiliation(s)
- Rebecca Greenberg
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Mount Sinai Hospital, Toronto, ON, Canada
| | - Aviva Goldberg
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Samantha Anthony
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, ON, Canada
| | - Daniel Z. Buchman
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | | | - Vanessa Gruben
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Faculty of Law, University of Ottawa, Ottawa, ON, Canada
| | - Sandra Holdsworth
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Bernard Le Foll
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Dale Lien
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Marie-Josee Lynch
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto General Research Institute, Toronto, ON, Canada
| | - Nazia Selzner
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Toronto General Research Institute, Toronto, ON, Canada
| | - Jennifer A. Chandler
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Faculty of Law, University of Ottawa, Ottawa, ON, Canada
| | - Marie-Chantal Fortin
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Centre de recherche du CHUM, Montreal, QC, Canada
- Faculty of Medicine, University of Montreal, QC, Canada
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16
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Allard J, Ballesteros F, Fortin MC. Québec health care professionals' perspectives on organ donation after medical assistance in dying. BMC Med Ethics 2021; 22:23. [PMID: 33663501 PMCID: PMC7934363 DOI: 10.1186/s12910-021-00594-7] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 02/24/2021] [Indexed: 11/18/2022] Open
Abstract
Background Medical assistance in dying (MAID) has been legal in Québec since December 2015 and in the rest of Canada since July 2016. Since then, more than 60 people have donated their organs after MAID. Such donations raise ethical issues about respect of patients’ autonomy, potential pressure to choose MAID, the information given to potential donors, the acceptability of directed donations in such a context and the possibility of death by donation. The objective of this study was to explore Québec professionals’ perspectives on the ethical issues related to organ donation after MAID. Methods We conducted semi-directed interviews with 21 health care professionals involved in organ donation such as intensivists and intensive care nurses, operating room nurses, organ donation nurses and coordinators. Results The participants were all favourable to organ donation after MAID in order to respect patients’ autonomy. They also favoured informing all potential donors of the possibility of donating organs. They highlighted the importance of assessing donors’ reasons for requesting MAID during the assessment. They were divided on directed donation, living donation before MAID and death by donation. Conclusion Organ donation after MAID was widely accepted among the participants, based on the principle of respect for the donor’s autonomy. The findings of this study only provide the perspectives of Québec health care professionals involved in organ donation. Future studies are needed to gather other stakeholders’ perspectives on this issue as well as patients’ and families’ experiences of organ donation after MAID.
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Affiliation(s)
- Julie Allard
- Bioethics Program, Department of Social and Preventive Medicine, École de Santé Publique de l'Université de Montréal, Montréal, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, Canada
| | - Fabian Ballesteros
- Department of Medicine, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CHUM), 900, rue Saint-Denis, R12-418, Montréal, QC, H2X 0A9, Canada
| | - Marie-Chantal Fortin
- Bioethics Program, Department of Social and Preventive Medicine, École de Santé Publique de l'Université de Montréal, Montréal, Canada. .,Canadian Donation and Transplantation Research Program, Edmonton, Canada. .,Department of Medicine, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CHUM), 900, rue Saint-Denis, R12-418, Montréal, QC, H2X 0A9, Canada.
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17
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Knoll GA, Fortin MC, Gill J, Grimshaw JM, Hartell DP, Karnabi P, Parsons CD, Vorster H, Kim SJ. Measuring quality in living donation and kidney transplantation: moving beyond survival metrics. Kidney Int 2020; 98:860-869. [PMID: 32791254 DOI: 10.1016/j.kint.2020.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/10/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Greg A Knoll
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Marie-Chantal Fortin
- Research Centre of the Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada; Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Jagbir Gill
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, Canada; Centre for Health Evaluation and Outcomes Sciences, University of British Columbia, Vancouver, Canada
| | - Jeremy M Grimshaw
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - David P Hartell
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Priscilla Karnabi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Christina D Parsons
- Organ and Tissue Donation and Transplantation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Hans Vorster
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada; Patient Governance Council, Can-SOLVE CKD Network, Vancouver, British Columbia, Canada
| | - S Joseph Kim
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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18
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Lam NN, Dipchand C, Fortin MC, Foster BJ, Ghanekar A, Houde I, Kiberd B, Klarenbach S, Knoll GA, Landsberg D, Luke PP, Mainra R, Singh SK, Storsley L, Gill J. Canadian Society of Transplantation and Canadian Society of Nephrology Commentary on the 2017 KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Can J Kidney Health Dis 2020; 7:2054358120918457. [PMID: 32577294 PMCID: PMC7288834 DOI: 10.1177/2054358120918457] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/25/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose of review: To review an international guideline on the evaluation and care of living
kidney donors and provide a commentary on the applicability of the
recommendations to the Canadian donor population. Sources of information: We reviewed the 2017 Kidney Disease: Improving Global Outcomes (KDIGO)
Clinical Practice Guideline on the Evaluation and Care of Living Kidney
Donors and compared this guideline to the Canadian 2014 Kidney Paired
Donation (KPD) Protocol for Participating Donors. Methods: A working group was formed consisting of members from the Canadian Society of
Transplantation and the Canadian Society of Nephrology. Members were
selected to have representation from across Canada and in various
subspecialties related to living kidney donation, including nephrology,
surgery, transplantation, pediatrics, and ethics. Key findings: Many of the KDIGO Guideline recommendations align with the KPD Protocol
recommendations. Canadian researchers have contributed to much of the
evidence on donor evaluation and outcomes used to support the KDIGO
Guideline recommendations. Limitations: Certain outcomes and risk assessment tools have yet to be validated in the
Canadian donor population. Implications: Living kidney donors should be counseled on the risks of postdonation
outcomes given recent evidence, understanding the limitations of the
literature with respect to its generalizability to the Canadian donor
population.
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Affiliation(s)
- Ngan N Lam
- Division of Nephrology, University of Calgary, AB, Canada
| | | | | | - Bethany J Foster
- Division of Pediatric Nephrology, McGill University, Montréal, QC, Canada
| | - Anand Ghanekar
- Department of Surgery, University of Toronto, ON, Canada
| | - Isabelle Houde
- Division of Nephrology, Centre Hospitalier de l'Université de Québec, Québec City, Canada
| | - Bryce Kiberd
- Division of Nephrology, Dalhousie University, Halifax, NS, Canada
| | | | - Greg A Knoll
- Division of Nephrology, University of Ottawa, ON, Canada
| | - David Landsberg
- Division of Nephrology, University of British Columbia, Vancouver, Canada
| | - Patrick P Luke
- Division of Urology, Western University, London, ON, Canada
| | - Rahul Mainra
- Division of Nephrology, University of Saskatchewan, Saskatoon, Canada
| | - Sunita K Singh
- Division of Nephrology, University of Toronto, ON, Canada
| | - Leroy Storsley
- Section of Nephrology, University of Manitoba, Winnipeg, Canada
| | - Jagbir Gill
- Division of Nephrology, University of British Columbia, Vancouver, Canada
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19
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Downar J, Shemie SD, Gillrie C, Fortin MC, Appleby A, Buchman DZ, Shoesmith C, Goldberg A, Gruben V, Lalani J, Ysebaert D, Wilson L, Sharpe MD. Deceased organ and tissue donation after medical assistance in dying and other conscious and competent donors: guidance for policy. CMAJ 2020; 191:E604-E613. [PMID: 31160497 DOI: 10.1503/cmaj.181648] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- James Downar
- Division of Palliative Care, Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Department of Pediatrics (Shemie), McGill University, Montréal, Que.; Canadian Blood Services (Shemie, Gillrie, Appleby, Lalani, Wilson), Ottawa, Ont.; Bioethics Program (Fortin), Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montréal, Que.; Dalla Lana School of Public Health (Buchman), University of Toronto, Toronto, Ont.; Department of Neurology (Shoesmith), Western University, London, Ont.; Department of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.; Faculty of Law (Gruben), University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Ysebaert), University of Antwerp, Antwerp, Belgium; Department of Anesthesia and Perioperative Medicine (Sharpe), Schulich School of Medicine, Western University, London, Ont.
| | - Sam D Shemie
- Division of Palliative Care, Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Department of Pediatrics (Shemie), McGill University, Montréal, Que.; Canadian Blood Services (Shemie, Gillrie, Appleby, Lalani, Wilson), Ottawa, Ont.; Bioethics Program (Fortin), Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montréal, Que.; Dalla Lana School of Public Health (Buchman), University of Toronto, Toronto, Ont.; Department of Neurology (Shoesmith), Western University, London, Ont.; Department of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.; Faculty of Law (Gruben), University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Ysebaert), University of Antwerp, Antwerp, Belgium; Department of Anesthesia and Perioperative Medicine (Sharpe), Schulich School of Medicine, Western University, London, Ont
| | - Clay Gillrie
- Division of Palliative Care, Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Department of Pediatrics (Shemie), McGill University, Montréal, Que.; Canadian Blood Services (Shemie, Gillrie, Appleby, Lalani, Wilson), Ottawa, Ont.; Bioethics Program (Fortin), Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montréal, Que.; Dalla Lana School of Public Health (Buchman), University of Toronto, Toronto, Ont.; Department of Neurology (Shoesmith), Western University, London, Ont.; Department of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.; Faculty of Law (Gruben), University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Ysebaert), University of Antwerp, Antwerp, Belgium; Department of Anesthesia and Perioperative Medicine (Sharpe), Schulich School of Medicine, Western University, London, Ont
| | - Marie-Chantal Fortin
- Division of Palliative Care, Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Department of Pediatrics (Shemie), McGill University, Montréal, Que.; Canadian Blood Services (Shemie, Gillrie, Appleby, Lalani, Wilson), Ottawa, Ont.; Bioethics Program (Fortin), Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montréal, Que.; Dalla Lana School of Public Health (Buchman), University of Toronto, Toronto, Ont.; Department of Neurology (Shoesmith), Western University, London, Ont.; Department of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.; Faculty of Law (Gruben), University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Ysebaert), University of Antwerp, Antwerp, Belgium; Department of Anesthesia and Perioperative Medicine (Sharpe), Schulich School of Medicine, Western University, London, Ont
| | - Amber Appleby
- Division of Palliative Care, Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Department of Pediatrics (Shemie), McGill University, Montréal, Que.; Canadian Blood Services (Shemie, Gillrie, Appleby, Lalani, Wilson), Ottawa, Ont.; Bioethics Program (Fortin), Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montréal, Que.; Dalla Lana School of Public Health (Buchman), University of Toronto, Toronto, Ont.; Department of Neurology (Shoesmith), Western University, London, Ont.; Department of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.; Faculty of Law (Gruben), University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Ysebaert), University of Antwerp, Antwerp, Belgium; Department of Anesthesia and Perioperative Medicine (Sharpe), Schulich School of Medicine, Western University, London, Ont
| | - Daniel Z Buchman
- Division of Palliative Care, Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Department of Pediatrics (Shemie), McGill University, Montréal, Que.; Canadian Blood Services (Shemie, Gillrie, Appleby, Lalani, Wilson), Ottawa, Ont.; Bioethics Program (Fortin), Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montréal, Que.; Dalla Lana School of Public Health (Buchman), University of Toronto, Toronto, Ont.; Department of Neurology (Shoesmith), Western University, London, Ont.; Department of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.; Faculty of Law (Gruben), University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Ysebaert), University of Antwerp, Antwerp, Belgium; Department of Anesthesia and Perioperative Medicine (Sharpe), Schulich School of Medicine, Western University, London, Ont
| | - Christen Shoesmith
- Division of Palliative Care, Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Department of Pediatrics (Shemie), McGill University, Montréal, Que.; Canadian Blood Services (Shemie, Gillrie, Appleby, Lalani, Wilson), Ottawa, Ont.; Bioethics Program (Fortin), Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montréal, Que.; Dalla Lana School of Public Health (Buchman), University of Toronto, Toronto, Ont.; Department of Neurology (Shoesmith), Western University, London, Ont.; Department of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.; Faculty of Law (Gruben), University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Ysebaert), University of Antwerp, Antwerp, Belgium; Department of Anesthesia and Perioperative Medicine (Sharpe), Schulich School of Medicine, Western University, London, Ont
| | - Aviva Goldberg
- Division of Palliative Care, Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Department of Pediatrics (Shemie), McGill University, Montréal, Que.; Canadian Blood Services (Shemie, Gillrie, Appleby, Lalani, Wilson), Ottawa, Ont.; Bioethics Program (Fortin), Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montréal, Que.; Dalla Lana School of Public Health (Buchman), University of Toronto, Toronto, Ont.; Department of Neurology (Shoesmith), Western University, London, Ont.; Department of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.; Faculty of Law (Gruben), University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Ysebaert), University of Antwerp, Antwerp, Belgium; Department of Anesthesia and Perioperative Medicine (Sharpe), Schulich School of Medicine, Western University, London, Ont
| | - Vanessa Gruben
- Division of Palliative Care, Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Department of Pediatrics (Shemie), McGill University, Montréal, Que.; Canadian Blood Services (Shemie, Gillrie, Appleby, Lalani, Wilson), Ottawa, Ont.; Bioethics Program (Fortin), Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montréal, Que.; Dalla Lana School of Public Health (Buchman), University of Toronto, Toronto, Ont.; Department of Neurology (Shoesmith), Western University, London, Ont.; Department of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.; Faculty of Law (Gruben), University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Ysebaert), University of Antwerp, Antwerp, Belgium; Department of Anesthesia and Perioperative Medicine (Sharpe), Schulich School of Medicine, Western University, London, Ont
| | - Jehan Lalani
- Division of Palliative Care, Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Department of Pediatrics (Shemie), McGill University, Montréal, Que.; Canadian Blood Services (Shemie, Gillrie, Appleby, Lalani, Wilson), Ottawa, Ont.; Bioethics Program (Fortin), Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montréal, Que.; Dalla Lana School of Public Health (Buchman), University of Toronto, Toronto, Ont.; Department of Neurology (Shoesmith), Western University, London, Ont.; Department of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.; Faculty of Law (Gruben), University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Ysebaert), University of Antwerp, Antwerp, Belgium; Department of Anesthesia and Perioperative Medicine (Sharpe), Schulich School of Medicine, Western University, London, Ont
| | - Dirk Ysebaert
- Division of Palliative Care, Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Department of Pediatrics (Shemie), McGill University, Montréal, Que.; Canadian Blood Services (Shemie, Gillrie, Appleby, Lalani, Wilson), Ottawa, Ont.; Bioethics Program (Fortin), Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montréal, Que.; Dalla Lana School of Public Health (Buchman), University of Toronto, Toronto, Ont.; Department of Neurology (Shoesmith), Western University, London, Ont.; Department of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.; Faculty of Law (Gruben), University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Ysebaert), University of Antwerp, Antwerp, Belgium; Department of Anesthesia and Perioperative Medicine (Sharpe), Schulich School of Medicine, Western University, London, Ont
| | - Lindsay Wilson
- Division of Palliative Care, Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Department of Pediatrics (Shemie), McGill University, Montréal, Que.; Canadian Blood Services (Shemie, Gillrie, Appleby, Lalani, Wilson), Ottawa, Ont.; Bioethics Program (Fortin), Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montréal, Que.; Dalla Lana School of Public Health (Buchman), University of Toronto, Toronto, Ont.; Department of Neurology (Shoesmith), Western University, London, Ont.; Department of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.; Faculty of Law (Gruben), University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Ysebaert), University of Antwerp, Antwerp, Belgium; Department of Anesthesia and Perioperative Medicine (Sharpe), Schulich School of Medicine, Western University, London, Ont
| | - Michael D Sharpe
- Division of Palliative Care, Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Department of Pediatrics (Shemie), McGill University, Montréal, Que.; Canadian Blood Services (Shemie, Gillrie, Appleby, Lalani, Wilson), Ottawa, Ont.; Bioethics Program (Fortin), Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montréal, Que.; Dalla Lana School of Public Health (Buchman), University of Toronto, Toronto, Ont.; Department of Neurology (Shoesmith), Western University, London, Ont.; Department of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.; Faculty of Law (Gruben), University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Ysebaert), University of Antwerp, Antwerp, Belgium; Department of Anesthesia and Perioperative Medicine (Sharpe), Schulich School of Medicine, Western University, London, Ont
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20
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Cardinal H, Ballesteros Gallego F, Affdal A, Fortin MC. Canadian transplant nephrologists' perspectives on the decision-making process for accepting or refusing a kidney from a deceased organ donor. Clin Transplant 2020; 34:e13793. [PMID: 31989699 DOI: 10.1111/ctr.13793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/02/2019] [Revised: 01/07/2020] [Accepted: 01/21/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Kidney transplantation is the best treatment for patients with end-stage renal disease. The decision to accept a kidney from a deceased donor can be a difficult one, especially when organs from high KDPI (>85%) donors are offered. This study aims to capture the perspectives of transplant nephrologists (TNs) on the decision-making process when an organ is offered. METHODS Fifteen Canadian TNs took part in semi-structured interviews between December 2017 and April 2018. The interviews were digitally recorded, transcribed, and analyzed using the thematic analysis method. RESULTS The decision to accept a deceased-donor kidney offer is a medical one for the participants. However, transplant candidates could be involved when the offered kidney is from a donor with a KDPI >85% or increased infectious risk donor. The TNs' past experience, comprehensive data on the donor, and education of the transplant candidate could facilitate the decision-making process. A decision aid could also facilitate the decision-making process, but different concerns should be addressed. CONCLUSION Although accepting a deceased-donor organ offer is often viewed as an opportunity for shared decision-making, participants in this study viewed the decision to accept or refuse an offer as a medical decision with little room for patient participation.
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Affiliation(s)
- Héloïse Cardinal
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, QC, Canada.,Université de Montréal, Montréal, QC, Canada
| | - Fabian Ballesteros Gallego
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, QC, Canada
| | | | - Marie-Chantal Fortin
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, QC, Canada.,Université de Montréal, Montréal, QC, Canada
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21
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Crawshaw J, Presseau J, van Allen Z, Pinheiro Carvalho L, Jordison K, English S, Fergusson DA, Lauzier F, Turgeon AF, Sarti AJ, Martin C, D'Aragon F, Li AHT, Knoll G, Ball I, Brehaut J, Burns KEA, Fortin MC, Weiss M, Meade M, Marsolais P, Shemie S, Zaabat S, Dhanani S, Kitto SC, Chassé M. Exploring the experiences and perspectives of substitute decision-makers involved in decisions about deceased organ donation: a qualitative study protocol. BMJ Open 2019; 9:e034594. [PMID: 31874899 PMCID: PMC7008441 DOI: 10.1136/bmjopen-2019-034594] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/26/2019] [Accepted: 12/05/2019] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION In Canada, deceased organ donation provides over 80% of transplanted organs. At the time of death, families, friends or others assume responsibility as substitute decision-makers (SDMs) to consent to organ donation. Despite their central role in this process, little is known about what barriers, enablers and beliefs influence decision-making among SDMs. This study aims to explore the experiences and perspectives of SDMs involved in making decisions around the withdrawal of life-sustaining therapies, end-of-life care and deceased organ donation. METHODS AND ANALYSIS SDMs of 60 patients admitted to intensive care units will be enrolled for this study. Ten hospitals across five provinces in Canada in a prospective multicentre qualitative cohort study. We will conduct semistructured telephone interviews in English or French with SDMs between 6 and 8 weeks after the patient's death. Our sampling frame will stratify SDMs into three groups: SDMs who were not approached for organ donation; SDMs who were approached and consented to donate and SDMs who were approached but did not consent to donate. We will use two complementary theoretical frameworks-the Common-Sense Self-Regulation Model and the Theoretical Domains Framework- to inform our interview guide. Interview data will be analysed using deductive directed content analysis and inductive thematic analysis. ETHICS AND DISSEMINATION This study has been approved by the Centre Hospitalier de l'Université de Montréal Research Ethics Board. The findings from this study will help identify key factors affecting substitute decision-making in deceased organ donation, reasons for non-consent and barriers to achieve congruency between SDM and patient wishes. Ultimately, these data will contribute to the development and evaluation of tools and training for healthcare providers to support SDMs in making decisions about organ donation. TRIAL REGISTRATION NUMBER NCT03850847.
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Affiliation(s)
- Jacob Crawshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Zack van Allen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Kim Jordison
- Canadian Donation and Transplant Research Program, Edmonton, Alberta, Canada
| | - Shane English
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Medicine (Critical Care), University of Ottawa, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Francois Lauzier
- Population Health and Optimal Health Practices Unit (Trauma-Emergency-Critical Care Medicine), CHU de Quebec-Universite Laval, Quebec City, Québec, Canada
- Department of Anesthesiology and Critical Care, Division of Critical Care Medicine, Université Laval, Quebec City, Québec, Canada
| | - Alexis F Turgeon
- Population Health and Optimal Health Practices Unit (Trauma-Emergency-Critical Care Medicine), CHU de Quebec-Universite Laval, Quebec City, Québec, Canada
- Department of Anesthesiology and Critical Care, Division of Critical Care Medicine, Université Laval, Quebec City, Québec, Canada
| | - Aimee J Sarti
- Critical Care Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Claudio Martin
- Medicine (Critical Care), Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Frédérick D'Aragon
- Anesthesiology, Universite de Sherbrooke Faculte de medecine et des sciences de la sante, Sherbrooke, Quebec, Canada
- Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - Alvin Ho-Ting Li
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Greg Knoll
- University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Ian Ball
- Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Jamie Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Karen E A Burns
- Critical Care, St Michael's Hospital, Toronto, Ontario, Canada
| | - Marie-Chantal Fortin
- Medicine (Critical Care), Centre Hospitalier de L'Universite de Montreal, Montréal, Québec, Canada
- Medicine (Critical Care), Université de Montréal, Montreal, Québec, Canada
| | - Matthew Weiss
- Canadian Donation and Transplant Research Program, Edmonton, Alberta, Canada
- Trauma-Emergency-Critical Care Medicine, Université Laval Faculté de médecine, Quebec City, Quebec, Canada
| | - Maureen Meade
- Medicine (Critical Care), McMaster University, Hamilton, Ontario, Canada
| | - Pierre Marsolais
- Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada
| | - Sam Shemie
- Critical Care, McGill University, Montreal, Québec, Canada
| | | | | | - Simon C Kitto
- Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada
| | - Michaël Chassé
- Innovation Hub, Centre de Recherche du CHUM, Montréal, Québec, Canada
- Medicine (Critical Care), Centre Hospitalier de L'Universite de Montreal, Montréal, Québec, Canada
- Medicine (Critical Care), Université de Montréal, Montreal, Québec, Canada
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22
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Greenberg R, Ballesteros-Gallego F, Allard J, Fortin MC. Organ Transplantation for Foreign Nationals in Canada: A Survey of Transplant Professionals. Can J Kidney Health Dis 2019; 6:2054358119859530. [PMID: 31308952 PMCID: PMC6607567 DOI: 10.1177/2054358119859530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 01/30/2019] [Accepted: 05/09/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Transplantation for foreign nationals (non-citizens and non-residents) (FNs) in Canada is a complex issue. Currently, there are no Canadian guidelines for the provision of organ transplantation for FNs, and no empirical data on this issue or on transplant professionals’ practices are available. Objective: This project aimed to gather empirical data on transplant professionals’ perspectives and practices regarding transplantation for FNs. Design: Survey research design. Setting: A Web-based survey of members of the Canadian Society of Transplantation (CST). Participants: All members of the CST were invited to participate between April and June 2016. Measurements: Multiple-choice questions were developed to capture participants’ attitudes toward different fictitious clinical scenarios in which an FN needed a transplant, their experiences with FNs, their attitude toward FNs in need of transplantation, their knowledge about relevant institutional and organ donation organization (ODO) policies, and their perspectives on a quota. There were two questions with a five-point Likert scale to measure respondents’ agreement with statements related to possible policy options and arguments for and against transplantation for FNs. There was one open-ended question about the content of transplant programs’ policies on transplantation for FNs. Methods: Descriptive statistical analysis were performed. Results: A total of 87 transplant professionals completed the survey. Over the 4-year period from 2012 to 2016, 47.1% of respondents dealt with at least one situation of listing or performing a transplant for an FN. Only 19.5% of respondents reported that their transplant program had a policy about transplantation for FNs and 59.7% did not know if their ODO had such a policy. When asked about policy options, 47.5% disagreed with a policy of no transplantation for FNs and 41.4% agreed with offering transplantation for FNs in some circumstances (including life-saving and non–life-saving organs). Study participants agreed that transplantation should not be offered to FNs traveling to Canada specifically for transplantation, that FNs should not be transplanted with organs not suitable for Canadian citizens and that there should not be a transplantation quota for FNs. Participants also seem to be more inclined to offer transplantation of life-saving organs, particularly for children. Limitations: The major limitation of this study is the low response rate of transplant professionals to this survey. Conclusion: This is the first study to describe Canadian transplant professionals’ perspectives on transplantation for FNs. The findings of this study will be of interest for future policy development on access to transplantation for FNs. Further studies are needed to gather various key stakeholders’ perspectives on this issue, as well as to analyze the legal and ethical issues and the economics, to develop future policies.
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Affiliation(s)
- Rebecca Greenberg
- Department of Bioethics, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, ON, Canada.,The Canadian Donation and Transplant Research Program, Edmonton, AB, Canada
| | - Fabián Ballesteros-Gallego
- The Canadian Donation and Transplant Research Program, Edmonton, AB, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Julie Allard
- The Canadian Donation and Transplant Research Program, Edmonton, AB, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Marie-Chantal Fortin
- The Canadian Donation and Transplant Research Program, Edmonton, AB, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Université de Montréal, QC, Canada
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23
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Massierer D, Sapir-Pichhadze R, Bouchard V, Dasgupta K, Fernandez N, da Costa D, Ahmed S, Fortin MC, Langevin R, Mayo N, Janaudis-Ferreira T. Web-Based Self-Management Guide for Kidney Transplant Recipients (The Getting on With Your Life With a Transplanted Kidney Study): Protocol for Development and Preliminary Testing. JMIR Res Protoc 2019; 8:e13420. [PMID: 31237243 PMCID: PMC6613326 DOI: 10.2196/13420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/25/2019] [Accepted: 04/12/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Although it is well known that compared with dialysis, kidney transplantation improves the quality of life (QoL) of patients with end-stage renal disease, posttransplant recovery of physical health and other aspects of QoL remain well below age- and sex-matched norms. In addition, most transplant recipients are not physically active even years after the transplant and face several barriers to engaging in physical activity (PA). This is of concern as low levels of PA in transplant recipients has been associated with increased risk of mortality and poor graft function. Optimization of QoL needs a team approach involving the patients and the members of the health care team. While members of the health care team are focused on optimizing the biological responses to transplant, patients may have few or no tools at their disposal to engage in behaviors that optimize QoL. To accomplish the need of supporting these patients in the self-management of their condition and to facilitate engagement with PA, new tools tailored to this population are required. OBJECTIVE The aim of this protocol study is to develop a Web-based, patient-centered self-management intervention to promote a healthy lifestyle, increase daily PA, and improve QoL in kidney transplant recipients. METHODS We will use the Obesity-Related Behavioral Intervention Trials model for developing behavioral treatments for chronic diseases to guide the proposed project. We will follow a modified version of the iterative 10-step process that was used to develop educational material for people with multiple sclerosis. The development of the intervention will occur in partnership with patients and a multidisciplinary team of clinicians and researchers. A comprehensive needs assessment including data from our pilot study, literature review, and focus groups will be conducted. The focus groups will be conducted with 6 to 10 participants for each type of stakeholders: patients and professional experts to identify areas of concerns of kidney transplant recipients that are appropriate to address through self-management. The areas of concern identified through the assessment needs will be included in the website. RESULTS This study has received funding from the Kidney Foundation of Canada for 2 years (2018-2020) and was recently granted ethics approval. Investigators have begun conducting the needs assessment described in step 1 of the study. The study is expected to be completed by the end of 2020. CONCLUSIONS This will be the first comprehensive, evidence- and experience-based self-management program for kidney transplant recipients. Once the intervention is developed, we anticipate improvements in patient experience, shared decision making, daily PA, QoL, and, in future studies, improvements in health outcomes and demonstrations of cost savings in posttransplant care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/13420.
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Affiliation(s)
- Daniela Massierer
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Ruth Sapir-Pichhadze
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Division of Nephrology and Multi-Organ Transplant Program, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Vanessa Bouchard
- Hôpital de Chicoutimi, Centre intégré universitaire de santé et services sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, QC, Canada
| | - Kaberi Dasgupta
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Division of Endocrinology & Metabolism, McGill University Health Centre, Montreal, QC, Canada.,Division of Internal Medicine, McGill University Health Centre, Montreal, QC, Canada.,Metabolic Disorders and Complications, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Nicolas Fernandez
- Department of Family Medicine and Emergency Medicine, University of Montreal, Montreal, QC, Canada
| | - Deborah da Costa
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Division of Internal Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Sara Ahmed
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | | | - Rosalie Langevin
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Nancy Mayo
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Division of Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada.,Division of Geriatrics, McGill University Health Centre, Montreal, QC, Canada
| | - Tania Janaudis-Ferreira
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.,Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
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Guignard VV, Fortin MC. Emerging Ethical Challenges in Living Kidney Donation. Curr Transpl Rep 2019. [DOI: 10.1007/s40472-019-00241-6] [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: 10/26/2022]
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25
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van Beinum A, Talbot H, Hornby L, Fortin MC, Dhanani S. Engaging family partners in deceased organ donation research—a reflection on one team’s experience. Can J Anaesth 2019; 66:406-413. [DOI: 10.1007/s12630-018-01287-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/04/2018] [Accepted: 10/04/2018] [Indexed: 11/29/2022] Open
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Sandal S, Charlebois K, Fiore JF, Wright DK, Fortin MC, Feldman LS, Alam A, Weber C. Health Professional-Identified Barriers to Living Donor Kidney Transplantation: A Qualitative Study. Can J Kidney Health Dis 2019; 6:2054358119828389. [PMID: 30792874 PMCID: PMC6376531 DOI: 10.1177/2054358119828389] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 10/02/2018] [Accepted: 12/18/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Living donor kidney transplantation (LDKT) has several advantages over deceased donor kidney transplantation. Yet rates of living donation are declining in Canada and there exists significant interprovincial variability. Efforts to improve living donation tend to focus on the patient and barriers identified at their level, such as not knowing how to ask for a kidney or lack of education. These efforts favor those who have the means and the support to find living donors. Thus, a Canadian Institutes of Health Research (CIHR)-organized workshop recommended that education efforts to understand and remove barriers should focus on health professionals (HPs). Despite this, little attention has been paid to what they identify as barriers to discussing LDKT with their patients. OBJECTIVE Our aim was to explore HP-identified barriers to discuss living donation with patients in 3 provinces of Canada with low (Quebec), moderate (Ontario), and high (British Columbia) rates of LDKT. DESIGN This study consists of an interpretive descriptive approach as it enables to move beyond description and inform clinical practice. SETTING Purposive criterion and quota sampling were used to recruit HPs from Quebec, Ontario, and British Columbia who are involved in the care of patients with kidney disease and/or with transplant coordination. PATIENTS Not applicable. MEASUREMENTS Semistructured interviews were conducted. The interview guide was developed based on a preliminary analytical framework and a review of the literature. METHODS Thematic analysis was used to analyze the data stemming from the interviews. The coding process comprised of a deductive and inductive approach, and the use of a qualitative analysis software (NVivo 11). Following this, themes were identified and developed. Interviews were conducted until thematic saturation was obtained. In total, we conducted 16 telephone interviews as thematic saturation was attained. RESULTS Six predominant themes emerged: (1) lack of communication between transplant and dialysis teams, (2) absence of referral guidelines, (3) role perception and lack of multidisciplinary involvement, (4) HP's lack of information and training, (5) negative attitudes of some HP toward LDKT, (6) patient-level barriers as defined by the HP. HPs did mention patients' attitudes and some characteristics as the main barriers to discussions about living donation; this was noted in all provinces. HPs from Ontario and British Columbia indicated multiple strategies being implemented to address some of these barriers. Those from Ontario mentioned strategies that center on the core principles of provincial-level standardization, while those from British Columbia center on engaging the entire multidisciplinary team and improved role perception. We noted a dearth of such efforts in Quebec; however, efforts around education and promotion, while tentative, have emerged. LIMITATIONS Social desirability and selection bias. Our analysis might not be applicable to other provinces. CONCLUSIONS HPs involved with the referral and coordination of transplantation play a major role in access to LDKT. We have identified challenges they face when discussing living donation with their patients that warrant further assessment and research to inform policy change.
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Affiliation(s)
- Shaifali Sandal
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | | | - Julio F. Fiore
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - David Kenneth Wright
- St. Mary’s Research Center, Montreal, QC, Canada
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Marie-Chantal Fortin
- Division of Nephrology, Department of Medicine, Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Liane S. Feldman
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Ahsan Alam
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Catherine Weber
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
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Côté J, Fortin MC, Auger P, Rouleau G, Dubois S, Boudreau N, Vaillant I, Gélinas-Lemay É. Web-Based Tailored Intervention to Support Optimal Medication Adherence Among Kidney Transplant Recipients: Pilot Parallel-Group Randomized Controlled Trial. JMIR Form Res 2018; 2:e14. [PMID: 30684400 PMCID: PMC6334708 DOI: 10.2196/formative.9707] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/16/2018] [Accepted: 06/18/2018] [Indexed: 12/05/2022] Open
Abstract
Background Optimal immunosuppressive medication adherence is essential to graft survival. Transplant-TAVIE is a Web-based tailored intervention developed to promote this adherence. Objective The objective of our study was to evaluate the Transplant-TAVIE intervention’s acceptability, feasibility, and preliminary efficacy. Methods In a pilot, parallel-group, randomized controlled trial, we randomly assigned a convenience sample of 70 kidney transplant patients on immunosuppressive medication either to an experimental group (Transplant-TAVIE) or to a control group (existing websites). Kidney transplant recipients had to be older than 18 years, be taking immunosuppressant medication, and have access to the internet to participate in this study. Transplant-TAVIE was composed of three interactive Web-based sessions hosted by a virtual nurse. We documented user appreciation of and exposure to the intervention. Furthermore, we assessed medication adherence, medication self-efficacy, intake-related skills, and medication side effects at baseline and 3 and 6 months later. Analyses of variance were used to assess intergroup differences over time. Results After baseline questionnaire completion, participants were randomly assigned either to Transplant-TAVIE (n=35) or to the websites (n=35) group. All participants had received their kidney graft <1 year to 32 years earlier (mean 6.8 years). Of the experimental group, 54% (19/35) completed the sessions of Transplant-TAVIE. Users found the intervention to be acceptable—33% were extremely satisfied (6/18), 39% were very satisfied (7/18), and 28% were satisfied (5/18). At baseline and over time, both experimental and control groups reported high medication adherence, high medication self-efficacy, and frequent use of skills related to medication intake. No intergroup differences emerged over time. Conclusions The results of this study support the feasibility and acceptability of Transplant-TAVIE. It could constitute an accessible adjunct in support of existing specialized services.
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Affiliation(s)
- José Côté
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada.,Faculty of Nursing, Université de Montréal, Montreal, QC, Canada.,Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Marie-Chantal Fortin
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.,Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Patricia Auger
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada.,Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Geneviève Rouleau
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada.,Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Sylvie Dubois
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | - Nathalie Boudreau
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Isabelle Vaillant
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
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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.
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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
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29
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Allard J, Fortin MC. Organ donation after medical assistance in dying or cessation of life-sustaining treatment requested by conscious patients: the Canadian context. J Med Ethics 2017; 43:601-605. [PMID: 28031256 DOI: 10.1136/medethics-2016-103460] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 11/03/2016] [Accepted: 12/01/2016] [Indexed: 06/06/2023]
Abstract
In June 2016, following the decision of the Supreme Court of Canada to decriminalise assistance in dying, the Canadian government enacted Bill C-14, legalising medical assistance in dying (MAID). In 2014, the province of Quebec had passed end-of-life care legislation making MAID available as of December 2015. The availability of MAID has many implications, including the possibility of combining this practice with organ donation through the controlled donation after cardiac death (cDCD) protocol. cDCD most often occurs in cases where the patient has a severe neurological injury but does not meet all the criteria for brain death. The donation is subsequent to the decision to withdraw life-sustaining treatment (LST). Cases where patients are conscious prior to the withdrawal of LST are unusual, and have raised doubts as to the acceptability of removing organs from individuals who are not neurologically impaired and who have voluntarily chosen to die. These cases can be compared with likely scenarios in which patients will request both MAID and organ donation. In both instances, patients will be conscious and competent. Organ donation in such contexts raises ethical issues regarding respect for autonomy, societal pressure, conscientious objections and the dead-donor rule. In this article, we look at relevant policies in other countries and examine the ethical issues associated with cDCD in conscious patients who choose to die.
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Affiliation(s)
- Julie Allard
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Bioethics Program, Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Bioethics Program, Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada
- Nephrology and Transplantation Division, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
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30
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Gill JS, Tinckam K, Fortin MC, Rose C, Shick-Makaroff K, Young K, Lesage J, Cole EH, Toews M, Landsberg DN, Gill J. Reciprocity to Increase Participation of Compatible Living Donor and Recipient Pairs in Kidney Paired Donation. Am J Transplant 2017; 17:1723-1728. [PMID: 28321984 DOI: 10.1111/ajt.14275] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 01/19/2017] [Revised: 03/02/2017] [Accepted: 03/09/2017] [Indexed: 01/25/2023]
Abstract
Inclusion of compatible living donor and recipient pairs (CPs) in kidney paired donation (KPD) programs could increase living donor transplantation. We introduce the concept of a reciprocity-based strategy in which the recipient of a CP who participates in KPD receives priority for a repeat deceased donor transplant in the event their primary living donor KPD transplant fails, and then we review the practical and ethical considerations of this strategy. The strategy limits prioritization to CPs already committed to living donation, minimizing the risk of unduly influencing donor behavior. The provision of a tangible benefit independent of the CP's actual KPD match avoids many of the practical and ethical challenges with strategies that rely on finding the CP recipient a better-matched kidney that might provide the CP recipient a future benefit to increase KPD participation. Specifically, the strategy avoids the potential to misrepresent the degree of future benefit of a better-matched kidney to the CP recipient and minimizes delays in transplantation related to finding a better-matched kidney. Preliminary estimates suggest the strategy has significant potential to increase the number of living donor transplants. Further evaluation of the acceptance of this strategy by CPs and by waitlisted patients is warranted.
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Affiliation(s)
- J S Gill
- Division of Nephrology, University of British Columbia, Vancouver, Canada.,Centre for Health Evaluation and Outcomes Sciences, Vancouver, Canada.,Division of Nephrology, Tuft-New England Medical Center, Boston, MA
| | - K Tinckam
- Department of Laboratory Medicine and Pathobiology, University Health Network, University of Toronto, Toronto, Canada
| | - M C Fortin
- Department of Nephrology and Transplantation, Centre Hospitalier de l'Université de Montréal, Montreal, Canada.,Centre de Recherché du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - C Rose
- Division of Nephrology, University of British Columbia, Vancouver, Canada.,Centre for Health Evaluation and Outcomes Sciences, Vancouver, Canada
| | | | - K Young
- Canadian Blood Services, Ottawa, Canada
| | - J Lesage
- Division of Nephrology, University of British Columbia, Vancouver, Canada
| | - E H Cole
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Canada
| | - M Toews
- Health Law Institute, Faculty of Law, University of Alberta, Alberta, Canada
| | - D N Landsberg
- Division of Nephrology, University of British Columbia, Vancouver, Canada
| | - J Gill
- Division of Nephrology, University of British Columbia, Vancouver, Canada.,Centre for Health Evaluation and Outcomes Sciences, Vancouver, Canada
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Simard-Meilleur MC, Bodson-Clermont P, St-Louis G, Pâquet MR, Girardin C, Fortin MC, Cardinal H, Hébert MJ, Lévesque R, Renoult E. Stabilization of renal function after the first year of follow-up in kidney transplant recipients treated for significant BK polyomavirus infection or BK polyomavirus-associated nephropathy. Transpl Infect Dis 2017; 19. [DOI: 10.1111/tid.12681] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/25/2016] [Accepted: 11/19/2016] [Indexed: 12/20/2022]
Affiliation(s)
| | - Paule Bodson-Clermont
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal; Montréal QC Canada
| | - Gilles St-Louis
- Département de Médecine; Service de Néphrologie; Centre Hospitalier de l'Université de Montréal; Montréal QC Canada
| | - Michel R. Pâquet
- Département de Médecine; Service de Néphrologie; Centre Hospitalier de l'Université de Montréal; Montréal QC Canada
| | - Catherine Girardin
- Département de Médecine; Service de Néphrologie; Centre Hospitalier de l'Université de Montréal; Montréal QC Canada
| | - Marie-Chantal Fortin
- Département de Médecine; Service de Néphrologie; Centre Hospitalier de l'Université de Montréal; Montréal QC Canada
| | - Héloïse Cardinal
- Département de Médecine; Service de Néphrologie; Centre Hospitalier de l'Université de Montréal; Montréal QC Canada
| | - Marie-Josée Hébert
- Département de Médecine; Service de Néphrologie; Centre Hospitalier de l'Université de Montréal; Montréal QC Canada
| | - Renée Lévesque
- Département de Médecine; Service de Néphrologie; Centre Hospitalier de l'Université de Montréal; Montréal QC Canada
| | - Edith Renoult
- Département de Médecine; Service de Néphrologie; Centre Hospitalier de l'Université de Montréal; Montréal QC Canada
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32
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Ambaraghassi G, Cardinal H, Corsilli D, Fortin C, Fortin MC, Martel-Laferrière V, Malaise J, Pâquet MR, Rouleau D. First Canadian Case Report of Kidney Transplantation From an HIV-Positive Donor to an HIV-Positive Recipient. Can J Kidney Health Dis 2017; 4:2054358117695792. [PMID: 28321326 PMCID: PMC5347410 DOI: 10.1177/2054358117695792] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 08/24/2016] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Kidney transplantation has become standard of care for carefully selected patients living with human immunodeficiency virus (HIV) and end-stage renal disease (ESRD) in the highly active antiretroviral therapy (HAART) era. American and European prospective cohort studies have reported similar patient and graft survival compared with HIV-negative kidney transplant recipients. Despite an increased rate of acute rejection, partially due to drug interactions, HIV immunovirologic parameter generally remains under control during immunosuppression. A few cases of kidney transplantation between HIV-infected patients were done in South Africa and showed favorable results. No cases of kidney transplantation from an HIV-positive donor in Canada have previously been reported. PRESENTING CONCERNS OF THE PATIENT A 60-year-old Canadian man with HIV infection presented in 2007 with symptoms compatible with acute renal failure secondary to IgA nephropathy. Chronic kidney disease resulted after the acute episode. DIAGNOSES Hemodialysis was started in 2012. The patient was referred for a kidney transplantation evaluation. INTERVENTIONS The patient underwent kidney transplantation from an HIV-positive donor in January 2016. The recipient's antiretroviral regimen consisted of abacavir, lamivudine, and dolutegravir. No drug interactions have been reported between these antiretrovirals and the maintenance immunosuppressive regimen used. OUTCOMES The outcome at 7 months post transplantation was excellent, with good graft function and adequate control of HIV replication, in the absence of opportunistic infections at a time when immunosuppression is at its highest intensity. No acute rejection was reported. An episode of bacteremic graft pyelonephritis due to Enterococcus faecalis was successfully treated after transplantation. NOVEL FINDING With careful selection of patient, kidney transplantation between HIV-infected patients is a viable option. The use of antiretroviral drugs free of interactions simplified the dosing and management of the immunosuppressive drugs.
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Affiliation(s)
- Georges Ambaraghassi
- Département de Microbiologie médicale et Infectiologie, Hôpital Maisonneuve-Rosemont, Québec, Canada
| | - Héloïse Cardinal
- Département de Néphrologie, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Daniel Corsilli
- Département des Soins intensifs, Hôpital Saint-Luc, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Claude Fortin
- Département de Microbiologie médicale et Infectiologie, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Marie-Chantal Fortin
- Département de Néphrologie, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Valérie Martel-Laferrière
- Département de Microbiologie médicale et Infectiologie, Hôpital Saint-Luc, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Jacques Malaise
- Département de Chirurgie, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Michel R Pâquet
- Département de Néphrologie, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Danielle Rouleau
- Département de Microbiologie médicale et Infectiologie, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Québec, Canada
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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.
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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
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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]
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Cardinal H, Durand C, Larrivée S, Verhave J, Pâquet MR, Fortin MC. Strategies to increase living kidney donation: a retrospective cohort study. Can J Kidney Health Dis 2015; 2:15. [PMID: 25926997 PMCID: PMC4414425 DOI: 10.1186/s40697-015-0049-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 01/08/2015] [Accepted: 03/12/2015] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Living kidney transplantation (LKT) offers the best medical outcomes for organ recipients. Historically, our centre had a low rate of LKT. In 2009, in an effort to increase living organ donation (LOD), a dedicated team was created. Its mandate was to promote LOD at our centre and at referring centres, to coordinate assessments of living organ donors, to facilitate the process, and to ensure long-term follow-up after the donation. In November 2010, our centre joined the national living donor paired exchange registry (LDPE). OBJECTIVE To document the impact of the LOD team and LDPE registry on LOD rates at our centre. DESIGN Retrospective cohort study. SETTING Single center study in a university hospital with an adult kidney transplant program. PATIENTS Using our electronic database, we included all potential living organ donors who contacted our centre from 01/01/2005 to 31/12/2008 and from 01/01/2009 to 31/12/2012. Follow-up was conducted until 31/12/2013. MEASUREMENTS Number of transplantations from living donors, number of potential donors who contacted the centre, donor and recipient characteristics. METHODS We compared the number of transplantations from living donors performed and the number of potential donors who contacted the centre before and after the creation of the LOD team and participation in the LDPE. RESULTS A total of 50 renal transplantations were performed using organs from living donors during the first time period, whereas this increased to 73 in the 2009-2012 cohort (incidence rate difference (IRD): 0.030, 95% confidence interval (CI) 0.003-0.056). We also observed a significant increase in the number of individuals who contacted our centre to donate a kidney. During the 2005-2008 period (cohort 1), 191 individuals interested in donating a kidney contacted our centre, whereas this figure was 304 during the 2009-2012 period (cohort 2) (IRD: 0.143, 95% CI 0.091-0.196). LIMITATIONS Single center study, relatively low sample size. CONCLUSION The implementation of a LOD team, combined with our participation in the LDPE registry, was associated with a significant increase in the actual number of living kidney transplantations performed. These data support initiatives such as the creation of dedicated LOD teams and LDPE registry to increase LKT.
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Affiliation(s)
- Héloïse Cardinal
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Canada ; Nephrology and Transplantation Division, Centre hospitalier de l'Université de Montréal (CHUM), 1560 Sherbrooke Street East, H2L 4M1 Montreal, QC Canada
| | - Céline Durand
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
| | - Sandra Larrivée
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
| | - Jacobien Verhave
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
| | - Michel R Pâquet
- Nephrology and Transplantation Division, Centre hospitalier de l'Université de Montréal (CHUM), 1560 Sherbrooke Street East, H2L 4M1 Montreal, QC Canada
| | - Marie-Chantal Fortin
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Canada ; Nephrology and Transplantation Division, Centre hospitalier de l'Université de Montréal (CHUM), 1560 Sherbrooke Street East, H2L 4M1 Montreal, QC Canada ; Bioethics Program, Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montréal, Canada
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Abstract
In Canada, there are currently no guidelines at either the federal or provincial level regarding the provision of kidney transplantation services to foreign nationals (FN). Renal transplant centres have, in the past, agreed to put refugee claimants and other FNs on the renal transplant waiting list, in part, because these patients (refugee claimants) had health insurance through the Interim Federal Health Programme to cover the costs of medication and hospital care. However, severe cuts recently made to this programme have forced clinicians to question whether they should continue with transplants for FNs, for financial and ethical reasons. This paper first examines different national policies (eg, in Canada, USA, France and the UK) to map the diversity of approaches regarding transplantation for FNs, and then works through different considerations commonly used to support or oppose the provision of organs to these patients: (1) the organ shortage; (2) the free-rider problem; (3) the risk of becoming a transplant destination; (4) the impact on organ donation rates; (5) physicians' duties; (6) economic concerns; (7) vulnerability. Using a Canadian case as a focus, and generalising through a review of various national policies, we analyse the arguments for and against transplantation for FNs with a view to bringing clarity to what is a sensitive political and clinical management issue. Our aim is to help transplant centres, clinicians and ethicists reflect on the merits of possible options, and the rationales behind them.
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Affiliation(s)
- Marie-Chantal Fortin
- Nephrology and Transplantation Division, Centre hospitalier de l'Université de Montréal, Montreal (CHUM), Canada Département de médecine sociale et préventive, École de santé publique de l'Université de Montréal, Montréal, Canada
| | - Bryn Williams-Jones
- Département de médecine sociale et préventive, École de santé publique de l'Université de Montréal, Montréal, Canada
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Allard J, Fortin MC. Is it ethical to prescribe generic immunosuppressive drugs to renal transplant patients? Can J Kidney Health Dis 2014; 1:23. [PMID: 25780612 PMCID: PMC4349684 DOI: 10.1186/s40697-014-0023-8] [Citation(s) in RCA: 5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 08/11/2014] [Indexed: 01/07/2023] Open
Abstract
PURPOSE OF THE REVIEW This review was conducted to determine the ethical acceptability of prescribing generic immunosuppressive drugs to renal transplant patients. SOURCES OF INFORMATION The literature search was conducted using Pubmed and Google Scholar. FINDINGS The use of generic immunosuppressive drugs (ISDs) in transplantation is a controversial topic. There is a consensus among transplant societies that clinical data is lacking and that caution should be exercised. The reluctance to use generic ISDs in organ transplantation is partly related to the fact that most are "critical dose drugs", and that either low dosing or overdosing could have serious adverse consequences for both patients and society (i.e., the loss of scarce organs). In this paper, we examine the various ethical issues involved such as distributive justice, physician duties, risks versus benefits, conflict of interest, informed consent, and logistical and economic issues. LIMITATIONS Our analysis was limited by the paucity of clinical data on generic ISDs and the absence of health economics studies to quantify the benefits of prescribing generic ISDs. IMPLICATIONS Our study led us to conclude that it would be ethical to prescribe generic ISDs provided certain conditions were met. These include regulatory safeguards to minimize the risks of substitution; education of patients; and further clinical and health economics studies to better inform clinicians, patients and society of the risks and costs related to drug substitution.
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Affiliation(s)
- Julie Allard
- Centre de recherche du Centre hospitalier de l′Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montreal, Quebec H2X 0A9 Canada
| | - Marie-Chantal Fortin
- Centre de recherche du Centre hospitalier de l′Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montreal, Quebec H2X 0A9 Canada ,Nephrology and Transplantation Division, Centre hospitalier de l’Université de Montréal (CHUM), 1560 Sherbrooke Street East, Montreal, Quebec H2L 4 M1 Canada ,Department of Social and Preventive Medicine, Bioethics Program, School of Public Health, Université de Montréal, Montreal, Canada
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Fortin MC. Is the Canadian Legal Framework Too Restrictive and Based on False Premises? Can J Kidney Health Dis 2014; 1:8. [PMID: 25780603 PMCID: PMC4349664 DOI: 10.1186/2054-3581-1-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 05/16/2014] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marie-Chantal Fortin
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
- Bioethics Program, Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montreal, Canada
- Nephrology and Transplantation Division, Centre hospitalier de l'Université de Montréal (CHUM), 1560 Sherbrooke Street East, Montreal, Quebec H2L 4M1, Canada
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Allard J, Goldberg A, Fortin MC. Regulated markets of kidneys in developed countries or how to increase health inequities. Am J Bioeth 2014; 14:44-45. [PMID: 25229586 DOI: 10.1080/15265161.2014.947442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Julie Allard
- a Centre de recherche du centre hospitalier de I'Université de Montréal
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Abstract
Living kidney transplantation offers the best results for patients with end-stage renal disease (ESRD). This form of transplantation is no longer restricted to genetically or emotionally related donors, as shown by the acceptance of non-directed living anonymous donors, and the development of exchange programmes (EPs). EPs make it possible to perform living kidney transplantation among incompatible pairs, but while such programmes can help increase living organ donation, they can also create a degree of unfairness. Kidney transplant recipients in the O blood group are at a disadvantage when it comes to EPs because they can only receive organs from O donors, whereas O donors are universal donors. This poses a major challenge in terms of distributive justice and equity. A way to remedy this situation is through altruistic unbalanced paired kidney exchange (AUPKE), in which a compatible pair consisting of an O blood group donor and a non-O recipient is invited to participate in an EP. Although the AUPKE approach appears fairer for O recipients, it still raises ethical questions. How does this type of exchange affect the donor/recipient gift relationship? Should recipients in compatible pairs receive a 'better organ' than the one they would otherwise have received from their intended donor? Finally, what is the role of transplant teams in AUPKE? This article will examine the organisational and ethical challenges associated with EPs and AUPKE, and compare different EP policies in countries where such programmes exist.
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Affiliation(s)
- Marie-Chantal Fortin
- Department of Nephrology and Transplantation, Centre Hospitelier de l'Université de Montréal, , Montreal, Quebec, Canada
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Durand C, Duplantie A, Chabot Y, Doucet H, Fortin MC. How is organ transplantation depicted in internal medicine and transplantation journals. BMC Med Ethics 2013; 14:39. [PMID: 24219177 PMCID: PMC3849931 DOI: 10.1186/1472-6939-14-39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 09/24/2013] [Indexed: 11/10/2022] Open
Abstract
Background In their book Spare Parts, published in 1992, Fox and Swazey criticized various aspects of organ transplantation, including the routinization of the procedure, ignorance regarding its inherent uncertainties, and the ethos of transplant professionals. Using this work as a frame of reference, we analyzed articles on organ transplantation published in internal medicine and transplantation journals between 1995 and 2008 to see whether Fox and Swazey’s critiques of organ transplantation were still relevant. Methods Using the PubMed database, we retrieved 1,120 articles from the top ten internal medicine journals and 4,644 articles from the two main transplantation journals (Transplantation and American Journal of Transplantation). Out of the internal medicine journal articles, we analyzed those in which organ transplantation was the main topic (349 articles). A total of 349 articles were randomly selected from the transplantation journals for content analysis. Results In our sample, organ transplantation was described in positive terms and was presented as a routine treatment. Few articles addressed ethical issues, patients’ experiences and uncertainties related to organ transplantation. The internal medicine journals reported on more ethical issues than the transplantation journals. The most important ethical issues discussed were related to the justice principle: organ allocation, differential access to transplantation, and the organ shortage. Conclusion Our study provides insight into representations of organ transplantation in the transplant and general medical communities, as reflected in medical journals. The various portrayals of organ transplantation in our sample of articles suggest that Fox and Swazey’s critiques of the procedure are still relevant.
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Fortin MC, Williams-Jones B. Who should travel in kidney exchange programs: the donor, or the organ? Open Med 2011; 5:e23-5. [PMID: 22046215 PMCID: PMC3205812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 10/18/2010] [Accepted: 10/18/2010] [Indexed: 11/29/2022]
Abstract
In 2009 the Canadian Blood services launched the Living Donor Paired Exchange Registry. This program circumvents the obstacle presented by blood-group or immunologic incompatibility between a living potential donor and his or her intended recipient. At the beginning, only 3 provinces joined the program, but as of October 2010 all Canadian provinces are participants. Up to now, participating donors have travelled to recipients’ transplant centres. We might question whether, in a country such as Canada, the donor or the organ should travel. In this article, we review the arguments for donor travel and the arguments for shipping the kidney.
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Fortin MC, Dion-Labrie M, Hébert MJ, Doucet H. The enigmatic nature of altruism in organ transplantation: a cross-cultural study of transplant physicians' views on altruism. BMC Res Notes 2010; 3:216. [PMID: 20673349 PMCID: PMC3161367 DOI: 10.1186/1756-0500-3-216] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 07/30/2010] [Indexed: 11/15/2022] Open
Abstract
Background Although altruism is a key principle in our current organ donation and transplantation system, the meanings and implications of the term have been widely debated. Recently, a new type of living organ donation--anonymous and non-directed, also called living altruistic donation (LAD)--has brought the issue into sharper focus. Transplant physicians' views on altruism might influence their attitudes and actions toward living altruistic donors. This study aimed to explore such views among transplant physicians in France and Quebec. Findings A total of 27 French and 19 Quebec transplant physicians participated in individual, semi-structured interviews between October 2004 and December 2005. The majority of these participants associated altruism with gratuitousness and saw altruistic acts as multiple and varied, ranging from showing consideration to saving a person's life. Conclusions The transplant physicians' discourses on altruism were quite diverse, leading us to question the relevance of the concept in organ transplantation and the appropriateness of the term "living altruistic donation."
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Affiliation(s)
- Marie-Chantal Fortin
- Nephrology and Transplantation Division, Centre Hospitalier de l'Université de Montréal, 1560 Sherbrooke East Street, Montreal, Quebec, H2L 4M1, Canada.
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Dion-Labrie M, Fortin MC, Hébert MJ, Doucet H. The use of personalized medicine for patient selection for renal transplantation: physicians' views on the clinical and ethical implications. BMC Med Ethics 2010; 11:5. [PMID: 20380726 PMCID: PMC2859770 DOI: 10.1186/1472-6939-11-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [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: 08/24/2009] [Accepted: 04/09/2010] [Indexed: 01/19/2023] Open
Abstract
Background The overwhelming scarcity of organs within renal transplantation forces researchers and transplantation teams to seek new ways to increase efficacy. One of the possibilities is the use of personalized medicine, an approach based on quantifiable and scientific factors that determine the global immunological risk of rejection for each patient. Although this approach can improve the efficacy of transplantations, it also poses a number of ethical questions. Methods The qualitative research involved 22 semi-structured interviews with nephrologists involved in renal transplantation, with the goal of determining the professionals' views about calculating the global immunological risk and the attendant ethical issues. Results The results demonstrate a general acceptance of this approach amongst the participants in the study. Knowledge of each patient's immunological risk could improve treatment and the post-graft follow-up. On the other hand, the possibility that patients might be excluded from transplantation poses a significant ethical issue. This approach is not seen as something entirely new, given the fact that medicine is increasingly scientific and evidence-based. Although renal transplantation incorporates scientific data, these physicians believe that there should always be a place for clinical judgment and the physician-patient relationship. Conclusions The participants see the benefits of including the calculation of the global immunological risk within transplantation. Such data, being more precise and rigorous, could be of help in their clinical work. However, in spite of the use of such scientific data, a place must be retained for the clinical judgment that allows a physician to make decisions based on medical data, professional expertise and knowledge of the patient. To act in the best interests of the patient is key to whether the calculation of the global immunological risk is employed.
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Affiliation(s)
- Marianne Dion-Labrie
- Groupe de recherche en bioéthique, Université de Montréal, P,O, Box 6128, Downtown Station, Montreal, Quebec H3C3J7, Canada.
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Dion-Labrie M, Fortin MC, Hébert MJ, Doucet H. Use of personalized medicine in the selection of patients for renal transplantation: views of Quebec transplant physicians and referring nephrologists. Per Med 2009; 6:485-499. [PMID: 29783306 DOI: 10.2217/pme.09.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM To explore the views of physicians on the use of personalized medicine tools to develop a new method for selecting potential recipients of a renal allograft. METHODS A total of 22 semidirected interviews, using clinical case studies. RESULTS According to the participants, this method has several possible applications within renal transplantation (individualizing immunosuppressive therapy, help with decision making, and possibly with the selection of patients). It could be more effective than the method presently used. The method must be validated scientifically, and must also involve clinical judgment. CONCLUSION The use of personalized medicine within transplantation must be in the best interests of the patient. An ethical reflection is necessary in order to focus on the possibility of patients being excluded, as well as on the resolution of the equity/efficacy dilemma. Empirical research has shown itself to be essential for ascertaining the views of the clinicians who will be working with the tools provided by personalized medicine.
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Affiliation(s)
- Marianne Dion-Labrie
- Groupe de recherche en bioéthique, Université de Montréal, P.O. Box 6128, Downtown Station, Montreal, Quebec, H3C 3J7, Canada.
| | - Marie-Chantal Fortin
- Centre Hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame, Québec, Canada
| | - Marie-Josée Hébert
- Shire Chair in Nephrology and Renal Transplantation and Regeneration Research Centre, Hôpital Notre-Dame, Québec, Canada
| | - Hubert Doucet
- Bioethics Department, Université de Montréal, Québec, Canada
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Fortin MC, Dion-Labrie M, Hébert MJ, Achille M, Doucet H. Are ‘anonymous’ and ‘non-directed’ prerequisites for living altruistic donation? The views of transplant physicians from France and Québec. Soc Sci Med 2008; 67:147-51. [DOI: 10.1016/j.socscimed.2008.02.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Indexed: 11/30/2022]
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Abstract
BACKGROUND The expansion of kidney transplantation by living donation has led to a disproportional increase in the women to men ratio among donors and this difference cannot be explained on the basis of medical exclusion. The present study was designed to test whether women donors are more likely to (i) display altruistic and gender-typed nurturing behaviour and (ii) be subtly influenced by family pressure to donate and less able to resist this pressure. METHODS All 71 (61% women) individuals who had donated a kidney at our centre between 1995 and 2005 were sent a survey. Thirty-nine individuals (71% response rate; 64% female participation) filled out and returned the survey, which included standardized measures of altruism, self-esteem, family dynamics and endorsement of gender-stereotyped roles, as well as sociodemographic questions and questions about donation. RESULTS Findings show no difference between women and men in terms of the psychological attributes measured. One woman and two men reported having felt pressure to donate, and 92% of women compared with 54% of men reported having felt free to change their mind. Men took longer than women to make the decision to donate. CONCLUSIONS Results suggest that among individuals who have already donated, there is no evidence that women may be more inclined to donate than man because of differences in their psychosocial profiles or because they may be more vulnerable to family pressure. Future research may gain from focusing on men and women donors and non-donors in families where transplantation is being considered.
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Affiliation(s)
- Marie Achille
- Department of Psychology, Université de Montréal, Montreal, QC, Canada.
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Fortin MC, Roigt D, Doucet H. What Should We Do with Patients Who Buy a Kidney Overseas? The Journal of Clinical Ethics 2007. [DOI: 10.1086/jce200718105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Fortin MC, Roigt D, Doucet H. What should we do with patients who buy a kidney overseas? J Clin Ethics 2007; 18:23-34. [PMID: 17546931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Fortin MC, Raymond MA, Madore F, Fugère JA, Pâquet M, St-Louis G, Hébert MJ. Increased risk of thrombotic microangiopathy in patients receiving a cyclosporin-sirolimus combination. Am J Transplant 2004; 4:946-52. [PMID: 15147429 DOI: 10.1111/j.1600-6143.2004.00428.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [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: 01/25/2023]
Abstract
A single-center cohort study of kidney and kidney-pancreas recipients was conducted to evaluate the association between new immunosuppressive regimens and risk of thrombotic microangiopathy (TMA). From January 1st,1996 to December 31, 2002, 368 patients received a kidney or kidney-pancreas transplant at our center. Four immunosuppressive regimens were evaluated as potential risk factors of TMA: cyclosporin + mycophenolate mofetil (CsA + MMF), cyclosporin + sirolimus (CsA + SRL), tacrolimus + myophenolate mofetil (FK + MMF), and tacrolimus + sirolimus (FK + SRL). Thirteen patients developed biopsy-proven TMA in the absence of vascular rejection. The incidence of TMA was significantly different in the four immunosuppressive regimens studied (p < 0.001). The incidence of TMA was highest in the CsA + SRL group (20.7%). The relative risk of TMA was 16.1 [95% confidence interval (CI): 4.3-60.8] for patients in the CsA + SRL group as compared with those in the FK + MMF group. We also investigated in vitro the pathophysiological basis of this association. The CsA-SRL combination was found to be the only regimen that concomitantly displayed pro-necrotic and anti-angiogenic activities on arterial endothelial cells. We propose that this combination concurs to development of TMA through dual activities on endothelial cell death and repair.
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Affiliation(s)
- Marie-Chantal Fortin
- CHUM, Notre-Dame Hospital, Nephrology and Transplantation, University of Montreal, Montreal, Quebec, Canada
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