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Neonatal Organ and Tissue Donation for Research: Options Following Death by Natural Causes.

ABSTRACT: The donation of organs and tissues from neonates (birth to 28 days) for transplantation has been a relatively infrequent occurrence. Less common has been the use of neonatal organs and tissues for research. Specific ethical and legal questions beg for rational and transparent guidelines with which to evaluate referrals of potential donors. Donation of organs and tissues from a neonate can play a key role in the care and support provided to families by health care professionals around the time of a neonate's death. We report on the recovery of neonatal organs and tissues for research. A working group made up of bioethicists, neonatologists, lawyers, obstetric practioners as well as organ procurement and tissue banking professionals evaluated legal, ethical and medical issues. Neonatal donor family members were also consulted. Our primary goals were (a) to ensure that referrals were made in compliance with all applicable federal and state laws, regulations and institutional protocols, and (b) to follow acceptable ethical standards. Algorithms and policies designed to assist in the evaluation of potential neonatal donors were developed. Neonatal donation is proving increasingly valuable for research into areas including diabetes, pulmonary, gastrointestinal, genitourinary and neurological development, rheumatoid arthritis, autism, childhood psychiatric and neurologic disorders, treatment of MRSA infection and pediatric emergency resuscitation. The development of policies and procedures will assist medical professionals who wish to offer the option of donation to family members anticipating the death of a neonate.

SUBMITTER: Anderson M

PROVIDER: S-EPMC7223177 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Neonatal Organ and Tissue Donation for Research: Options Following Death by Natural Causes.

Anderson Martha M Youngner Stuart S Smith Regina Dunne RD Nandyal Raja R RR Orlowski Jeffrey P JP Jessie Hill B B Barsman Sarah Gutin SG

Cell and tissue banking 20200313 2

The donation of organs and tissues from neonates (birth to 28 days) for transplantation has been a relatively infrequent occurrence. Less common has been the use of neonatal organs and tissues for research. Specific ethical and legal questions beg for rational and transparent guidelines with which to evaluate referrals of potential donors. Donation of organs and tissues from a neonate can play a key role in the care and support provided to families by health care professionals around the time of ...[more]

PMID: 32166424

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Project description:BackgroundPosthumous organ procurement is hindered by the consenting process. Several consenting systems have been proposed. There is limited information on public relative attitudes towards various consenting systems, especially in Middle Eastern/Islamic countries.MethodsWe surveyed 698 Saudi Adults attending outpatient clinics at a tertiary care hospital. Preference and perception of norm regarding consenting options for posthumous organ donation were explored. Participants ranked (1, most agreeable) the following, randomly-presented, options from 1 to 11: no-organ-donation, presumed consent, informed consent by donor-only, informed consent by donor-or-surrogate, and mandatory choice; the last three options ± medical or financial incentive.ResultsMean(SD) age was 32(9) year, 27% were males, 50% were patients' companions, 60% had???college education, and 20% and 32%, respectively, knew an organ donor or recipient. Mandated choice was among the top three choices for preference of 54% of respondents, with an overall median[25%,75%] ranking score of 3[2,6], and was preferred over donor-or-surrogate informed consent (4[2,7], p?<?0.001), donor-only informed consent (5[3,7], p?<?0.001), and presumed consent (7[3,10], p?<?0.001). The addition of a financial or medical incentive, respectively, reduced ranking of mandated choice to 7[4,9], p?<?0.001, and 5[3,8], p?<?0.001; for donor-or-surrogate informed consent to 7[5,9], p?<?0.001, and 5[3,7], p?=?0.004; and for donor-only informed consent to 8[6,10], p?<?0.001, and 5[3,7], p?=?0.56. Distribution of ranking score of perception of norm and preference were similar except for no-organ donation (11[7,11] vs. 11[6,11], respectively, p?=?0.002). Compared to females, males more perceived donor-or-surrogate informed consent as the norm (3[1,6] vs. 5[3,7], p?<?0.001), more preferred mandated choice with financial incentive option (6[3,8] vs. 8[4,9], p?<?0.001), and less preferred mandated choice with medical incentive option (7[4,9] vs. 5[2,7], p?<?0.001). There was no association between consenting options ranking scores and age, health status, education level, or knowing an organ donor or recipient.ConclusionsWe conclude that: 1) most respondents were in favor of posthumous organ donation, 2) mandated choice system was the most preferred and presumed consent system was the least preferred, 3) there was no difference between preference and perception of norm in consenting systems ranking, and 4) financial (especially in females) and medical (especially in males) incentives reduced preference.

Project description:BACKGROUND:Discussing deceased organ donation can be difficult not only for families but for health professionals who initiate and manage the conversations. It is well recognised that the methods of communication and communication skills of health professionals are key influences on decisions made by families regarding organ donation. METHODS:This multicentre study is being performed in nine intensive care units with follow-up conducted by the Organ and Tissue Donation Service in New South Wales (NSW) Australia. The control condition is pre-intervention usual practice for at least six months before each site implements the intervention. The COMFORT intervention consists of six elements: family conversations regarding offers for organ donation to be led by a "designated requester"; family offers for donation are deferred to the designated requester; the offer of donation is separated from the end-of-life discussion that death is inevitable; it takes place within a structured family donation conversation using a "balanced" approach. Designated requesters may be intensivists, critical care nurses or social workers prepared by attending the three-day national "Family Donation Conversation" workshops, and the half-day NSW Simulation Program. The design is pre-post intervention to compare rates of family consent for organ donation six months before and under the intervention. Each ICU crosses from using the control to intervention condition after the site initiation visit. The primary endpoint is the consent rate for deceased organ donation calculated from 140 eligible next of kin families. Secondary endpoints are health professionals' adherence rates to core elements of the intervention; identification of predictors of family donation decision; and the proportion of families who regret their final donation decision at 90 days. DISCUSSION:The pragmatic design of this study may identify 'what works' in usual clinical settings when requesting organ donation in critical care areas, both in terms of changes in practice healthcare professionals are willing and able to adopt, and the effect this may have on desired outcomes. The findings of this study will be indicative of the potential benefits of the intervention and be relevant and transferrable to clinical settings in other states and countries. TRIAL REGISTRATION:Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613000815763 (24 July 2013). ClinicalTrials.gov: NCT01922310 (14 August 2013) (retrospectively registered).

Project description:BackgroundThe cause of brain injury may influence the number of organs that can be procured and transplanted with donation following neurologic determination of death. We investigated whether the distribution of causes responsible for neurologic death has changed over time and, if so, whether this has had an impact on organ quality, transplantation rates and recipient outcomes.MethodsWe performed a cohort study involving consecutive brain-dead organ donors in southern Alberta between 2003 and 2014. For each donor, we determined last available measures of organ injury and number of organs transplanted, and compared these variables for various causes of neurologic death. We compared trends to national Canadian data for 2000-2013 (2000-2011 for Quebec).ResultsThere were 226 brain-dead organ donors over the study period, of whom 100 (44.2%) had anoxic brain injury, 63 (27.9%) had stroke, and 51 (22.6%) had traumatic brain injury. The relative proportion of donors with traumatic brain injury decreased over time (> 30% in 2003-2005 v. 6%-23% in 2012-2014) (p = 0.004), whereas that with anoxic brain injury increased (14%-37% v. 46%-80%, respectively) (p < 0.001). Nationally, the annual number of brain-dead donors with traumatic brain injury decreased from 4.4 to less than 3 per million population between 2000 and 2013, and that with anoxic brain injury increased from 1.1 to 3.1 per million. Donors with anoxic brain injury had higher concentrations of creatinine, alanine aminotransferase and troponin T, and lower PaO2/FIO2 and urine output than donors with other diagnoses. The average number of organs transplanted per donor was 3.6 with anoxic brain injury versus 4.5 with traumatic brain injury or stroke (p = 0.002).InterpretationAnoxic brain injury has become a leading cause of organ donation after neurologic determination of death in Canada. Organs from donors with anoxic brain injury have a greater degree of injury, and fewer are transplanted. These findings have implications for availability of organs for transplantation in patients with end-stage organ failure.

Project description:BackgroundThis study aimed to investigate differences in knowledge, and attitudes toward deceased organ and tissue donation of emergency physicians. Additionally, we analyzed factors affecting the attitudes toward deceased organ and tissue donation.MethodsWe conducted a survey of specialists and residents registered with the Korean Society of Emergency Medicine in December 2020. The respondents' sex, age, position, personal registration for organ donation, experience of soliciting organ donation, participation in related education, knowledge, and attitude about brain death organ donation, and attitude toward stopping life-sustaining treatments were investigated. According to the characteristics of the respondents (specialists or residents, experience and education on organ and tissue donation), their knowledge and attitude toward deceased organ donation were compared. Stepwise hierarchical multiple regression analysis was used to investigate the factors affecting the attitudes toward deceased organ and tissue donation.ResultsOf the total 428 respondents, there were 292 emergency medicine specialists and 136 medical residents. Specialists and those who registered or wished to donate organs had higher knowledge and attitude scores regarding deceased organ and tissue donation. Those who had experience recommending organ and tissue donation more than 6 times had higher knowledge scores on deceased organ and tissue donation and higher overall scores in attitude. Those who received education from the Korean Organ Donation Agency had higher knowledge scores. Specialists, and those who wished to donate or had registered as organ donors and had a higher life-sustaining treatment attitude score and knowledge about deceased organ and tissue donation, had more positive attitudes toward deceased organ and tissue donation.ConclusionFor more potential deceased organ and tissue donors to be referred for donation, there should be continuous education for emergency physicians on brain-dead organ and tissue donation-related knowledge and procedures. In addition, institutional or systematic improvements that can lead to organ donation when deciding on the withdrawal of life-sustaining treatment should be considered.

Project description:ObjectivesTo collate and synthesise available literature on burnout and compassion fatigue (CF) among organ and tissue donation coordinators (OTDCs) and to respond to the research question: what is known about burnout and CF among OTDCs worldwide?DesignScoping review using Joanna Briggs Institute methodology for scoping reviews.Data sourcesMedline, EMBASE, PsycINFO, CINAHL, LILACS, PTSpubs and grey literature (ResearchGate, OpenGrey, Organ Donation Organization (ODO) websites, open access theses and dissertations) up to April 2020.Study selectionStudies reporting aspects of burnout and CF among OTDCs, including risk and protective factors.Data extractionTwo reviewers independently screened the studies for eligibility and extracted data from chosen sources using a data extraction tool developed for this study; NVIVO was used to perform a qualitative directed content analysis.ResultsThe searches yielded 741 potentially relevant records, of which 29 met the inclusion criteria. The majority of articles were from the USA (n=7, 24%), Canada (n=6, 21%) and Brazil (n=6, 21%), published between 2013 and 2020 (n=13, 45%) in transplant journals (n=11, 38%) and used a qualitative design approach (n=12, 41%). In the thematic analysis, we classified the articles into five categories: (1) burnout characteristics, (2) CF characteristics, (3) coping strategies, (4) protective factors and (5) ambivalence.ConclusionWe identified aspects of burnout and CF among OTDCs, including defining characteristics, demographic predispositions, protective factors, coping strategies, precursors, consequences and personal ambivalences. Researchers described burnout and CF characteristics but did not use consistent terms when referring to CF and burnout, which may have hindered the identification of all relevant sources. This gap should be addressed by the application of consistent terminology, systematic approaches and appropriate research methods that combine quantitative and qualitative investigation to examine the underlying reasons for the development of burnout and CF among OTDCs.

Dataset Information

Neonatal Organ and Tissue Donation for Research: Options Following Death by Natural Causes.

Publications

Neonatal Organ and Tissue Donation for Research: Options Following Death by Natural Causes.

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