The "New Caledonia COVID-19 Paradox": Dramatic Indirect Impact of the Pandemic on Organ Donation and Transplantation in a Nonprevalence Country.
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ABSTRACT:
SUBMITTER: Haidar F
PROVIDER: S-EPMC8295055 | biostudies-literature | 2021 Sep
REPOSITORIES: biostudies-literature
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The "New Caledonia COVID-19 Paradox": Dramatic Indirect Impact of the Pandemic on Organ Donation and Transplantation in a Nonprevalence Country.
Haidar Fadi F Issa Naim N Gourinat Ann-Claire AC Savalle Magali M Chalus Elodie E Laurence Jerome J Chadban Steven S Wyburn Kate K
Kidney international reports 20210722 9
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Project description:The coronavirus 2019 (COVID-19) pandemic has disrupted health systems worldwide, including solid organ donation and transplantation programs. Guidance on how best to screen patients who are potential organ donors to minimize the risks of COVID-19 as well as how best to manage immunosuppression and reduce the risk of COVID-19 and manage infection in solid organ transplant recipients (SOTr) is needed.MethodsIterative literature searches were conducted, the last being January 2021, by a team of 3 information specialists. Stakeholders representing key groups undertook the systematic reviews and generation of recommendations using a rapid response approach that respected the Appraisal of Guidelines for Research and Evaluation II and Grading of Recommendations, Assessment, Development and Evaluations frameworks.ResultsThe systematic reviews addressed multiple questions of interest. In this guidance document, we make 4 strong recommendations, 7 weak recommendations, 3 good practice statements, and 3 statements of "no recommendation."ConclusionsSOTr and patients on the waitlist are populations of interest in the COVID-19 pandemic. Currently, there is a paucity of high-quality evidence to guide decisions around deceased donation assessments and the management of SOTr and waitlist patients. Inclusion of these populations in clinical trials of therapeutic interventions, including vaccine candidates, is essential to guide best practices.
| S-EPMC8425831 | biostudies-literature
Project description:Purpose of reviewPsychiatrists and other mental health professionals typically assist with evaluating and treating psychiatric and behavioral issues in transplant candidates, recipients, and living organ donors. In this review recent findings on specific psychiatric issues in adult solid organ transplant candidates and recipients, as well as living donors are discussed as well as their relevance to clinical practice.Recent findingsPatients with complex mental health and addiction histories can have outcomes similar to patients without these disorders but may require specialized pretransplant preparation or posttransplant interventions to optimize their outcomes. Specific attention to the preparation and wellbeing of living donors is needed.SummaryAs transplant programmes increasingly consider patients with complex mental health histories, psychiatrists, and mental health professionals evaluating and treating these patients need to consider plans for early identification and treatment. Psychiatric care provided across the preoperative to postoperative periods will best address the longitudinal care needs of patients with mental health disorders. Abstinence from substances and complete adherence to medical directives provides the best chance for optimal outcomes. Treatment of depression may improve transplant outcomes. Research is needed to identify effective interventions and the best strategies to engage patients to improve adherence.Video abstracthttp://links.lww.com/YCO/A30.
| S-EPMC4623706 | biostudies-literature
Project description:The coronavirus disease 2019 (COVID-19) pandemic is a rapidly changing circumstance with dramatic policy changes and universal efforts to deal with the initial crisis and minimize its consequences. To identify changes to organ donation and transplantation during this time, an anonymous web-based survey was distributed to 19 select organ procurement organizations (OPOs) throughout the United States comparing 90-day activity during March-May 2020 and March-May 2019. Seventeen OPOs responded to the survey (response rate of 89.5%). Organ authorization decreased by 11% during the current pandemic (n = 1379 vs n = 1552, P = .0001). Organ recovery for transplantation fell by 17% (P = .0001) with a further 18% decrease in the number of organs transplanted (P = .0001). Donor cause of death demonstrated a 4.5% decline in trauma but a 35% increase in substance abuse cases during the COVID-19 period. All OPOs reported significant modifications in response to the pandemic, limiting the onsite presence of staff and transitioning to telephonic approaches for donor family correspondence. Organ donation during the current climate has seen significant changes and the long-term implications of such shifts remain unclear. These trends during the COVID-19 era warrant further investigation to address unmet needs, plan for a proportionate response to the virus and mitigate the collateral impact.
| S-EPMC7404840 | biostudies-literature
Project description:BackgroundAn emerging strategy to increase deceased organ donation is to use dedicated donation physicians to champion organ donation. We sought to conduct a systematic review of the effectiveness of donation physicians in improving organ donation outcomes.ObjectiveA systematic review was conducted following Cochrane principles. MEDLINE, Embase, and CINHAL databases were searched from inception to March 26, 2020.MethodsQuantitative studies examining the effects of donation physicians on all deceased organ donation outcomes were considered for inclusion. Review articles, editorials and opinion articles, and case studies were excluded. Study selection was completed independently by 2 team members; all discrepancies were resolved by consensus. Two team members independently extracted data from studies.ResultsA total of 1017 studies were screened, and 12 met inclusion criteria. Included studies were published between 1994 and 2019. Half used an interrupted time series design (n = 6; 50%), 3 (25%) were cohort studies, and 3 (25%) used a before-and-after study design. Outcomes (reported in greater than 50% of included articles) included consent/refusal rate (n = 8; 67%), number of potential donors (n = 7; 58%), and number of actual donors (n = 7; 58%). Across studies and design types, there was an increase in potential organ donors ranging from 8% to 143% (Mdn = 33%), an increase in actual organ donors from 15% to 113% (Mdn = 27%), an increase in donor consent rate from -3% to 258% (Mdn = 12%), and an increase in deceased donor transplants from 13% to 24% (Mdn = 19%) following the introduction of donation physicians.ConclusionsDonation physicians have the potential to significantly improve deceased organ donation. Further implementation and evaluation of donation physician programs is warranted. However, implementation should be undertaken with a clear plan for a methodologically rigorous evaluation of outcomes.
| S-EPMC9218440 | biostudies-literature
Project description:Although overall donation and transplantation activity is higher in Europe than on other continents, differences between European countries in almost every aspect of transplantation activity (for example, in the number of transplantations, the number of people with a functioning graft, in rates of living versus deceased donation, and in the use of expanded criteria donors) suggest that there is ample room for improvement. Herein we review the policy and clinical measures that should be considered to increase access to transplantation and improve post-transplantation outcomes. This Roadmap, generated by a group of major European stakeholders collaborating within a Thematic Network, presents an outline of the challenges to increasing transplantation rates and proposes 12 key areas along with specific measures that should be considered to promote transplantation. This framework can be adopted by countries and institutions that are interested in advancing transplantation, both within and outside the European Union. Within this framework, a priority ranking of initiatives is suggested that could serve as the basis for a new European Union Action Plan on Organ Donation and Transplantation.
| S-EPMC8097678 | biostudies-literature
Project description:BackgroundThis study aimed to evaluate the ability of Donation Advisor (DA), a validated clinical decision support tool that uses continuous monitoring, variability analysis, and predictive models, to (i) predict likelihood of successful donation after circulatory determination of death (DCD) before withdrawal of life-sustaining measures (WLSM), and (ii) describe ischemia during WLSM in DCD patients.MethodsEligible patients were screened at the 5 sites where DA was implemented. DA reports were generated in real time but shown to clinicians after the donation was complete (noninterventional). Clinicians were interviewed for improvement of the tool.ResultsWe enrolled 34 donor patients in the study; 27 had DCD attempts and 20 proceeded to organ recovery. DA reports were generated before WLSM in all 27 attempted DCD patients (100%) while post-WLSM ischemia reports were generated in 26 of 27 DCD attempts (96%). Nineteen of 34 involved clinicians completed interviews, 10 from intensive care, and 9 from transplantation team members. Following a user-centered design approach, feedback was used to create 5 versions. Revisions included additions, removals, clarifications, and formatting changes; the number of revisions decreased with each amendment. The report's predictive scores were found to be useful by most practitioners (83%). We identified barriers and drivers to use the report in future practice, some of which may be addressed through improved education and awareness.ConclusionsDA can be deployed in real time during the DCD process. The usefulness and usability of the DA report has improved through user feedback; both barriers and drivers to implementation exist.
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Project description:A recent commentary defends 1) the concept of 'brain arrest' to explain what brain death is, and 2) the concept that death occurs at 2-5 minutes after absent circulation. I suggest that both these claims are flawed. Brain arrest is said to threaten life, and lead to death by causing a secondary respiratory then cardiac arrest. It is further claimed that ventilation only interrupts this way that brain arrest leads to death. These statements imply that brain arrest is not death itself. Brain death is a devastating state that leads to death when intensive care, which replaces some of the brain's vital functions such as breathing, is withdrawn and circulation stops resulting in irreversible loss of integration of the organism. Circulatory death is said to occur at 2-5 minutes after absent circulation because, in the context of DCD, the intent is to not attempt reversal of the absent circulation. No defense of this weak construal of irreversible loss of circulation is given. This means that patients in identical physiologic states are dead (in the DCD context) or alive (in the resuscitation context); the current state of death (at 2-5 minutes) is contingent on a future event (whether there will be resuscitation) suggesting backward causation; and the commonly used meaning of irreversible as 'not capable of being reversed' is abandoned. The literature supporting the claim that autoresuscitation does not occur in the context of no cardiopulmonary resuscitation is shown to be very limited. Several cases of autoresuscitation are summarized, suggesting that the claim that these cases are not applicable to the current debate may be premature. I suggest that brain dead and DCD donors are not dead; whether organs can be harvested before death from these patients whose prognosis is death should be debated urgently.
| S-EPMC2211498 | biostudies-literature
Project description:The coronavirus disease 2019 (COVID-19) pandemic has upended healthcare systems worldwide and led to an inevitable decrease in liver transplantation (LT) activity. During the first pandemic wave, administrators and clinicians were obliged to make the difficult decision of whether to suspend or continue a life-saving procedure based on the scarce available evidence regarding the risk of transmission and mortality in immunosuppressed patients. Those centers where the activity continued or was heavily restricted were obliged to screen donors and recipients, design COVID-safe clinical pathways, and promote telehealth to prevent nosocomial transmission. Despite the ever-growing literature on COVID-19, the amount of high-quality literature on LT remains limited. This review will provide an updated view of the impact of the pandemic on LT programs worldwide. Donor and recipient screening, strategies for waitlist prioritization, and posttransplant risk of infection and mortality are discussed. Moreover, a particular focus is given to the possibility of donor-to-recipient transmission and immunosuppression management in COVID-positive recipients.
| S-EPMC7968133 | biostudies-literature
Project description:Background Despite the importance of organ donation and transplantation in improving the quality of life, still, there is a shortage of organ donations, worldwide. Lack of knowledge among the public could be the reason. In previous studies, the focus was predominantly on medical students at universities. The aim of this study was to assess university students’ knowledge and attitude about organ donation and transplantation among different colleges at the university. Method A cross-sectional study was conducted among university students between August 2021 and February 2022 using a validated self-designed questionnaire. The questionnaire consisted of five sections. The first section was about the research information. The second section was informed consent. The third section was about sociodemographic information. The fourth section was about the knowledge of organ donation. The last section was about the attitude toward organ donation. The data were analyzed by descriptive statistics and chi-square tests. Results The study included 2,125 students. 68.1% were females, and 93.1% were in the age group 17–24 years old. Only 34.1% had good knowledge about organ donation, 70.2% had a low attitude, and 7.53% had adequate information about brain death. The most common reason for supporting donating organs among university students was to save a life (76.8%) and the most common reason for refusing organs, was I am still unaware. In addition, only 25.66% of the participants had a high attitude toward people with poor knowledge about organ donation. The majority of the students (84.13%) used online sources and social networks as the primary sources of information about organ donation. Conclusion The knowledge and attitudes of university students toward organ donation and transplantation were low. Saving a life was the most common reason for supporting organ donation, and knowledge was the biggest obstacle. Online sources and social networks were the primary sources of knowledge. The attitude was greatly influenced by knowledge. Organizing campaigns, and events, and incorporating organ donation and transplantation into university curricula will increase university students’ knowledge and attitudes.
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Project description:Reducing wait list mortality among patients awaiting liver transplantation remains a substantial challenge because of organ shortage. In efforts to expand the donor pool there has been a trend toward increased use of donation after circulatory death (DCD) liver grafts. However, these marginal grafts are prone to higher complication rates, particularly biliary complications. In addition, many procured DCD livers are then deemed unsuitable for transplant. Despite these limitations, DCD grafts represent an important resource to address the current organ shortage, and as such there are research efforts directed toward improving the use of and outcomes for transplantation of these grafts. We review the current progress in DCD liver transplantation.
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