Showing posts with label transplant. Show all posts
Showing posts with label transplant. Show all posts

Tuesday, June 16, 2015

Opening A Dialogue About Organ Donation

By: Joann Schulte  DO, MPH; Editorial Board Member  
Department of Foreign Affairs
   
  The waiting game can be a long haul for children in need of organ transplants and a third of these children will die waiting.  Recent figures from the Transplant Programs and Organ Procurement Service indicate that about 16% of adults die while waiting for a donor1.
     Reducing that waiting period and increasing the number of organ donors is important.  That's why understanding who makes the decision to donate organs on behalf of an adult or pediatric patient is important. A new study published this month in Pediatrics explores the decision-making process.  Smirnoff et al. (doi:10.1542/peds.2014-3652) conducted phone interviews with 1,601 family decision makers  (FDM), relatives who had the authority to decide whether or not to donate on behalf of an adult or pediatric patient who met brain death criteria.   The FDM were approached between January 2009 and March 2012 and represented requests from nine different organ procurement centers in the USA. The authors examined the request process, the FDM’s perceptions and ultimate decision for the donor patient. The authors sought to ascertain FDM differences comparing decisions made for adult and pediatric donors and non-donors.   
     The authors mailed a study description to FDM several months after the donation decision had been made.  Most of the FDM who participated in the study were deciding for adult donor patients (1369, 85.5%).  FDM deciding on behalf of pediatric donor patients accounted for a minority of decisions (232, 14.5%).   The mean ages of donor patients for whom FDM decided were 49 years for adults and14 years for children
     FDM making the donation decision were usually female and most reported Christian religious affiliations.  FDM for pediatric donations tended to be younger and were more likely to be divorced, separated or never married.
     Overall 84.1% of the FDM authorized the donation, but pediatric decision makers were more likely to do so than were adult counterparts (89.7% vs. 83.2%).   Decision makers for pediatric donor patients were also more likely to report willingness to donate their own organs posthumously and to raise the issue of organ donation.  Pediatric FDM were also more likely to express satisfaction with the interpersonal skills of the person requesting the donation, provision of grief support and to not regret the donation decision later.
     The choice facing a FDM who must decide on organ donation for an adult or child family member is difficult.   It includes the need to deal with the loss of a family member, what meaning and comfort a family may associate with organ donation and how donation can shape the grieving process.   This study suggests that the communication process and how the organ donation is requested are important factors authorizing an organ donation.  

1. Organ Procurement and Transplantation Network.  Date Reports.  31 January 2014.  optn.transplant.hrsa.gov/latestData/ViewDateReports.asp

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Wednesday, April 30, 2014

Sibling Donors for Pediatric Stem Cell Transplant: Do (or Should) They Have a Say?

Photo by Andrew Nourse via Flickr
It is common to consider a sibling a possible donor for
a pediatric hematopoietic stem cell transplant, even when that sibling is a child or adolescent.

Yet how often are these potential donors informed about the risks and benefits of being a donor, and should parents insist they be told? Better yet, do parents feel siblings should even be given a choice in the decision to be a donor for their sibling?

Pentz et al. (doi:10.1542/peds.2013-3067) tackle this ethically challenging topic by sharing the results of qualitative interviews with more than 30 families (and over a hundred family members) who were interviewed pre- and post-transplant, regarding siblings being given a choice or concerns that parents and siblings had about being worked up as donors for transplant.

Clearly, this is a controversial area, so we also enlisted two medical ethicists Drs. Lainie Ross and Armand Antommaria (doi: 10.1542/peds.2014-0375) to reflect on the findings in this study in an accompanying commentary.

Whether or not you have had one of your patients undergo a bone marrow transplant from a sibling donor, you will find these two articles well-worth your consideration and reflection as to your role in making sure siblings are fully informed before they are evaluated as prospective donors.

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Thursday, March 13, 2014

What Does a Quarter Century of Doing Pediatric Kidney Transplants Tell Us?

Kidney transplants have been performed in this country for decades now, and one wonders whether outcome data has been improving, worsening or staying the same as the years go by.

Photo by Hey Paul Studios via Flickr
Van Arendonk et al. (doi: 10.1542/ peds.2013-2775) opted to look back on 25 years of kidney transplant
outcomes and look at graft survival statistics based on the characteristics of donors and recipients. The trends in improved outcomes are quite impressive so take a peek at this detailed look at graft and patient outcomes and the multiple logistic regression analysis that identifies risk factors for prognosis. With more than 17,400 pediatric kidney-only transplants performed from 1987 to 2012, there’s much to be learned from the large data set included in this study.

In fact, as positive as the outcome trends are over the years, there is still more that can be done to further improve these trends, and Dr. Uptal Patel shares his thoughts on just what’s next in renal transplantation in an accompanying commentary (doi: 10.1542/peds.2013-0124). Read this interesting study and commentary and see what we mean.

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