More Than Numbers: Effects of Social Media Virality Metrics on Intention to Help Unknown Others in the Context of Bone Marrow Donation.

PubMed

Lee-Won, Roselyn J; Abo, Melissa M; Na, Kilhoe; White, Tiffany N

2016-06-01

A bone marrow transplant is often the only key to recovery and survival for patients suffering from blood cancers. Social media platforms have allowed nonprofit organizations as well as family members and friends of patients in need of a matching donor to make their solicitation messages go viral and reach out to the broadest possible audience to increase the likelihood of finding a matching donor. Noting that social media audiences are exposed not only to the content of a social media message but also to the metrics representing the virality of the message (i.e., how many times the content has been shared), we conducted an online experiment to investigate the effects of virality metrics on perceived social norms and behavioral intention to join a bone marrow registry. In doing so, we considered the potential moderating role of perceived threat posed by blood cancers. The experiment was conducted with 152 participants who met the general eligibility guidelines set by the National Marrow Donor Program (NMDP). The results of the experiment showed that exposure to high virality metrics led to greater perceived injunctive norms. The results also revealed that the effect of virality metrics on perceived injunctive norms was significant among those perceiving low levels of blood cancer threat. Furthermore, the results demonstrated that high virality metrics led to greater intention to join a bone marrow registry through perceived injunctive norms only when perceived threat of blood cancers was low. Theoretical and practical implications of these findings are discussed.

Impact of Selection of Cord Blood Units from the United States and Swiss Registries on the Cost of Banking Operations

PubMed Central

Bart, Thomas; Boo, Michael; Balabanova, Snejana; Fischer, Yvonne; Nicoloso, Grazia; Foeken, Lydia; Oudshoorn, Machteld; Passweg, Jakob; Tichelli, Andre; Kindler, Vincent; Kurtzberg, Joanne; Price, Thomas; Regan, Donna; Shpall, Elizabeth J.; Schwabe, Rudolf

2013-01-01

Background Over the last 2 decades, cord blood (CB) has become an important source of blood stem cells. Clinical experience has shown that CB is a viable source for blood stem cells in the field of unrelated hematopoietic blood stem cell transplantation. Methods Studies of CB units (CBUs) stored and ordered from the US (National Marrow Donor Program (NMDP) and Swiss (Swiss Blood Stem Cells (SBSQ)) CB registries were conducted to assess whether these CBUs met the needs of transplantation patients, as evidenced by units being selected for transplantation. These data were compared to international banking and selection data (Bone Marrow Donors Worldwide (BMDW), World Marrow Donor Association (WMDA)). Further analysis was conducted on whether current CB banking practices were economically viable given the units being selected from the registries for transplant. It should be mentioned that our analysis focused on usage, deliberately omitting any information about clinical outcomes of CB transplantation. Results A disproportionate number of units with high total nucleated cell (TNC) counts are selected, compared to the distribution of units by TNC available. Therefore, the decision to use a low threshold for banking purposes cannot be supported by economic analysis and may limit the economic viability of future public CB banking. Conclusions We suggest significantly raising the TNC level used to determine a bankable unit. A level of 125 × 107 TNCs, maybe even 150 × 107 TNCs, might be a viable banking threshold. This would improve the return on inventory investments while meeting transplantation needs based on current selection criteria. PMID:23637645

[Study on correlation between HLA-A, B, DR alleles and Duchenne muscular dystrophy].

PubMed

Chen, Wei; Xiao, Lulu; Zhang, Cheng; Wu, Hong-ling

2007-10-01

To analyze the polymorphism of HLA-A, B and DR alleles of Duchenne muscular dystrophy (DMD) patients in Han nationality of South China and to discuss the role of immune and genetic factors in the pathogenesis of DMD and muscular fiber necrosis. Polymerase chain reaction-reverse sequence specific oligonucleotide (PCR-RSSO) and National Marrow Donor Program (NMDP) were used to analyze the polymorphism of HLA-A,B and DR alleles of 113 DMD patients and 406 normal controls in Han nationality of South China. The frequencies of HLA-A24, A30 alleles in DMD group were 11.25% and 5.46% respectively, indicating notable difference (P=0.001, < 0.01) from 22.16% and 0.87% of control group; the frequencies of HLA-B13, B15, B61 and B62 alleles in DMD group were 12.26%, 16.92%, 0.44% and 0.44%, indicating a notable difference (P=0.016, < 0.01, 0.001) from 6.76%, 1.49%, 4.79% and 5.05% of control group; the frequencies of HLA-DR04, DR07, DR12 alleles in DMD group were 17.45%, 6.40% and 19.62%, indicating a notable difference (P=0.018, < 0.01, 0.012) from 10.67%, 2.24% and 11.92% of control group. There are significant differences in the HLA gene frequencies between DMD patients and normal controls. These results suggest that HLA genotype relates to the muscular necrosis and the pathogenesis of DMD.

Engaging Patients in Setting a Patient-Centered Outcomes Research Agenda in Hematopoietic Cell Transplantation

PubMed Central

Burns, Linda J; Abbetti, Beatrice; Arnold, Stacie D; Bender, Jeffrey; Doughtie, Susan; El-Jawahiri, Areej; Gee, Gloria; Hahn, Theresa; Horowitz, Mary M; Johnson, Shirley; Juckett, Mark; Krishnamurit, Lakshmanan; Kullberg, Susan; LeMaistre, C. Fred; Loren, Alison; Majhail, Navneet S; Murphy, Elizabeth A; Rizzo, Doug; Roche-Green, Alva; Saber, Wael; Schatz, Barry A; Schmit-Pokorny, Kim; Shaw, Bronwen E; Syrjala, Karen L; Tierney, D. Kathryn; Ullrich, Christina; Vanness, David J; Wood, William A; Denzen, Ellen M

2018-01-01

The goal of patient-centered outcomes research (PCOR) is to help patients and those who care for them make informed decisions about healthcare. However, the clinical research enterprise has not involved patients, caregivers, and other non-providers routinely in the process of prioritizing, designing and conducting research in hematopoietic cell transplantation (HCT). To address this need, the National Marrow Donor Program (NMDP)/Be The Match® engaged patients, caregivers, researchers and other key stakeholders in a two-year project with the goal of setting a PCOR agenda for the HCT community. Through a collaborative process, we identified six major areas of interest: 1) Patient, Caregiver and Family Education and Support; 2) Emotional, Cognitive and Social Health; 3) Physical Health and Fatigue; 4) Sexual Health and Relationships; 5) Financial Burden; and 6) Models of Survivorship Care Delivery. We then organized into multi-stakeholder Working Groups to identify gaps in knowledge and make priority recommendations for critical research to fill those gaps. Gaps varied by Working Group, but all noted that a historical lack of consistency in measures utilized and patient populations made it difficult to compare outcomes across studies and urged investigators to incorporate uniform measures and homogenous patient groups in future research. Some groups advised that additional pre-emptory work is needed before conducting prospective interventional trials, whereas others felt ready to proceed with comparative clinical effectiveness research studies. This report presents the results of this major initiative, and makes recommendations by Working Group on priority questions for PCOR in HCT. PMID:29408289

Effect of pore size of three-dimensionally ordered macroporous chitosan-silica matrix on solubility, drug release, and oral bioavailability of loaded-nimodipine.

PubMed

Gao, Yikun; Xie, Yuling; Sun, Hongrui; Zhao, Qinfu; Zheng, Xin; Wang, Siling; Jiang, Tongying

2016-01-01

To explore the effect of the pore size of three-dimensionally ordered macroporous chitosan-silica (3D-CS) matrix on the solubility, drug release, and oral bioavailability of the loaded drug. 3D-CS matrices with pore sizes of 180 nm, 470 nm, and 930 nm were prepared. Nimodipine (NMDP) was used as the drug model. The morphology, specific surface area, and chitosan mass ratio of the 3D-CS matrices were characterized before the effect of the pore size on drug crystallinity, solubility, release, and in vivo pharmacokinetics were investigated. With the pore size of 3D-CS matrix decreasing, the drug crystallinity decreased and the aqueous solubility increased. The drug release was synthetically controlled by the pore size and chitosan content of 3D-CS matrix in a pH 6.8 medium, while in a pH 1.2 medium the erosion of the 3D-CS matrix played an important role in the decreased drug release rate. The area under the curve of the drug-loaded 3D-CS matrices with pore sizes of 930 nm, 470 nm, and 180 nm was 7.46-fold, 5.85-fold, and 3.75-fold larger than that of raw NMDP respectively. Our findings suggest that the oral bioavailability decreased with a decrease in the pore size of the matrix.

Survey of body donation programs in the US concerning the use of donor personal information with medical students.

PubMed

Gerwer, Johanna; Gest, Thomas R

2017-05-01

Body donor programs need to balance ethical concerns and educational needs. Among donor programs in the US, there is variability in the amount of donor personal information that is provided to medical students. This study assesses this variability and investigates the reasons for the variability among donor programs. Telephone interviews and email surveys were used to collect information concerning the provision and use of donor personal information with medical students. One hundred fifty-one donor programs in the US were contacted via email or telephone interview or both. Fifty-three donor programs responded to the survey or participated in the telephone interview. The survey results show variation, not only in the amount of donor personal information provided to medical students, but also in the attitudes and beliefs of the donor program personnel concerning donor personal information. This research documents the variability of the educational use of donor personal information. It is hoped that this description of the various approaches to using donor information will encourage the ethical use of donor information within the context of medical education. Clin. Anat. 30:445-449, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Cost Evaluation of a Donation after Cardiac Death Program: How Cost per Organ Compares to Other Donor Types.

PubMed

Lindemann, Jessica; Dageforde, Leigh Anne; Vachharajani, Neeta; Stahlschmidt, Emily; Brockmeier, Diane; Wellen, Jason R; Khan, Adeel; Chapman, William C; Doyle, Mb Majella

2018-05-01

Donation after cardiac death (DCD) is one method of organ donation. Nationally, more than half of evaluated DCD donors do not yield transplantable organs. There is no algorithm for predicting which DCD donors will be appropriate for organ procurement. Donation after cardiac death program costs from an organ procurement organization (OPO) accounting for all evaluated donors have not been reported. Hospital, transportation, and supply costs of potential DCD donors evaluated at a single OPO from January 2009 to June 2016 were collected. Mean costs per donor and per organ were calculated. Cost of DCD donors that did not yield a transplantable organ were included in cost analyses resulting in total cost of the DCD program. Donation after cardiac death donor costs were compared with costs of in-hospital donation after brain death (DBD) donors. There were 289 organs transplanted from 264 DCD donors evaluated. Mean cost per DCD donor yielding transplantable organs was $9,306. However, 127 donors yielded no organs, at a mean cost of $8,794 per donor. The total cost of the DCD program was $32,020 per donor and $15,179 per organ. Mean cost for an in-hospital DBD donor was $33,546 and $9,478 per organ transplanted. Mean organ yield for DBD donors was 3.54 vs 2.21 for DCD donors (p < 0.0001), making the cost per DBD organ 63% of the cost of a DCD organ. Mean cost per DCD donor is comparable with DBD donors, however, individual cost of DCD organs increases by almost 40% when all costs of an entire DCD program are included. Published by Elsevier Inc.

The Canadian kidney paired donation program: a national program to increase living donor transplantation.

PubMed

Cole, Edward H; Nickerson, Peter; Campbell, Patricia; Yetzer, Kathy; Lahaie, Nick; Zaltzman, Jeffery; Gill, John S

2015-05-01

Establishment of a national kidney paired donation (KPD) program represents a unique achievement in Canada's provincially organized health care system. Key factors enabling program implementation included consultation with international experts, formation of a unique organization with a mandate to facilitate interprovincial collaboration, and the volunteer efforts of members of the Canadian transplant community to overcome a variety of logistical barriers. As of December 2013, the program had facilitated 240 transplantations including 10% with Calculated panel reactive antibody (cPRA) ≥97%. Unique features of the Canadian KPD program include participation of n = 55 nondirected donors, performance of only donor specific antibody negative transplants, the requirement for donor travel, and nonuse of bridge donors. The national KPD program has helped maintain the volume of living kidney donor transplants in Canada over the past 5 years and serves as a model of inter-provincial collaboration to improve the delivery of health care to Canadians.

Incidence of death and potentially life-threatening near-miss events in living donor hepatic lobectomy: a world-wide survey.

PubMed

Cheah, Yee Lee; Simpson, Mary Ann; Pomposelli, James J; Pomfret, Elizabeth A

2013-05-01

The incidence of morbidity and mortality after living donor liver transplantation (LDLT) is not well understood because reporting is not standardized and relies on single-center reports. Aborted hepatectomies (AHs) and potentially life-threatening near-miss events (during which a donor's life may be in danger but after which there are no long-term sequelae) are rarely reported. We conducted a worldwide survey of programs performing LDLT to determine the incidence of these events. A survey instrument was sent to 148 programs performing LDLT. The programs were asked to provide donor demographics, case volumes, and information about graft types, operative morbidity and mortality, near-miss events, and AHs. Seventy-one programs (48%), which performed donor hepatectomy 11,553 times and represented 21 countries, completed the survey. The average donor morbidity rate was 24%, with 5 donors (0.04%) requiring transplantation. The donor mortality rate was 0.2% (23/11,553), with the majority of deaths occurring within 60 days, and all but 4 deaths were related to the donation surgery. The incidences of near-miss events and AH were 1.1% and 1.2%, respectively. Program experience did not affect the incidence of donor morbidity or mortality, but near-miss events and AH were more likely in low-volume programs (≤50 LDLT procedures). In conclusion, it appears that independently of program experience, there is a consistent donor mortality rate of 0.2% associated with LDLT donor procedures, yet increased experience is associated with lower rates of AH and near-miss events. Potentially life-threatening near-miss events and AH are underappreciated complications that must be discussed as part of the informed consent process with any potential living liver donor. Copyright © 2012 American Association for the Study of Liver Diseases.

The impact of living-unrelated transplant on establishing deceased-donor liver program in Syria.

PubMed

Saeed, Bassam

2014-10-01

Liver transplant is the criterion standard for patients with end-stage liver disease. Yet there is no liver transplant in Syria. Traveling abroad for a liver transplant is a luxury few Syrians can afford. There is currently an on-going debate whether to start a liver transplant program using living or deceased donors. In 2003, a new law was enacted, authorizing the use of organs from volunteer strangers and deceased donors. Despite the positive aspects of this law (allowing unrelated donors to increase the number of transplants in the country); the negative aspects also were obvious. The poor used the law to sell their organs to the rich, and this model is in violation of the Istanbul Declaration. To better document transplant communities' perceptions on organ donation, an e-mail survey was sent to a nationally representative sample of physicians (n = 115) that showed that 58% of respondents did not support the start of liver transplant from live donors, as they fear a considerable risk for the donor and the recipient. Seventy-one percent of respondents believe that unrelated kidney donation has contributed to tarnishing the reputation of transplant, and 56% believe that a deceased-donor program can run in parallel with unrelated organ donations. The interest in deceased-donor program has been affected negatively by the systematic approach of using poor persons as the source of the organ. This lack of interest has affected starting a liver program that relies on deceased donors; especially the need for kidneys is more than livers. Health authorities in Syria were inclined to initiate a liver transplant program from live donors, despite the risks of serious morbidities and mortality. In conclusion then, paid kidney donation in actual effect is actually a hindrance to establishing a deceased-donor liver program.

Reimbursing Live Organ Donors for Incurred Non-Medical Expenses: A Global Perspective on Policies and Programs

PubMed Central

Sickand, M.; Cuerden, M. S.; Klarenbach, S. W.; Ojo, A. O.; Parikh, C. R.; Boudville, N.; Garg, A. X.

2015-01-01

Methods to reimburse living organ donors for the non-medical expenses they incur have been implemented in some jurisdictions and are being considered in others. A global understanding of existing legislation and programs would help decision makers implement and optimize policies and programs. We searched for and collected data from countries that practice living organ donation. We examined legislation and programs that facilitate reimbursement, focusing on policy mechanisms, eligibility criteria, program duration and types of expenses reimbursed. Of 40 countries, reimbursement is expressly legal in 16, unclear in 18, unspecified in 6 and expressly prohibited in 1. Donor reimbursement programs exist in 21 countries; 6 have been enacted in the last 5 years. Lost income is reimbursed in 17 countries, while travel, accommodation, meal and childcare costs are reimbursed in 12 to 19 countries. Ten countries have comprehensive programs, where all major cost categories are reimbursed to some extent. Out-of-country donors are reimbursed in 10 jurisdictions. Reimbursement is conditional on donor income in 7 countries, and recipient income in 2 countries. Many nations have programs that help living donors with their financial costs. These programs differ in operation and scope. Donors in other regions of the world are without support. PMID:19788503

Reimbursing live organ donors for incurred non-medical expenses: a global perspective on policies and programs.

PubMed

Sickand, M; Cuerden, M S; Klarenbach, S W; Ojo, A O; Parikh, C R; Boudville, N; Garg, A X

2009-12-01

Methods to reimburse living organ donors for the non-medical expenses they incur have been implemented in some jurisdictions and are being considered in others. A global understanding of existing legislation and programs would help decision makers implement and optimize policies and programs. We searched for and collected data from countries that practice living organ donation. We examined legislation and programs that facilitate reimbursement, focusing on policy mechanisms, eligibility criteria, program duration and types of expenses reimbursed. Of 40 countries, reimbursement is expressly legal in 16, unclear in 18, unspecified in 6 and expressly prohibited in 1. Donor reimbursement programs exist in 21 countries; 6 have been enacted in the last 5 years. Lost income is reimbursed in 17 countries, while travel, accommodation, meal and childcare costs are reimbursed in 12 to 19 countries. Ten countries have comprehensive programs, where all major cost categories are reimbursed to some extent. Out-of-country donors are reimbursed in 10 jurisdictions. Reimbursement is conditional on donor income in 7 countries, and recipient income in 2 countries. Many nations have programs that help living donors with their financial costs. These programs differ in operation and scope. Donors in other regions of the world are without support.

Problem of living liver donation in the absence of deceased liver transplantation program: Mansoura experience.

PubMed

Wahab, Mohamed Abdel; Hamed, Hosam; Salah, Tarek; Elsarraf, Waleed; Elshobary, Mohamed; Sultan, Ahmed Mohamed; Shehta, Ahmed; Fathy, Omar; Ezzat, Helmy; Yassen, Amr; Elmorshedi, Mohamed; Elsaadany, Mohamed; Shiha, Usama

2014-10-07

We report our experience with potential donors for living donor liver transplantation (LDLT), which is the first report from an area where there is no legalized deceased donation program. This is a single center retrospective analysis of potential living donors (n = 1004) between May 2004 and December 2012. This report focuses on the analysis of causes, duration, cost, and various implications of donor exclusion (n = 792). Most of the transplant candidates (82.3%) had an experience with more than one excluded donor (median = 3). Some recipients travelled abroad for a deceased donor transplant (n = 12) and some died before finding a suitable donor (n = 14). The evaluation of an excluded donor is a time-consuming process (median = 3 d, range 1 d to 47 d). It is also a costly process with a median cost of approximately 70 USD (range 35 USD to 885 USD). From these results, living donor exclusion has negative implications on the patients and transplant program with ethical dilemmas and an economic impact. Many strategies are adopted by other centers to expand the donor pool; however, they are not all applicable in our locality. We conclude that an active legalized deceased donor transplantation program is necessary to overcome the shortage of available liver grafts in Egypt.

A national program for nondirected kidney donation from living unrelated donors: the Philippine experience.

PubMed

Manauis, M N; Pilar, K A; Lesaca, R; de Belen Uriarte, R; Danguilan, R; Ona, E

2008-09-01

The objectives of this study are to describe the mechanism of the program and to present initial donor outcome. This is a descriptive study evaluating the performance of a national program for nondirected kidney donation from living unrelated donors (LURDs) in the Philippines in its 3-year implementation. It explains the mechanism of the program and socioeconomic and clinical profiling of donors. Frequencies and percentages were used to measure donor demographic data, medical follow-up compliance rate, and employment predonation and postdonation. Diagnostic laboratory criteria were required to show donor clinical profiles. In 2002, the local Health Department issued an administrative order to create a National Transplant Ethics Committee (NTEC) to address issues of rampant organ sale and donor exploitation. It also set guidelines and intended to oversee transplantation from LURDs. Salient points to the program are as follows: (1) prohibition of sale; (2) accreditation of transplantation centers; (3) enrollment of waitlisted patients in both deceased donor and nondirected LURD program; (4) ethics committee evaluation of LURDs; (5) creation of a national kidney transplant wait list and live donor registry allowing centralized, nondirected kidney allocation; (6) 10% cap on allocation to foreigners; (7) creation of a kidney donor monitoring unit with free 10-year annual medical follow-up for feedback evaluation on donor outcome; and (8) allowance of gratitudinal gifts such as health and life insurance, reimbursement for lost income, educational plan, and job placement to LURDs run by a foundation. From 2004 to 2006, 695 potential donors enrolled; 97 were accepted and deemed medically fit to donate. The remaining 598 were rejected due to demand for outright sale (103), medical unsuitability (77), disapproval by the Ethics Committee (12), and retracted consent (406). Of the 97 qualified donors, 79 had donated, 9 were being evaluated, and 9 await allocation at the end of 2006. Donor demographics show the following: 54% (381) single, 77% (538) males, and 70% (488) aged 21-40 years old. Sixty-eight of 79 became small-scale entrepreneurs postdonation. Also, 53% (42 of 79) complied with medical follow-up requirements. Mean serum creatinine level at 6 months, 1 years, and 2 years were 1.3, 1.33, and 1.05 mg/dL, respectively. Two donors had trace protein and 1 had (+1) protein. The majority of the donors are single males, aged 21-40 years with blue collar jobs. Major reasons for dropouts are retracted consent and medical unsuitability. Donors have improved socioeconomic status. In this study, 53% complied with expected medical follow-up, showing mean serum creatinine within normal range. Proteinuria appeared in 2 of 79 donors. This regulated approach provides a rational, accessible, and equitable donor allocation program. It safeguards the rights of donors and avoids donor exploitation and proliferation of unregulated organ sale. Data collection on their postoperative renal function will show long-term outcome of kidney donation from live donors.

Effects of donor proliferation in development aid for health on health program performance: A conceptual framework.

PubMed

Pallas, Sarah Wood; Ruger, Jennifer Prah

2017-02-01

Development aid for health increased dramatically during the past two decades, raising concerns about inefficiency and lack of coherence among the growing number of global health donors. However, we lack a framework for how donor proliferation affects health program performance to inform theory-based evaluation of aid effectiveness policies. A review of academic and gray literature was conducted. Data were extracted from the literature sample on study design and evidence for hypothesized effects of donor proliferation on health program performance, which were iteratively grouped into categories and mapped into a new conceptual framework. In the framework, increases in the number of donors are hypothesized to increase inter-donor competition, transaction costs, donor poaching of recipient staff, recipient control over aid, and donor fragmentation, and to decrease donors' sense of accountability for overall development outcomes. There is mixed evidence on whether donor proliferation increases or decreases aid volume. These primary effects in turn affect donor innovation, information hoarding, and aid disbursement volatility, as well as recipient country health budget levels, human resource capacity, and corruption, and the determinants of health program performance. The net effect of donor proliferation on health will vary depending on the magnitude of the framework's competing effects in specific country settings. The conceptual framework provides a foundation for improving design of aid effectiveness practices to mitigate negative effects from donor proliferation while preserving its potential benefits. Copyright © 2017 Elsevier Ltd. All rights reserved.

The National Heart, Lung, and Blood Institute retrovirus epidemiology donor studies (Retrovirus Epidemiology Donor Study and Retrovirus Epidemiology Donor Study-II): twenty years of research to advance blood product safety and availability.

PubMed

Kleinman, Steven; King, Melissa R; Busch, Michael P; Murphy, Edward L; Glynn, Simone A

2012-10-01

The Retrovirus Epidemiology Donor Study (REDS), conducted from 1989 to 2001, and the REDS-II, conducted from 2004 to 2012, were National Heart, Lung, and Blood Institute-funded, multicenter programs focused on improving blood safety and availability in the United States. The REDS-II also included international study sites in Brazil and China. The 3 major research domains of REDS/REDS-II have been infectious disease risk evaluation, blood donation availability, and blood donor characterization. Both programs have made significant contributions to transfusion medicine research methodology by the use of mathematical modeling, large-scale donor surveys, innovative methods of repository sample storage, and establishing an infrastructure that responded to potential emerging blood safety threats such as xenotropic murine leukemia virus-related virus. Blood safety studies have included protocols evaluating epidemiologic and/or laboratory aspects of human immunodeficiency virus, human T-lymphotropic virus 1/2, hepatitis C virus, hepatitis B virus, West Nile virus, cytomegalovirus, human herpesvirus 8, parvovirus B19, malaria, Creutzfeldt-Jakob disease, influenza, and Trypanosoma cruzi infections. Other analyses have characterized blood donor demographics, motivations to donate, factors influencing donor return, behavioral risk factors, donors' perception of the blood donation screening process, and aspects of donor deferral. In REDS-II, 2 large-scale blood donor protocols examined iron deficiency in donors and the prevalence of leukocyte antibodies. This review describes the major study results from over 150 peer-reviewed articles published by these 2 REDS programs. In 2011, a new 7-year program, the Recipient Epidemiology and Donor Evaluation Study-III, was launched. The Recipient Epidemiology and Donor Evaluation Study-III expands beyond donor-based research to include studies of blood transfusion recipients in the hospital setting and adds a third country, South Africa, to the international program. Copyright © 2012 Elsevier Inc. All rights reserved.

The NHLBI Retrovirus Epidemiology Donor Studies (REDS and REDS-II): Twenty years of research to advance blood product safety and availability

PubMed Central

Kleinman, Steven; King, Melissa R; Busch, Michael P; Murphy, Edward L; Glynn, Simone A.

2012-01-01

The Retrovirus Epidemiology Donor Study (REDS), conducted from 1989–2001, and the Retrovirus Epidemiology Donor Study-II (REDS-II), conducted from 2004–2012, were National Heart Lung and Blood Institute (NHLBI) funded multicenter programs focused on improving blood safety and availability in the United States. REDS-II also included international study sites in Brazil and China. The three major research domains of REDS/REDS-II have been infectious disease risk evaluation, blood donation availability, and blood donor characterization. Both programs have made significant contributions to transfusion medicine research methodology by the use of mathematical modeling, large-scale donor surveys, innovative methods of repository sample storage, and establishing an infrastructure that responded to potential emerging blood safety threats such as XMRV. Blood safety studies have included protocols evaluating epidemiologic and/or laboratory aspects of HIV, HTLV I/II, HCV, HBV, WNV, CMV, HHV-8, B19V, malaria, CJD, influenza, and T. cruzi infections. Other analyses have characterized: blood donor demographics, motivations to donate, factors influencing donor return, behavioral risk factors, donors’ perception of the blood donation screening process, and aspects of donor deferral. In REDS-II, two large-scale blood donor protocols examined iron deficiency in donors and the prevalence of leukocyte antibodies. This review describes the major study results from over 150 peer-reviewed articles published by these two REDS programs. In 2011, a new seven year program, the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III), was launched. REDS-III expands beyond donor-based research to include studies of blood transfusion recipients in the hospital setting, and adds a third country, South Africa, to the international program. PMID:22633182

How the Avahan HIV prevention program transitioned from the Gates Foundation to the government of India.

PubMed

Sgaier, Sema K; Ramakrishnan, Aparajita; Dhingra, Neeraj; Wadhwani, Alkesh; Alexander, Ashok; Bennett, Sara; Bhalla, Aparajita; Kumta, Sameer; Jayaram, Matangi; Gupta, Pankaj; Piot, Peter K; Bertozzi, Stefano M; Anthony, John

2013-07-01

Developing countries face diminishing development aid and time-limited donor commitments that challenge the long-term sustainability of donor-funded programs to improve the health of local populations. Increasing country ownership of the programs is one solution. Transitioning managerial and financial responsibility for donor-funded programs to governments and local stakeholders represents a highly advanced form of country ownership, but there are few successful examples among large-scale programs. We present a transition framework and describe how it was used to transfer the Bill & Melinda Gates Foundation's HIV/AIDS prevention program, the Avahan program, to the Government of India. Essential features recommended for the transition of donor-funded programs to governments include early planning with the government, aligning donor program components with government structures and funding models prior to transition, building government capacity through active technical and management support, budgeting for adequate support during and after the transition, and dividing the transition into phases to allow time for adjustments and corrections. The transition of programs to governments is an important sustainability strategy for efforts to scale up HIV prevention programs to reach the populations most at risk.

Past, present and future of kidney paired donation transplantation in India

PubMed Central

Kute, Vivek B; Patel, Himanshu V; Shah, Pankaj R; Modi, Pranjal R; Shah, Veena R; Rizvi, Sayyed J; Pal, Bipin C; Modi, Manisha P; Shah, Priya S; Varyani, Umesh T; Wakhare, Pavan S; Shinde, Saiprasad G; Ghodela, Vijay A; Patel, Minaxi H; Trivedi, Varsha B; Trivedi, Hargovind L

2017-01-01

One third of healthy willing living kidney donors are rejected due to ABO blood group incompatibility and donor specific antibody. This increases pre-transplant dialysis duration leading to increased morbidity and mortality on the kidney transplantation waiting list. Over the last decade kidney paired donation is most rapidly increased source of living kidney donors. In a kidney transplantation program dominated by living donor kidney transplantation, kidney paired donation is a legal and valid alternative strategy to increase living donor kidney transplantation. This is more useful in countries with limited resources where ABO incompatible kidney transplantation or desensitization protocol is not feasible because of costs/infectious complications and deceased donor kidney transplantation is in initial stages. The matching allocation, ABO blood type imbalance, reciprocity, simultaneity, geography were the limitation for the expansion of kidney paired donation. Here we describe different successful ways to increase living donor kidney transplantation through kidney paired donation. Compatible pairs, domino chain, combination of kidney paired donation with desensitization or ABO incompatible transplantation, international kidney paired donation, non-simultaneous, extended, altruistic donor chain and list exchange are different ways to expand the donor pool. In absence of national kidney paired donation program, a dedicated kidney paired donation team will increase access to living donor kidney transplantation in individual centres with team work. Use of social networking sites to expand donor pool, HLA based national kidney paired donation program will increase quality and quantity of kidney paired donation transplantation. Transplant centres should remove the barriers to a broader implementation of multicentre, national kidney paired donation program to further optimize potential of kidney paired donation to increase transplantation of O group and sensitized patients. This review assists in the development of similar programs in other developing countries. PMID:28507916

Past, present and future of kidney paired donation transplantation in India.

PubMed

Kute, Vivek B; Patel, Himanshu V; Shah, Pankaj R; Modi, Pranjal R; Shah, Veena R; Rizvi, Sayyed J; Pal, Bipin C; Modi, Manisha P; Shah, Priya S; Varyani, Umesh T; Wakhare, Pavan S; Shinde, Saiprasad G; Ghodela, Vijay A; Patel, Minaxi H; Trivedi, Varsha B; Trivedi, Hargovind L

2017-04-24

One third of healthy willing living kidney donors are rejected due to ABO blood group incompatibility and donor specific antibody. This increases pre-transplant dialysis duration leading to increased morbidity and mortality on the kidney transplantation waiting list. Over the last decade kidney paired donation is most rapidly increased source of living kidney donors. In a kidney transplantation program dominated by living donor kidney transplantation, kidney paired donation is a legal and valid alternative strategy to increase living donor kidney transplantation. This is more useful in countries with limited resources where ABO incompatible kidney transplantation or desensitization protocol is not feasible because of costs/infectious complications and deceased donor kidney transplantation is in initial stages. The matching allocation, ABO blood type imbalance, reciprocity, simultaneity, geography were the limitation for the expansion of kidney paired donation. Here we describe different successful ways to increase living donor kidney transplantation through kidney paired donation. Compatible pairs, domino chain, combination of kidney paired donation with desensitization or ABO incompatible transplantation, international kidney paired donation, non-simultaneous, extended, altruistic donor chain and list exchange are different ways to expand the donor pool. In absence of national kidney paired donation program, a dedicated kidney paired donation team will increase access to living donor kidney transplantation in individual centres with team work. Use of social networking sites to expand donor pool, HLA based national kidney paired donation program will increase quality and quantity of kidney paired donation transplantation. Transplant centres should remove the barriers to a broader implementation of multicentre, national kidney paired donation program to further optimize potential of kidney paired donation to increase transplantation of O group and sensitized patients. This review assists in the development of similar programs in other developing countries.

Facing the Metabolic Syndrome Epidemic in Living Kidney Donor Programs.

PubMed

Mejía-Vilet, Juan M; Córdova-Sánchez, Bertha M; Arreola-Guerra, José M; Alberú, Josefina; Morales-Buenrostro, Luis E

2016-07-22

BACKGROUND Due to the shortage of organs for transplantation, there has been increased interest in developing living-donor kidney transplantation (LDKT) programs. MATERIAL AND METHODS A total of 668 potential living kidney donors (PLKD) for 496 intended recipients were evaluated in a LDKT program between 2010 and 2014. Causes for PLKD exclusion were recorded, as well as patient survival. RESULTS After evaluation, 250 (37.4%) PLKD were considered suitable for kidney donation, 331 (49.6%) were excluded for medical reasons, and 87 (13.0%) withdrew their consent. The main cause of exclusion was metabolic syndrome and its components: 131 (39.6%) obesity, 37 (11.2%) new diagnosis of diabetes mellitus, and 25 (7.6%) new diagnosis of hypertension. Sixty-three (19.0%) were excluded for previously undetected renal diseases. Forty-six (13.9%) PLKD were excluded for immunological incompatibility. A total of 158 patients (31.9%) were transplanted from living donors and 31 (6.3%) from deceased donors (after the donor was considered non-suitable). Three-year patient survival was 99.4% for transplanted patients and 41.4% for patients who remained on dialysis. CONCLUSIONS Metabolic diseases constitute the main cause of donor exclusion in some LDKT programs. The high mortality rate of patients whose donor is excluded renews the debate over expanding donor criteria against the long-term risks they may pose to the living kidney donor.

[Transplant cross-over, an attractive option].

PubMed

Maddalena, Emanuela

2013-01-01

Kidney transplant from living donors is an excellent option for patients with end- stage renal disease: around the world approximately 10-20% of patients on waiting lists have intended living donors incompatible by blood type or for the presence of donor-specific antibodies. Current strategies to overcome these barriers are desensitization protocols and the recent option of the kidney exchange programs. In this work we describe the types of donor exchange programs, from the two-way Kidney Paired Donation, where two incompatible donor-recipient couples exchange donors, to complex chains of transplants where the altruistic donation of a kidney (Living Non-direct Donor, or non-specific donation) is associated to a Kidney Paired Exchange Program (Domino Kidney Paired Donation, NEAD chains). The thesis also discusses some related ethical topics that have become international matters of debate, as well as some important cultural and social arguments for and against the application of kidney exchanges in Italy.

[Research resource network and Parkinson disease brain bank donor registration program in Japan].

PubMed

Arima, Kunimasa

2010-10-01

In spite of the increasing need for brain tissue in biomedical research, overall brain banking activities in Japan has been lagging behind. On the initiative of the National Center of Neurology and Psychiatry, 2 projects have been carried out; the Research Resource Network (RRN) and the Parkinson's Disease Brain Bank (PDBB) donor registration program. RRN is a nation-wide network that links 15 brain repositories, and 1,463 autopsy brains have been registered in this network as of December 2009. The brain donor registration program for PDBB was established in 2006. A donor without cognitive impairment can enroll in this PDBB donor registration program. When the donor dies, the next-of-kin will contact the PDBB coordinators for subsequent autopsy services and brain retention. On obtaining the next-of-kin's consent at the time of donor's death, autopsy will be performed at PDBB collaborating hospitals of National Center of Neurology and Psychiatry, Juntendo University Hospital, and Tokyo Metropolitan Geriatric Hospital. In order to arouse public interest, lecture meetings for citizens have been held on a regular basis. Fifty individuals have registered in the PDBB donor registration program including 27 patients with PD, 4 patient with Parkinson syndrome, 1 patient with progressive supranuclear palsy, and 18 individuals without PD or related disorders as of December 2009. Autopsies have been performed for 2 of these donors. To promote brain banking activities,it is necessary to establish legal and ethical guidelines for the use of autopsied materials in biomedical research.

Full-sibling embryos created by anonymous gamete donation in unrelated recipients.

PubMed

Dicken, Cary L; Zapantis, Athena; Illions, Edward; Pollack, Staci; Lieman, Harry J; Bevilacqua, Kris; Jindal, Sangita K

2011-09-01

To report the rare occurrence of full-sibling embryos in unrelated women using independently chosen donor sperm and donor oocytes in two different cycles unintentionally created at our IVF program, and to discuss the concept of disclosure to the patients. Case report. Academic IVF program. Two women independently undergoing donor recipient cycles with anonymous donor oocytes and donor sperm. Both women received oocytes from the same donor several months apart and then by coincidence selected the same anonymous sperm donor to create anonymous full-sibling embryos. Clinical pregnancy after donor-recipient IVF cycle. Both women conceived using the same donor sperm and donor oocytes in independent cycles, resulting in simultaneous pregnancy of full siblings. As providers with the knowledge that anonymous full sibling embryos have been created, we may have an obligation to disclose this information to the patients. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Paired kidney donations to expand the living donor pool.

PubMed

Ferrari, Paolo; de Klerk, Marry

2009-01-01

The shortage of available deceased donors and the longer kidney transplant waiting lists in many countries around the world have placed greater emphasis on living donation (LD) as a means of meeting demand for transplantation in patients with end-stage kidney disease (ESKD). Increased LD rates are also driven by less invasive approaches to donor nephrectomy and by the excellent long-term results. LD kidney transplant outcomes are equivalent, if not superior, to those from deceased donors, even when donor and recipient are not genetically related, as is the case with spousal donations, the most frequent cohort of LD. Approximately 30% of willing and otherwise appropriate kidney donor/recipient pairs are biologically incompatible and do not proceed to live donor transplantation. In recent years, a number of strategies have been introduced to expand living donation programs beyond the classical direct donation, to overcome immunological barriers of blood group or HLA sensitization of recipients. New strategies in LD include paired kidney exchange (PKE), altruistic donation, altruistic donor chains and list exchange programs. Other alternative programs are desensitization and transplantation across the blood-type barrier. Regular PKE programs operate nationally in The Netherlands and the United Kingdom, or regionally in South Korea, Romania, the United States and Australia. If PKE were performed routinely using 2-way or 3-way PKE and altruistic donor chains, the rate of kidney transplants could increase by between 7% and 10%.

The role of the altruistic unbalanced chain in exchange living donor renal transplantation: single-center experience.

PubMed

Ahn, B K; Kwon, O J; Kang, C M

2012-01-01

The exchange donor program in renal transplantation is an efficient solution for recipients with a blood type or crossmatch-incompatible donor. However, this program has some difficulties to define unacceptable human leukocyte antigen matches, deteriorating clinical potential recipient condition, and withdrawal of donor consent. We analyzed the outcomes of exchange donor renal transplantation through the altruistic unbalanced chain. Among 152 cases of exchange donor renal transplantation from 1991 to 2010 in our hospital, we performed 58 procedures through altruistic unbalanced chains. We compared their outcomes with the direct and balanced chain group. We analyzed retrospectively whether this program expanded the donor pool, seeking better immunologic, size, and age matching. The graft survival and acute rejection rates did not differ significantly in the two groups. Of 152 cases, 58 (38.2%) renal transplantations were performed through an unbalanced chain. Seventeen waiting list recipients were transplanted through an altruistic unbalanced chain. In blood type O recipients (n = 32), the causes of registration in the exchange program were ABO incompatibility (93.3%), and positive crossmatch (6.7%). Nine altruistic blood type O donors and 9 (28.1%) type O recipients underwent transplantations through this chain. We suggest the altruistic unbalanced chain may expand the donor pool with advantages for difficult-to-match pairs. The disadvantages of type O recipients may be overcome through the use of an unbalanced chain. The altruistic unbalanced exchange transplantation program can help easy-to-match subjects, shortening the waiting periods. Copyright © 2012 Elsevier Inc. All rights reserved.

Donor Lung Procurement by Surgical Fellow with an Expectation of High Rate of Lung Utilisation.

PubMed

Smail, Hassiba; Saxena, Pankaj; Wallinder, Andreas; Lin, Enjarn; Snell, Gregory I; Hobson, Jamie; Zimmet, Adam D; Marasco, Silvana F; McGiffin, David C

2017-12-22

There is an ever increasing demand for donor lungs in patients waiting for transplantation. Lungs of many potential donors will be rejected if the standard criteria for donor assessment are followed. We have expanded our donor lung pool by accepting marginal donors and establishing a donation after circulatory death program. We have achieved comparable results using marginal donors and accepting donor lungs following donation after circulatory death. We present our assessment and technical guidelines on lung procurement taking into consideration an increasingly complex cohort of lung donors. These guidelines form the basis of the lung procurement training program involving surgical Fellows at the Alfred Hospital in Melbourne, Australia. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

The National Heart, Lung, and Blood Institute Recipient Epidemiology and Donor Evaluation Study (REDS-III): A research program striving to improve blood donor and transfusion recipient outcomes

PubMed Central

Kleinman, Steven; Busch, Michael P; Murphy, Edward L; Shan, Hua; Ness, Paul; Glynn, Simone A.

2014-01-01

Background The Recipient Epidemiology and Donor Evaluation Study -III (REDS-III) is a 7-year multicenter transfusion safety research initiative launched in 2011 by the National Heart, Lung, and Blood Institute. Study design The domestic component involves 4 blood centers, 12 hospitals, a data coordinating center, and a central laboratory. The international component consists of distinct programs in Brazil, China, and South Africa which involve US and in-country investigators. Results REDS-III is using two major methods to address key research priorities in blood banking/transfusion medicine. First, there will be numerous analyses of large “core” databases; the international programs have each constructed a donor/donation database while the domestic program has established a detailed research database that links data from blood donors and their donations, the components made from these donations, and data extracts from the electronic medical records of the recipients of these components. Secondly, there are more than 25 focused research protocols involving transfusion recipients, blood donors, or both that are either in progress or scheduled to begin within the next 3 years. Areas of study include transfusion epidemiology and blood utilization; transfusion outcomes; non-infectious transfusion risks; HIV-related safety issues (particularly in the international programs); emerging infectious agents; blood component quality; donor health and safety; and other donor issues. Conclusions It is intended that REDS-III serve as an impetus for more widespread recipient and linked donor-recipient research in the US as well as to help assure a safe and available blood supply in the US and in international locations. PMID:24188564

Donor issues in Indonesia: A developing country in South East Asia.

PubMed

Soedarmono, Yuyun S M

2010-01-01

In most developing countries in South East Asia blood services have not been treated properly as an important service to support health program. Indonesia as a large archipelago country in South East Asia has specific obstacles in managing a blood service. To position the country blood service profile especially in term of donor issues, we compared our blood service with that in other South East Asia countries. Indonesia has 17 thousand islands with 220 million inhabitants. Blood services have been mostly run by the Indonesian Red Cross as a government assignment since 1950. Donor recruitment programs have been directed toward 100% of Voluntary Non Remunerated Blood Donor (VNRD), which now have reached 81.3%. Dissemination of information on VNRD, donor recruiter's training and VNRD appreciation programs are strategies to increase and maintain the VNRD. Limited female donors and insufficient blood supply during the fasting month and holidays constitute major challenges. Low hemoglobin level, low body weight and fear are reasons for low number of female donors. Poor management of blood stock during fasting month, long holidays and also poor networking of blood supply are reasons for insufficient blood supply during the year. Considering the great size of Indonesia with different ethnic groups and cultures, worsened by lack of infrastructure, decisive and effective strategies in donor recruitment and retention programs are needed. Copyright 2010 The International Association for Biologicals. Published by Elsevier Ltd. All rights reserved.

Who donates their body to science? An international, multicenter, prospective study.

PubMed

Cornwall, Jon; Perry, Gary F; Louw, Graham; Stringer, Mark D

2012-01-01

The altruistic act of body donation provides a precious resource for both teaching and researching human anatomy. However, relatively little is known about individuals who donate their bodies to science (donors), and in particular whether donors in different geographical locations share similar characteristics. A multicenter prospective survey of donors registering during 2010 in three different geographical locations, New Zealand, Ireland, and the Republic of South Africa, was conducted to identify donor characteristics. The 28-question survey included sections on body donation program awareness, reasons for donating, giving tendency, education, ethnicity, relationship status, occupation, religion, and political preference. Two hundred surveys (81%) were returned [New Zealand 123 (85% response rate), Republic of South Africa 41 (67%), and Ireland 36 (92%)]. Results indicate that donors share certain characteristics including reason for donating (80% cited a desire to aid medical science as the main reason for wishing to donate their body); family structure (most donors are or have been in long-term partnerships and ≥ 85% have siblings); and a higher proportion with no religious affiliation compared to their reference population. Some variations between locations were noted including donor age, the mode of program awareness, occupation, relationship status, political preference, organ donor status and with whom donors had discussed their decision to donate. This information could be important for assisting the identification of potential body donors in new and established bequest programs. Copyright © 2012 American Association of Anatomists.

Donor Research in Australia: Challenges and Promise

PubMed Central

Masser, Barbara; Smith, Geoff; Williams, Lisa A.

2014-01-01

Summary Donors are the key to the core business of Blood Collection Agencies (BCAs). However, historically, they have not been a focus of research undertaken by these organizations. This model is now changing, with significant donor research groups established in a number of countries, including Australia. Donor research in the Australian Red Cross Blood Service (Blood Service) is concentrated in the Donor and Community Research (DCR) team. Cognizant of the complex and ever-changing landscape with regard to optimal donor management, the DCR team collaborates with academics located at universities around Australia to coordinate a broad program of research that addresses both short- and-long term challenges to the blood supply. This type of collaboration is not, however, without challenges. Two major collaborative programs of the Blood Service's research, focusing on i) the recruitment and retention of plasmapheresis donors and ii) the role of the emotion pride in donor motivation and return, are showcased to elucidate how the challenges of conducting collaborative BCA research can be met. In so doing, these and the other research programs described herein demonstrate how the Blood Service supports and contributes to research that not only revises operational procedures but also contributes to advances in basic science. PMID:25254025

Ethical guidelines for the evaluation of living organ donors

PubMed Central

Wright, Linda; Faith, Karen; Richardson, Robert; Grant, David

2004-01-01

Transplantation is an effective, life-prolonging treatment for organ failure. Demand has steadily increased over the past decade, creating a shortage in the supply of organs. In addition, the number of deceased organ donors has reached a plateau. Living-donor transplantation is increasingly an option, influenced by favourable clinical outcomes and increased waiting times at most transplant centres across North America. Living-donor kidney transplants have exceeded deceased-donor transplant rates at some centres. Organ donations from living donors have challenged transplant programs to develop a framework for determining donor acceptability. After a multidisciplinary consensus-building process of discussion and debate, the Multi-Organ Transplant Program of the University Health Network in Toronto has developed ethical guidelines for these procedures. These proposed guidelines address ethical concerns related to selection criteria and procedures, voluntariness, informed consent and disclosure of risks and benefits to both donor and recipient. PMID:15646438

Organized Hypocrisy in EFL Teacher Training Programs

ERIC Educational Resources Information Center

Karim, Abdul; Mohamed, Abdul Rashid; Ismail, Shaik Abdul Malik Mohamed; Rahman, Mohammad Mosiur

2018-01-01

Embracing the reasons for the failure of donor-sponsored English-teacher training programs is very critical since it precedes the revisions, improvements and quality assurance for the futuristic training programs. Ideating such philosophy, the current study concerns the blatant penetration with regard to the donor-aided training programs in…

Expanding the live kidney donor pool: ethical considerations regarding altruistic donors, paired and pooled programs.

PubMed

Patel, Shaneel Rajendra; Chadha, Priyanka; Papalois, Vassilios

2011-06-01

In renal transplant, there is a well-known deficiency in organ supply relative to demand. Live donation provides superior results when compared with deceased donation including a better rate of graft success and fewer immunologic complications. This deficiency in organs leads to significant morbidity and mortality rates. Alternative avenues have been extensively explored that may expand the live donor pool. They include altruistic donation as well as paired and pooled exchange programs. Altruistic donation is a truly selfless act from a donor unknown to the recipient. Kidney paired donation involves 2 incompatible donor-recipient pairs swapping donors to produce compatibility. Pooled donation involves at least 2 pairs, and can take the form of domino chains in which altruistic input sets up a chain of transplants, in which each recipient's incompatible donor makes a donation for the next recipient. Despite application of these various methods, there lie extensive ethical issues surrounding them. Misconceptions frequently occur; for instance, the perceived benefit that donating an organ to a loved one is greater for a related donor than for an altruistic one. Additionally, it is frequently believed that immunologic incompatibility offers coerced donors liberation from surgery, and that overcoming these barriers by introducing exchange programs provides vulnerable donors less protection. This article explores these and other complex ethical issues surrounding the various methods of expanding the donor pool. The authors offer opinions that challenge the ethical issues and attempt to overcome those views that hinder progress in the field.

Entrepreneurial ventures and whole-body donations: a regional perspective from the United States.

PubMed

Anteby, Michel; Hyman, Mikell

2008-02-01

Human cadavers are crucial to medical science. While the debate on how to secure sufficient cadavers has focused primarily on donors' behaviors, procuring organizations' roles in increasing donations remain less explored. The United States offers a unique setting in which to examine this question since entrepreneurial ventures supplying cadavers for medical science have recently emerged alongside traditional academic-housed programs, raising both hopes and fears about their impact on whole-body donations. To assess their potential impact, an archival survey of voluntary, in-state whole-body donors to two programs procuring in the same U.S. state was conducted. The programs' specimen recipients were also analyzed. One program is academic-housed and the other is an entrepreneurial venture. Both offered equal levels of financial support to donating parties. Eighty donations and 120 specimen shipping invoices from 2005 were analyzed in each program. Donations to the two programs did not significantly differ in terms of donors' sex, marital status, maximum educational level, and estimated hourly wage. The entrepreneurial venture's donors were, however, significantly younger, more likely to be from a minority group, and more likely to have died from cancer. For-profit organizations, continuing medical training organizations, and medical device companies were more likely recipients of the entrepreneurial venture's specimens. Non-profit and academic organizations were more likely recipients of the academic-housed program's specimens. These findings suggest that although the programs procured from a somewhat similar pool of donors, they also complemented one another. The entrepreneurial program procured donations that the academic-housed program often did not attract. Specimen recipients' distinct demands partly explain these procurement behaviors. Thus, organizational efforts to meet demands seem to shape the supply. Examining organizations alongside donors might provide new answers to secure donations.

Non-heart-beating donors: an excellent choice to increase the donor pool.

PubMed

Nuñez, J R; Del Rio, F; Lopez, E; Moreno, M A; Soria, A; Parra, D

2005-11-01

A specific program was adopted to obtain organs, for transplant purposes from people who die at home or in the street from sudden or unexpected death (type I non-heart-beating donors [NHBD] according to the Maastricht classification). The objective of our program was to increase the donor pool by obtaining organs from well-selected potential donors who die at home, work, or in the street and are maintained on advanced life support (ALS) until hospital arrival. The great number of people who die in a previously healthy situation constitute an excellent source of organs for transplant purposes. Our program includes pre- and in-hospital attendance. Prehospital attendance is based on application of cardiopulmonary resuscitation in situ and ALS until arrival at hospital. In hospital, specific preservation maneuvers must be performed and family assessment and judge permission obtained. In the last 15 years, we developed a kidney transplant program with better results than transplants performed with organs obtained from encephalic death donors (EDD). A specific NHBD subprogram for lung transplant was developed with excellent results as well. We are now improving the liver transplant program. NHBD are an important source of human tissues, including pancreas islets. It is clear that NHBD are a great source of organs and tissues for transplant, and that this kind of program must be established in all countries in which legal regulations allow it.

Research Donor Program Needs Your Help to Advance Cancer and AIDS Research | Poster

Cancer.gov

NCI at Frederick employees have a unique opportunity to contribute directly to cancer and AIDS research by donating blood, saliva, and other samples through the Research Donor Program (RDP). Donors are compensated for their time, which is typically between 10 and 30 minutes. The RDP, which is administered by Occupational Health Services (OHS), Leidos Biomedical Research, provides samples from healthy donors for use in in vitro research conducted at NCI at Frederick and Fort Detrick. Samples are provided anonymously to researchers.

Operation Blue, ULTRA: DION--the donation inmate organ network.

PubMed

Bartz, Clifford Earle

2003-03-01

Presently more than 80,000 Americans await an organ transplant, while 10 to 12 people die each day because of the lack of organs. The program proposed here would allow federal inmates additional "time off" for agreeing to become living donors or to provide organs or their bodies upon death. Such a program could add 100 to 170 thousand new organ donors to the pool, with another 10 to 12 thousand added annually. If the program were applied to all state inmates, up to 4 million new donors might be added, with another 10 to 13 thousand added annually. Given the extreme need for more organ donors and the need for more living donors, the current National Transplant Act of 1984 and the Uniform Anatomical Gift Act must be amended, while still retaining control of donation procedures.

The Netherlands Brain Bank for Psychiatry.

PubMed

Rademaker, Marleen C; de Lange, Geertje M; Palmen, Saskia J M C

2018-01-01

The Netherlands Brain Bank (NBB) performs rapid autopsies of donors who gave written informed consent during life for the use of their brain tissue and medical files for research. The NBB initiated the Netherlands Brain Bank for Psychiatry (NBB-Psy), a prospective donor program for psychiatric diseases. NBB-Psy wants to expand the tissue collections in order to provide a strong incentive to increase research in psychiatry. The ultimate goal of NBB-Psy is to reduce the burden of psychiatric disorders for patients, their families, and for society as a whole. NBB-Psy consists of an antemortem and postmortem donor program. This chapter focuses on the design of NBB-Psy and the antemortem donor program, where patients and relatives are actively informed on the possibility to become a brain donor. Since the initiation of NBB-Psy, the number of registered donors with a psychiatric diagnosis has increased from 149 in 2010 to 1018 in May 2016. Copyright © 2018 Elsevier B.V. All rights reserved.

Practices for Supporting and Confirming Decision-Making Involved in Kidney and Liver Donation by Related Living Donors in Japan: A Nationwide Survey.

PubMed

Nishimura, K; Kobayashi, S; Tsutsui, J; Kawasaki, H; Katsuragawa, S; Noma, S; Kimura, H; Egawa, H; Yuzawa, K; Umeshita, K; Aikawa, A; Uemoto, S; Takahara, S; Ishigooka, J

2016-03-01

This nationwide survey investigated the actual practices for supporting and confirming the decision-making involved in related living-organ donations in Japan, focusing on organ type and program size differences. Answers to a questionnaire survey were collected from 89 of the 126 (71%) kidney and 30 of the 35 (86%) liver transplantation programs in Japan that were involved in living-donor transplantations in 2013. In 70% of the kidney and 90% of the liver transplantation programs, all donors underwent "third-party" interviews to confirm their voluntariness. The most common third parties were psychiatrists (90% and 83%, respectively). Many programs engaged in practices to support decision-making by donor candidates, including guaranteeing the right to withdraw consent to donate (70% and 100%, respectively) and prescribing a set "cooling-off period" (88% and 100%, respectively). Most donors were offered care by mental health specialists (86% and 93%, respectively). Third parties were designated by more of the larger kidney transplant programs compared with the smaller programs. In conclusion, the actual practices supporting and confirming the decision to donate a living organ varied depending on the organ concerned and the number of patients in the program. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

Research Donor Program Needs Your Help to Advance Cancer and AIDS Research | Poster

Cancer.gov

NCI at Frederick employees have a unique opportunity to contribute directly to cancer and AIDS research by donating blood, saliva, and other samples through the Research Donor Program (RDP). Donors are compensated for their time, which is typically between 10 and 30 minutes. The RDP, which is administered by Occupational Health Services (OHS), Leidos Biomedical Research,

Maternal health development programs: comparing priorities of bilateral and private donors.

PubMed

Deleye, Cécile; Lang, Achim

2014-11-19

The face of international aid for health and development is changing. Private donors such as foundations and corporations are playing an increasingly important role, working in international development as direct operators or in partnerships with governments. This study compares maternal health programs of new development actors to traditional governmental donors. It aims to investigate what maternal health programs large governmental donors, foundations and corporate donors are conducting, and how and why they differ. A total of 263 projects were identified and analyzed. We focus on nine categories of maternal health programs: family planning services, focus on specific diseases, focus on capacity building, use of information and communication technology (ICT), support of research initiatives, cooperation with local non-state or state partners and cooperation with non-local non-state or state partners. Data analysis was carried out using Generalized Linear Mixed-Effects Models (GLMER). Maternal health policies of public and private donors differ with regard to strategic approaches, as can be seen in their diverging positions regarding disease focus, family planning services, capacity building, and partner choice. Bilateral donors can be characterized as focusing on family planning services, specific diseases and capacity-building while disregarding research and ICT. Bilateral donors cooperate with local public authorities and with governments and NGOs from other developed countries. In contrast, corporations focus their donor activities on specific diseases, capacity-building and ICT while disregarding family planning services and research. Corporations cooperate with local and in particular with non-local non-state actors. Foundations can be characterized as focusing on family planning services and research, while disregarding specific diseases, capacity-building and ICT. Foundations cooperate less than other donors; but when they do, they cooperate in particular with non-state actors, local as well as non-local. These findings should help developing coordination mechanisms that embrace the differences and similarities of the different types of donors. As donor groups specialize in different contexts, NGOs and governments working on development and health aid may target donors groups that have specialized in certain issues.

BLISS: a computer program for the protection of blood donors. Technical report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Catsimpoolas, N.; Cooke, C.; Valeri, C.R.

1982-06-28

A BASIC program has been developed for the Hewlett-Packard Model 9845 desk-top computer which allows the creation of blood donor files for subsequent retrieval, update, and correction. A similar modified version was developed for hte HP 9835 Model. This software system has been called BLISS which stands for Blood Information and Security System. In addition to its function as a file management system, BLISS provides warnings before a donation is performed to protect the donor from excessive exposure to radioactivity and DMSO levels, from too frequent of donations of blood, and from adverse reactions. The program can also be usedmore » to select donors who have participated in specific studies and to list the experimental details which have been stored in the file. The BLISS system has been actively utilized at the Naval Blood Research Laboratory in Boston and contains the files of over 750 donors.« less

National Marrow Donor Program. HLA Typing for Bone Marrow Transplantation

DTIC Science & Technology

2014-11-30

educate the transplant community about the critical importance of establishing a nationwide contingency response plan. 2. Rapid Identification of...Expand Network Communications 59 IIB 4.2 Central Contingency Management 59 IIC Immunogenetic Studies 63 IIC.1.1 Donor Recipient Pair Project 63 IIC...Amendment CMCR Centers for Medical Countermeasures Against Radiation CMDP China Marrow Donor Program CME Continuing Medical Education CMF Community

Advanced Donation Programs and Deceased Donor-Initiated Chains-2 Innovations in Kidney Paired Donation.

PubMed

Wall, Anji E; Veale, Jeffrey L; Melcher, Marc L

2017-12-01

Kidney paired donation (KPD) strategies have facilitated compatible living-donor kidney transplants for end-stage renal disease patients with willing but incompatible living donors. Success has inspired further innovations that expand opportunities for kidney-paired donation. Two such innovations are the advanced donation strategy in which a donor provides a kidney before their recipient is matched, or even in need of, a kidney transplant, and deceased donor initiated chains in which chains are started with deceased donors rather than altruistic living donors. Although these innovations may expand KPD, they raise several ethical issues. Specific concerns raised by advanced donation include the management of uncertainty, the extent of donor and recipient consent, the scope of the obligation that the organization has to the kidney exchange paired recipient, the naming of alternative recipients, and the potential to unfairly advantage the recipient. Use of deceased donors for chain-initiating kidneys raises ethical issues concerning the consent process for each involved party, the prioritization of deceased donor kidneys, the allocation of chain ending kidneys, and the value of a living donor kidney versus a deceased donor kidney. We outline each ethical issue and discuss how it can be conceptualized and managed so that these KPD innovations programs are ultimately successful.

Patient selection and volume in the era surrounding implementation of Medicare conditions of participation for transplant programs.

PubMed

White, Sarah L; Zinsser, Dawn M; Paul, Matthew; Levine, Gregory N; Shearon, Tempie; Ashby, Valarie B; Magee, John C; Li, Yi; Leichtman, Alan B

2015-04-01

To evaluate evidence of practice changes affecting kidney transplant program volumes, and donor, recipient and candidate selection in the era surrounding the introduction of Centers for Medicare and Medicaid Services (CMS) conditions of participation (CoPs) for organ transplant programs. Scientific Registry of Transplant Recipients; CMS ESRD and Medicare claims databases. Retrospective analysis of national registry data. A Cox proportional hazards model of 1-year graft survival was used to derive risks associated with deceased-donor kidney transplants performed from 2001 to 2010. Among programs with ongoing noncompliance with the CoPs, kidney transplant volumes declined by 38 percent (n = 766) from 2006 to 2011, including a 55 percent drop in expanded criteria donor transplants. Volume increased by 6 percent (n = 638) among programs remaining in compliance. Aggregate risk of 1-year graft failure increased over time due to increasing recipient age and obesity, and longer ESRD duration. Although trends in aggregate risk of 1-year kidney graft loss do not indicate that the introduction of the CoPs has systematically reduced opportunities for marginal candidates or that there has been a systematic shift away from utilization of higher risk deceased donor kidneys, total volume and expanded criteria donor utilization decreased overall among programs with ongoing noncompliance. © Health Research and Educational Trust.

Trends in US minority red blood cell unit donations.

PubMed

Yazer, Mark H; Delaney, Meghan; Germain, Marc; Karafin, Matthew S; Sayers, Merlyn; Vassallo, Ralph; Ziman, Alyssa; Shaz, Beth

2017-05-01

To provide the appropriately diverse blood supply necessary to support alloimmunized and chronically transfused patients, minority donation recruitment programs have been implemented. This study investigated temporal changes in minority red blood cell (RBC) donation patterns in the United States. Data on donor race and ethnicity from 2006 through 2015, including the number of unique donors, collections, RBCs successfully donated, and average annual number of RBC donations per donor (donor fraction), were collected from eight US blood collectors. Minority donors were stratified into the following groups: Asian, black or African American, Hispanic or Latino, Native Indian or Alaska Native, Native Hawaiian or other Pacific Islander, white, multiracial/other, and no answer/not sure. Over the 10-year period, white donors annually constituted the majority of unique donors (range, 70.7%-73.9%), had the greatest proportion of collections (range, 76.1%-79.8%), and donated the greatest proportion of RBC units (range, 76.3%-80.2%). These donors also had the highest annual donor fraction (range, 1.82-1.91 units per donor). Black or African American donors annually constituted between 4.9 and 5.2% of all donors during the study period and donated between 4.0 and 4.3% of all RBC units. Linear regression analysis revealed decreasing numbers of donors, collections, and donated RBC units from white donors over time. Although the US population has diversified, and minority recruitment programs have been implemented, white donors constitute the majority of RBC donors and donations. Focused and effective efforts are needed to increase the proportion of minority donors. © 2017 AABB.

Regulated compensation for kidney donors in the Philippines.

PubMed

Padilla, Benita S

2009-04-01

The purpose of this review is to discuss the recent events and experiences in the Philippines related to compensated kidney donation. Between 2002 and 2008, the Philippine government, through the Department of Health, administered a program called the Philippine Organ Donation Program that allowed prospective kidney providers to sign up, be allocated to prospective recipients and receive gratuities for their kidney. Transplant tourism flourished during this period because of rampant disregard for the regulation limiting foreign recipients to 10% of total kidney transplants. There is evidence of inadequate donor care. Efforts to curb the problem included a ban on foreigners coming to the Philippines to have kidney transplants with Filipinos as donors as well as strengthening of the implementing rules and regulations of both the antihuman trafficking law and the organ donation law that allowed donation after brain death. The experience in the Philippines mirrored those in India and Pakistan where paid donors reported poor outcomes. An effective national kidney disease prevention program and the deceased donor program for transplantation should be aggressively promoted. Legislation against transplant commercialism is needed.

42 CFR 121.7 - Identification of organ recipient.

Code of Federal Regulations, 2010 CFR

2010-10-01

....8. (3) When a donor or donor organ does not meet a transplant program's donor acceptance criteria... documentation of activities conducted to determine the suitability of the organ donor and shall maintain this... for another potential recipient in accordance with paragraph (b)(2) of this section. (e) Blood vessels...

A Kidney Graft Survival Calculator that Accounts for Mismatches in Age, Sex, HLA, and Body Size.

PubMed

Ashby, Valarie B; Leichtman, Alan B; Rees, Michael A; Song, Peter X-K; Bray, Mathieu; Wang, Wen; Kalbfleisch, John D

2017-07-07

Outcomes for transplants from living unrelated donors are of particular interest in kidney paired donation (KPD) programs where exchanges can be arranged between incompatible donor-recipient pairs or chains created from nondirected/altruistic donors. Using Scientific Registry of Transplant Recipients data, we analyzed 232,705 recipients of kidney-alone transplants from 1998 to 2012. Graft failure rates were estimated using Cox models for recipients of kidney transplants from living unrelated, living related, and deceased donors. Models were adjusted for year of transplant and donor and recipient characteristics, with particular attention to mismatches in age, sex, human leukocyte antigens (HLA), body size, and weight. The dependence of graft failure on increasing donor age was less pronounced for living-donor than for deceased-donor transplants. Male donor-to-male recipient transplants had lower graft failure, particularly better than female to male (5%-13% lower risk). HLA mismatch was important in all donor types. Obesity of both the recipient (8%-18% higher risk) and donor (5%-11% higher risk) was associated with higher graft loss, as were donor-recipient weight ratios of <75%, compared with transplants where both parties were of similar weight (9%-12% higher risk). These models are used to create a calculator of estimated graft survival for living donors. This calculator provides useful information to donors, candidates, and physicians of estimated outcomes and potentially in allowing candidates to choose among several living donors. It may also help inform candidates with compatible donors on the advisability of joining a KPD program. Copyright © 2017 by the American Society of Nephrology.

Predictors of Donor Heart Utilization for Transplantation in United States.

PubMed

Trivedi, Jaimin R; Cheng, Allen; Gallo, Michele; Schumer, Erin M; Massey, H Todd; Slaughter, Mark S

2017-06-01

Optimum use of donor organs can increase the reach of the transplantation therapy to more patients on waiting list. The heart transplantation (HTx) has remained stagnant in United States over the past decade at approximately 2,500 HTx annually. With the use of the United Network of Organ Sharing (UNOS) deceased donor database (DCD) we aimed to evaluate donor factors predicting donor heart utilization. UNOS DCD was queried from 2005 to 2014 to identify total number of donors who had at least one of their organs donated. We then generated a multivariate logistic regression model using various demographic and clinical donor factors to predict donor heart use for HTx. Donor hearts not recovered due to consent or family issues or recovered for nontransplantation reasons were excluded from the analysis. During the study period there were 80,782 donors of which 23,606 (29%) were used for HTx, and 38,877 transplants (48%) were not used after obtaining consent because of poor organ function (37%), donor medical history (13%), and organ refused by all programs (5%). Of all, 22,791 donors with complete data were used for logistic regression (13,389 HTx, 9,402 no-HTx) which showed significant predictors of donor heart use for HTx. From this model we assigned probability of donor heart use and identified 3,070 donors with HTx-eligible unused hearts for reasons of poor organ function (28%), organ refused by all programs (15%), and recipient not located (9%). An objective system based on donor factors can predict donor heart use for HTx and may help increase availability of hearts for transplantation from existing donor pool. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Ethical Issues in Live-Donor Reimbursement Program.

PubMed

Voo, T C; Koh, S; Campbell, A V

2016-04-01

Reimbursement of expenses and costs incurred by live organ donation is permitted in many countries to encourage donation and to protect the welfare of live donors. Potential ethical issues may arise with reimbursement programs and their implementation, which vary across countries. This paper discusses some ethical issues with live donor reimbursement to stimulate discussion on how to ethically enhance its implementation to improve outcomes for both donors and recipients. In addition, we will consider whether reimbursement should be supplemented with compensation for nonfinancial losses, such as pain and suffering, to encourage live donation. Copyright © 2016 Elsevier Inc. All rights reserved.

Outcomes of strategic alternative donor selection or suspending donor search based on Japan Marrow Donor Program coordination status.

PubMed

Kawashima, Naomi; Nishiwaki, Satoshi; Shimizu, Naoko; Kamoshita, Sonoko; Watakabe, Kyoko; Yokohata, Emi; Kurahashi, Shingo; Ozawa, Yukiyasu; Miyamura, Koichi

2018-05-01

In allogeneic hematopoietic stem cell transplantation (allo-HSCT) from unrelated donors, delays in donor search are adversely associated with patient outcome. However, the optimal duration for either waiting for an unrelated donor or selecting alternative sources remains undetermined. Using data from the Japan Marrow Donor Program (JMDP) registry, we retrospectively analyzed 349 adult patients who had searched for unrelated donors. Two hundred and three patients received allo-HSCT from JMDP donors (Group A) with a median of 140 days required to identify a donor, 60 received allo-HSCT from alternative sources (Group B) after a median of 111.5 days at which point either all donor candidates had failed or the patient achieved a second or subsequent complete remission, and 77 suspended allo-HSCT (Group C) after a median of 310 days. The 5-year overall survival (OS) rate in Group A was superior to that of Group C (48.6 vs 38.5%, P = 0.001). Although Group B included more patients with high or very high disease risk index (DRI) at the time of allo-HSCT compared with Group A, the 5-year OS was not significantly different between Groups A and B (48.6 vs 40.9%, P = 0.07), indicating that switching to alternative donors may benefit patients with high DRI.

Female-partnered and single women's contact motivations and experiences with donor-linked families.

PubMed

Goldberg, A E; Scheib, J E

2015-06-01

What are female-partnered and single mothers' motivations and experiences at one donor insemination (DI) program with regard to contacting other families who share the same sperm donor? By and large, women reported seeking contact to obtain (i) support for their children and/or themselves, and (ii) information about shared traits and medical problems, ultimately describing a range of contact experiences, both positive (e.g. special bond created) and negative (e.g. uncomfortable encounters). There is a growing phenomenon of donor insemination families-parents and/or offspring-seeking others who share their donor (i.e. are 'donor-linked'). There is limited understanding about parental motivations and experiences-especially in the presence of a second parent-due to the methodological constraints of previous quantitative studies. Semi-structured telephone interviews were conducted with 50 donor insemination mothers (14 single, 36 female-partnered). Participants were recruited by email invitation to parent members of a family-matching service at one donor insemination program in the USA. The criterion for inclusion was having matched to at least one donor-linked family. Among the 50 mothers interviewed, all had at least one child conceived via donor insemination, who was between ages 0 and 15 years at first contact. Families matched with a median of three donor-linked families (range 1-10). Interview data were analyzed through qualitative (i.e. thematic) analysis. Overarching themes emerged of seeking contact to obtain (i) support and (ii) information about children's shared physical and psychological traits. Some wanted to increase their child's family network, through adding a sibling, but more often as extended family. Data, from partnered parents especially, revealed the challenges of balancing the boundaries of family formed without the genetic link with the perceived benefits of exploring the child's donor origins. Interviews focused on openness and information-sharing were conducted with parents from one American donor insemination program. Findings are limited to individuals who were open enough to share their experiences and able to take the time to do so. As donor-linking services become established independently (e.g. donor insemination program registries) or by the government (e.g. Victoria, Australia's Voluntary Register), these findings provide evidence that linking services are valued by individuals affected by donor conception. Caution is warranted, however, in that some participants reported mismatched expectations, both across donor-linked families and within families (e.g. between partners), suggesting the need for information and guidance both during and after matching. Overall, the range and balance of reported positives and negatives indicate that donor-linking can provide individuals with support and donor origins information-which are particularly important when these are not available elsewhere. Clark University provided support. No competing interests. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Meeting the family: promoting humanism in gross anatomy.

PubMed

Crow, Sheila M; O'Donoghue, Dan; Vannatta, Jerry B; Thompson, Britta M

2012-01-01

Human dissection commonly occurs early in the undergraduate medical school curriculum, thus presenting an immediate opportunity for educators to teach and encourage humanistic qualities of respect, empathy, and compassion. The purpose of this study was to measure the impact of the Donor Luncheon, a unique program in which medical students meet the families of the anatomical donor prior to dissection in the anatomy course at the University of Oklahoma College of Medicine. Students were randomized into groups of 8 to attend the luncheon and either met with family of the donor or attended the luncheon with no donor family present. A questionnaire measured students' attitudes at 2 weeks, 6 weeks, and at the conclusion of the anatomy course. Factor analysis revealed 5 scales. Analysis revealed statistically significant differences across time for Donor as Person, Dissection Process, and Donor as Patient and statistically significant differences between groups for Donor as Person and Donor as Patient. These results suggest that this program can provide students with the opportunity to maintain more humanistic attitudes at the beginning of their medical education career.

Is Donor Service Area Market Competition Associated With Organ Procurement Organization Performance?

PubMed

Adler, Joel T; Yeh, Heidi; Markmann, James F; Axelrod, David A

2016-06-01

Organ procurement organizations (OPOs) are currently evaluated on donation rates and number of organs per donor. However, there is significant variability in market characteristics which affect transplant programs' donor organ acceptance practices and OPOs' ability to successfully place higher risk organs. The impact of transplant market characteristics on OPO performance metrics has not been evaluated. The OPO performance measures were correlated annually with the Herfindahl Hirschman Index, a standard measure of market competition for centers within the OPO donor service areas from 2003 to 2011. More competitive donor service areas were associated with increased number of donors (P = 0.01) and eligible deaths (P < 0.001). Market competition was associated with increased use of high Donor Risk Index for kidney (P = 0.03) and liver (P = 0.01) allografts. The OPOs with increased competition in liver transplant also were noted to have a higher donor conversion rate (P < 0.001), more donors per million population (P < 0.001), and a higher utilization rate for liver allografts (P = 0.007). These data suggest that proposals to increase district size to increase competition among transplant programs could result in improved organ utilization over time by incentivizing the use of marginal donor organs and increasing access to transplantation.

[Present situaltion of living-donor kidney transplantation in Spain and other countries: past, present and future of an excellent therapeutic option].

PubMed

Domínguez-Gil, Beatriz; de la Oliva Valentín, María; Martín Escobar, Eduardo; Cruzado, José María; Pascual, Julio; Fernández Fresnedo, Gema

2010-01-01

Kidney transplantation from living donor is an established treatment in Spain since the 60s but has maintained a low level of activity until 2000, when the number of procedures and hospitals that perform this therapy experienced a gradual increase, reaching the highest figure in our history in 2009, with 235 living donor kidney transplants (which represents 10% of renal transplant activity). The reasons why living donor kidney transplantation is emerging in our country are diverse and can be focused in four main areas. 1) Better outcomes obtained when using living donors for kidney transplantation than those obtained with kidneys from deceased donors. Younger recipients with better HLA matching, the good health of the donor, the absence of any damages that occur in the kidney secondary to brain death, the small ischemic time and the possibility of preemptive transplantation can explain the best graft and patient survival. 2) The scarcity of sources: the relaxation of entry criteria on the waiting list implies an increasing challenge of the demand for transplant without the contribution of living donor kidney transplantation, especially in young recipients where the chances of obtaining an age-appropriate deceased donor are lower, due to the change in the profile of the deceased donor (increasingly older). 3) Improvement in the safety of the donor: the excellent evaluation and monitoring of donors (based on international standards) plus the use of less invasive surgical techniques are related to a low complication rate and to survival expectancies of living donors being similar to those of the general population. 4) Barriers overcome: The training effort by the transplant teams, hospital and regional coordinations, and the National Transplant Organization is giving excellent results, visible in the gradual increase in the number of hospitals with a program of living donor kidney transplantation and its activity. In addition, desensitization programs and the national cross-over kidney transplantation program have removed barriers to transplantation in cases of ABO incompatibility or positive crossmatch.

Increasing access to kidney transplantation in countries with limited resources: the Indian experience with kidney paired donation.

PubMed

Kute, Vivek B; Vanikar, Aruna V; Shah, Pankaj R; Gumber, Manoj R; Patel, Himanshu V; Engineer, Divyesh P; Modi, Pranjal R; Shah, Veena R; Trivedi, Hargovind L

2014-10-01

According to the Indian chronic kidney disease registry, in 2010 only 2% of end stage kidney disease patients were managed with kidney transplantation, 37% were managed with dialysis and 61% were treated conservatively without renal replacement therapy. In countries like India, where a well-organized deceased donor kidney transplantation program is not available, living donor kidney transplantation is the major source of organs for kidney transplantation. The most common reason to decline a donor for directed living donation is ABO incompatibility, which eliminates up to one third of the potential living donor pool. Because access to transplantation with human leukocyte antigen (HLA)-desensitization protocols and ABO incompatible transplantation is very limited due to high costs and increased risk of infections from more intense immunosuppression, kidney paired donation (KPD) promises hope to a growing number of end stage kidney disease patients. KPD is a rapidly growing and cost-effective living donor kidney transplantation strategy for patients who are incompatible with their healthy, willing living donor. In principle, KPD is feasible for any centre that performs living donor kidney transplantation. In transplant centres with a large living donor kidney transplantation program KPD does not require extra infrastructure, decreases waiting time, avoids transplant tourism and prevents commercial trafficking. Although KPD is still underutilized in India, it has been performed more frequently in recent times. To substantially increase donor pool and transplant rates, transplant centres should work together towards a national KPD program and frame a uniform acceptable allocation policy. © 2014 Asian Pacific Society of Nephrology.

Who requests their sperm donor's identity? The first ten years of information releases to adults with open-identity donors.

PubMed

Scheib, Joanna E; Ruby, Alice; Benward, Jean

2017-02-01

To report findings from 10 years of requests from adults eligible to obtain their open-identity sperm donor's information. Analysis of archived family and donor data. Semistructured interviews at information releases. Not applicable. A total of 85 DI adults requesting 43 donor identities; program data on 256 DI families. None. We identified [1] demographic predictors of requesting donor identities, [2] information release timing and length, and [3] request motives. Just >35% of eligible DI adults requested their donor's identity. Adults ranged from 18-27 years, requesting at median age 18 years. More women than men requested. Proportionally fewer adults requested when they had heterosexual-couple parents, and proportionally more when they had one rather than two parents. In interviews, the common theme was wanting to know more about the donor, especially about shared characteristics. Most adults planned to contact their donor. More than 94% of adults had donors who were open to contact; adults expressed modest expectations about this contact. In 2001, the first adults became eligible to obtain their open-identity sperm donor's information. Ten years of identity requests at one program indicates that information about one's donor is important to a significant proportion of these DI adults. Most requested their donor's identity soon after becoming eligible, suggesting some urgency to wanting the information. Interview data highlighted the role of donor information in helping adults better understand themselves and their ancestry. Findings hold important implications for practice and policy. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Optimal Decisions for Organ Exchanges in a Kidney Paired Donation Program.

PubMed

Li, Yijiang; Song, Peter X-K; Zhou, Yan; Leichtman, Alan B; Rees, Michael A; Kalbfleisch, John D

2014-05-01

The traditional concept of barter exchange in economics has been extended in the modern era to the area of living-donor kidney transplantation, where one incompatible donor-candidate pair is matched to another pair with a complementary incompatibility, such that the donor from one pair gives an organ to a compatible candidate in the other pair and vice versa. Kidney paired donation (KPD) programs provide a unique and important platform for living incompatible donor-candidate pairs to exchange organs in order to achieve mutual benefit. In this paper, we propose novel organ allocation strategies to arrange kidney exchanges under uncertainties with advantages, including (i) allowance for a general utility-based evaluation of potential kidney transplants and an explicit consideration of stochastic features inherent in a KPD program; and (ii) exploitation of possible alternative exchanges when the originally planned allocation cannot be fully executed. This allocation strategy is implemented using an integer programming (IP) formulation, and its implication is assessed via a data-based simulation system by tracking an evolving KPD program over a series of match runs. Extensive simulation studies are provided to illustrate our proposed approach.

The impact of disclosure on donor gamete participants: donors, intended parents and offspring.

PubMed

Greenfeld, Dorothy A

2008-06-01

The present review examines recent publications that provide insight into how the trend toward nonanonymity and disclosure in gamete donation impacts donors, intended parents, and their donor-conceived children. Recent findings show an increase in donor programs that offer open-identity between donors and offspring. The psychological needs of gamete donors and their attitudes toward disclosure are increasingly given consideration. Qualitative research on how parents of donor gamete offspring make decisions about disclosure reveals that even when couples initially disagree about disclosing to offspring, most ultimately come to a united disclosure decision. The literature on the impact of disclosure on donor gamete offspring has extended to include children conceived through embryo donation and children born as a result of surrogacy. The absence of genetic or gestational link between parents and their child does not have a negative impact on parent-child relationships. Parents through surrogacy tend to disclose the method of family creation to their child, whereas parents through embryo donation tend to be secretive about their child's origins. The trend toward greater openness in gamete donation has been accompanied by an increase in programs offering open-identity donation. In addition, the psychological needs of gamete donors and their attitudes toward disclosure are increasingly being given consideration. Parents of donor gamete offspring give careful thought to their disclosure decisions, and the psychological well being of donor-conceived children does not seem to be impacted by those decisions.

Dual kidney transplantation involving organs from expanded criteria donors: a review of our series and an update on current indications.

PubMed

Medina-Polo, J; Pamplona-Casamayor, M; Miranda-Utrera, N; González-Monte, E; Passas-Martínez, J B; Andrés Belmonte, A

2014-12-01

Our purpose was to review our kidney transplantation program based on the use of expanded criteria donors, and to determine current indications for dual kidney transplantation (DKT). In 1996, a program was initiated to transplant kidneys from donors of over 60 years performing single or dual transplantation. In 1996, a program was initiated to transplant kidneys from donors of over 60 years performing single or dual transplantation. DKT were performed with donors >75 and donors between 60 and 74 years of age and glomerulosclerosis of >15%. The kidneys of donors between 60 and 74 years of age and with glomerulosclerosis of <15% were used for single kidney transplantation (SKT). In 2005, we started to perform SKT despite glomerulosclerosis being >15%, taking into account donor and recipient characteristics. From 1996 to 2004, 222 SKTs and 88 DKTs were performed. Graft survival after 1 and 4 years was, respectively, 91% and 78% for SKT and 95% and 79% for DKT. In 2005, we started to perform SKT despite glomerulosclerosis being >15%, taking into account donor and recipient characteristics. From 2005 to 2011, 328 SKT and 32 DKT were performed. During this period most kidneys used for DKT were from female donors >75 years old, weighing <65 kg, with a creatinine of >1 mg/dL and glomerulosclerosis of >15%. The recipients for DKT were mostly male, <70 years old and whose weight was >75 kg. DKT from expanded criteria donors shows good outcomes. However, in many cases SKT may fulfill the need of the recipient. The archetype for DKT is an older female weighing <65 kg and the most common recipient is an overweight male who is <70 years old. Copyright © 2014 Elsevier Inc. All rights reserved.

The transplantation donation process in the Centro de Investigaciones Medico Quirurgicas of Cuba: 1999-2002.

PubMed

Abdo, A; Ugarte, J C; Castellanos, R; González, L; López, O; Hernández, J C; Valdivia, J; Almora, E; Suárez, O; Diaz, J; Collera, S; Enamorado, A; Vázquez, A; Beníte, P; Dominguez, J; Wilford, M; Falcon, J

2003-08-01

In 1998 in the Centro de Investigaciones Medico Quirurgicas the Transplant Coordination Office (TCO) was created, with the aim to organize a system to support a hepatic transplantation program. This organization, which changed the transplantation-donation process not only in our center but in the whole country, is described in this article. The files of donors generated in our hospital were studied together with the transplant coordination records, from 1999 till the first half of 2002. In the period studied, 21 potential donors were diagnosed with brain death, yielding a donation rate of 71.4%. Brain death was most frequently caused by vascular brain disease; however, in the realized donor group, the cranioencephalic trauma predominated. The typical donor was a man of average age 39.2 years (range, 18-86 years). Among the potential donors, 24% were excluded based on medical criteria, and 5% due to family objections. Forty liver transplantation were performed in 36 patients including 1 liver-kidney simultaneous procedure. The principal etiologies for transplant included hepatitis C virus cirrhosis, 22%; alcoholic, 19%; and acute hepatic failure, 13%. Kidney transplantations were performed in 70 patients, including 41 from cadaveric donors (53.6%) and 29 from living related donors (41.4%). In 2001, a pancreas-kidney transplantation program was started. The creation of the TCO has been of paramount importance to optimize transplantation program functions.

Effects of structured education program on organ donor designation of nursing students and their families: A randomized controlled trial.

PubMed

Murakami, Minoru; Fukuma, Shingo; Ikezoe, Masaya; Iizuka, Chizuko; Izawa, Satoshi; Yamamoto, Yosuke; Yamazaki, Shin; Fukuhara, Shunichi

2016-11-01

Little is known about the effect of education programs on changing attitudes and behaviors of participants and their families toward deceased organ donation. The subjects of this randomized trial were Japanese nursing students who were not previously designated organ donors. They were randomly assigned to either the education program or information booklet group. The program comprised a lecture followed by group discussion and information booklet. The primary outcome was self-reported organ donor designation. Outcomes were assessed by questionnaire. Data of 203 (99.0%) students were analyzed. At study end, seven of 102 students (6.9%) of the program group and one of 101 students (1.0%) of the booklet group consented to donate organs (proportion ratio 6.93 [95% CI 0.87-55.32]). There were significant between-group differences in willingness to consent for donation (54.9% vs 39.6%; proportion ratio 1.39 [95% CI 1.03-1.87]), family discussion (31.4% vs 15.9%; 1.98 [1.16-3.38]), and organ donor designation of family members (11.8% vs 2.0%; 5.94 [1.36-25.88]). No group differences were found in willingness for organ donation by students and family members. Although there were no significant between-group differences in organ donor designation, the program seems to indirectly promote consent to organ donation by their families. © 2016 The Authors. Clinical Transplantation Published by John Wiley & Sons Ltd.

The Tzu Chi Silent Mentor Program: Application of Buddhist Ethics to Teach Student Physicians Empathy, Compassion, and Self-Sacrifice.

PubMed

Santibañez, Scott; Boudreaux, Debra; Tseng, Guo-Fang; Konkel, Kimberly

2016-10-01

The Buddhist Tzu Chi Silent Mentor Program promotes the donation of one's body to science as a selfless act by appealing to the Buddhist ethics of compassion and self-sacrifice. Together, faculty, families, and donors help medical students to learn the technical, spiritual, emotional, and psychological aspects of medicine. Students assigned to each "Silent Mentor" visit the family to learn about the donor's life. They see photos and hear family members' stories. Afterwards, students write a brief biography of the donor which is posted on the program website, in the medical school, and on the dissection table. In this paper, we: (1) summarize the Silent Mentor Program; (2) describe findings from an assessment of medical students who recently completed a new version of the program in Malaysia; and (3) explore how healthcare settings could benefit from this innovative program.

Health Education about AIDS among Seropositive Blood Donors.

ERIC Educational Resources Information Center

Cleary, Paul D.; And Others

1986-01-01

This article reviews the theoretical and empirical work that resulted in the New York Blood Center health education and psychosocial support program for blood donors who are notified that they are HIV (Human Immunodeficiency Virus) antibody positive. Also describes how the program is being implemented. (Author/CT)

Effects of a CME Program on Physicians' Transfusion Practices.

ERIC Educational Resources Information Center

Hull, Alan L.; And Others

1989-01-01

The hospital charts of 44 patients who were autologous blood donors undergoing elective orthopedic surgery and a matched group of 44 patients who were not autologous blood donors were analyzed to determine their physicians' transfusion practices. A continuing medical education program was developed. (Author/MLW)

Finding long chains in kidney exchange using the traveling salesman problem.

PubMed

Anderson, Ross; Ashlagi, Itai; Gamarnik, David; Roth, Alvin E

2015-01-20

As of May 2014 there were more than 100,000 patients on the waiting list for a kidney transplant from a deceased donor. Although the preferred treatment is a kidney transplant, every year there are fewer donors than new patients, so the wait for a transplant continues to grow. To address this shortage, kidney paired donation (KPD) programs allow patients with living but biologically incompatible donors to exchange donors through cycles or chains initiated by altruistic (nondirected) donors, thereby increasing the supply of kidneys in the system. In many KPD programs a centralized algorithm determines which exchanges will take place to maximize the total number of transplants performed. This optimization problem has proven challenging both in theory, because it is NP-hard, and in practice, because the algorithms previously used were unable to optimally search over all long chains. We give two new algorithms that use integer programming to optimally solve this problem, one of which is inspired by the techniques used to solve the traveling salesman problem. These algorithms provide the tools needed to find optimal solutions in practice.

Finding long chains in kidney exchange using the traveling salesman problem

PubMed Central

Anderson, Ross; Ashlagi, Itai; Gamarnik, David; Roth, Alvin E.

2015-01-01

As of May 2014 there were more than 100,000 patients on the waiting list for a kidney transplant from a deceased donor. Although the preferred treatment is a kidney transplant, every year there are fewer donors than new patients, so the wait for a transplant continues to grow. To address this shortage, kidney paired donation (KPD) programs allow patients with living but biologically incompatible donors to exchange donors through cycles or chains initiated by altruistic (nondirected) donors, thereby increasing the supply of kidneys in the system. In many KPD programs a centralized algorithm determines which exchanges will take place to maximize the total number of transplants performed. This optimization problem has proven challenging both in theory, because it is NP-hard, and in practice, because the algorithms previously used were unable to optimally search over all long chains. We give two new algorithms that use integer programming to optimally solve this problem, one of which is inspired by the techniques used to solve the traveling salesman problem. These algorithms provide the tools needed to find optimal solutions in practice. PMID:25561535

77 FR 71173 - Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-29

... the Military Health System (MHS) with a comprehensive enterprise wide Blood Donor Management System (BDMS) and a Blood Management Blood Bank and Transfusion Service (BMBB/TS). The Blood Donor Management... DoD's Blood Program capabilities for Donor Centers through the seamless integration of blood products...

What drives donor funding in population assistance programs? Evidence from OECD countries.

PubMed

van Dalen, Hendrik P; Reuser, Mieke

2006-09-01

The 1994 International Conference on Population and Development (ICPD) established goals for the expansion of population assistance. To date, the financial promises made by donor countries in 1994 have not been met. To unravel the gap between ambitions and contributions, we use panel estimation methods to see what lies behind the level of donor contributions and the sharing of burdens across the various categories of population and HIV/AIDS assistance in 21 donor countries for the years 1996-2002. Contributions by donors depend heavily on the economic wealth and subjective preferences of donor countries. The sharing of the ICPD burden within the group of OECD/DAC countries is in line with the countries' ability to pay, although within the aggregate we observe a specialization in channels for aid: small countries predominantly use multilateral aid agencies, whereas large countries rely more on bilateral aid channels. Catholic countries are averse to donating unrestricted funds (flowing primarily to multilateral agencies) or restricted funds targeted at family planning programs.

Analysis of the Effect of Race, Socioeconomic Status, and Center Size on Unrelated National Marrow Donor Program Donor Outcomes: Donor Toxicities Are More Common at Low-Volume Bone Marrow Collection Centers.

PubMed

Shaw, Bronwen E; Logan, Brent R; Kiefer, Deidre M; Chitphakdithai, Pintip; Pedersen, Tanya L; Abdel-Azim, Hisham; Abidi, Muneer H; Akpek, Gorgun; Diaz, Miguel A; Artz, Andrew S; Dandoy, Christopher; Gajewski, James L; Hematti, Peiman; Kamble, Rammurti T; Kasow, Kimberley A; Lazarus, Hillard M; Liesveld, Jane L; Majhail, Navneet S; O'Donnell, Paul V; Olsson, Richard F; Savani, Bipin N; Schears, Raquel M; Stroncek, David F; Switzer, Galen E; Williams, Eric P; Wingard, John R; Wirk, Baldeep M; Confer, Dennis L; Pulsipher, Michael A

2015-10-01

Previous studies have shown that risks of collection-related pain and symptoms are associated with sex, body mass index, and age in unrelated donors undergoing collection at National Marrow Donor Program centers. We hypothesized that other important factors (race, socioeconomic status [SES], and number of procedures at the collection center) might affect symptoms in donors. We assessed outcomes in 2726 bone marrow (BM) and 6768 peripheral blood stem cell (PBSC) donors collected between 2004 and 2009. Pain/symptoms are reported as maximum levels over mobilization and collection (PBSC) or within 2 days of collection (BM) and at 1 week after collection. For PBSC donors, race and center volumes were not associated with differences in pain/symptoms at any time. PBSC donors with high SES levels reported higher maximum symptom levels 1 week after donation (P = .017). For BM donors, black males reported significantly higher levels of pain (OR, 1.90; CI, 1.14 to 3.19; P = .015). No differences were noted by SES group. BM donors from low-volume centers reported more toxicity (OR, 2.09; CI, 1.26 to 3.46; P = .006). In conclusion, race and SES have a minimal effect on donation-associated symptoms. However, donors from centers performing ≤ 1 BM collection every 2 months have more symptoms after BM donation. Approaches should be developed by registries and low-volume centers to address this issue. Copyright © 2015 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

The Psychosocial and Independent Living Donor Advocate Evaluation and Post-surgery Care of Living Donors.

PubMed

Rudow, Dianne LaPointe; Swartz, Kathleen; Phillips, Chelsea; Hollenberger, Jennifer; Smith, Taylor; Steel, Jennifer L

2015-09-01

Solid organ transplantation as a treatment for end stage organ failure has been an accepted treatment option for decades. Despite advances in medicine and technology, and increased awareness of organ donation and transplantation, the gap between supply and demand continues to widen. Living donation has been an option that has increased the number of transplants despite the continued shortage of deceased organs. In the early 2000s live donor transplantation reached an all-time high in the United States. As a result, a consensus meeting was convened in 2000 to increase the oversight of living donor transplantation. Both the Centers for Medicare and Medicaid Services and the United Network for Organ Sharing developed regulations that transplant programs performing live donor transplantation. These regulations and guidelines involve the education, evaluation, informed consent process and living donor follow-up care. Two areas in which had significant changes included the psychosocial and the independent living donor advocate (ILDA) evaluation. The purpose of this paper was to outline the current regulations and guidelines associated with the psychosocial and ILDA evaluation as well as provide further recommendations for the administration of a high quality evaluation of living donors. The goals and timing of the evaluation and education of donors; qualifications of the health care providers performing the evaluation; components of the evaluation; education provided to donors; documentation of the evaluation; participation in the selection committee meeting; post-decline and post-donation care of donors is described. Caveats including the paired donor exchange programs and non-directed and directed donation are also considered.

Strategies to expand the living donor pool for kidney transplantation.

PubMed

de Klerk, Marry; Zuidema, Willij C; Ijzermans, Jan N M; Weimar, Willem

2008-05-01

Structural shortage of deceased donor kidneys for transplantation has resulted in the expansion of living donation programs. A number of possibilities are now being explored, since it became clear that donors do not need to be genetically related to their recipients. Apart from classical direct donation we now conduct paired exchange, list exchange, altruistic donation and domino paired exchange programs. Other alternative programs are desensitization and transplantation across the blood type barrier. The purpose of this article is to give a general view of all optimizing living donation programs by reviewing the literature. First we describe logistic solutions, thereafter the more intensive medical treatments. We observed a wide variation in clinical experiences with living donation dependent on local jurisdiction, culture and customs. Professionals disagree on various ethical issues inherent to alternative programs. In our opinion logistic solutions like paired exchange, list exchange and altruistic donation programs are to be preferred over the more medical demanding programs e.g. desensitization and transplantation across the blood type barrier.

Sperm donor anonymity and compensation: an experiment with American sperm donors

PubMed Central

Cohen, Glenn; Coan, Travis; Ottey, Michelle; Boyd, Christina

2016-01-01

Abstract Most sperm donation that occurs in the USA proceeds through anonymous donation. While some clinics make the identity of the sperm donor available to a donor-conceived child at age 18 as part of ‘open identification’ or ‘identity release programs,’ no US law requires clinics to do so, and the majority of individuals do not use these programs. By contrast, in many parts of the world, there have been significant legislative initiatives requiring that sperm donor identities be made available to children after a certain age (typically when the child turns 18). One major concern with prohibiting anonymous sperm donation has been that the number of willing sperm donors will decrease leading to shortages, as have been experienced in some of the countries that have prohibited sperm donor anonymity. One possible solution, suggested by prior work, would be to pay current anonymous sperm donors more per donation to continue to donate when their anonymity is removed. Using a unique sample of current anonymous and open identity sperm donors from a large sperm bank in the USA, we test that approach. As far as we know, this is the first attempt to examine what would happen if the USA adopted a prohibition on anonymous sperm donation that used the most ecologically valid population, current sperm donors. We find that 29% of current anonymous sperm donors in the sample would refuse to donate if the law changed such that they were required to put their names in a registry available to donor-conceived children at age 18. When we look at the remaining sperm donors who would be willing to participate, we find that they would demand an additional $60 per donation (using our preferred specification). We also discuss the ramifications for the industry. PMID:28852536

Decision Making in Kidney Paired Donation Programs with Altruistic Donors*

PubMed Central

Li, Yijiang; Song, Peter X.-K.; Leichtman, Alan B.; Rees, Michael A.; Kalbfleisch, John D.

2014-01-01

In recent years, kidney paired donation (KPD) has been extended to include living non-directed or altruistic donors, in which an altruistic donor donates to the candidate of an incompatible donor-candidate pair with the understanding that the donor in that pair will further donate to the candidate of a second pair, and so on; such a process continues and thus forms an altruistic donor-initiated chain. In this paper, we propose a novel strategy to sequentially allocate the altruistic donor (or bridge donor) so as to maximize the expected utility; analogous to the way a computer plays chess, the idea is to evaluate different allocations for each altruistic donor (or bridge donor) by looking several moves ahead in a derived look-ahead search tree. Simulation studies are provided to illustrate and evaluate our proposed method. PMID:25309603

Organ Donation in the United States: The Tale of the African-American Journey of Moving From the Bottom to the Top.

PubMed

Callender, C O; Koizumi, N; Miles, P V; Melancon, J K

2016-09-01

The purpose was to review the increase of minority organ donation. The methodology was based on the efforts of the DC Organ Donor Program and the Dow Take Initiative Program that focused on increasing donors among African Americans (AAs). From 1982 to 1988, AA donor card signings increased from 20/month to 750/month, and Black donations doubled. A review of the data, including face-to-face grassroots presentations combined with national media, was conducted. Gallup polls in 1985 and 1990 indicated a tripling of black awareness of transplantation and the number of blacks signing donor cards. Based on the applied successful methodologies, in 1991, the National Minority Organ Tissues Transplant Education Program was established targeting AA, Hispanic, Asian, and other ethnic groups. A review of the United Network for Organ Sharing (UNOS) database from 1990 to 2010 was accomplished. Nationally, ethnic minority organ donors per million (ODM) increased from 8-10 ODM (1982) to 35 ODM (AA and Latino/Hispanics) in 2002. In 1995, ODMs were white 34.2, black 33.1, Hispanic 31.5, and Asian 17.9. In 2010, Black organ donors per million totaled 35.36 versus white 27.07, Hispanic 25.59, and Asian 14.70. Based on the data retrieved from UNOS in 2010, blacks were ranked above whites and other ethnic minority populations as the number one ethnic group of organ donors per million in the US. Copyright © 2016 Elsevier Inc. All rights reserved.

Patient-Centered mHealth Living Donor Transplant Education Program for African Americans: Development and Analysis

PubMed Central

Sieverdes, John Christopher; Nemeth, Lynne S; Magwood, Gayenell S; Baliga, Prabhakar K; Chavin, Kenneth D; Brunner-Jackson, Brenda; Patel, Sachin K; Ruggiero, Kenneth J

2015-01-01

Background There is a critical need to expand the pool of available kidneys for African Americans who are on the transplant wait-list due to the disproportionally lower availability of deceased donor kidneys compared with other races/ethnic groups. Encouraging living donation is one method to fill this need. Incorporating mHealth strategies may be a way to deliver educational and supportive services to African American transplant-eligible patients and improve reach to those living in remote areas or unable to attend traditional group-session-based programs. Before program development, it is essential to perform formative research with target populations to determine acceptability and cultivate a patient-centered and culturally relevant approach to be used for program development. Objective The objectives of this study were to investigate African American kidney transplant recipients’ and kidney donors’/potential donors’ attitudes and perceptions toward mobile technology and its viability in an mHealth program aimed at educating patients about the process of living kidney donation. Methods Using frameworks from the technology acceptance model and self-determination theory, 9 focus groups (n=57) were administered to African Americans at a southeastern medical center, which included deceased/living donor kidney recipients and living donors/potential donors. After a demonstration of a tablet-based video education session and explanation of a group-based videoconferencing session, focus groups examined members’ perceptions about how educational messages should be presented on topics pertaining to the process of living kidney donation and the transplantation. Questionnaires were administered on technology use and perceptions of the potential program communication platform. Transcripts were coded and themes were examined using NVivo 10 software. Results Qualitative findings found 5 major themes common among all participants. These included the following: (1) strong support for mobile technology use; (2) different media formats were preferred; (3) willingness to engage in video chats, but face-to-face interaction sometimes preferred; (4) media needs to be user friendly; (5) high prevalence of technology access. Our results show that recipients were willing to spend more time on education than the donors group, they wanted to build conversation skills to approach others, and preferred getting information from many sources, whereas the donor group wanted to hear from other living donors. The questionnaires revealed 85% or more of the sample scored 4+ on a 5-point Likert scale, which indicates high degree of interest to use the proposed program, belief that other mHealth technologies would help with adherence to medical regimens, and doctors would make regimen adjustments quicker. In addition, high utilization of mobile technology was reported; 71.9% of the participants had a mobile phone and 43.9% had a tablet. Conclusions Our study supports the use of an mHealth education platform for African Americans to learn about living donation. However, potential recipients and potential donors have differing needs, and therefore, programs should be tailored to each target audience. PMID:26265532

Role of the independent donor advocacy team in ethical decision making.

PubMed

Rudow, Dianne LaPointe; Brown, Robert S

2005-09-01

Adult living donor liver transplantation has developed as a direct result of the critical shortage of deceased donors. Recent regulations passed by New York State require transplant programs to appoint an Independent Donor Advocacy Team to evaluate, educate, and consent to all potential living liver donors. Ethical issues surround the composition of the team, who appoints them, and the role the team plays in the process. Critics of living liver donation have questioned issues surrounding motivation and the ability of donors to provide true informed consent during a time of family crisis. This article will address issues surrounding the controversies and discuss how using the team can effectively evaluate and educate potential living liver donors and improve practice to ensure safety of living donors.

"Mortui vivos docent" or who gives his body to science? The analysis of the personal questionnaires of Polish donors in the Conscious Body Donation Program.

PubMed

Bajor, Grzegorz; Likus, Wirginia; Kuszewski, Piotr; Kostro, Karol; Łoś, Andrzej; Kłakus, Piotr

2015-01-01

The Conscious Body Donation Program conducted since 2003 by the Department of Human Anatomy, Medical University of Silesia in Katowice was the first innovative project aimed at obtaining informed donors' bodies for the purpose of teaching anatomy in Poland. The aim of this prospective study was to determine the declared donors' characteristics and to establish the possible motivation for body donation. A total of 244 application files were reviewed and the following information was analyzed: donor's age, age at which the decision to donate the body was made, donor's place of residence and declared nationality, family background, education and profession, family structure and religion. Our results showed that mainly elderly people decided to donate their bodies (68.5 ± 11.84 years), living mostly in large and medium-sized cities. Men--donors often lived in small towns. Most of the donors were of blue-collar parentage, completed secondary education and at the time of taking decision to donate where married and retired. Widows were more likely to make the decision to donate than widowers. Most of our donors were Catholic. Our analysis of the profile of Polish donors may be useful to understand better for which groups of people death is not to be perceived as the end, and may become a value, which can be beneficial to living people.

The efficiency of a donor-recipient program using infertile donors' egg cryo-banking: a Brazilian reality.

PubMed

Figueira, Rita de Cássia Sávio; Setti, Amanda S; Braga, Daniela P A F; Iaconelli, Assumpto; Borges, Edson

2014-08-01

To determine whether Brazilian egg donation treatment outcomes with oocytes donated from infertile couples are equivalent to those obtained worldwide with oocytes donated from fertile egg-donors. In this descriptive study, egg-donation cycles from 259 women, performed from January 2009 to July 2013, were evaluated. Oocytes were obtained from patients undergoing ICSI who decided to donate their surplus oocytes. We described the survival, fertilization, blastocyst, implantation and pregnancy rates obtained in our infertile donor-recipient program. In addition, we described the results obtained in previous published studies. In our egg-donation program we obtained a fertilization rate of 72.9 %, a blastocyst formation rate of 53.2 %, an implantation rate of 31.1 % and the estimated clinical pregnancy rate per warmed oocyte was 5.4 %. The analyzed studies, performed between 2008 and 2013, included varying numbers of egg-donors (range: 20-600), warmed oocytes (range: 123-3826) and survival rates (range: 85.6-92.5 %). Fertilization rates ranged from 74.2 to 87.0 %, blastocyst formation rate ranged from 41.3 % to 68.0 %, implantation rates ranged from 24.7 % to 55.3 % and the clinical pregnancy rate per warmed oocyte ranged from 3.9 % to 9.8 %. New and reassuring information derived from our egg-donation program demonstrates outcomes similar to those reported for other egg donation programs.

Screening blood donors for human immunodeficiency virus antibody: cost-benefit analysis.

PubMed Central

Eisenstaedt, R S; Getzen, T E

1988-01-01

The costs and benefits of screening blood donors for antibody to human immunodeficiency virus (HIV) are assessed. Total costs, including testing, discarding processed blood, marginal donor recruiting, notifying and evaluating positive donors, are $36,234,000 annually for 10 million donors in 1986. Screening these donors will prevent 292 cases of transfusion-transmitted acquired immune deficiency syndrome (TT-AIDS), saving the costs of therapy and loss of earnings for total benefits of $43,490,480, a benefit:cost ratio of 1.2:1. Net economic benefits of $0.73 per donor will arise from the program. Calculated benefits will rise as increased numbers of infected recipients are diagnosed with longer follow-up or as partially effective therapy increases the cost of caring for patients with AIDS. Changes in test sensitivity, follow-up procedures, estimated value of life, and testing costs will also alter these projections, but none as dramatically as a change in the overall specificity of the screening process. The cost per case of TT-AIDS prevented, $124,089, and cost per year of life extended, $10,885, are comparable to costs of other screening programs. PMID:3126676

The impact of e-mail in acquiring and retaining whole-blood donors: a comparative analysis of the Puget Sound Blood Center donor e-mail communication program.

PubMed

Geyer, Maria Elena

2005-12-01

With the emergence of e-mail as a common form of communication, it is important to understand the role and impact e-mail can have on acquiring and retaining whole-blood donors. Whole-blood donors who opted in to receive e-mail communications (n = 43,232) from the Puget Sound Blood Center (PSBC) and as a result participated in one or more of five e-mail marketing campaigns between July 2002 and March 2003 were studied. New donors with e-mail addresses grew by 74 percent over the measurement period compared with 2 percent growth of those without e-mail addresses. Nearly 15,000 prospective donors were reached as a result of donors passing along e-mails they received from PSBC to friends and family. Nearly 5 percent of PSBC e-mail campaign recipients registered to donate online. PSBC e-mail campaigns have outperformed e-mail marketing industry mean open rates by 44 percent and click-through rates by 36 percent. E-mail is now a mainstream communication medium. It has proven to be an effective method of reaching new donors and generating new donation registrations. Donors respond more favorably to e-mail communications from PSBC compared with e-mail they receive from other organizations. Deeper understanding of how different segments of blood donors use e-mail may help blood centers adjust their donor acquisition and retention programs. New recruitment methods are needed to grow the overall donor base, and e-mail appears to have the potential to make a significant contribution to meeting this objective.

Non-Heart-Beating Donor Program: Results After 3 Years of Experience.

PubMed

Martin-Villen, L; Revuelto-Rey, J; Aldabo-Pallas, T; Correa-Chamorro, E; Gallego-Corpa, A; Ruiz Del Portal-Ruiz Granados, P; Roncero-Rodriguez, M A; Egea-Guerrero, J J

2015-11-01

Non-heart-beating donation (NHBD) is a useful way to obtain organs and tissues. Therefore, since 2012 we have had an NHBD protocol in the metropolitan area of Seville. The aim of this work was to present the results obtained after 3 years of program. Prospective observational study carried out from 2012 to 2014. We included all patients with an extrahospitalary sudden death who did not survive despite cardiopulmonary resuscitation, becoming a potential donors (PD). Variables included number of consultations, PD, allowed donor (AD), real donor (RD), and family or legal refusals; minutes of out-hospital care, in-hospital care, cannulation, and perfusion of the RD; and number of organs and tissues removed and viable proportion. Nonallowed donors were grouped according to the discarding cause. We received 97 consultations, of which 40 were performed as PD. Of these, 24 were AD (60%) and 22 RD (55%). There were only 2 family refusals. In 2012, 10 patients were donors, 5 in 2013, and 7 in 2014. The out-hospital median time was 71 (interquartile range [IQR] 60-76) minutes, in-hospital 29 (26-34) minutes, cannulation 28 (24-33) minutes, and perfusion 135 (105-177) minutes. Eighteen tissues and 43 organs were extracted, of which 32 were implanted (75%), with kidneys (96%) being more frequent. Nonallowed donors numbered 12 in 2012, 4 in 2013, and 1 in 2014, and out-hospital causes were the most frequent discard reason. NHBD is a useful program in our city with a low refusal rate (8%), an average of 1.45 organs per donor, and kidney the most frequent organ. Copyright © 2015 Elsevier Inc. All rights reserved.

The early implementation of Trypanosoma cruzi antibody screening of donors and donations within England: preempting a problem.

PubMed

Kitchen, Alan D; Hewitt, Patricia E; Chiodini, Peter L

2012-09-01

Trypanosoma cruzi is a parasitic infection endemic in Central and Southern America, but is spreading into nonendemic countries with migration of infected individuals from endemic countries. The parasite is transmitted by transfusion or transplantation and donation screening is performed routinely in endemic countries to prevent transmission. In situations where migrants from endemic countries have settled in nonendemic countries and present as donors (blood or other cellular products), intervention is required to prevent transfusion or transplantation transmission. A screening program for T. cruzi was developed and has been used successfully for over 10 years that includes donor selection and donation screening. Donor selection criteria to identify specific risk of T. cruzi infection were developed together with laboratory screening of donations for T. cruzi antibodies and the subsequent confirmation of screen reactivity. Since the introduction of T. cruzi screening in England in 1998, a total of 38,585 donors and donations have been screened for T. cruzi antibodies, of which 223 were repeat reactive on screening and referred for confirmation: 206 confirmed negative, 14 inconclusive, and three positive. Since the move in 2005 from donor qualification to donation release testing, 15,536 donations were collected and screened, of which 15,499 (99.8%) were T. cruzi antibody negative and released to inventory. An effective program to minimize risk of the transmission of T. cruzi infection via donations has been developed and implemented. Not only does the program minimize risk of transmission, it also minimizes the cumulative, and needless, loss of donors and donations that would ensue if permanent donor deferral alone was adopted. © 2012 American Association of Blood Banks.

Establishment of an oocyte donor program. Donor screening and selection.

PubMed

Quigley, M M; Collins, R L; Schover, L R

1991-01-01

IVF with donated oocytes, followed by embryo placement in the uterus of a recipient who has been primed with exogenous steroids, is a successful treatment for special cases of infertility. Preliminary results indicate that the success rate in this situation is even greater than that usually seen with normal IVF (with placement of the embryos back into the uteri of the women from whom the oocytes were recovered). Although different sources for donated oocytes have been identified, the use of "excess" oocytes from IVF cycles and the attempted collection of oocytes at the time of otherwise indicated pelvic surgery have ethical and practical problems associated with their use. We have herein described the establishment of a successful program relying on anonymous volunteers who go through ovarian stimulation, monitoring, and oocyte recovery procedures solely to donate oocytes. The potential donors go through an exhaustive screening and education process before they are accepted in the program. Psychological evaluation of our potential donors indicated a great degree of turmoil in their backgrounds and a wide variety of motivations for actually participating. Despite the extensive educational and screening process, a substantial percentage of the donors did not complete a donation cycle, having either voluntarily withdrawn or been dropped because of lack of compliance. Further investigation of the psychological aspects of participating in such a program is certainly warranted. The use of donated oocytes to alleviate specific types of infertility is quite successful, but the application of this treatment is likely to be limited by the relative unavailability of suitable oocyte donors.

Brain donation in psychiatry: results of a Dutch prospective donor program among psychiatric cohort participants.

PubMed

de Lange, Geertje M; Rademaker, Marleen; Boks, Marco P; Palmen, Saskia J M C

2017-10-20

Human brain tissue is crucial to study the molecular and cellular basis of psychiatric disorders. However, the current availability of human brain tissue is inadequate. Therefore, the Netherlands Brain Bank initiated a program in which almost 4.000 participants of 15 large Dutch psychiatric research cohorts were asked to register as prospective brain donors. We approached patients with schizophrenia, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, post-traumatic stress disorder, families with a child with autism or Attention Deficit Hyperactivity Disorder, healthy relatives and healthy unrelated controls, either face-to-face or by post. We investigated whether diagnosis, method of approach, age, and gender were related to the likelihood of brain-donor registration. We found a striking difference in registration efficiency between the diagnosis groups. Patients with bipolar disorder and healthy relatives registered most often (25% respectively 17%), followed by unrelated controls (8%) and patients with major depressive disorder, post-traumatic stress disorder, and obsessive-compulsive disorder (9%, 6% resp. 5%). A face-to-face approach was 1.3 times more effective than a postal approach and the likelihood of registering as brain donor significantly increased with age. Gender did not make a difference. Between 2013 and 2016, our prospective brain-donor program for psychiatry resulted in an almost eightfold increase (from 149 to 1149) in the number of registered psychiatric patients at the Netherlands Brain Bank. Based on our results we recommend, when starting a prospective brain donor program in psychiatric patients, to focus on face to face recruitment of people in their sixties or older.

Being Sherlock Holmes: the Internet as a tool for assessing live organ donors.

PubMed

Bramstedt, Katrina A; Katznelson, Steven

2009-01-01

Donor advocacy is a critical feature of live donor transplantation. Donor Advocates and Donor Advocate Teams (DAT) are now routine to the practice of live donor evaluation in the USA. Multidisciplinary in nature, DATs gather both medical and psychosocial information about potential live organ donors and then render a decision as to whether or not these individuals are suitable to participate. Because of the critical ethical and psychosocial concerns about live donation, thorough donor evaluations are essential. Additionally, the information gathered must be accurate, and this requires honest disclosure by the donor candidate. In this paper, we describe how DATs can use various forms of free, public content available on the Internet to aid live donor assessments. In this way, the DAT assumes somewhat of an investigative role; however, this is ethically justified in light of the DAT duty to protect the donor. The protective effect can also spread to the transplant program, in general, when inappropriate donors are excluded from the donation process.

A perspective on the selection of unrelated donors and cord blood units for transplantation

PubMed Central

Spellman, Stephen R.; Eapen, Mary; Logan, Brent R.; Mueller, Carlheinz; Rubinstein, Pablo; Setterholm, Michelle I.; Woolfrey, Ann E.; Confer, Dennis L.; Hurley, Carolyn K.

2012-01-01

Selection of a suitable graft for allogeneic hematopoietic stem cell transplantation involves consideration of both donor and recipient characteristics. Of primary importance is sufficient donor-recipient HLA matching to ensure engraftment and acceptable rates of GVHD. In this Perspective, the National Marrow Donor Program and the Center for International Blood and Marrow Transplant Research provide guidelines, based on large studies correlating graft characteristics with clinical transplantation outcomes, on appropriate typing strategies and matching criteria for unrelated adult donor and cord blood graft selection. PMID:22596257

First-time blood donors: demographic trends.

PubMed

Wu, Y; Glynn, S A; Schreiber, G B; Wright, D J; Lo, A; Murphy, E L; Kleinman, S H; Garratty, G

2001-03-01

With changing demographics of the United States population and the continuous need to recruit new donors, it is important to monitor the demographic profile of first-time donors and to evaluate changes in the donor pool to improve recruitment targeting. First-time whole blood (n = 901,862) donors at five United States blood centers between 1991 and 1996 were analyzed. The total number of first-time donors appears to be decreasing. Over the 6-year period, there was an overall increase in the proportion of Hispanic and other minority first-time donors and a concurrent decrease in the proportion of white donors at Retrovirus Epidemiology Donor Study centers. Other variables, including age, sex, and education, did not show a consistent trend. The demographic profile of first-time donors is changing. These data highlight the importance for blood centers to continuously monitor the donor population. A better understanding of the donor population may help blood centers adjust their donor outreach, recruitment, and retention programs. New recruitment efforts appear needed to counter general apathy toward donating blood, and minority groups appear to be receptive to becoming blood donors.

The Dirt on the Donors.

ERIC Educational Resources Information Center

Walker, Mary Margaret

1996-01-01

A discussion of donor records in college and university fund-raising programs looks at a variety of issues, including who sees them (administrators, donors, volunteers, and members of the legal profession), how access to them is controlled, and what is kept in them. Suggestions are offered for managing such records, and the experiences of a number…

The body donation program at the Federal University of Health Sciences of Porto Alegre: a successful experience in Brazil.

PubMed

da Rocha, Andrea Oxley; Tormes, Diane Alícia; Lehmann, Natassia; Schwab, Rafael Santos; Canto, Raphael Teixeira

2013-01-01

The use of dissection to study human anatomy is the foundation for educational excellence among future health professionals, as it offers an ideal opportunity to learn the body's morphology in three dimensions while also providing students with a more humanistic education. The shortage of bodies for dissection, combined with the Brazilian population's lack of knowledge concerning the possibility of voluntarily donating their own bodies, led to the creation of the Body Donation Programs for Education and Research in Anatomy at the Federal University of Health Sciences of Porto Alegre (UFCSPA). The program is based on three pillars: Informing the general public about the program, donor registration, and donation itself. Since the creation of the donor program in 2008, there has been an increase in both the number of donations made during donor's lifetime and the number of bodies received by the university. There has also been a shift in relation to the origin of these bodies, as before the creation of the program most bodies were unclaimed cadavers, while today most of the bodies are sourced from voluntary donations. The initial results regarding the public's acceptance of the possibility of making body donations have been encouraging, as shown by the annual growth in donor registrations. Consequently, the quality and quantity of the material available for educational purposes have greatly improved. Copyright © 2012 American Association of Anatomists.

Lower risk for serious adverse events and no increased risk for cancer after PBSC vs BM donation

PubMed Central

Pulsipher, Michael A.; Chitphakdithai, Pintip; Logan, Brent R.; Navarro, Willis H.; Levine, John E.; Miller, John P.; Shaw, Bronwen E.; O’Donnell, Paul V.; Majhail, Navneet S.; Confer, Dennis L.

2014-01-01

We compared serious early and late events experienced by 2726 bone marrow (BM) and 6768 peripheral blood stem cell (PBSC) donors who underwent collection of PBSC or BM between 2004 and 2009 as part of a prospective study through the National Marrow Donor Program. Standardized FDA definitions for serious adverse events (SAEs) were used, and all events were reviewed by an independent physician panel. BM donors had an increased risk for SAEs (2.38% for BM vs 0.56% for PBSC; odds ratio [OR], 4.13; P < .001), and women were twice as likely to experience an SAE (OR for men, 0.50; P = .005). Restricting the analysis to life-threatening, unexpected, or chronic/disabling events, BM donors maintained an increased risk for SAEs (0.99% for BM vs 0.31% for PBSC; OR, 3.20; P < .001). Notably, the incidence of cancer, autoimmune illness, and thrombosis after donation was similar in BM vs PBSC donors. In addition, cancer incidence in PBSC donors was less than that reported in the general population (Surveillance, Epidemiology, and End Results Program database). In conclusion, SAEs after donation are rare but more often occurred in BM donors and women. In addition, there was no evidence of increased risk for cancer, autoimmune illness, and stroke in donors receiving granulocyte colony-stimulating factor during this period of observation. PMID:24735965

Transport Measurements on Si Nanostructures with Counted Sb Donors

NASA Astrophysics Data System (ADS)

Singh, Meenakshi; Bielejec, Edward; Garratt, Elias; Ten Eyck, Gregory; Bishop, Nathaniel; Wendt, Joel; Luhman, Dwight; Carroll, Malcolm; Lilly, Michael

2014-03-01

Donor based spin qubits are a promising platform for quantum computing. Single qubits using timed implant of donors have been demonstrated.1 Extending this to multiple qubits requires precise control over the placement and number of donors. Such control can be achieved by using a combination of low-energy heavy-ion implants (to reduce depth straggle), electron-beam lithography (to define position), focused ion beam (to localize implants to one lithographic site) and counting the number of implants with a single ion detector.2 We report transport measurements on MOS quantum dots implanted with 5, 10 and 20 Sb donors using the approach described above. A donor charge transition is identified by a charge offset in the transport characteristics. Correlation between the number of donors and the charge offsets is studied. These results are necessary first steps towards fabricating donor nanostructures for two qubit interactions. This work was performed, in part, at the Center for Integrated Nanotechnologies, a U.S. DOE Office of Basic Energy Sciences user facility. The work was supported by Sandia National Laboratories Directed Research and Development Program. Sandia National Laboratories is a multi-program laboratory operated by Sandia Corporation, a Lockheed-Martin Company, for the U. S. Department of Energy under Contract No. DE-AC04-94AL85000. 1J. J. Pla et al., Nature 496, 334 (2013) 2J. A. Seamons et al., APL 93, 043124 (2008).

Liver transplantation using organs from deceased organ donors: a single organ transplant center experience.

PubMed

Han, Ming; Guo, Zhi-Yong; Zhao, Qiang; Wang, Xiao-Ping; Yuan, Xiao-Peng; Jiao, Xing-Yuan; Yang, Chun-Hua; Wang, Dong-Ping; Ju, Wei-Qiang; Wu, Lin-Wei; Hu, An-Bin; Tai, Qiang; Ma, Yi; Zhu, Xiao-Feng; He, Xiao-Shun

2014-08-01

In 2011, a pilot program for deceased organ donation was initiated in China. We describe the first successful series of liver transplants in the pilot program. From July 2011 to August 2012, our center performed 26 liver transplants from a pool of 29 deceased donors. All organ donation and allograft procurement were conducted according to the national protocol. The clinical data of donors and recipients were collected and summarized retrospectively. Among the 29 donors, 24 were China Category II donors (organ donation after cardiac death), and five were China Category III donors (organ donation after brain death followed by cardiac death). The recipients were mainly the patients with hepatocellular carcinoma. The one-year patient survival rate was 80.8% with a median follow-up of 422 (2-696) days. Among the five mortalities during the follow-up, three died of tumor recurrence. In terms of post-transplant complications, 9 recipients (34.6%) experienced early allograft dysfunction, 1 (3.8%) had non-anastomotic biliary stricture, and 1 (3.8%) was complicated with hepatic arterial thrombosis. None of these complications resulted in patient death. Notably, primary non-function was not observed in any of the grafts. With careful donor selection, liver transplant from deceased donors can be performed safely and plays a critical role in overcoming the extreme organ shortage in China.

You...as Blood Donor: Teacher Strategies and Student Worksheets.

ERIC Educational Resources Information Center

Degroat, Diane Zagare; And Others

This curriculum guide for teaching about blood donation was prepared to improve school-community participation in the New York City Blood Donor Program. It contains plans for five lessons on the following topics: (1) the nature of blood; (2) blood and technology--modern-day advances; (3) blood and your personal health; (4) the blood donor as good…

The Willed Body Donor Interview Project: Medical Student and Donor Expectations

ERIC Educational Resources Information Center

Bohl, Michael; Holman, Alexis; Mueller, Dean A.; Gruppen, Larry D.; Hildebrandt, Sabine

2013-01-01

The Anatomical Donations Program at the University of Michigan Medical School (UMMS) has begun a multiphase project wherein interviews of donors will be recorded and later shown to medical students who participate in the anatomical dissection course. The first phase of this project included surveys of both current UMMS medical students and donors…

Experience of a Maastrich type II non heart beating donor program in a small city: preliminary results.

PubMed

Miñambres, E; Suberviola, B; Guerra, C; Lavid, N; Lassalle, M; González-Castro, A; Ballesteros, M A

2015-10-01

To study the results of a non-controlled cardiac death (Maastricht type II) donor program in a city of 200,000 inhabitants. The study was initially focused on lung donation and was extended to kidney donation after 9 months. A prospective observational study was conducted between October 2012 and December 2013. The Intensive Care Unit of Marqués de Valdecilla University Hospital in Santander (Spain), and surrounding areas. Patients (< 55 years) who died of out-of-hospital cardiac arrest. All out-of-hospital cardiac arrests were treated with mechanical cardiac compression (LUCAS II). The diagnosis of death and organ preservation were performed in the ICU. A total of 14 calls were received, of which three were discarded. Of the 11 potential donors, 7 were effective donors with a median age of 39.5 years (range: 32-48). A total of 5 single lung transplants and four kidney transplants were performed. In addition, corneas and tissues were harvested. The non-valid donors were rejected mainly due to technical problems. There were no donation refusals on the part of the patient relatives. The lung transplant patient survival rate was 100% after one month and 80% after one year. One month after transplantation, the kidney recipients had a serum creatinine concentration of<2mg/dl. The interval from cardiac arrest to renal preservation was 80minutes (range: 71-89), and the interval from cardiac arrest to lung preservation was 84minutes (range: 77-94). A Maastricht type II donation program in a small city is viable for both abdominal and thoracic organs. The program was initially very cautious, but its potential is easily improvable by increasing donor and by equipping mobile ICU ambulances with mechanical cardiac compression systems. Full management of the donor in the ICU, avoiding the emergency department or operating rooms, reduces the warm ischemia time, thereby improving transplant outcomes. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

Profitability of our lung retrieval program from non heart beating donors.

PubMed

Fernández, Elena; Calatayud, Joaquín; Jarabo, José Ramón; Hernando, Florentino; Rodríguez, Olga; Gómez, Ana María; Soria, Ana; Del Río, Francisco

2009-02-01

In 2002 the first lung transplant from non heart beating (NHB) donors took place in Madrid. The objective of this study was to analyse our Maastricht type I NHB lung donors retrieval program and to check out its profitability. Based on the NHB lung donors retrieval program carried out at Hospital Clínico San Carlos (Madrid) in association with Hospital Puerta de Hierro (Madrid), all lung donors from the beginning of the program from June 2002 to December 2006 have been analysed. When faced with a case of sudden death, advanced life support manoeuvres are initiated before 15 min. If the patient meets a given set of criteria, code 0/9 is activated. Arrival time to the hospital cannot exceed 90 min. Femoral artery and vein are cannulated, extracorporeal circulation is started and lungs are preserved. After the relatives' and judicial authorisation lungs are retrieved. Out of a total of 322 occurrences of code 0/9, 43 lung retrievals and 25 implants were reported. A total of 95% of donors were male, with an average age of 41 years and 91% with blood group A or O. 2004 saw the highest number of retrievals (14). January, May and December showed the highest number of retrievals. Incidence of sudden deaths was higher from 7 to 10 a.m. and from 7 to 10 p.m. Twenty-three implants at Hospital Puerta de Hierro and three more at Hospital Marqués de Valdecilla (Santander) were reported. A considerable amount of preserved lungs, valid for transplant, were not retrieved because of a lack of an appropriate recipient at the time. A total of 58.1% of preserved lungs were implanted. The ratio of obtained lungs was 11.4% of actual donors and 7.7% of total occurrences. However, this percentage could have been higher if we take into account the number of valid lungs that were not transplanted because of the lack of recipients.

Gifts on a High Note: A Case Study of Major Donors to Music Programs in Higher Education

ERIC Educational Resources Information Center

Barascout, Roger

2012-01-01

This study is an examination of the giving decision-making process, as well as the factors, characteristics, and motivators of major donors to music programs in higher education. The college and the conservatory of music selected for this study are part of large, public, doctoral, research universities in metropolitan areas with at least three…

Electron shuttling in phosphorus donor qubit systems

NASA Astrophysics Data System (ADS)

Jacobson, N. Tobias; Gamble, John King; Nielsen, Erik; Muller, Richard P.; Witzel, Wayne M.; Montano, Ines; Carroll, Malcolm S.

2014-03-01

Phosphorus donors in silicon are a promising qubit architecture, due in large part to their long nuclear coherence times and the recent development of atomically precise fabrication methods. Here, we investigate issues related to implementing qubits with phosphorus donors in silicon, employing an effective mass theory that non-phenomenologically takes into account inter-valley coupling. We estimate the significant sources of decoherence and control errors in this system to compute the fidelity of primitive gates and gate timescales. We include the effects of valley repopulation during the process of shuttling an electron between a donor and nearby interface or between neighboring donors, evaluating the control requirements for ensuring adiabaticity with respect to the valley sector. This work was supported in part by the LDRD program at Sandia National Labs, a multi-program laboratory managed and operated by Sandia Corp, a wholly owned subsidiary of Lockheed Martin Corp, for the U.S. DOE NNSA under contract DE-AC04-94AL85000.

Contribution of the Retrovirus Epidemiology Donor Study (REDS) to research on blood transfusion safety in Brazil.

PubMed

Loureiro, Paula; de Almeida-Neto, Cesar; Proietti, Anna Bárbara Carneiro; Capuani, Ligia; Gonçalez, Thelma Terezinha; de Oliveira, Claudia Di Lorenzo; Leão, Silvana Carneiro; Lopes, Maria Inês; Sampaio, Divaldo; Patavino, Giuseppina Maria; Ferreira, João Eduardo; Blatyta, Paula Fraiman; Lopes, Maria Esther Duarte; Mendrone-Junior, Alfredo; Salles, Nanci Alves; King, Melissa; Murphy, Edward; Busch, Michael; Custer, Brian; Sabino, Ester Cerdeira

2014-03-01

The Retrovirus Epidemiology Donor Study (REDS) program was established in the United States in 1989 with the purpose of increasing blood transfusion safety in the context of the HIV/AIDS and human T-lymphotropic virus epidemics. REDS and its successor, REDS-II were at first conducted in the US, then expanded in 2006 to include international partnerships with Brazil and China. In 2011, a third wave of REDS renamed the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) was launched. This seven-year research program focuses on both blood banking and transfusion medicine research in the United States of America, Brazil, China, and South Africa. The main goal of the international programs is to reduce and prevent the transmission of HIV/AIDS and other known and emerging infectious agents through transfusion, and to address research questions aimed at understanding global issues related to the availability of safe blood. This article describes the contribution of REDS-II to transfusion safety in Brazil. Articles published from 2010 to 2013 are summarized, including database analyses to characterize blood donors, deferral rates, and prevalence, incidence and residual risk of the main blood-borne infections. Specific studies were developed to understand donor motivation, the impact of the deferral questions, risk factors and molecular surveillance among HIV-positive donors, and the natural history of Chagas disease. The purpose of this review is to disseminate the acquired knowledge and briefly summarize the findings of the REDS-II studies conducted in Brazil as well as to introduce the scope of the REDS-III program that is now in progress and will continue through 2018.

Current Canadian initiatives to reimburse live organ donors for their non-medical expenses.

PubMed

Vlaicu, Sorina; Klarenbach, Scott; Yang, Robert C; Dempster, Todd; Garg, Amit X

2007-01-01

Living organ donors frequently incur non-medical expenses for travel, accommodation, prescription drugs, loss of income, and child care in conjunction with organ donation. Despite international precedent and widespread public support, Canada currently lacks a unified strategy to reimburse donors for these expenses. In 2005, we communicated with 78 individuals within the field of Canadian transplantation to identify which initiatives for reimbursement of living donors existed in each province. Saskatchewan was the only province in which public employees were granted paid leave for organ donation. Six provincial governments partially reimbursed travel and accommodation. At the federal level, other expenses could be partially reimbursed through an income tax credit, while the Employment Insurance program and the Canada Pension Plan provided funding for donors who become unemployed or develop long-term disability as a result of donation. Charities helped a limited number of patients in financial need through grants and no-interest loans, but funding was generally limited by contributions received. While reimbursing living donors for their non-medical expenses is considered just, existing programs only partially reimburse expenses and are not available in all provinces. Developing future reimbursement policies will remove a disincentive faced by some potential donors, and may increase rates of transplantation in Canada.

Using Body Donor Demographics to Assist the Implementation of Donation Programs in Brazil

ERIC Educational Resources Information Center

da Rocha, Andrea Oxley; de Campos, Deivis; Farina, Marco Aurélio; Pacini, Gabriel Sartori; Girotto, Marina Cornelli; Hilbig, Arlete

2017-01-01

The use of human material in anatomy education depends upon the generosity of body donors. However, little is known regarding the demographics of body donors in Brazil, where voluntary body donation is a relatively rare phenomenon. Hence, the aim of the present study was to elucidate the demographic profile of applicants to the Body Donation…

Donor Motivations and Decision Making: Understanding the Major Gift Development Process from a Donor's Perspective

ERIC Educational Resources Information Center

Morrison, Anna Lee

2015-01-01

Higher education is faced with a challenge to its traditional funding structure. As a result, academic programs must seek alternative sources of support. Chief among these sources is philanthropy in the form of major gifts. Insight into donor motivations and decision making when approached to consider a major gift may help to maximize the success…

Organ Donation From Deceased Donors: A Proactive Detection Program in Saudi Arabia.

PubMed

Shaheen, Faissal A M; Souqiyyeh, Muhammad Ziad; Attar, Besher; Ibrahim, Amal; Alsayyari, Abdulla

2015-11-01

Several challenging obstacles remain to increasing the number of organ donations from deceased patients in a hospital setting. These include medical, administrative, and ethical issues. Possible medical obstacles include the failure of early recognition of possible donors and inadequate care of potential and actual donors. To maximize the use of donated organs, proper care of the donors and expedited donor consent cannot be overemphasized. The care rendered to patients should ensure appropriate perfusion and nutrition of the organs, with meticulous follow-up until organ recovery. For example, patients involved in accidents are presumed to be healthy, but many have no available medical history on file. At the time of organ recovery, unexpected infections or malignancies can be minimized by raising the index of suspicion of the presence of serious conditions in donors, especially in donors with unknown medical history. A careful physical examination and an appropriate and aggressive laboratory investigation may disclose the cause of suspected clinical conditions in these potential donors. Individuals who work in intensive care units are the main group of health care providers directly involved in the process of organ donation. Appointing a donor coordinator in each intensive care unit could improve all aspects of organ donation. Such coordination could harmonize efforts toward the goals mentioned above and surmount the obstacles encountered during deceased-donor organ donation. Here, we describe the preliminary results of the Proactive Detection Program, a collaboration between the Saudi Center for Organ Transplantation (the national organ donation and transplant supervising center) and intensive care units of donating hospitals. With its success in Saudi Arabia, it is hoped that it will be widely adopted in other regions.

Ethical aspects of organ donation activities.

PubMed

Stephan, Antoine; Barbari, Antoine; Younan, Farida

2007-12-01

Renal transplant remains the treatment of choice for patients with end-stage renal disease. Human organs can be harvested from 2 main sources: living and deceased donors. Preference should be given to deceased-donor transplants since they represent the only source of organs for several nonrenal solid-organ transplants and the only modality where there is no risk to the donor. Unfortunately, even the most well-developed deceased-donor program (eg, the Spanish program) can barely cover 50% of its waiting list because the demand for deceased-donor organs far exceeds supply. The success of transplant surgery has created a waiting list dilemma. Despite all efforts, deceased-donor donation cannot meet current needs and therefore, living donation demands serious consideration. This is supported by the fact that the risk to live donors is minimal, graft survival is significantly better than that of deceased-donor kidneys regardless of HLA matching, and professional ethical philosophers have fewer difficulties with voluntary living donations than with the removal of an organ from a cadaver. This is especially true in our region. Living-related donation has always been acceptable ethically. It is, however, limited by the number of willing and qualified donors, the high incidence of familial renal diseases, and donor coercion (especially in our area). Living-unrelated donation increases the availability of donors, decreases the chances of coercion, and eliminates the problem of consanguinity. It raises, however, the ethical issues of commercialism, transplant tourism, and organ trafficking. The arguments for and against living-unrelated donation are innumerable. They have been the subject of several international forums and have raised endless discussions. We have set long ago a series of rules and regulations that are in close agreement with the recent Amsterdam and Kuwait resolutions. We have been continually modifying them over the last 15 years to try to implement our ideal, which is to protect the interest of the living donor and avoid commercialism.

Regional variability in fecal microbiota transplantation practices: a survey of the Southern Ontario Fecal Microbiota Transplantation Movement.

PubMed

Hota, Susy S; Surangiwala, Salman; Paterson, Aimee S; Coburn, Bryan; Poutanen, Susan M

2018-04-18

There is growing evidence that fecal microbiota transplantation (FMT) is an effective treatment for recurrent Clostridium difficile infection, but little guidance exists for implementation of FMT programs. The objective of this study is to describe the program characteristics and protocols of 9 planned or operating FMT programs in the Southern Ontario Fecal Microbiota Transplantation (SOFT) Movement, to help guide future FMT program implementation. A 59-item survey was administered electronically to clinical leads of the SOFT Movement on June 2, 2016. The survey evaluated 7 domains: FMT program characteristics, FMT recipients, donor screening/selection, transplant manufacturing, FMT administration, good manufacturing procedures/biosafety procedures and infection-control procedures. We used descriptive statistics to analyze quantitative data. All 9 programs responded to the survey: 6 were active, 1 had FMT standard operating procedures developed but did not have clinical experience, and 2 were in the process of forming FMT programs. All 6 active programs performed FMT in adult patients with C. difficile infection. About 1300 FMT procedures were performed between 2003 and 2016. Five of the 6 operating programs administered the preparation via enema. Programs were driven primarily by physicians. All programs used universal FMT donors and followed Health Canada's screening guidelines, with considerable variability in screening frequency (every 3-6 mo) and modality. Locations for transplant preparation and manufacturing protocols varied across programs. Stool mass for FMT ranged from 20 g to 150 g, and transplant volume ranged from 25 mL to 300 mL. The experience of this high-volume regional FMT network highlights current challenges in FMT program development, including a high reliance on physicians and the costly nature of donor screening. Standardization and optimization through development of regional centres of excellence for FMT donor recruitment and administration should be explored. Copyright 2018, Joule Inc. or its licensors.

Honoring our donors: a survey of memorial ceremonies in United States anatomy programs.

PubMed

Jones, Trahern W; Lachman, Nirusha; Pawlina, Wojciech

2014-01-01

Many anatomy programs that incorporate dissection of donated human bodies hold memorial ceremonies of gratitude towards body donors. The content of these ceremonies may include learners' reflections on mortality, respect, altruism, and personal growth told through various humanities modalities. The task of planning is usually student- and faculty-led with participation from other health care students. Objective information on current memorial ceremonies for body donors in anatomy programs in the United States appears to be lacking. The number of programs in the United States that currently plan these memorial ceremonies and information on trends in programs undertaking such ceremonies remain unknown. Gross anatomy program directors throughout the United States were contacted and asked to respond to a voluntary questionnaire on memorial ceremonies held at their institution. The results (response rate 68.2%) indicated that a majority of human anatomy programs (95.5%) hold memorial ceremonies. These ceremonies are, for the most part, student-driven and nondenominational or secular in nature. Participants heavily rely upon speech, music, poetry, and written essays, with a small inclusion of other humanities modalities, such as dance or visual art, to explore a variety of themes during these ceremonies. © 2013 American Association of Anatomists.

Organ Donation After Circulatory Death: Ethical Issues and International Practices.

PubMed

Jericho, Barbara G

2018-05-21

Donation after circulatory death (DCD) is an increasingly utilized practice that can contribute to reducing the difference between the supply of organs and the demand for organs for transplantation. As the number of transplanted organs from DCD donors continues to increase, there is an essential need to address the ethical aspects of DCD in institutional DCD protocols and clinical practice. Ethical issues of respecting the end-of-life wishes of a potential donor, respecting a recipient's wishes, and addressing potential conflicts of interest are important considerations in developing policies and procedures for DCD programs. Although there may be diversity among DCD programs in Europe, Australia, Israel, China, the United States, and Canada, addressing ethical considerations in these DCD programs is essential to respect donors and recipients during the altruistic and generous act of organ donation.

Kidney and pancreas transplantation at Wake Forest University Baptist Medical Center.

PubMed

Stratta, Robert J; Rohr, Michael S; Adams, Patricia L; Sundberg, Aimee K; Hartmann, Erica L; Armstrong, Greg; Anderson, Teresa K; Farney, Alan C; Roskopf, Julie A; Hairston, Gloria; Kiger, David F; Nagaraj, Shashi K; Iskandar, Samy S; Assimos, Dean G

2003-01-01

More than 1,100 transplants have been performed at WFUBMC, including 60 pediatric transplants and 40 pancreas transplants. The one-year living donor kidney graft survival rate exceeds 90% and the 2 year deceased donor kidney graft survival rate exceeds 80%. The current active waiting list includes more than 300 candidates. Despite more transplants being performed, we continue to under-serve our referral area, which has among the highest rates of hypertension, diabetes, and end stage renal disease in the country. The AOTP has experienced a period of rapid growth over the past 2 years based upon sharing of zero HLA antigen-mismatched kidneys, use of ECD kidneys, liberalization of donor and recipient selection criteria, and the continued development of the pancreas transplant and laparoscopic donor nephrectomy programs. The pancreas transplant program will continue to grow as the waiting list enlarges and matures, with a 200% increase in activity expected within the next few years. The LDKT program will expand as more emphasis is placed on our pretransplant practice, including the more liberal application of laparoscopic donor nephrectomy, which has now become a standard procedure at our WFUBMC is involved in a number of clinical research projects studying new immunosuppressive agents and regimens. In this chapter, we have presented our recent experience with KTX in the elderly, ECD kidneys, alternate day Thymoglobulin administration, valganciclovir prophylaxis, SRL conversion using daclizumab bridge therapy, and pancreas transplantation with portal-enteric drainage. We plan to initiate a number of new protocols in the immediate future, including desensitization of the highly sensitized patient, ABO incompatible transplantation, transplantation of the HIV-positive patient, steroid withdrawal and avoidance regimens, living kidney donation from the anonymous altruistic donor, paired kidney exchanges from living donors, and islet transplantation. WFUBMC remains the most active donor hospital in North Carolina, and a non-heart beating donor protocol has been successfully initiated at our facility. Although much has been accomplished, a number of challenges remain. We look forward to building on our accomplishments, confronting the challenges, and achieving a level of excellence that could only be attained by mutual commitment from a dedicated, multidisciplinary team.

Remuneration of hematopoietic stem cell donors: principles and perspective of the World Marrow Donor Association.

PubMed

Boo, Michael; van Walraven, Suzanna M; Chapman, Jeremy; Lindberg, Brian; Schmidt, Alexander H; Shaw, Bronwen E; Switzer, Galen E; Yang, Edward; Egeland, Torstein

2011-01-06

Hematopoietic stem cell transplantation is a curative procedure for life-threatening hematologic diseases. Donation of hematopoietic stem cells (HSCs) from an unrelated donor, frequently residing in another country, may be the only option for 70% of those in need of unrelated hematopoietic stem cell transplantation. To maximize the opportunity to find the best available donor, individual donor registries collaborate internationally. To provide homogeneity of practice among registries, the World Marrow Donor Association (WMDA) sets standards against which registries are accredited and provides guidance and regulations about unrelated donor safety and care. A basic tenet of the donor registries is that unrelated HSC donation is an altruistic act; nonpayment of donors is entrenched in the WMDA standards and in international practice. In the United States, the prohibition against remuneration of donors has recently been challenged. Here, we describe the reasons that the WMDA continues to believe that HSC donors should not be paid because of ethical concerns raised by remuneration, potential to damage the public will to act altruistically, the potential for coercion and exploitation of donors, increased risk to patients, harm to local transplantation programs and international stem cell exchange, and the possibility of benefiting some patients while disadvantaging others.

Clinical results of an organ procurement organization effort to increase utilization of donors after cardiac death.

PubMed

Whiting, James F; Delmonico, Francis; Morrissey, Paul; Basadonna, Giacomo; Johnson, Scott; Lewis, W David; Rohrer, Richard; O'Connor, Kevin; Bradley, James; Lovewell, Tammy D; Lipkowitz, George

2006-05-27

To stimulate organ donation, an organ procurement organization (OPO)-wide effort was undertaken to increase donors after cardiac death (DCD) over a 5-year period. This included commonality of protocols, pulsatile perfusion of kidneys, centralization of data and a regional allocation variance designed to minimize cold ischemia times and encourage adoption of DCD protocols at transplant centers. In one OPO, eight centers initiated DCD programs in 11 hospitals. A total of 52 DCD donors were procured, increasing from four in 1999 to 21 in 2003. Eleven donors had care withdrawn in the operating room, whereas 41 had care withdrawn in the ICU. In all, 91 patients received renal transplants from these 52 donors (12 kidneys discarded, one double transplant), whereas 5 patients received liver transplants. One-, two-, and three-year kidney graft survival rates were 90%, 90%, and 82%, respectively. Fifty-five percent of patients needed at least one session of hemodialysis postoperatively. Mean recipient hospital length of stay was 11.1+/-6 days. Mean creatinine levels at 3, 6, 12, and 24 months were 1.65, 1.40, 1.41, and 1.40, respectively. DCD donors can be an important source of donor organs and provide excellent overall outcomes. Regional cooperation and a prospectively considered allocation and distribution system are important considerations in stimulating DCD programs.

Direct and indirect costs incurred by Australian living kidney donors.

PubMed

Barnieh, Lianne; Kanellis, John; McDonald, Stephen; Arnold, Jennifer; Sontrop, Jessica M; Cuerden, Meaghan; Klarenbach, Scott; Garg, Amit X; Boudville, Neil

2017-12-07

To describe the direct and indirect costs incurred by Australian living kidney donors. We studied 55 living kidney donors from 3 centres in Perth, Australia and 1 centre in Melbourne, Australia (2010-2014); 49 donors provided information on expenses incurred during the donor evaluation period and up to 3 months after donation. We used a micro-costing approach to measure and value the units of resources consumed. Expenses were grouped as direct costs (ground and air travel, accommodation, and prescription medications) and indirect costs (lost wages and lost productivity). We standardized costs to the year 2016 in Australian dollars. The most common direct costs were for ground travel (100%), parking (76%), and post-donation pain medications or antibiotics (73%). The highest direct costs were for air travel (median $1,986 [3 donors]) and ground travel (median $459 [49 donors]). Donors also reported lost wages (median $9,891 [37 donors]). The inability to perform household activities or care for dependants were reported by 32 (65%) and 23 (47%) donors. Total direct costs averaged $1,682 per donor (median $806 among 49 donors). Total indirect costs averaged $7,249 per donor (median $7,273 among 49 donors). Total direct and indirect costs averaged $8,932 per donor (median $7,963 among 49 donors). Many Australian living kidney donors incur substantial costs during the donation process. Our findings inform the continued development of policies and programs designed to minimize costs incurred by living kidney donors. This article is protected by copyright. All rights reserved.

Derivation and Implementation of a Protocol in Israel for Organ Donation after Cardio-Circulatory Death.

PubMed

Cohen, Jonathan; Rahamimov, Ruth; Hoffman, Aaron; Katvan, Eyal; Grozovski, Kyril; Ashkenazi, Tamar

2017-09-01

Strategies aimed at expanding the organ donor pool have been sought, which has resulted in renewed interest in donation after cardio-circulatory death (DCCD), also known as non-heart beating donors (NHBDs). To describe the derivation and implementation of a protocol for DCCD in Israel and report on the results with the first six cases. After receiving approval from an extraordinary ethics committee, Ministry of Health, the steering committee of the National Transplant Center defined and reached consensus on the unique challenges presented by a DCCD program. These protocol included medical aspects (construction of a clinical pathway), social and ethical aspects (presentation of the protocol at a public gathering(, legal/ethical aspects (consent for organ preservation procedures being either implied if the donor had signed an organ donor card or received directly from a surrogate decision maker), and logistical aspects (pilot study confined to kidney retrieval and to four medical centers). Data regarding organ donors and recipients were recorded. The protocol was implemented at four medical centers. Consent for organ donation was received from four of the six potential donors meeting criteria for inclusion, in all cases, from a surrogate decision maker. Of the eight kidneys retrieved, only four were suitable for transplantation, which was carried out successfully for four recipients. Graft function remained normal in all cases in 6-12 months follow-up. The DCCD program was successfully implemented and initial results are encouraging, suggesting that expansion of the program might further aid in decreasing the gap between needs and availability of organs.

Ethical issues surrounding the use of images from donated cadavers in the anatomical sciences.

PubMed

Cornwall, Jon; Callahan, David; Wee, Richman

2016-01-01

Body donor programs rely on the generosity and trust of the public to facilitate the provision of cadaver resources for anatomical education and research. The uptake and adoption of emerging technologies, including those allowing the acquisition and distribution of images, are becoming more widespread, including within anatomical science education. Images of cadavers are useful for research and education, and their supply and distribution have commercial potential for textbooks and online education. It is unclear whether the utilization of images of donated cadavers are congruent with donor expectations, societal norms and boundaries of established public understanding. Presently, no global "best practices" or standards exist, nor is there a common model requiring specific image-related consent from body donors. As ongoing success of body donation programs relies upon the ethical and institutional governance of body utilization to maintain trust and a positive relationship with potential donors and the community, discussions considering the potential impact of image misuse are important. This paper discusses the subject of images of donated cadavers, commenting on images in non-specific use, education, research, and commercial applications. It explores the role and significance of such images in the context of anatomical science and society, and discusses how misuse - including unconsented use - of images has the potential to affect donor program success, suggesting that informed consent is currently necessary for all images arising from donated cadavers. Its purpose is to encourage discussion to guide responsible utilization of cadaver images, while protecting the interests of body donors and the public. © 2015 Wiley Periodicals, Inc.

Initial Poor Function and Primary Nonfunction in Deceased-Donor Orthotopic Liver Transplantation Maintaining Short Cold Ischemic Time.

PubMed

Das, Somak; Swain, Sudeepta Kumar; Addala, Pavan Kumar; Balasubramaniam, Ramakrishnan; Gopakumar, C V; Zirpe, Dinesh; Renganathan, Kirubakaran; Kollu, Harsha; Patel, Darshan; Vibhute, Bipin B; Rao, Prashantha S; Krishnan, Elankumaran; Gopasetty, Mahesh; Khakhar, Anand K; Vaidya, Anil; Ramamurthy, Anand

2016-12-01

Nations with emerging deceased-donor liver transplantation programs, such as India, face problems associated with poor donor maintenance. Cold ischemic time (CIT) is typically maintained short by matching donor organ recovery and recipient hepatectomy to achieve maximum favorable outcome. We analyzed different extended criteria donor factors including donor acidosis, which may act as a surrogate marker of poor donor maintenance, to quantify the risk of primary nonfunction (PNF) or initial poor function (IPF). A single-center retrospective outcome analysis of prospectively collected data of patients undergoing deceased-donor liver transplantation over 2 years to determine the impact of different extended criteria donor factors on IPF and PNF. From March 2013 to February 2015, a total of 84 patients underwent deceased-donor liver transplantation. None developed PNF. Thirteen (15.5%) patients developed IPF. Graft macrosteatosis and donor acidosis were only related to IPF ( P = .002 and P = .032, respectively). Cold ischemic time was maintained short (81 cases ≤8 hours, maximum 11 hours) in all cases. Poor donor maintenance as evidenced by donor acidosis and graft macrosteatosis had significant impact in developing IPF when CIT is kept short. Similar study with larger sample size is required to establish extended criteria cutoff values.

Next Generation Highly Conducting Organic Films Using Novel Donor-Acceptor Molecules for Opto-electronic Applications

DTIC Science & Technology

2010-06-01

addition, a new class of donor molecules was invented in the course of the DRI program. 2.1 Polymer Based Donor-acceptor Material The following work by...average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data...information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information

The roles of dominos and nonsimultaneous chains in kidney paired donation.

PubMed

Gentry, S E; Montgomery, R A; Swihart, B J; Segev, D L

2009-06-01

Efforts to expand kidney paired donation have included matching nondirected donors (NDDs) to incompatible pairs. In domino paired donation (DPD), an NDD gives to the recipient of an incompatible pair, beginning a string of simultaneous transplants that ends with a living donor giving to a recipient on the deceased donor waitlist. Recently, nonsimultaneous extended altruistic donor (NEAD) chains were introduced. In a NEAD chain, the last donor of the string of transplants initiated by an NDD is reserved to donate at a later time. Our aim was to project the impact of each of these strategies over 2 years of operation for paired donation programs that also allocate a given number of NDDs. Each NDD facilitated an average of 1.99 transplants using DPD versus 1.90 transplants using NEAD chains (p = 0.3), or 1.0 transplants donating directly to the waitlist (p < 0.001). NEAD chains did not yield more transplants compared with simultaneous DPD. Both DPD and NEAD chains relax reciprocality requirements and rebalance the blood-type distribution of donors. Because traditional paired donation will leave many incompatible pairs unmatched, novel approaches like DPD and NEAD chains must be explored if paired donation programs are to help a greater number of people.

Beef donor cows with high number of retrieved COC produce more in vitro embryos compared with cows with low number of COC after repeated ovum pick-up sessions.

PubMed

Monteiro, F M; Batista, E O S; Vieira, L M; Bayeux, B M; Accorsi, M; Campanholi, S P; Dias, E A R; Souza, A H; Baruselli, P S

2017-03-01

The aim of the present study was to evaluate whether repeated ovum pick-up (OPU) procedures may affect the efficiency of OPU programs for in vitro embryo production (IVEP) in Bos indicus (Nelore) donors. In addition, the repeatability (r) efficiency of IVEP was also assessed. Data available were from 432 OPU-IVEP sessions that were performed at random stages of the estrous cycle in 36 cycling, nonlactating Nelore donors. Semen from three Nelore bulls was used for the IVF. Donors were submitted to 12 consecutive OPU procedures, with an interval of approximately 30 days between sessions. Data were analyzed as repeated measures using the GLIMMIX procedure of SAS 9.3. Cows yielding ≥15 COCs were defined as "high" COCs and cows with less than 15 COCs were defined as "low" COCs donors. The number of COCs retrieved decreased over time in donors classified with high COCs and remained fairly steady in cows with low COCs at the beginning of the program (P session*COC retrieved groups  = 0.02). Moreover, the number of COCs retrieved (P < 0.0001), and number of blastocysts produced per OPU (P = 0.001) was greater for the high COCs donors compared with the low COCs category, and these results were consistent across OPU sessions. Interestingly, there was no effect of COCs category on the rate of blastocyst development (P = 0.83). In addition, number of blastocysts produced were not affected by repeated OPU (P = 0.37) and interactions between time and COC category (P = 0.72). Similarly, blastocyst rate was not affected by repeated OPU (P = 0.21) and interactions between time and COC category (P = 0.58). Despite of COC category of the donor cows, repeatability was high for the number of COCs retrieved (r = 0.81), number of blastocysts produced per OPU (r = 0.79), and blastocyst rate (0.69). In conclusion, overall numbers of COCs decreased over time in donors classified as having high COCs. However, cumulative amounts of produced blastocysts were greater in donors with high COCs. More importantly, high repeatability was observed in terms of IVEP efficiency. Therefore, IVEP programs can be significantly improved with more aggressive selection toward donors with greater numbers of COCs. Copyright © 2016 Elsevier Inc. All rights reserved.

Travel for transplantation in iran: pros and cons regarding Iranian model.

PubMed

Ossareh, Shahrzad; Broumand, Behrooz

2015-04-01

Transplant tourism is one of the main unacceptable aspects of medical tourism, implicating travel to another country to receive an allograft. Organ shortages in wealthier countries have persuaded patients to preclude organ waiting lists and travel to other countries for getting organs especially kidneys. On the other hand, in many countries, there is no transplant program, and hemodialysis is expensive. Hence, patients with end-stage kidney disease may have to travel to get a kidney allograft for the sake of their lives. In Iran, a legal compensated and regulated living unrelated donor kidney transplant program has been adopted since 1988, in which recipients are matched with liveunrelated donors through the Iran Kidney Foundation and the recipients are compensated dually by the government and the recipient. In this model regulations were adopted to prevent transplant tourism: foreigners were not allowed to receive a kidney from Iranian donors or donate a kidney to Iranian patients; however, they could be transplanted from donors of their own nationality, after full medical workup, with the authorization of the Ministry of Health. This was first considered as a humanitarian assistance to patients of the countries with no transplant program and limited and low quality dialysis. However, the policy of "foreign nationality transplant" gradually established a spot where residents of many countries, where living-unrelated donor transplant was illegal, could bring their donors and be transplanted mainly in private hospitals, with high incentives for the transplant teams. By June 2014, six hundred eight foreign nationality kidney transplants were authorized by Ministry of Health for citizens for 17 countries. In this review, we examine the negative aspects of transplant for foreign citizens in Iran and the reasons that changed "travel for transplant" to "transplant tourism " in our country and finally led us to stop the program after more than 10 years.

An academic-based hospital donor site: do physicians donate blood?

PubMed

Kanner, William A; Jeffus, Susanne; Wehrli, Gay

2009-01-01

The objectives of this prospective, cross-sectional study were to characterize blood donors in an academic-based hospital donor center, to determine whether physicians donate, and to elucidate the donation impetus. A confidential survey was issued to presenting, potential donors over 200 weekdays. Three questions were asked: their role at the institution, if and when they had previously donated blood, and what prompted the current donation. The majority of the 687 respondents were institution-affiliated (73.5%) and 79.3% had previously donated, with a median of 3 mo since the prior donation. Only 21 (3.1%) respondents were physicians. The predominant reasons for donor presentation were an appointment, knowing it had been 8 wk since the last donation, and contact by the blood center to donate. This study shows the dearth of physician blood donors and a strong cohort of institution-affiliated repeat donors. Physicians represent a potential, stable, and sustainable donor pool; further studies are needed to establish physician recruitment programs.

Living donor kidney transplantation: "beauty and the beast"!

PubMed

Danovitch, Gabriel M

2013-01-01

The report by Terasaki and colleagues in 1995 that the outcomes of spousal and biologically unrelated transplants were essentially the same as for 1-haplotype matched living related transplants changed the course of clinical transplantation. This article, entitled metaphorically "Beauty and the Beast", describes the dramatic change in the practice of living donor transplantation that followed. In the ensuing two decades, biologically unrelated living donor transplantation became commonplace in the developed world and reached its apotheosis in cross-country living donor paired exchange programs that have made transplantation accessible to many whose donors were deemed "incompatible". Such exchanges can indeed be thought of as a "thing of beauty". Sadly, the same observation was abused to exploit vulnerable donors, and the "beast" in the form of transplant tourism became a feature of transplantation in the developing world. The responsibility of the transplant community to protect the welfare of living donors and their recipients and the key role of trust in the evaluation of living donors is discussed.

Banking on Living Kidney Donors-A New Way to Facilitate Donation without Compromising on Ethical Values.

PubMed

Martin, Dominique E; Danovitch, Gabriel M

2017-10-01

Public surveys conducted in many countries report widespread willingness of individuals to donate a kidney while alive to a family member or close friend, yet thousands suffer and many die each year while waiting for a kidney transplant. Advocates of financial incentive programs or "regulated markets" in kidneys present the problem of the kidney shortage as one of insufficient public motivation to donate, arguing that incentives will increase the number of donors. Others believe the solutions lie-at least in part-in facilitating so-called "altruistic donation;" harnessing the willingness of relatives and friends to donate by addressing the many barriers which serve as disincentives to living donation. Strategies designed to minimize financial barriers to donation and the use of paired kidney exchange programs are increasingly enabling donation, and now, an innovative program designed to address what has been termed "chronologically incompatible donation" is being piloted at the University of California, Los Angeles, and elsewhere in the United States. In this program, a person whose kidney is not currently required for transplantation in a specific recipient may instead donate to the paired exchange program; in return, a commitment is made to the specified recipient that priority access for a living-donor transplant in a paired exchange program will be offered when or if the need arises in the future. We address here potential ethical concerns related to this form of organ "banking" from living donors, and argue that it offers significant benefits without undermining the well-established ethical principles and values currently underpinning living donation programs. © The Author 2017. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Design and approach of the Living Organ Video Educated Donors (LOVED) program to promote living kidney donation in African Americans.

PubMed

Sieverdes, John C; Price, Matthew; Ruggiero, Kenneth J; Baliga, Prabhakar K; Chavin, Kenneth D; Brunner-Jackson, Brenda; Patel, Sachin; Treiber, Frank A

2017-10-01

To describe the rationale, methodology, design, and interventional approach of a mobile health education program designed for African Americans with end stage renal disease (ESRD) to increase knowledge and self-efficacy to approach others about their need for a living donor kidney transplant (LDKT). The Living Organ Video Educated Donors (LOVED) program is a theory-guided iterative designed, mixed methods study incorporating three phases: 1) a formative evaluation using focus groups to develop program content and approach; 2) a 2-month proof of concept trial (n=27) to primarily investigate acceptability, tolerability and investigate increases of LDKT knowledge and self-efficacy; and 3) a 6-month, 2-arm, 60-person feasibility randomized control trial (RCT) to primarily investigate increases in LDKT knowledge and self-efficacy, and secondarily, to increase the number of living donor inquiries, medical evaluations, and LDKTs. The 8-week LOVED program includes an interactive web-based app delivered on 10″ tablet computer incorporating weekly interactive video education modules, weekly group video chat sessions with an African American navigator who has had LDKT and other group interactions for support and improve strategies to promote their need for a kidney. Phase 1 and 2 have been completed and the program is currently enrolling for the feasibility RCT. Phase 2 experienced 100% retention rates with 91% adherence completing the video modules and 88% minimum adherence to the video chat sessions. We are in the early stages of an RCT to evaluate the LOVED program; to date, we have found high tolerability reported from Phase 2. Copyright © 2017 Elsevier Inc. All rights reserved.

Excess of Methyl Donor in the Perinatal Period Reduces Postnatal Leptin Secretion in Rat and Interacts with the Effect of Protein Content in Diet

PubMed Central

Giudicelli, Fanny; Brabant, Anne-Laure; Grit, Isabelle; Parnet, Patricia; Amarger, Valérie

2013-01-01

Methionine, folic acid, betaine and choline interact in the one-carbon metabolism which provides methyl groups for methylation reactions. An optimal intake of these nutrients during pregnancy is required for successful completion of fetal development and evidence is growing that they could be involved in metabolic long-term programming. However, the biological pathways involved in the action of these nutrients are still poorly known. This study investigated the interaction between methyl donors and protein content in maternal diet during the preconceptual, pregnancy and lactation periods and the consequences on the rat offspring in the short and long term. Methyl donor supplementation reduced leptin secretion in offspring, whereas insulin levels were mostly affected by protein restriction. The joint effect of protein restriction and methyl donor excess strongly impaired postnatal growth in both gender and long term weight gain in male offspring only, without affecting food intake. In addition, rats born from protein restricted and methyl donor supplemented dams gained less weight when fed a hypercaloric diet. Methylation of the leptin gene promoter in adipose tissue was increased in methyl donor supplemented groups but not affected by protein restriction only. These results suggest that maternal methyl donor supplementation may influence energy homeostasis in a gender-dependent manner, without affecting food intake. Moreover, we showed that macronutrients and micronutrients in maternal diet interact to influence the programming of the offspring. PMID:23840890

Excess of methyl donor in the perinatal period reduces postnatal leptin secretion in rat and interacts with the effect of protein content in diet.

PubMed

Giudicelli, Fanny; Brabant, Anne-Laure; Grit, Isabelle; Parnet, Patricia; Amarger, Valérie

2013-01-01

Methionine, folic acid, betaine and choline interact in the one-carbon metabolism which provides methyl groups for methylation reactions. An optimal intake of these nutrients during pregnancy is required for successful completion of fetal development and evidence is growing that they could be involved in metabolic long-term programming. However, the biological pathways involved in the action of these nutrients are still poorly known. This study investigated the interaction between methyl donors and protein content in maternal diet during the preconceptual, pregnancy and lactation periods and the consequences on the rat offspring in the short and long term. Methyl donor supplementation reduced leptin secretion in offspring, whereas insulin levels were mostly affected by protein restriction. The joint effect of protein restriction and methyl donor excess strongly impaired postnatal growth in both gender and long term weight gain in male offspring only, without affecting food intake. In addition, rats born from protein restricted and methyl donor supplemented dams gained less weight when fed a hypercaloric diet. Methylation of the leptin gene promoter in adipose tissue was increased in methyl donor supplemented groups but not affected by protein restriction only. These results suggest that maternal methyl donor supplementation may influence energy homeostasis in a gender-dependent manner, without affecting food intake. Moreover, we showed that macronutrients and micronutrients in maternal diet interact to influence the programming of the offspring.

Impact of a National Controlled Donation After Circulatory Death (DCD) Program on Organ Donation in the United Kingdom: A 10-Year Study.

PubMed

Hodgson, R; Young, A L; Attia, M A; Lodge, J P A

2017-12-01

Organ transplantation is the most successful treatment for some forms of organ failure, yet a lack of organs means many die on the waiting list. In the United Kingdom, the Organ Donation Taskforce was set up to identify barriers to organ donation and in 2008 released its first report (Organ Donation Taskforce Report; ODTR). This study assesses the success since the ODTR and examines the impact of the United Kingdom's controlled donation after circulatory death (DCD) program and the controversies surrounding it. There were 12 864 intended donation after brain death (DBD) or DCD donors from April 2004 to March 2014. When the 5 years preceding the ODTR was compared to the 5 years following, intended DCD donors increased 292% (1187 to 4652), and intended DBD donors increased 11% (3327 to 3698). Organs retrieved per intended DBD donor remained static (3.30 to 3.26), whereas there was a decrease in DCD (1.54 to 0.99) due to a large rise in donors who did not proceed to donation (325 to 2464). The majority of DCD donors who proceeded did so within 30 min from time of withdrawal. Our study suggests further work on converting eligible referrals to organ donation and exploring methods of converting DCD to DBD donors. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

“Mortui Vivos Docent” or Who Gives His Body to Science? The Analysis of the Personal Questionnaires of Polish Donors in the Conscious Body Donation Program

PubMed Central

Kuszewski, Piotr; Kostro, Karol; Łoś, Andrzej; Kłakus, Piotr

2015-01-01

The Conscious Body Donation Program conducted since 2003 by the Department of Human Anatomy, Medical University of Silesia in Katowice was the first innovative project aimed at obtaining informed donors' bodies for the purpose of teaching anatomy in Poland. The aim of this prospective study was to determine the declared donors' characteristics and to establish the possible motivation for body donation. A total of 244 application files were reviewed and the following information was analyzed: donor’s age, age at which the decision to donate the body was made, donor’s place of residence and declared nationality, family background, education and profession, family structure and religion. Our results showed that mainly elderly people decided to donate their bodies (68.5 ± 11.84 years), living mostly in large and medium-sized cities. Men - donors often lived in small towns. Most of the donors were of blue-collar parentage, completed secondary education and at the time of taking decision to donate where married and retired. Widows were more likely to make the decision to donate than widowers. Most of our donors were Catholic. Our analysis of the profile of Polish donors may be useful to understand better for which groups of people death is not to be perceived as the end, and may become a value, which can be beneficial to living people. PMID:25790303

Interventional radiology in living donor liver transplant

PubMed Central

Cheng, Yu-Fan; Ou, Hsin-You; Yu, Chun-Yen; Tsang, Leo Leung-Chit; Huang, Tung-Liang; Chen, Tai-Yi; Hsu, Hsien-Wen; Concerjero, Allan M; Wang, Chih-Chi; Wang, Shih-Ho; Lin, Tsan-Shiun; Liu, Yueh-Wei; Yong, Chee-Chien; Lin, Yu-Hung; Lin, Chih-Che; Chiu, King-Wah; Jawan, Bruno; Eng, Hock-Liew; Chen, Chao-Long

2014-01-01

The shortage of deceased donor liver grafts led to the use of living donor liver transplant (LDLT). Patients who undergo LDLT have a higher risk of complications than those who undergo deceased donor liver transplantation (LT). Interventional radiology has acquired a key role in every LT program by treating the majority of vascular and non-vascular post-transplant complications, improving graft and patient survival and avoiding, in the majority of cases, surgical revision and/or re-transplant. The aim of this paper is to review indications, diagnostic modalities, technical considerations, achievements and potential complications of interventional radiology procedures after LDLT. PMID:24876742

Ethical Dilemmas for Oocyte Donations: Slippery Slope for Conflicts of Interest.

PubMed

Tulay, Pinar

2016-01-01

Oocyte donations have increased with improvements in oocyte cryopreservation procedures in recent years. Women with medical conditions that require chemotherapy or radiotherapy have begun to opt for oocyte cryo¬preservation prior to their treatment or to enroll in an oocyte donation program. Alternatively, some women apply for "third-party" oocyte donation programs for nonmedical reasons such as delayed childbearing. Although society seems to accept oocyte donations for medical reasons, it appears that there are still some moral issues surrounding nonmedical oocyte donations. In this review, the ethical aspects of oocyte donations and donors' perspectives are discussed. With developing technologies, the genetic screening of donors has expanded to include diseases. This review explores the ethical issues involved in genetic screening of gamete donors.

The Liver Transplant Program at Tianjin First Center Hospital.

PubMed

Shen, Zhongyang

2011-01-01

The liver transplant program at the transplant center of Tianjin First Center Hospital opened in 1994 and has become a leading center for academic research and development in clinical liver transplantation during the past 18 years. As of Nov 30, 2011, we had performed 4,103 liver transplantations in patients ranging from 6 months to 79 years old. Since 1998, the program has ranked first in mainland China in the annual number of liver transplants performed, the cumulative total liver transplants and the number of long-surviving patients. We've accomplished a number of "firsts" among the Chinese liver transplant centers, including: the first split liver transplantation, the first pediatric liver transplant, the first living donor simultaneous liver-kidney transplant, the first dual-graft liver transplant using a domino right lobe and a living donor left lobe, the first laparoscopic assisted live donor right hepatectomy including the middle hepatic vein and we have assembled the first liver transplant chain comprising multiple donors and recipients. We have performed the largest number of living related and split liver transplantations in mainland China. The combined prophylactic protocol of "Lamivudine and HBIG" to prevent HBV recurrence post transplantation was first used by our center in China and now is utilized by most of the domestic transplant centers. We have begun using livers from donors after cardiac death (DCD) during the past 2 years, with careful donor selection and recipient management. All the approaches and techniques we've developed are aimed at the utilization of all types of available grafts. However, increasing the rate of transplantation with excellent graft and recipient survival are still the challenges facing us.

Surveillance of risk profiles among new and repeat blood donors with transfusion-transmissible infections from 1995 through 2003 in the Netherlands.

PubMed

Van der Bij, Akke K; Coutinho, Roel A; Van der Poel, Cees L

2006-10-01

To evaluate the effectiveness of blood donor selection, this study reports risk profiles of donors with transfusion-transmissible infections as obtained by ongoing surveillance, 1995 through 2003, in the Netherlands. A surveillance program was installed to monitor risk profiles among new and repeat donors infected with human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV), or human T-lymphotropic virus (HTLV), or positive for the presence of syphilis antibodies. At posttest counseling, a physician interviewed donors to clarify possible sources of infection. A total of 167 repeat donors and 404 new donors were interviewed: 33 with HIV, 123 with HCV, 279 with HBV, 21 with HTLV, and 112 with syphilis antibodies. Most HBV, HCV, and HTLV infections were among new donors (80, 85, and 67%), whereas most HIV infections were among repeat donors (79%). Nearly 25 percent of the donors did not report factors at screening that would have deferred them from donating blood. At posttest interviews, new donors with HCV often reported injecting drug use (19%). Repeat donors with HIV often reported male-to-male sex (8/26, 31%). A significant level of deferrable behavioral risks was found among donors with confirmed transfusion-transmissible infections that persist despite current donor selection. Reporting such behavior at initial donor selection would have eliminated a substantial part of the infections found. This study argues against relaxing the existing donor deferral of persons practicing male-to-male sex, given their significant proportion of HIV infections among repeat donors. Systematic surveillance of risk factors among infected blood donors provides ongoing information about the effectivity of donor selection and is recommended to evaluate and optimize blood policies.

Voluntary organ donation system adapted to Chinese cultural values and social reality.

PubMed

Huang, Jiefu; Millis, J Michael; Mao, Yilei; Millis, M Andrew; Sang, Xinting; Zhong, Shouxian

2015-04-01

Organ donation and transplant systems have unique characteristics based on the local culture and socioeconomic context. China's transplant and organ donation systems developed without regulatory oversight until 2006 when regulation and policy were developed and then implemented over the next several years. Most recently, the pilot project of establishing a voluntary citizen-based deceased donor program was established. The pilot program addressed the legal, financial, and cultural barriers to organ donation in China. The pilot program has evolved into a national program. Significantly, it established a uniquely Chinese donor classification system. The Chinese donor classification system recognizes donation after brain death (category I), donation after circulatory death (category II), and donation after brain death followed by circulatory death (category III). Through August 2014, the system has identified 2326 donors and provided 6416 organs that have been allocated though a transparent organ allocation system. The estimated number of donors in 2014 is 1147. As China's attitudes toward organ donation have matured and evolved and as China, as a nation, is taking its place on the world stage, it is recognizing that its past practice of using organs from executed prisoners is not sustainable. It is time to recognize that the efforts to regulate transplantation and provide voluntary citizen-based deceased organ donation have been successful and that China should use this system to provide organs for all transplants in every province and hospital in China. At the national organ transplant congress on October 30, 2014, the Chairman of the China's national organ donation and transplantation committee, Jeifu Huang required all hospitals to stop using organs from executed prisoners immediately and the civilian organ donation will be sole source for organ transplant in China starting January 2015. © 2015 American Association for the Study of Liver Diseases.

Spin Measurements of an Electron Bound to a Single Phosphorous Donor in Silicon

NASA Astrophysics Data System (ADS)

Luhman, D. R.; Nguyen, K.; Tracy, L. A.; Carr, S. M.; Borchardt, J.; Bishop, N. C.; Ten Eyck, G. A.; Pluym, T.; Wendt, J.; Carroll, M. S.; Lilly, M. P.

2014-03-01

The spin of an electron bound to a single donor implanted in silicon is potentially useful for quantum information processing. We report on our efforts to measure and manipulate the spin of an electron bound to a single P donor in silicon. A low number of P donors are implanted using a self-aligned process into a silicon substrate in close proximity to a single-electron-transistor (SET) defined by lithographically patterned polysilicon gates. The SET is used to sense the occupancy of the electron on the donor and for spin read-out. An adjacent transmission line allows the application of microwave pulses to rotate the spin of the electron. We will present data from various experiments designed to exploit these capabilities. This work was performed, in part, at the Center for Integrated Nanotechnologies, a U.S. DOE Office of Basic Energy Sciences user facility. The work was supported by Sandia National Laboratories Directed Research and Development Program. Sandia National Laboratories is a multi-program laboratory operated by Sandia Corporation, a Lockheed-Martin Company, for the U. S. Department of Energy under Contract No. DE-AC04-94AL85000.

Minority donation in the United States: challenges and needs.

PubMed

Shaz, Beth H; Hillyer, Christopher D

2010-11-01

In the United States, blood donation rates of African-Americans are 25-50% of that of white individuals. As African-Americans make up an ever increasing and now substantial minority, and African-American recipients of blood transfusion, both specialized, such as sickle cell disease patients, and general hospitalized patients, have a better chance of receiving phenotype-matched or appropriate red blood cell units when there is a significant percentage of products in the inventory from African-American donors, it is important to understand the reason for the observed difference. Possible reasons for this discrepancy in donation rates include increased rates of donor deferral and ineligibility; increased barriers to donation, such as fear and distrust; and different marketing and education strategies. Thus, to increase the blood availability to African-American recipients, the reasons for these donation rate differences must be better understood and subsequently addressed through improved blood donor recruitment programs. The majority of African-American donor recruitment programs have focused on donating for sickle cell disease patients, particularly children, which have been of limited success. Significant improvements in African-American donor recruitment are needed to adequately meet the demand of African-American patients as well as the entire population.

Ins and Outs

ERIC Educational Resources Information Center

Oguntoyinbo, Lekan

2012-01-01

The success of an institution's fundraising program increasingly relies on the leader's ability to nurture relationships with major donors and alumni and articulate, as well as execute, a vision for the institution donors can support. Leadership stability becomes critically important because longer spells of service by presidents, deans, and heads…

Fermilab Friends for Science Education | Calendar

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Archives Scholarships Programs Current Programs Historical Review Testimonials Our Donors Board of Directors Board Tools Calendar Join Us Donate Now Get FermiGear! Education Office Search Programs Calendar

Fermilab Friends for Science Education | Mission

Science.gov Websites

Archives Scholarships Programs Current Programs Historical Review Testimonials Our Donors Board of Directors Board Tools Calendar Join Us Donate Now Get FermiGear! Education Office Search Programs Calendar

Case Report of Kidney Paired Donation (KPD) with Desensitization: the Strategy and Experience of 3-Way KPD in Samsung Medical Center.

PubMed

Oh, Dongkyu; Kang, Eun Suk; Yu, Shinae; Chun, Kyoungsuk; Huh, Wooseong; Jang, Hye Ryoun; Cho, Chan Woo; Lee, Nuri; Lee, Kyo Won; Park, Hyojun; Park, Jae Berm; Kim, Sung Joo

2018-01-29

As the need for the organ donation increases, strategies to increase kidney transplantation (KT) through expanded living donation have become essential. These include kidney paired donation (KPD) programs and desensitization in incompatible transplantations. KPD enables kidney transplant candidates with incompatible living donors to join a registry with other incompatible pairs in order to find potentially compatible living donor. Positive cross match and ABO incompatible transplantation has been successfully accomplished in selective cases with several pre-conditionings. Patients who are both difficult-to-match due to broad sensitization and hard-to-desensitize because of donor conditions can often be successfully transplanted through a combination of KPD and desensitization. According to the existing data, KPD can increase the number of KTs from living donors with excellent clinical results. This is also a cost-effective treatment as compared with dialysis and desensitization protocols. We carried out 3-way KPD transplantation with one highly sensitized, positive cross match pair and with two ABO incompatible pairs. Herein we report our first successful 3-way KPD transplantation in a single center. To maximize donor-recipient matching and minimize immunologic risk, KPD programs should use proper algorithms with desensitization to identify optimal donor with simultaneous two-, three- or more complex multi-way exchanges. © 2018 The Korean Academy of Medical Sciences.

Quarterly Performance/Technical Report of the National Marrow Donor Program

DTIC Science & Technology

2009-02-10

and epitope level matching for HLA-DPB1. Submitted. o Z Shamim , L Ryder, M Haagenson , S Spellman, T Wang, S Lee, K Müller. Polymorphism in the...3, 4 6. AUTHOR( S ) Setterholm, Michelle 5f. WORK UNIT NUMBER N/A 7. PERFORMING ORGANIZATION NAME( S ) AND ADDRESS(ES) National Marrow Donor...Program 3001 Broadway St., N.E., Ste. 500 Minneapolis, MN 55413 8. PERFORMING ORGANIZATION REPORT NUMBER N/A 10. SPONSOR/MONITOR’S ACRONYM( S ) ONR 9

Race and ethnicity influences collection of G-CSF mobilized peripheral blood progenitor cells from unrelated donors, a CIBMTR analysis

PubMed Central

Hsu, Jack W.; Wingard, John R.; Logan, Brent R.; Chitphakdithai, Pintip; Akpek, Gorgun; Anderlini, Paolo; Artz, Andrew S.; Bredeson, Chris; Goldstein, Steven; Hale, Gregory; Hematti, Pieman; Joshi, Sarita; Kamble, Rammurti T.; Lazarus, Hillard M.; O'Donnell, Paul V.; Pulsipher, Michael A.; Savani, Bipin; Schears, Raquel M.; Shaw, Bronwen E.; Confer, Dennis L.

2014-01-01

Little information exists on the effect of race and ethnicity on collection of peripheral blood stem cells (PBSC) for allogeneic transplantation. We studied 10776 donors from the National Marrow Donor Program who underwent PBSC collection from 2006-2012. Self-reported donor race/ethnic information included Caucasian, Hispanic, Black/African American (AA), Asian/Pacific Islander (API), and Native American (NA). All donors were mobilized with subcutaneous filgrastim (G-CSF) at an approximate dose of 10 µg/kg/d for 5 days. Overall, AA donors had the highest median yields of mononuclear cells (MNC)/L and CD34+ cells/L blood processed (3.1 × 109 and 44 × 106 respectively) while Caucasians had the lowest median yields at 2.8 × 109 and 33.7 × 106 respectively. Multivariate analysis of CD34+/L mobilization yields using Caucasians as the comparator and controlling for age, gender, body mass index, and year of apheresis revealed increased yields in overweight and obese AA and API donors. In Hispanic donors, only male obese donors had higher CD34+/L mobilization yields compared to Caucasian donors. No differences in CD34+/L yields were seen between Caucasian and NA donors. Characterization of these differences may allow optimization of mobilization regimens to allow enhancement of mobilization yields without compromising donor safety. PMID:25316111

Barriers to implementing protocols for kidney paired donation and desensitization: survey of U.S. transplant programs.

PubMed

Clark, Emma; Hanto, Ruthanne; Rodrigue, James R

2010-12-01

Special types of kidney transplant exist for patients who have willing but incompatible donors. Two types of transplants that circumvent donor-recipient incompatibility are "kidney paired donation" and "desensitization." Lack of access to these protocols limits living donations and shortens the life span of patients with willing but incompatible donors. To understand potential barriers to implementing kidney paired donation and desensitization, as well as attitudes toward nondirected donation and compatible type O donation, which would maximize the number of kidney paired donation transplants performed via chains. We created a 56-question Web-based survey to elicit information from US transplant program directors about 24 potential barriers to implementing these protocols. Of 166 programs contacted, 96 responded, including 88 complete and 8 partial responses. After pediatric-only programs and multiple responses from the same program were removed, 84 total (78 complete) remained. Respondents were asked to designate each barrier as "major," "minor," or "not a barrier". Availability of dedicated nurse coordinators and the United Network for Organ Sharing's variance request process (although kidney paired donation does not actually require a variance) were significant barriers to kidney paired donation. Most respondents (54%, 42/78) would prefer to participate in a regional rather than a national protocol for kidney paired donation. Risk of complications was the most significant barrier to desensitization. University affiliation, region, and training (nephrologist vs surgeon) had little effect on perception of barriers. Most (92%, 71/78) would evaluate nondirected donations; 53% (41/78) would encourage compatible type O donors to enter kidney paired donation.

The role of the donor liaison officer at PlusLife (Perth Bone and Tissue Bank Inc.), Western Australia.

PubMed

Smythe, Claire; White, Nicola; Winter, Joyleen; Cowie, Anne

2015-06-01

Femoral head donation at the time of hip replacement surgery provides a much needed resource of bone allograft to orthopaedic surgeons. Prior to 2005, potential femoral head donors were identified and consented in the hospital setting on the day of surgery. This resulted in over 40 % of donations failing post operatively suggesting that more effort could be given to pre-operative screening resulting in substantial savings in the cost associated with collection and testing of donors who were subsequently failed. The Donor Liaison role was implemented in 2005 to coordinate a Femoral Head Donation program maximising the number of successful donations through pre-operative screening. This study reviews the effectiveness of pre-operative screening of potential femoral head donors at PlusLife from 2002-2012. A retrospective audit of the database was undertaken 2002-2012 and medical/social reasons for pre-operative and postoperative failures were collated into 4 main categories to enable comparison: malignancy, autoimmune conditions, variant Creutzfeldt Jakob disease risk and general medical/social reasons. The number of femoral heads failed post operatively has decreased significantly from 26 % in 2003 to 6 % in 2012. A cost of $121,000 was expended on femoral heads failed post operatively in 2004, as compared to $20,350 in 2012. Donors excluded due to the 4 main categories (medical/social history) were identified pre-operatively in over 80 % of all cases. Preoperative screening of femoral head donors through a coordinated Femoral Head Donation Program is a safe and cost effective method.

Increasing organ donation via changes in the default choice or allocation rule

PubMed Central

Li, Danyang; Hawley, Zackary; Schnier, Kurt

2013-01-01

This research utilizes a laboratory experiment to evaluate the effectiveness of alternative public policies targeted at increasing the rate of deceased donor organ donation. The experiment includes treatments across different default choices and organ allocation rules inspired by the donor registration systems applied in different countries. Our results indicate that the opt-out with priority rule system generates the largest increase in organ donation relative to an opt-in only program. However, sizeable gains are achievable using either a priority rule or opt-out program separately, with the opt-out rule generating approximately 80% of the benefits achieved under a priority rule program. PMID:24135615

The correlation between preoperative volumetry and real graft weight: comparison of two volumetry programs.

PubMed

Mussin, Nadiar; Sumo, Marco; Lee, Kwang-Woong; Choi, YoungRok; Choi, Jin Yong; Ahn, Sung-Woo; Yoon, Kyung Chul; Kim, Hyo-Sin; Hong, Suk Kyun; Yi, Nam-Joon; Suh, Kyung-Suk

2017-04-01

Liver volumetry is a vital component in living donor liver transplantation to determine an adequate graft volume that meets the metabolic demands of the recipient and at the same time ensures donor safety. Most institutions use preoperative contrast-enhanced CT image-based software programs to estimate graft volume. The objective of this study was to evaluate the accuracy of 2 liver volumetry programs (Rapidia vs . Dr. Liver) in preoperative right liver graft estimation compared with real graft weight. Data from 215 consecutive right lobe living donors between October 2013 and August 2015 were retrospectively reviewed. One hundred seven patients were enrolled in Rapidia group and 108 patients were included in the Dr. Liver group. Estimated graft volumes generated by both software programs were compared with real graft weight measured during surgery, and further classified into minimal difference (≤15%) and big difference (>15%). Correlation coefficients and degree of difference were determined. Linear regressions were calculated and results depicted as scatterplots. Minimal difference was observed in 69.4% of cases from Dr. Liver group and big difference was seen in 44.9% of cases from Rapidia group (P = 0.035). Linear regression analysis showed positive correlation in both groups (P < 0.01). However, the correlation coefficient was better for the Dr. Liver group (R 2 = 0.719), than for the Rapidia group (R 2 = 0.688). Dr. Liver can accurately predict right liver graft size better and faster than Rapidia, and can facilitate preoperative planning in living donor liver transplantation.

[Diversification is the financial alternative for family planning].

PubMed

Castro Villamil, R

1991-12-01

During the 1960s, when family planning services were institutionalized in Colombia by PROFAMILIA, abundant foreign assistance was readily available. Few questions were asked about the longterm funding of family planning programs or the need for financial self-sufficiency. The emphasis was on program development without great attention to costs. Beginning around the early 1980s, international donors began to place a higher priority and greater investment in the incipient family planning programs of less developed countries. At present a greater number and higher quality of services are being demanded from PROFAMILIA at the lowest possible cost. Efficiency has replaced efficacy as the overriding goal. PROFAMILIA, due to its excellent results, has lost priority in the eyes of international donors. It has therefore reoriented its financing strategies toward a short, medium, and long term plan to reduce its financial dependence on international donor agencies. Self-sufficiency could be increased through various means, including total government subsidy, charging fees for services and materials sufficient to cover program costs, establishing services and marketing programs aside from family planning programs for the specific purpose of obtaining funds to cover program deficits, or establishing accounting and operational controls to reduce costs through greater efficiency. But large government subsidies are unlikely in a time of budgetary constraints, and raising fees for family planning users would exclude a large number of low-income clients from the family planning program. Cost reduction and implementation of diversified programs should therefore be emphasized for the present. The diversified program should be related to family planning so that use can be made of idle resources. PROFAMILIA has emphasized surgical procedures and medical consultations to utilize clinic facilities more fully and to increase income without increasing fixed costs. In 1990, foreign donations accounted for 47.3% of PROFAMILIA income and PROFAMILIA contributed the rest. 18.1% came from family planning activities, 20.2% from surgical procedures, consultations, sales of medications, and laboratory services, and 20.2% from service contracts, national donations, interest, and other sources. In the same year, family planning programs accounted for 68.9% of expenditures, diversification programs for 11.5%, technical assistance for 8.6%, and administration for 11%. The income and expenditure data indicate that the diversification programs make a significant financial contribution to the family planning program, at the same time reducing dependency on international donor agencies.

Prevalence of HIV-1 in blood donations following implementation of a structured blood safety policy in South Africa.

PubMed

Heyns, Anthon du P; Benjamin, Richard J; Swanevelder, J P Ronel; Laycock, Megan E; Pappalardo, Brandee L; Crookes, Robert L; Wright, David J; Busch, Michael P

2006-02-01

The South African National Blood Service collects more than 700,000 units of blood annually from a population in which 11.4% is infected with human immunodeficiency virus 1 (HIV-1). The prevalence of HIV-1 in blood donations increased to 0.26% (1:385) in 1998, indicating that a significant number of window-period infective units were entering the blood supply (risk 3.4/100,000). To determine whether the implementation of a new donor selection policy and educational program introduced in 1999 was associated with reductions in the incidence and prevalence of HIV-1 in blood donations and the reduced transmission risk. We compared the prevalence of HIV-1 in 880,534 blood donations collected from 1999 through 2000 with the 791,639 blood donations collected from 2001 through 2002. We estimated the incidence of HIV-1 in 93,378 (1999-2000) and 67,231 (2001-2002) first-time donations and the residual risk for all donations in 2001-2002 using the less-sensitive enzyme-linked immunoassay and incidence-window period model. All blood donors in the Inland region of the South African National Blood Service were analyzed. Donor clinics in high HIV prevalence areas were closed. Programs targeting repeat donors and youth were initiated and HIV risk behavior education programs were developed. Structured donor interviews and an enhanced donor self-exclusion questionnaire were institutionalized. The prevalence of HIV-1 in blood donations declined from 0.17% in 1999-2000 to 0.08% in 2001-2002 after the implementation of the new donor selection and education policy. The number of high-risk donations collected decreased from 2.6% to 1.7% (P<.001), and the likelihood of these donations being infected decreased from 4.8% to 3.25%. The likelihood of first-time donors being recently infected with HIV-1 decreased from 18% to 14% (P = .07) and respective incidence of high-risk donations collected decreased from 2.6% to 1.7%. Donations from the majority black population declined from 6.6% to 4.2% (P<.001). Analysis of HIV-1 incidence in 2001-2002 suggests a residual risk of collecting a window period infectious unit of 2.6/100,000. The implementation of enhanced education and selection policies in South Africa was associated with decreased prevalence of HIV-1 in blood donations.

Using Classification Trees to Predict Alumni Giving for Higher Education

ERIC Educational Resources Information Center

Weerts, David J.; Ronca, Justin M.

2009-01-01

As the relative level of public support for higher education declines, colleges and universities aim to maximize alumni-giving to keep their programs competitive. Anchored in a utility maximization framework, this study employs the classification and regression tree methodology to examine characteristics of alumni donors and non-donors at a…

Educating Prospective Kidney Transplant Recipients and Living Donors about Living Donation: Practical and Theoretical Recommendations for Increasing Living Donation Rates

PubMed Central

Waterman, Amy D.; Robbins, Mark L.; Peipert, John D.

2016-01-01

A promising strategy for increasing living donor kidney transplant (LDKT) rates is improving education about living donation for both prospective kidney transplant recipients and living donors to help overcome the proven knowledge, psychological, and socioeconomic barriers to LDKT. A recent Consensus Conference on Best Practices in Live Kidney Donation recommended that comprehensive LDKT education be made available to patients at all stages of chronic kidney disease (CKD). However, in considering how to implement this recommendation across different healthcare learning environments, the current lack of available guidance regarding how to design, deliver, and measure the efficacy of LDKT education programs is notable. In the current article, we provide an overview of how one behavior change theory, the Transtheoretical Model of Behavior Change, can guide the delivery of LDKT education for patients at various stages of CKD and readiness for LDKT. We also discuss the importance of creating educational programs for both potential kidney transplant recipients and living donors, and identify key priorities for educational research to reduce racial disparities in LDKT and increase LDKT rates. PMID:27347475

Cost analysis of living donor liver transplantation: the first Italian economical data.

PubMed

Passarani, S; De Carlis, L; Maione, G; Alberti, A B; Bevilacqua, L; Baraldi, S

2007-10-01

Over a period of 30 months, the Niguarda Ca'Granda Hospital performed 12 living donor liver transplants (LDLT) on adult subjects using the split-liver technique and transplant of the right lobe. The purpose of this work is to evaluate the financial obligation that this technique will bring, the ethical and cultural aspects, and the mortality related to surgery on a healthy donor whose only reward is in the knowledge of having done everything possible for a loved family member. The analysis of the costs of the surgical process takes into account the simultaneous consideration of both types of patients: the donor and the recipient. The diagnostic course is subdivided into seven functional phases of the cost centers, and the transitory sequences of the foreseeable events of the entire process. The method used consists in the appraisal of all the clinical activities in chronological order several the centers of cost. The direct expenses are evaluated according to an analytical method, and the indirect costs has been carried out on the criterion of the activities of support to the process (management of the orders, recording and programming of the activities) and support to the organization (maintenance, management supplying and contests of contract, programming of the business production, management warehouses, supplyings, marketing and relations with the public). The cost of all the patients evaluated that were not able to donate has been added to the direct expenses of 12 donor and 12 recipient patients, in all 30 patients, so as to shift the added expenses only to the donor patient, since these costs are not included in the typical costs of transplantation from a cadaver. The indirect cost calculated for each patient has been added to the direct costs of the donor and recipient patients. The total calculated cost of LDLT is 175, 210.78 Euros. The analysis of the economical obligation that this practice brings is the starting point for an accurate evaluation of all the new technology that, in conjunction with the results of clinical efficacy and efficiency trials, is part of program of a larger scope to fulfil the general social principles of equity and justice.

Screening blood donors for diabetes: analysis of use, accuracy, and cost.

PubMed

Lenhard, M James; Maser, Raelene E; Kolm, Paul; Healy, Michael J; Seshadri, Prakash

2013-11-01

The objective was to determine if a free, voluntary diabetes screening program as a part of the blood donation process might be cost-effective. During the first 6 months of the program, 26,415 donors were screened using a single random plasma glucose (RPG) level. All donors were asked to eat before donation. Low-, moderate-, and high-risk groups were formed based on RPG levels (<140, 140-200, and >200 mg/dL). Contact with a telephone questionnaire was made with 139 of 178 (78%) of the persons in the high-risk group with 33 new cases of diabetes diagnosed by the donor's physician and 26 donors indicating that they were not diagnosed with diabetes. Sex- and age-matched donors in the low- and moderate-risk groups were contacted and administered the same questionnaire. The three risk groups were similar, except for body mass index (28.1 ± 5.4 kg/m2 vs. 29.9 ± 5.5 kg/m2 vs. 32.7 ± 5.6 kg/m2 , p < 0.001). The discriminative effectiveness of screening was evaluated by the area under the receiver operating characteristics (AROC) curve. The AROC curve was 0.950 (95% confidence interval, 0.920-0.979) for the identification of diabetes. Using a RPG cutoff of 200 mg/dL, sensitivity was 100%, specificity was 82%, and positive predictive value was 56%. Cost analyses showed that the mean cost to screen, per donor, was less than $1. Cost per case identified was estimated to be less than $500 for a RPG cutoff of 200 mg/dL. Screening during the blood donation process appears to be accurate, convenient, and inexpensive. © 2013 American Association of Blood Banks.

Commercial living non-related organ transplantation: a viewpoint from a developed country.

PubMed

Hoyer, Peter F

2006-10-01

In developed countries, the use of living unrelated donors is restricted to purely altruistic donors who have a close and emotional relationship with the recipients. By law, commercial transplantation is illegal. Increasing shortness of donors, the excellent results of kidney transplants from spousal and living unrelated donors as well as the very low risk for the donor has been used as an argument for paid organ donation. Arguments in favour are the relief of donor-organ shortage, short waiting times for renal transplantation, economic benefits for the donor as well as the economic benefits for society by reducing the costs of dialysis by more transplants. Major arguments against are exploitation of the donor, coercion, and a growing black market. Despite the fact that different societies have different norms or reproaches that we are failing our patients and accept the death of thousands, kidney trade has created an environment of corruption and commercialisation, which brings even the cadaver transplant program into disrepute. However, denying the existence of paid organ donation does not contribute to solve the problem. A public discussion about consequences of changing ethics and human rights, rather than pragmatic solutions, is needed.

Perspectives of Canadian oocyte donors and recipients on donor compensation and the establishment of a personal health information registry.

PubMed

Blyth, Eric; Yee, Samantha; Ka Tat Tsang, A

2012-01-01

We report the views of 33 women who were involved in an altruistic oocyte donation program about provisions under Canada's Assisted Human Reproduction Act 2004 to prohibit donor compensation and to establish a Personal Health Information Registry. The participants had been either donors of oocytes to a recipient known to them (15) or recipients of such donation (18) through services provided by a clinic in a large Canadian city, and they each participated in a semi-structured face-to-face or telephone interview. Among the 15 donor participants, seven were friends of the recipient, six were sisters, one was a niece of the recipient, and one donor donated twice, once to her sister and once to a friend. In eight cases the donor and recipient participated in interviews independently. At the time of interview, 11 of the 25 separate cases had resulted in a live birth and one in an ongoing pregnancy, so that "successful" and "unsuccessful" donations were equally represented among participants. While divergent views were reported among and between donors and recipients on an altruistic model versus a compensated model of donation, most participants largely endorsed the establishment of a personal health information registry.

Children as living organ donors: current views and practice in the United States.

PubMed

Olbrisch, Mary E; Levenson, James L; Newman, Joel D

2010-04-01

To summarize recent practices and views regarding children as living organ donors in the USA. Living donors have become an increasingly important source of organs for transplantation. Concern for the rights of donors has resulted in reconsideration of the use of minors as living organ donors. Most commentators have voiced concerns that minors deserve extraordinary protection, but are unwilling to ban the practice of living donation by minors outright. Instead, factors to be considered in individual situations have been enumerated, and safeguards recommended. These same safeguards have also been recommended to be extended to adults, as attainment of legal age does not in itself confer immunity from exploitation. Developmental factors of importance include brain maturation affecting decision making, executive function and impulse control; the dependent status of minors, usually on the persons who may most want them to be donors; youthful idealism and sense of invulnerability; and incomplete identity formation. Fewer children in the USA have become living donors in the past decade. Preadolescent children in particular should probably be considered as potential donors only in extraordinary circumstances. Safeguards protect not only children, but transplant physicians, programs and the image of the transplant endeavor.

Regulated compensated donation in Pakistan and Iran.

PubMed

Rizvi, Adibul Hasan S; Naqvi, Anwar S A; Zafar, Naqi M; Ahmed, Ejaz

2009-04-01

Paid living unrelated kidney donor transplantation has flourished in Pakistan and Iran. This review discusses the dynamics and consequences of organ trade in Pakistan and of a regulated paid donor model in Iran on transplant activities in these countries. In 2007, over 2500 renal transplants were performed in Pakistan, where more than 70% were from socioeconomic disadvantaged kidney vendors. More than half of recipients were foreigners who paid US$20,000-30,000. Recipients of vendor kidneys had poor outcome and high infectious complications. Regulated paid donor kidney transplant in Iran number around 1500 per year and constitute 70% of the total transplants. Graft survival rates are similar to those for living related donors. The donors are paid US$1200 and additional monies are negotiated between the recipient-donor pair. This model claims to have abolished waiting lists, although many poor patients wait for deceased donors. In both countries, recipients are relatively rich and vendors are the poor of the society who sell kidneys for quick money or to repay debts. Paid donation, regulated or commercial, leads to coercion and exploitation of the poor and benefits the rich. This situation has forestalled deceased donor program and hence other solid-organ transplants. The way forward is to promote deceased donors by making transplant available to all who need it.

Fostering repeat donations in Ghana.

PubMed

Owusu-Ofori, S; Asenso-Mensah, K; Boateng, P; Sarkodie, F; Allain, J-P

2010-01-01

Most African countries are challenged in recruiting and retaining voluntary blood donors by cost and other complexities and in establishing and implementing national blood policies. The availability of replacement donors who are a cheaper source of blood has not enhanced repeat voluntary donor initiatives. An overview of activities for recruiting and retaining voluntary blood donors was carried out. Donor records from mobile sessions were reviewed from 2002 to 2008. A total of 71,701 blood donations; 45,515 (63.5%) being voluntary donations with 11,680 (25%) repeat donations were collected during the study period. Donations from schools and colleges contributed a steady 60% of total voluntary whilst radio station blood drives increased contribution from 10 to 27%. Though Muslim population is less than 20%, blood collection was above the 30-donation cost-effectiveness threshold with a repeat donation trend reaching 60%. In contrast Christian worshippers provided <25 unit/session and 30% repeat donations. Repeat donation trends amongst school donors and radio blood drives were 20% and 70% respectively. Repeat donations rates have been variable amongst different blood donor groups in Kumasi, Ghana. The impact of community leaders in propagating altruism cannot be overemphasized. Programs aiming at motivating replacement donors to be repeat donors should be developed and assessed. Copyright 2009 The International Association for Biologicals. All rights reserved.

Acute toxicities of unrelated bone marrow versus peripheral blood stem cell donation: results of a prospective trial from the National Marrow Donor Program

PubMed Central

Chitphakdithai, Pintip; Logan, Brent R.; Shaw, Bronwen E.; Wingard, John R.; Lazarus, Hillard M.; Waller, Edmund K.; Seftel, Matthew; Stroncek, David F.; Lopez, Angela M.; Maharaj, Dipnarine; Hematti, Peiman; O'Donnell, Paul V.; Loren, Alison W.; Leitman, Susan F.; Anderlini, Paolo; Goldstein, Steven C.; Levine, John E.; Navarro, Willis H.; Miller, John P.; Confer, Dennis L.

2013-01-01

Although peripheral blood stem cells (PBSCs) have replaced bone marrow (BM) as the most common unrelated donor progenitor cell product collected, a direct comparison of concurrent PBSC versus BM donation experiences has not been performed. We report a prospective study of 2726 BM and 6768 PBSC donors who underwent collection from 2004 to 2009. Pain and toxicities were assessed at baseline, during G-CSF administration, on the day of collection, within 48 hours of donation, and weekly until full recovery. Peak levels of pain and toxicities did not differ between the 2 donation processes for most donors. Among obese donors, PBSC donors were at increased risk of grade 2 to 4 pain as well as grade 2 to 4 toxicities during the pericollection period. In contrast, BM donors were more likely to experience grade 2 to 4 toxicities at 1 week and pain at 1 week and 1 month after the procedure. BM donors experienced slower recovery, with 3% still not fully recovered at 24 weeks, whereas 100% of PBSC donors had recovered. Other factors associated with toxicity included obesity, increasing age, and female sex. In summary, this study provides extensive detail regarding individualized risk patterns of PBSC versus BM donation toxicity, suggesting donor profiles that can be targeted with interventions to minimize toxicity. PMID:23109243

Acute toxicities of unrelated bone marrow versus peripheral blood stem cell donation: results of a prospective trial from the National Marrow Donor Program.

PubMed

Pulsipher, Michael A; Chitphakdithai, Pintip; Logan, Brent R; Shaw, Bronwen E; Wingard, John R; Lazarus, Hillard M; Waller, Edmund K; Seftel, Matthew; Stroncek, David F; Lopez, Angela M; Maharaj, Dipnarine; Hematti, Peiman; O'Donnell, Paul V; Loren, Alison W; Leitman, Susan F; Anderlini, Paolo; Goldstein, Steven C; Levine, John E; Navarro, Willis H; Miller, John P; Confer, Dennis L

2013-01-03

Although peripheral blood stem cells (PBSCs) have replaced bone marrow (BM) as the most common unrelated donor progenitor cell product collected, a direct comparison of concurrent PBSC versus BM donation experiences has not been performed. We report a prospective study of 2726 BM and 6768 PBSC donors who underwent collection from 2004 to 2009. Pain and toxicities were assessed at baseline, during G-CSF administration, on the day of collection, within 48 hours of donation, and weekly until full recovery. Peak levels of pain and toxicities did not differ between the 2 donation processes for most donors. Among obese donors, PBSC donors were at increased risk of grade 2 to 4 pain as well as grade 2 to 4 toxicities during the pericollection period. In contrast, BM donors were more likely to experience grade 2 to 4 toxicities at 1 week and pain at 1 week and 1 month after the procedure. BM donors experienced slower recovery, with 3% still not fully recovered at 24 weeks, whereas 100% of PBSC donors had recovered. Other factors associated with toxicity included obesity, increasing age, and female sex. In summary, this study provides extensive detail regarding individualized risk patterns of PBSC versus BM donation toxicity, suggesting donor profiles that can be targeted with interventions to minimize toxicity.

Organ donor screening practices for Strongyloides stercoralis infection among US organ procurement organizations.

PubMed

Abanyie, Francisca A; Valice, Emily; Delli Carpini, Kristin W; Gray, Elizabeth B; McAuliffe, Isabel; Chin-Hong, Peter V; Handali, Sukwan; Montgomery, Susan P; Huprikar, Shirish

2018-03-07

Targeted donor screening for strongyloidiasis performed at the time of organ procurement can prevent this life-threatening donor-derived infection. The Association of Organ Procurement Organizations surveyed members to determine the number of US organ procurement organizations (OPOs) performing donor screening for Strongyloides infection and their screening practices. All 58 OPOs responded to the survey. Only 6 (10%) currently screen donors for strongyloidiasis; most OPOs started 6-36 months before the survey and one started 6 years prior. All used risk-based criteria to determine which donors to screen, though the criteria varied among OPOs. A median of 56 donors have been screened at each OPO since initiating their screening programs, with a median of 2 infected donors (range 0-13) identified. Overall, 53 organs have been transplanted from 22 infected donors, including hearts, lungs, kidneys, and livers. Of 52 OPOs not currently screening, 20 had considered screening and one plans to start screening in the near future. Of those considering risk-based screening, most had not decided on the criteria. Uncertainty about the benefits of and guidelines for screening and misconceptions about the interpretation of test results were concerns shared by non-screening OPOs. Continued education and advocacy on the importance of targeted donor screening are needed. Published 2018. This article is a U.S. Government work and is in the public domain in the USA.

[Organ procurement and transplantation from non-heart-beating donors].

PubMed

Antoine, Corinne; Brun, Frédéric; Tenaillon, Alain; Loty, Bernard

2008-02-01

Despite a significant increase in procurement and transplantation activities observed in France in the last eight years, the shortage in grafts is on the rise and demand keeps being much higher than supply. Since 1968 and until now, procurement was limited to heart beating brain donors. The results of kidneys transplanted from non-heart-beating donors have significantly improved and are nowadays comparable to those of kidney transplantations from brain death donors, thanks to a more accurate selection of donors and recipients, to better respect of preventing cold and warm ischemia times and to several major therapeutic innovations. Procurement on non-heart-beating donors are therefore being reconsidered under considerations of feasibility, results and ethical and legal consequences, under a specific medical protocol issued by the agency of biomedicine with the pilot hospital center agreement to comply with the protocol. Referring to foreign experiences, this program is likely to decrease the organ shortage, which is jeopardizing the treatment of a large number of patients awaiting transplantation.

Economic Consequences Incurred by Living Kidney Donors: A Canadian Multi-Center Prospective Study

PubMed Central

Klarenbach, S; Gill, J S; Knoll, G; Caulfield, T; Boudville, N; Prasad, G V R; Karpinski, M; Storsley, L; Treleaven, D; Arnold, J; Cuerden, M; Jacobs, P; Garg, A X

2014-01-01

Some living kidney donors incur economic consequences as a result of donation; however, these costs are poorly quantified. We developed a framework to comprehensively assess economic consequences from the donor perspective including out-of-pocket cost, lost wages and home productivity loss. We prospectively enrolled 100 living kidney donors from seven Canadian centers between 2004 and 2008 and collected and valued economic consequences ($CAD 2008) at 3 months and 1 year after donation. Almost all (96%) donors experienced economic consequences, with 94% reporting travel costs and 47% reporting lost pay. The average and median costs of lost pay were $2144 (SD 4167) and $0 (25th–75th percentile 0, 2794), respectively. For other expenses (travel, accommodation, medication and medical), mean and median costs were $1780 (SD 2504) and $821 (25th–75th percentile 242, 2271), respectively. From the donor perspective, mean cost was $3268 (SD 4704); one-third of donors incurred cost >$3000, and 15% >$8000. The majority of donors (83%) reported inability to perform usual household activities for an average duration of 33 days; 8% reported out-of-pocket costs for assistance with these activities. The economic impact of living kidney donation for some individuals is large. We advocate for programs to reimburse living donors for their legitimate costs. In a prospective costing study, the authors find that economic consequences incurred by living kidney donors are frequent and nontrivial, and a notable proportion of donors experience significant costs. PMID:24597854

Financing HIV Programming: How Much Should Low- And Middle-Income Countries and their Donors Pay?

PubMed Central

Galárraga, Omar; Wirtz, Veronika J.; Santa-Ana-Tellez, Yared; Korenromp, Eline L.

2013-01-01

Global HIV control funding falls short of need. To maximize health outcomes, it is critical that national governments sustain reasonable commitments, and that international donor assistance be distributed according to country needs and funding gaps. We develop a country classification framework in terms of actual versus expected national domestic funding, considering resource needs and donor financing. With UNAIDS and World Bank data, we examine domestic and donor HIV program funding in relation to need in 84 low- and middle-income countries. We estimate expected domestic contributions per person living with HIV (PLWH) as a function of per capita income, relative size of the health sector, and per capita foreign debt service. Countries are categorized according to levels of actual versus expected domestic contributions, and resource gap. Compared to national resource needs (UNAIDS Investment Framework), we identify imbalances among countries in actual versus expected domestic and donor contributions: 17 countries, with relatively high HIV prevalence and GNI per capita, have domestic funding below expected (median per PLWH $143 and $376, respectively), yet total available funding including from donors would exceed the need ($368 and $305, respectively) if domestic contribution equaled expected. Conversely, 27 countries have actual domestic funding above the expected (medians $294 and $149) but total (domestic+donor) funding does not meet estimated need ($685 and $1,173). Across the 84 countries, in 2009, estimated resource need totaled $10.3 billion, actual domestic contributions $5.1 billion and actual donor contributions $3.7 billion. If domestic contributions would increase to the expected level in countries where the actual was below expected, total domestic contributions would increase to $7.4 billion, turning a funding gap of $1.5 billion into a surplus of $0.8 billion. Even with imperfect funding and resource-need data, the proposed country classification could help improve coherence and efficiency in domestic and international allocations. PMID:23861772

Ethnic differences in HLA antigens in Chilean donors and recipients: data from the National Renal Transplantation Program.

PubMed

Droguett, M A; Beltran, R; Ardiles, R; Raddatz, N; Labraña, C; Arenas, A; Flores, J; Alruiz, P; Mezzano, S; Ardiles, L

2008-11-01

To describe HLA antigen distribution, looking for possible markers of renal disease in Mapuche and non-Mapuche people in the renal transplantation program, we reviewed data from 1297 histocompatibility studies of the Chilean national renal transplantation program (421 donors and 876 recipients), performed between 2000 and 2005. Mapuche people were classified according to their family surnames. The most frequent antigens found among the total Chilean population were A2 (48%), A19 (33%), B16 (33%), B35 (26%), DR4 (38%), and DR6 (28%), without significant differences between donors and recipients. Among the 114 individuals (9%) classified as Mapuche, the most frequent antigens were A28 (49%), A2 (44%), B16 (63%), B35 (24%), DR4 (48%), and DR8 (30%), with A28/B16/DR4 as the most common haplotype. In contrast, A28, B16, DR4, and DR8 were significantly more frequent in Mapuche compared with non-Mapuche people. B8 was significantly more frequent in Mapuche recipients than in non-Mapuche recipients and Mapuche donors. The higher frequency of some HLA antigens in Mapuche people was confirmed, possibly corresponding to ethnic markers. The special concentration of B8 among Mapuche recipients might represent a genetic factor predisposing to chronic renal disease in this human group.

Recruitment and retention of blood donors in four Canadian cities: an analysis of the role of community and social networks.

PubMed

Smith, André; Matthews, Ralph; Fiddler, Jay

2013-12-01

This study approaches the decision to donate blood as a dynamic process involving interplay between blood donors' personal motives, donors' social contexts, and the donor recruitment and retention activities of blood collection agencies. Data were gathered from four blood donation clinics using in-depth interviews with Canadian Blood Services employees, donors, and nondonors in 25 organizations participating in Life Link, a donor recruitment program that supports organizations to educate employees about the benefits of blood donation. Further data were obtained from ethnographic observations of blood collection and donor recruitment activities. Thematic analysis resulted in three umbrella themes: leveraging social networks, embedding the clinic in the community, and donating blood and social reciprocity. Donor recruitment activities at all four clinics enhanced awareness of blood donation in the workplace by using experienced donors to motivate their coworkers in making a first-time donation. Clinic employees reported varying success in improving awareness of blood donation in the broader community, in part because of varying employee engagement in community-wide activities and celebrations. Altruistic motives were mentioned by experienced donors, who also identified a desire to reciprocate to their community as another strong motive. This study contextualizes donor recruitment and retention as involving activities that tie blood donation to meaningful aspects of donors' social networks and community. The findings point to the need for further analyses of the institutional dimensions of blood donation to develop effective strategies beyond appeals to altruism. © 2013 American Association of Blood Banks.

Which Donor for Uterus Transplants: Brain-Dead Donor or Living Donor? A Systematic Review.

PubMed

Lavoué, Vincent; Vigneau, Cécile; Duros, Solène; Boudjema, Karim; Levêque, Jean; Piver, Pascal; Aubard, Yves; Gauthier, Tristan

2017-02-01

The aim of this systematic review was to evaluate and compare the pros and cons of using living donors or brain-dead donors in uterus transplantation programs, 2 years after the first worldwide live birth after uterus transplantation. The Medline database and the Central Cochrane Library were used to locate uterine transplantation studies carried out in human or nonhuman primates. All types of articles (case reports, original studies, meta-analyses, reviews) in English or French were considered for inclusion. Overall, 92 articles were screened and 44 were retained for review. Proof of concept for human uterine transplantation was demonstrated in 2014 with a living donor. Compared with a brain-dead donor strategy, a living donor strategy offers greater possibilities for planning surgery and also decreases cold ischemia time, potentially translating into a higher success rate. However, this approach poses ethical problems, given that the donor is exposed to surgery risks but does not derive any direct benefit. A brain-dead donor strategy is more acceptable from an ethical viewpoint, but its feasibility is currently unproven, potentially owing to a lack of compatible donors, and is associated with a longer cold ischemia time and a potentially higher rejection rate. The systematic review demonstrates that uterine transplantation is a major surgical innovation for the treatment of absolute uterine factor infertility. Living and brain-dead donor strategies are not mutually exclusive and, in view of the current scarcity of uterine grafts and the anticipated future rise in demand, both will probably be necessary.

Statement of the Declaration of Istanbul Custodian Group Regarding Payments to Families of Deceased Organ Donors.

PubMed

Capron, Alexander Morgan; Delmonico, Francis L; Dominguez-Gil, Beatriz; Martin, Dominique Elizabeth; Danovitch, Gabriel M; Chapman, Jeremy

2016-09-01

Governmental and private programs that pay next of kin who give permission for the removal of their deceased relative's organs for transplantation exist in a number of countries. Such payments, which may be given to the relatives or paid directly for funeral expenses or hospital bills unrelated to being a donor, aim to increase the rate of donation. The Declaration of Istanbul Custodian Group-in alignment with the World Health Organization Guiding Principles and the Council of Europe Convention Against Trafficking in Human Organs-has adopted a new policy statement opposing such practices. Payment programs are unwise because they produce a lower rate of donations than in countries with voluntary, unpaid programs; associate deceased donation with being poor and marginal in society; undermine public trust in the determination of death; and raise doubts about fair allocation of organs. Most important, allowing families to receive money for donation from a deceased person, who is at no risk of harm, will make it impossible to sustain prohibitions on paying living donors, who are at risk. Payment programs are also unethical. Tying coverage for funeral expenses or healthcare costs to a family allowing organs to be procured is exploitative, not "charitable." Using payment to overcome reluctance to donate based on cultural or religious beliefs especially offends principles of liberty and dignity. Finally, while it is appropriate to make donation "financially neutral"-by reimbursing the added medical costs of evaluating and maintaining a patient as a potential donor-such reimbursement may never be conditioned on a family agreeing to donate.

Report of the First Peritoneal Dialysis Program in Guyana, South America

PubMed Central

Altieri, Maria; Jindal, Tarun R.; Patel, Mayur; Oliver, David K.; Falta, Edward M.; Elster, Eric A.; Doyle, Alden; Guy, Stephen R.; Womble, Arthur L.; Jindal, Rahul M.

2013-01-01

♦ Introduction: In 2008, we initiated the first Guyanese comprehensive kidney replacement program, comprising hemodialysis (HD), peritoneal dialysis (PD), vascular access procedures, and living-donor kidney transplantation. The government of Guyana, US-based philanthropists, US-based physicians, and Guyanese caregivers teamed up to form a public-private partnership. This pilot program was free of cost to the patients. ♦ Methods: From July 2010 to the time of writing, we placed 17 patients with end-stage kidney disease on PD, which was used as a bridge to living-donor kidney transplantation. During the same period, we placed 12 primary arteriovenous fistulae. ♦ Results: The 17 patients who received a PD catheter had a mean age of 43.6 years and a mean follow-up of 5.3 months. In that group, 2 deaths occurred (from multi-organ failure) within 2 weeks of catheter placement, and 2 patients were switched to HD because of inadequate clearance. Technical issues were noted in 2 patients, and 3 patients developed peritonitis (treated with intravenous antibiotics). An exit-site abscess in 1 patient was drained under local anesthesia. The peritonitis rate was 0.36 episodes per patient-year. Of the 17 patients who received PD, 4 underwent living-donor kidney transplantation. ♦ Conclusions: In Guyana, PD is a safe and cost-effective option; it may be equally suitable for similar developing countries. In Guyana, PD was used as a bridge to living-donor kidney transplantation. We have been able to sustain this program since 2008 by making incremental gains and nurturing the ongoing public-private partnership. PMID:23478372

The correlation between preoperative volumetry and real graft weight: comparison of two volumetry programs

PubMed Central

Mussin, Nadiar; Sumo, Marco; Choi, YoungRok; Choi, Jin Yong; Ahn, Sung-Woo; Yoon, Kyung Chul; Kim, Hyo-Sin; Hong, Suk Kyun; Yi, Nam-Joon; Suh, Kyung-Suk

2017-01-01

Purpose Liver volumetry is a vital component in living donor liver transplantation to determine an adequate graft volume that meets the metabolic demands of the recipient and at the same time ensures donor safety. Most institutions use preoperative contrast-enhanced CT image-based software programs to estimate graft volume. The objective of this study was to evaluate the accuracy of 2 liver volumetry programs (Rapidia vs. Dr. Liver) in preoperative right liver graft estimation compared with real graft weight. Methods Data from 215 consecutive right lobe living donors between October 2013 and August 2015 were retrospectively reviewed. One hundred seven patients were enrolled in Rapidia group and 108 patients were included in the Dr. Liver group. Estimated graft volumes generated by both software programs were compared with real graft weight measured during surgery, and further classified into minimal difference (≤15%) and big difference (>15%). Correlation coefficients and degree of difference were determined. Linear regressions were calculated and results depicted as scatterplots. Results Minimal difference was observed in 69.4% of cases from Dr. Liver group and big difference was seen in 44.9% of cases from Rapidia group (P = 0.035). Linear regression analysis showed positive correlation in both groups (P < 0.01). However, the correlation coefficient was better for the Dr. Liver group (R2 = 0.719), than for the Rapidia group (R2 = 0.688). Conclusion Dr. Liver can accurately predict right liver graft size better and faster than Rapidia, and can facilitate preoperative planning in living donor liver transplantation. PMID:28382294

[Changes in the transplantation world--from altruism to a utilitarian approach].

PubMed

Mor, Eytan

2006-10-01

The lack of organs for transplantation is a worldwide problem that has created a moral conflict between the traditional altruistic basis of organ donation and alternative solutions based on utilitarian grounds. Survival of grafts achieved in recent decades after unrelated living-donor kidney transplantation between spouses is longer than with deceased donor transplantation. This experience justified the extension of kidney donation beyond the traditional close family relationships including: anonymous donors and paired exchange programs. However, unrelated donation of kidneys within altruistic norms could not provide an ultimate solution for the lack of organs for transplantation. On the other hand, globalization and development of advanced medical technology in developing countries that do not provide transplantation for all their citizens, created an opportunity for a worldwide flourish of transplant tourism as an alternative solution for transplant candidates. Transplant tourism functions according to market laws and is profit-driven, as opposed to the legal organ exchange programs in Europe and the U.S.A., which are non-profit and patient-oriented. The transition from trade in kidneys from unrelated living-donors to the use of other organs (heart, lung and liver) from death penalty prisoners in China was only a matter of deciding where to lay the moral border when justifying the act for the sake of life-saving. Considering the inability of current legal altruistic transplantation practice to supply the growing need for organs, healthcare authorities and professional transplantation organizations have to tackle the donor crisis by designing legally acceptable utilitarian solutions. For instance, through the formation of international organ exchange programs under formal agreements or, in the case of kidney transplantation, through the establishment of a regulated compensated donation system.

Professional education and hospital development for organ donation.

PubMed

Fukushima, N; Konaka, S; Kato, O; Ashikari, J

2012-05-01

Because of the strict Organ Transplantation Act, only 81 brain dead (BD) organ donations had been performed in Japan for 13 years since 1997. The Act was revised on July 17, 2010, allowing, organs to be donated after BD with consent from the family, if the subject had not denied organ donation previously. This act has lead to an expectation of a 6-7-fold increase in BD donation. The 82 organ procurement coordinators (OPC) in Japan include 32 belonging to the Japanese Organ Network (JOT) and the others to each administrative division. JOT has guideline manuals of standard roles and procedures of OPC during organ procurement from BD and cardiac death donors. To manage the increased organ donations after the revision of the act, we have modified the education system. First, we modified the guideline manuals for OPC to correspond to the revised Transplant Act and governmental guidelines. Second, all OPC gathered in a meeting room to learn the new organ procurement system to deal with the revised Transplant Act and guidelines. Third, a special education program for 2 months was provided for the 10 newcomers. Last, the practical training in each donor case for newcomers was performed by older OPC. Topics of the education program were the revised transplant act and guidelines, family approach to organ donation, BD diagnosis, donor evaluation and management, organ procurement and preservation, allocation system, hospital development and family care. In the future, each OPC will be divided into special categories, such as the donor family OPC, the donor management OPC, and the operating room OPC. Therefore, we need to construct separate special education programs for each category. Copyright © 2012 Elsevier Inc. All rights reserved.

First liver transplant in Qatar: an evolving program facing many challenges.

PubMed

Khalaf, Hatem; Derballa, Moataz; Elmasry, Mohammed; Khalil, Ahmed; Yakoob, Rafie; Almohannadi, Muneera; Almaslamani, Muna; Fadhil, Riadh; Al-Kaabi, Saad; Al-Ansari, Abdulla; Almaslamani, Yousuf

2013-10-01

Beginning to do liver transplants in a developing country is challenging. We report on the first few liver transplants performed in Qatar and discuss future exceptions and challenges facing our program. The first liver transplant was performed in Qatar on December 6, 2011. Since starting the program, 4 deceased-donor liver transplants have been performed in Qatar. All recipients underwent a standard deceased-donor liver transplant procedure, which included a duct-to-duct biliary anastomosis without a veno-venous bypass. All liver transplants were performed at the Hamad Medical Corporation by a local team of surgeons without external assistance. The 4 patients were all men, with a median age of 56 years (age range, 46-63 y). Indications for liver transplant included hepatitis C cirrhosis in 2 patients, and 1 patient with hepatitis B cirrhosis with hepatocellular carcinoma, and the other patient with cryptogenic liver cirrhosis. Median amount of blood transfused was 6 units (range, 0-10 U); median time spent in the intensive care unit was 2 days (range, 2-5 d); median amount of time spent in the hospital was 10 days (range, 9-16 d). All 4 recipients have survived after a median follow-up of 438 days (range, 33-602 d) and are enjoying a healthy life, with no significant posttransplant complications. A deceased-donor liver transplant can be performed in Qatar with no external assistance. However, a severe organ shortage remains the biggest obstacle facing us. Efforts should be directed toward improving the number and quality of available deceased donors in Qatar. Meanwhile, live-donor liver transplant may be the only way for us, going forward, to prevent deaths on the waiting list.

A national program for control of acute respiratory tract infections: the Philippine experience.

PubMed

Dayrit, E S

1999-02-01

Maturing programs on child immunization and diarrheal diseases, a community-based research project, and a rational drug-use program facilitated the launching in 1989 of a nationwide Philippine Control of Acute Respiratory Infections program (Phil-CARI). From 1990 to 1991 the Phil-CARI expanded rapidly, training >80% of its middle managers and frontline health care providers on the case-management protocols of the World Health Organization for acute respiratory infection. Multiple donors and good collaboration with various societies and medical schools assisted the program. However, by 1992, there were difficulties in maintaining training quality, follow-up, and supervision. Donor assistance dwindled and the health care delivery system decentralized. Government procurement systems were unable to meet the logistics demands of the program. The monitoring and evaluation system was inadequate to measure impact. The Phil-CARI provides lessons in searching for more sustainable approaches and systems to meet the various demands of a nationwide ARI control program and to create the desired impact.

Study of education program of in-hospital procurement transplant coordinators in Japan.

PubMed

Fukushima, N; Konaka, S; Yasuhira, M; Izawa, M

2014-01-01

As the number of donated organs is still extremely small in Japan compared with other developed countries, in-hospital procurement transplant coordinators (In-Hp PTC) may play an important role in increasing organ donation and making the procurement procedure smoother. In this study, our education program of In-Hp PTC is described. In May 2012, our department started the In-Hp PTC Education Program. In the first semester, a 2-hour lecture is provided every 2 weeks for 5 months to 15 In-Hp PTCs working near Osaka. In the second semester, 20 lectures were provided for 3 consecutive days to 31 In Hp PTCs, more than 80% of whom work far from Osaka. Lecture topics were the history and current status of organ donation in Japan, social regulation of organ donation, care of transplant recipients, overall procedures of organ donation, the role of In-Hp PTC, donor family care, donor indications, and donor assessment and management. Lectures also included simulations of the organ donation process. Participants were surveyed for their opinions after the program, Most participants were satisfied with the program, topics and duration. As most of them are not full-time In-Hp PTCs, they preferred to attend the 3-day program. Many participants are currently working as main In-Hp PTCs and establishing their own organ donation system in their hospital. In-Hp PTCs have an important role to play in establishing an organ procurement system and increasing organ donation in Japan. This program may help establish a systematic education program for this occupation in Japan. Copyright © 2014 Elsevier Inc. All rights reserved.

Philanthropic Donor Perspectives on Supporting Nursing Excellence in a Community Hospital.

PubMed

Fickley, Sharon K; Mishler, Ray R; Black, Amelia S; DeGuzman, Pam B

2016-11-01

The purpose of this research is to explore donors' perspectives on support of nursing excellence in a community hospital. Philanthropic support is rapidly becoming critical to support nursing excellence in hospitals, including continuing education, nursing research, and professional development. However, no research has examined the experience of private donors who support nursing programs in community hospitals. Structured interviews were conducted with individuals with a history of providing significant financial support (gifts >$50 000) targeted specifically for nursing in a 176- bed community hospital in the southeastern United States. Analysis was performed using descriptive content analysis. Four themes emerged that centered around making a difference, helping nurses meet new challenges, an existing foundation of service, and valuing excellent nursing care received. This research provides specific information that nursing administrators can use when seeking philanthropic gifts to support nursing excellence programs in US community hospitals.

Bacterial contamination of amniotic membrane in a tissue bank from Iran.

PubMed

Aghayan, Hamid Reza; Goodarzi, Parisa; Baradaran-Rafii, Alireza; Larijani, Bagher; Moradabadi, Leila; Rahim, Fakher; Arjmand, Babak

2013-09-01

Human Amniotic Membrane (AM) transplantation can promote tissue healing and reduce inflammation, tissue scarring and neovascularization. Homa Peyvand Tamin (HPT) tissue bank has focused on manufacturing human cell and tissue based products including AM. The purpose of this study is to evaluate and identify bacterial contamination of AMs that is produced by HPT for several ophthalmic applications. From July 2006 to April 2011, 122 placentas from cesarean sections were retrieved by HPT after obtaining informed consent from the donors. Besides testing donor's blood sample for viral markers, microbiological evaluation was performed pre and post processing. During tissue processing, decontamination was performed by an antibiotic cocktail including; Gentamicin, Ceftriaxone and Cloxacillin. Of 271 cesarean section AM donors who were screened as potential donors, 122 were accepted for processing and assessed for microbiological contamination. Donors' age were between 21 and 41 years (Mean = 27.61 ± 0.24). More than 92% of mothers were in their first or second gravidity with full term pregnancies. The most prevalent organisms were Staphylococci species (72.53%). After processing, contamination rates markedly decreased by 84.62% (p value = 0.013). According to our results, most of bacterial contaminations were related to donation process and the contamination pattern suggests procurement team as a source. Therefore we recommend that regular training programs should be implemented by tissue banks for procurement staff. These programs should focus on improved donor screening and proper aseptic technique for tissue retrieval. We also suggest that tissue banks should periodically check the rate and types of tissue contaminations. These data help them to find system faults and to update processing methods.

Coordinating unspecified living kidney donation and transplantation across the blood-type barrier in kidney exchange.

PubMed

Glorie, Kristiaan M; de Klerk, Marry; Wagelmans, Albert P M; van de Klundert, Joris J; Zuidema, Willij C; Claas, Frans H J; Weimar, Willem

2013-11-15

This article studies multicenter coordination of unspecified living kidney donation and transplantation across the blood-type barrier in kidney exchange. Important questions are whether such coordination should use domino paired donation or non simultaneous extended altruistic donor chains, what the length of the segments in such chains should be, when they should be terminated, and how much time should be allowed between matching rounds. Furthermore, it is controversial whether the different modalities should be coordinated centrally or locally and independently. Kidney exchange policies are simulated using actual data from the Dutch national kidney exchange program. Sensitivity analysis is performed on the composition of the population, the time unspecified and bridge donors wait before donating to the wait list, the time between matching rounds, and donor renege rates. Central coordination of unspecified donation and transplantation across the blood-type barrier can increase transplants by 10% (PG0.001). Especially highly sensitized and blood type O patients benefit. Sufficient time between matching rounds is essential: three-monthly exchanges result in 31% more transplants than weekly exchanges. Benefits of non simultaneous extended altruistic donor chains are limited in case of low numbers of highly sensitized patients and sufficient unspecified donors. Chains are best terminated when no further segment is part of an optimal exchange within 3 months. There is clear synergy in the central coordination of both unspecified donation and transplantation across the blood-type barrier in kidney exchange. The best configuration of a national program depends on the composition of the patient Y donor population.

The Bleeder's Digest: A Campus Blood Collection Reference Manual.

ERIC Educational Resources Information Center

Bean, Melissa; And Others

This manual was written for students and blood donor recruiters interested in starting a campus blood program or in improving an already existing blood program. Contents include discussions of the reasons for blood programs, goals, elements of successful programs, organization of student committees, and comprehensive planning for annual campus and…

Toward a conditional approach to anonymity? An explorative multicenter longitudinal study among anonymous living kidney donors and recipients.

PubMed

Pronk, Mathilde C; Slaats, Dorthe; van der Pant, Karlijn A M I; Vervelde, Janneke; Dooper, Ine M; Dor, Frank J M F; Weimar, Willem; van de Wetering, Jacqueline; Zuidema, Willij C; Massey, Emma K

2017-12-01

Anonymity between living donors and recipients is a topic of discussion among transplant professionals. This longitudinal study explored living kidney donors' and patients' perspectives on anonymity. Prior to surgery (T0) and 3 months afterward (T1), participants in unspecified or specified indirect donation programs completed a questionnaire on their experiences with and attitudes toward anonymity as well as demographic and medical characteristics. Nonparametric tests were used to assess group differences and associations. Participants were content with anonymity at T0 and T1. Fourteen and 23% wanted to meet at T0 and T1, respectively. If the other party expressed the wish to meet, 50% (T0) and 55% (T1) would be willing to meet. Most participants agreed that meeting should be allowed if both parties agree. Attitude toward anonymity did not differ between donors/recipients, nor between T0/T1 and unspecified/specified indirect donation programs. This study showed that most donors and recipients who participated in anonymous donation schemes are in favor of a conditional approach to anonymity. Guidelines on how to revoke anonymity if both parties agree are needed and should include education about pros and cons of (non-) anonymity and a logistical plan on how, when, where, and by whom anonymity should be revoked. © 2017 Steunstichting ESOT.

The infectious disease blood safety risk of Australian hemochromatosis donations.

PubMed

Hoad, Veronica; Bentley, Peter; Bell, Barbara; Pathak, Praveen; Chan, Hiu Tat; Keller, Anthony

2016-12-01

It has been suggested that blood donors with hereditary hemochromatosis may pose an increased infectious disease risk and adversely affect recipient outcomes. This study compares the infectious disease risk of whole blood (WB) donors enrolled as therapeutic (T) donors to voluntary WB donors to evaluate the safety of blood products provided by the T donors. This was a retrospective cohort study of all WB donations at the Australian Red Cross Blood Service who donated between January 1, 2011, and December 31, 2013, comparing a yearly mean of 11,789 T donors with 107,773 total donations and a yearly mean of 468,889 voluntary WB donors with 2,584,705 total donations. We compared postdonation notification of infectious illnesses, bacterial contamination screening results, and positive tests for blood borne viruses in T and WB donors. Rates of transfusion-transmissible infections in donations destined for component manufacture were significantly lower in therapeutic donations compared to voluntary donations (8.4 vs. 21.6 per 100,000 donations). Bacterial contamination (43.0 vs. 45.9 per 100,000 donations) and postdonation illness reporting (136.2 vs. 110.8 per 100,000 donations) were similar in both cohorts. The Australian therapeutic venisection program enables T donors to provide a safe and acceptable source of donated WB that has a low infectious disease risk profile. © 2016 AABB.

Economic consequences incurred by living kidney donors: a Canadian multi-center prospective study.

PubMed

Klarenbach, S; Gill, J S; Knoll, G; Caulfield, T; Boudville, N; Prasad, G V R; Karpinski, M; Storsley, L; Treleaven, D; Arnold, J; Cuerden, M; Jacobs, P; Garg, A X

2014-04-01

Some living kidney donors incur economic consequences as a result of donation; however, these costs are poorly quantified. We developed a framework to comprehensively assess economic consequences from the donor perspective including out-of-pocket cost, lost wages and home productivity loss. We prospectively enrolled 100 living kidney donors from seven Canadian centers between 2004 and 2008 and collected and valued economic consequences ($CAD 2008) at 3 months and 1 year after donation. Almost all (96%) donors experienced economic consequences, with 94% reporting travel costs and 47% reporting lost pay. The average and median costs of lost pay were $2144 (SD 4167) and $0 (25th-75th percentile 0, 2794), respectively. For other expenses (travel, accommodation, medication and medical), mean and median costs were $1780 (SD 2504) and $821 (25th-75th percentile 242, 2271), respectively. From the donor perspective, mean cost was $3268 (SD 4704); one-third of donors incurred cost >$3000, and 15% >$8000. The majority of donors (83%) reported inability to perform usual household activities for an average duration of 33 days; 8% reported out-of-pocket costs for assistance with these activities. The economic impact of living kidney donation for some individuals is large. We advocate for programs to reimburse living donors for their legitimate costs. © 2014 The Authors. American Journal of Transplantation Published by Wiley Periodicals, Inc. on behalf of American Society of Transplant Surgeons.

Marginal kidney donor

PubMed Central

Gopalakrishnan, Ganesh; Gourabathini, Siva Prasad

2007-01-01

Renal transplantation is the treatment of choice for a medically eligible patient with end stage renal disease. The number of renal transplants has increased rapidly over the last two decades. However, the demand for organs has increased even more. This disparity between the availability of organs and waitlisted patients for transplants has forced many transplant centers across the world to use marginal kidneys and donors. We performed a Medline search to establish the current status of marginal kidney donors in the world. Transplant programs using marginal deceased renal grafts is well established. The focus is now on efforts to improve their results. Utilization of non-heart-beating donors is still in a plateau phase and comprises a minor percentage of deceased donations. The main concern is primary non-function of the renal graft apart from legal and ethical issues. Transplants with living donors outnumbered cadaveric transplants at many centers in the last decade. There has been an increased use of marginal living kidney donors with some acceptable medical risks. Our primary concern is the safety of the living donor. There is not enough scientific data available to quantify the risks involved for such donation. The definition of marginal living donor is still not clear and there are no uniform recommendations. The decision must be tailored to each donor who in turn should be actively involved at all levels of the decision-making process. In the current circumstances, our responsibility is very crucial in making decisions for either accepting or rejecting a marginal living donor. PMID:19718332

Quality management of Body Donation Program at the University of Padova.

PubMed

Porzionato, Andrea; Macchi, Veronica; Stecco, Carla; Mazzi, Anna; Rambaldo, Anna; Sarasin, Gloria; Parenti, Anna; Scipioni, Antonio; De Caro, Raffaele

2012-01-01

Quality management improvement has become a recent focus of attention in medical education. The program for the donation of bodies and body parts (Body Donation Program) at the University of Padova has recently been subjected to a global quality management standard, the ISO 9001:2008 certification. The aim of the present work is to show how the above standard is useful in enhancing the efficiency of body donation procedures and the quality and output of medical education. The program is managed by means of the following interlinked procedures: the collection of body donations, death certificates, data, and body parts from living donors; the transportation and identification of cadavers; the management of bodies, body parts, equipment, instruments, purchasing of necessary materials, and setting up anatomical training sessions; the management of preventive and corrective actions; the management of documents and registration; the management of internal and external quality audits; and the review of outcomes and improvement planning. Monitoring indicators are identified in the numbers of donors and of donated body parts per year, education sessions, and satisfaction of learners and donors, as evaluated by questionnaires. The process management approach, the integrated involvement of medical, technical, and administrative staff in defining procedures, and the application of monitoring indicators allow quality improvement in all aspects of the Body Donation Program. Copyright © 2012 American Association of Anatomists.

Development of a large commercial camel embryo transfer program: 20 years of scientific research.

PubMed

Anouassi, Abdelhaq; Tibary, Ahmed

2013-01-10

Embryo transfer in camels was initiated to respond to demand from the camel industry particularly in the United Arab Emirates since 1990. This paper reviews the research performed in critical areas of reproductive physiology and reproductive function evaluation that constitute a pre-requisite for a successful embryo transfer program. A description of donor and recipient management as well as a retrospective evaluation of calf production in the embryo transfer program at Sweihan, UAE is provided. The program utilized two management systems for donors, with and without ovarian superstimulation. Non-stimulated donors are flushed every 14-15 days with a mean embryo production per year per female of 8.5±3.1 (mean±SEM). Response to gonadotropin stimulation is extremely variable. FSH doses and frequency of administration is often adjusted to a specific female. In the period of 1990-2010, 11,477 embryos were transferred to recipients. Transfers from 1990 to 2009 (n=10,600) resulted in 2858 weaned calves, representing an overall efficiency (% weaned calves/transfer) of 27%. Pregnancy rates at 60 days post transfer varied from 19 to 44%. Pregnancy length following transfer is extremely variable. A major challenge in a large embryo transfer program is finding good quality recipients. Causes of pregnancy and neonatal losses are under study. Copyright © 2012 Elsevier B.V. All rights reserved.

Controlled donation after circulatory death in the Netherlands: more organs, more efforts.

PubMed

Leiden, H; Haase-Kromwijk, B; Hoitsma, A; Jansen, N

2016-08-01

The Netherlands was one of the first countries in Europe to stimulate controlled donation after circulatory death (cDCD) at a national level in addition to donation after brain death (DBD). With this program the number of organ transplants increased, but it also proved to have challenges as will be shown in this 15-year review. Data about deceased organ donation in the Netherlands, from 2000 until 2014, were analysed taking into account the whole donation process from donor referral to the number of organs transplanted. Donor referral increased by 58%, from 213 to 336 donors per year, and the number of organs transplanted rose by 42%. Meanwhile the contribution of cDCD donors increased from 14% in 2000 to 54% in 2014 among all referrals. The organs were transplanted from 92-99% of referred DBD donors, but this percentage was significantly lower for cDCD donors and also decreased from 86% in 2000-2002 to 67% in 2012-2014. In 16% of all referred cDCD donors, organs were not recovered because donors did not die within the expected two-hour time limit after withdrawal of life- upporting treatment. Furthermore, cDCD is more often performed at a higher donor age, which is associated with a lower percentage of transplanted organs. Although cDCD resulted in more transplants, the effort in donor recruitment is considerably higher. Important challenges in cDCD that need further attention are the time limit after withdrawal of life-supporting treatment and donor age, as well as the possibilities to stimulate non-renal transplants including the heart by machine preservation.

Tunnel coupling tuning of a QD-donor S-T qubit

NASA Astrophysics Data System (ADS)

Jock, R. M.; Rudolph, M.; Harvey-Collard, P.; Jacobson, T.; Wendt, J.; Pluym, T.; Dominguez, J.; Manginell, R.; Lilly, M. P.; Carroll, M. S.

Coherent coupling between an electrostatic quantum dot (QD) and an implanted 31P donor has been recently demonstrated in a singlet-triplet qubit design. Controlling the tunnel coupling between the QD and donor is a key design challenge. We demonstrate the ability to voltage-tune the tunnel coupling between a QD and a donor in a new, implanted, MOS-QD design. The tunnel coupling is extracted from the frequency dependence of coherent singlet-triplet oscillations on detuning. By tailoring the electrostatic tuning of the QD, we observe a near-order-of-magnitude change in QD-donor tunnel coupling. Independent control of the QD-lead tunnel rates is also demonstrated. This new MOS foundry compatible QD-donor design shows promise for substantially relaxing fabrication requirements for donor based qubits. This work was performed, in part, at the Center for Integrated Nanotechnologies, an Office of Science User Facility operated for the U.S. Department of Energy (DOE) Office of Science. Sandia National Laboratories is a multi-program laboratory managed and operated by Sandia Corporation, a wholly owned subsidiary of Lockheed Martin Corporation, for the U.S. DOE's National Nuclear Security Administration under contract DE-AC04-94AL85000.

Undisclosed Human Immunodeficiency Virus Risk Factors Identified through a Computer-based Questionnaire Program among Blood Donors in Brazil

PubMed Central

Blatyta, Paula Fraiman; Custer, Brian; Gonçalez, Thelma Terezinha; Birch, Rebecca; Lopes, Maria Esther; Ferreira, Maria Ines Lopes; Proietti, Anna Barbara Carneiro; Sabino, Ester Cerdeira; Page, Kimberly; de Almeida Neto, Cesar

2013-01-01

Background HIV risk factor screening among blood donors remains a cornerstone for the safety of blood supply and is dependent on prospective donor self-disclosure and an attentive predonation interview. Residual risk of HIV transmission through blood transfusion is higher in Brazil than in many other countries. Audio computer-assisted structured-interview (ACASI) has been shown to increase self-reporting of risk behaviors. Study design and methods This cross-sectional study was conducted between January 2009 and March 2011 at four Brazilian blood centers to identify the population of HIV-negative eligible blood donors that answered face-to-face interviews without disclosing risks, but subsequently disclosed deferrable risk factors by ACASI. Compared to the donor interview, the ACASI contained expanded content on demographics, sexual behavior and other HIV risk factors questions. Results 901 HIV-negative blood donors were interviewed. On the ACASI, 13% of donors (N=120) declared a risk factor that would have resulted in deferral that was not disclosed during the face-to-face assessment. The main risk factors identified were recent unprotected sex with an unknown or irregular partner (49 donors), sex with a person with exposure to blood/ fluids (26 donors), multiple sexual partners (19 donors), and male-male sexual behavior (10 donors). Independent factors associated with the disclosure of any risk factor for HIV were age (≥40 years vs. 18–25 years, AOR=0.45; 95% CI 0.23–0.88) and blood center (Hemope vs. Hemominas, AOR=2.51; 95% CI 1.42–4.44). Conclusion ACASI elicited increased disclosure of HIV risk factors among blood donors. ACASI may be a valuable modality of interview to be introduced in Brazilian blood banks. PMID:23521083

Approach to the Highly Sensitized Kidney Transplant Candidate

PubMed Central

Vranic, Gayle M.

2016-01-01

For patients with ESRD, kidney transplant offers significant survival and quality-of-life advantages compared with dialysis. But for patients seeking transplant who are highly sensitized, wait times have traditionally been long and options limited. The approach to the highly sensitized candidate for kidney transplant has changed substantially over time owing to new advances in desensitization, options for paired donor exchange (PDE), and changes to the deceased-donor allocation system. Initial evaluation should focus on determining living-donor availability because a compatible living donor is always the best option. However, for most highly sensitized candidates this scenario is unlikely. For candidates with an incompatible donor, PDE can improve the prospects of finding a compatible living donor but for many highly sensitized patients the probability of finding a match in the relatively small pools of donors in PDE programs is limited. Desensitization of a living donor/recipient pair with low levels of incompatibility is another reasonable approach. But for pairs with high levels of pathologic HLA antibodies, outcomes after desensitization for the patient and allograft are less optimal. Determining the degree of sensitization by calculated panel-reactive antibody (cPRA) is critical in counseling the highly sensitized patient on expected wait times to deceased-donor transplant. For candidates with a high likelihood of finding a compatible deceased donor in a reasonable time frame, waiting for a kidney is a good strategy. For the candidate without a living donor and with a low probability of finding a deceased-donor match, desensitization on the waiting list can be considered. The approach to the highly sensitized kidney transplant candidate must be individualized and requires careful discussion among the transplant center, patient, and referring nephrologist. PMID:26915916

Donor Experiences of Second Marrow or Peripheral Blood Stem Cell Collection Mirror the First, but CD34+ Yields Are Less.

PubMed

Stroncek, David F; Shaw, Bronwen E; Logan, Brent R; Kiefer, Deidre M; Savani, Bipin N; Anderlini, Paolo; Bredeson, Christopher N; Hematti, Peiman; Ganguly, Siddhartha; Diaz, Miguel Angel; Abdel-Azim, Hisham; Ahmed, Ibrahim; Maharaj, Dipnarine; Seftel, Matthew; Beitinjaneh, Amer; Seo, Sachiko; Yared, Jean A; Halter, Joerg; O'Donnell, Paul V; Hale, Gregory A; DeFilipp, Zachariah; Lazarus, Hillard; Liesveld, Jane L; Zhou, Zheng; Munshi, Pashna; Olsson, Richard F; Kasow, Kimberly Anne; Szer, Jeffrey; Switzer, Galen E; Chitphakdithai, Pintip; Shah, Nirali; Confer, Dennis L; Pulsipher, Michael A

2018-01-01

Little is known about the experiences of individuals donating peripheral blood stem cells (PBSCs) or marrow for a second time. To study this, unrelated donors making a second donation through the National Marrow Donor Program between 2004 and 2013 were evaluated. Experiences of second-time donors giving marrow (n = 118: first donation was PBSC in 76 and marrow in 42) were compared with those making only 1 marrow donation (n = 5829). Experiences of second-time donors giving PBSCs (n = 602) (first donation was PBSCs in 362; marrow in 240) were compared to first-time PBSC donors (n = 16,095). For donors giving a second PBSC or marrow donation there were no significant differences in maximum skeletal pain, maximum symptoms measured by an established modified toxicity criteria, and recovery time compared with those who donated only once. Notably, the yield of marrow nucleated cells and PBSC CD34 + cells with second donations was less. As previously noted with single first-time donations, female (PBSCs and marrow) and obese donors (PBSCs) had higher skeletal pain and/or toxicity with a second donation. PBSC donors who experienced high levels of pain or toxicity with the first donation also experienced high levels of these symptoms with their second donation and slower recovery times. In conclusion, for most donors second donation experiences were similar to first donation experiences, but CD34 + yields were less. Knowledge of the donor's first experience and stem cell yields may help centers decide whether second donations are appropriate and institute measures to improve donor experiences. Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Assessment of the knowledge of living unrelated donors of the complications of kidney donation in Iran.

PubMed

Ossareh, Shahrzad; Karbasi, Arsha

2009-12-01

Living unrelated donors (LURDs) constitute the major source of renal allograft in Iran. LURD transplantation (Tx) is performed in a controlled program, supervised by university Tx teams, and assisted by the Dialysis and Transplant Patient's Association (DATPA). This study evaluated the knowledge of donors about possible short- and long-term complications of kidney donation and the need for regular follow-up. We interviewed 100 consecutive living donors/donation candidates (all called donors), 35 in the postoperative period in the renal Tx ward, and 65 after completion of preoperative assessment in the office of the DATPA, to assess their knowledge about complications of nephrectomy and their intention to participate in the postoperative follow-up. Seventy-nine donors were men and 21 women. Mean age was 27 +/- 4.4 years. Ninety-seven donors were unrelated to the recipient and three were related (LRD). The motivation for donation was altruistic in nine (three LRD and six LURD) and financial in 89. Eighty donors were not aware of the possible short- or long-term complications of nephrectomy. Six donors mentioned the possibility of potential intraoperative complications, and 16 mentioned the risk of renal failure. Only 44 donors knew that they should visit doctors regularly after donation, most of them (61%) from the postoperative group. We conclude that most donors do not have enough knowledge about possible in-hospital and long-term complications of kidney donation and may not participate in regular follow-up after operation. Considering the young age of our renal Tx donors, we suggest that they should receive more preoperative orientation (both verbal and written) about possible complications and the need for regular postoperative medical follow-up.

Lean, mean ... and in-between: corporate language and philanthropy. Promote philanthropy with effective language.

PubMed

Tippie, William D

2002-01-01

With many of our donors in the corporate world, we often use their corporate language when speaking about our institutions. Be careful--a "corporate-only" message can undermine the efforts of a development program. Many of your donors may be wondering why your institution needs funds if you are the paragon on corporate success.

Results from the organ and tissue transplant program in Nuevo Leon, Mexico, 1996 to 2001.

PubMed

Carbajal, H; Cabriales, H

2003-12-01

Before 1996, solid organs from cadaveric donors (CD) did not account for more than 2% of all transplants. The need for more transplants led the state to undergo several legislative, societal, organizational, and infrastructure changes. A descriptive analysis of the evolution of the transplant program in the State of Nuevo León, Mexico, from 1996 to 2001. Trimester reports have been routinely performed since 1996 from the 14 institutions that are licensed to perform organ and tissue transplants in the State of Nuevo León, Mexico. All reports were concentrated and a descriptive analysis is presented herein. From 1996 until 2001, a total of 1457 organ and tissue (OT) transplants have been performed. At the end of this period, there was a 214% increase in the total number of transplants. By 2001, 73% of the program's total of 1457 OT transplants came from cadaveric donors. The state transplant program of Nuevo León has experienced a dramatic growth since 1996. The percent of organs transplanted from cadaveric donors is one of the highest in Mexico. There is still much work to be done at the state and national levels; better epidemiological studies and dialysis registries are needed as well as investment in transplant research.

DCD lung donation: donor criteria, procedural criteria, pulmonary graft function validation, and preservation.

PubMed

Erasmus, Michiel E; van Raemdonck, Dirk; Akhtar, Mohammed Zeeshan; Neyrinck, Arne; de Antonio, David Gomez; Varela, Andreas; Dark, John

2016-07-01

In an era where there is a shortage of lungs for transplantation is increased utilization of lungs from donation after circulatory death (DCD) donors. We review the reports of 11 controlled and 1 uncontrolled DCD programs focusing on donor criteria, procedural criteria, graft assessment, and preservation techniques including the use of ex vivo lung perfusion. We have formulated conclusions and recommendations for each of these areas, which were presented at the 6th International Conference on Organ Donation. A table of recommendations, the grade of recommendations, and references are provided. © 2015 Steunstichting ESOT.

Fermilab Friends for Science Education | Programs | Past Donors

Science.gov Websites

to support science education in this way. Here are their thoughts: I have attended many programs for teachers around the country. Sometimes just attending, sometimes presenting. Most programs were top down assessments WITH teachers, and trusted teachers to set up and run the programs. In other words, it was

Innovative strategies to expand cadaveric donor pool for liver transplantation (SITF project): a network between Italian transplantation centers supported by the Ministry of Health.

PubMed

Santori, G; Andorno, E; Valente, R; Ghirelli, R; Pensalfini, F; Castiglione, A G; Valente, U

2005-01-01

In 2002, the Italian Ministry of Health (IMH) launched a formal call for health research programs within the Research and Development (R&D) Policy. In this context, the research program "Innovative Strategies to Expand Cadaveric Donor Pool for Liver Transplantation" (SITF Project) has been proposed. The SITF Project has been formally approved by IMH as a 2-year research program included in the R&D Policy. The main goals of the SITF Project are to improve matching criteria for split liver transplantation (SLT) in both pediatric and adult recipients, to promote an increase of the SLT/full- size liver transplantation ratio at the national level, and, especially, to establish shared criteria for SLT in 2 adult recipients. The original executive plan of the SITF Project prefigured the participation of both the Italian transplantation centers with more advanced experience in the field of SLT, and institutional partnership, such as Nord Italia Transplant (NITp) and Italian National Transplant Center. A first Web public area concerning the SITF Project has been activated, as well as a reserved Web area with the aim to share cadaveric donors and patients in the waiting lists between Operative Units involved in the research program. For this objective, the first version Oracle-based database able to perform an automatic matching between a single cadaveric donor and 2 potential adult recipients has been released at the beginning of 2005. The SITF Project represents a new approach in the management of SLT for 2 adult recipients in Italy and a model for a functional network between Italian transplantation centers.

ESR Experiments on a Single Donor Electron in Isotopically Enriched Silicon

NASA Astrophysics Data System (ADS)

Tracy, Lisa; Luhman, Dwight; Carr, Stephen; Borchardt, John; Bishop, Nathaniel; Ten Eyck, Gregory; Pluym, Tammy; Wendt, Joel; Witzel, Wayne; Blume-Kohout, Robin; Nielsen, Erik; Lilly, Michael; Carroll, Malcolm

In this talk we will discuss electron spin resonance experiments in single donor silicon qubit devices fabricated at Sandia National Labs. A self-aligned device structure consisting of a polysilicon gate SET located adjacent to the donor is used for donor electron spin readout. Using a cryogenic HEMT amplifier next to the silicon device, we demonstrate spin readout at 100 kHz bandwidth and Rabi oscillations with 0.96 visibility. Electron spin resonance measurements on these devices show a linewidth of 30 kHz and coherence times T2* = 10 us and T2 = 0.3 ms. We also discuss estimates of the fidelity of our donor electron spin qubit measurements using gate set tomography. This work was performed, in part, at the Center for Integrated Nanotechnologies, a U.S. DOE Office of Basic Energy Sciences user facility. Sandia National Laboratories is a multi-program laboratory operated by Sandia Corporation, a Lockheed-Martin Company, for the U. S. Department of Energy under Contract No. DE-AC04-94AL85000. ESR Experiments on a Single Donor Electron in Isotopically Enriched Silicon.

Utilization of Deceased Donor Kidneys to Initiate Living Donor Chains.

PubMed

Melcher, M L; Roberts, J P; Leichtman, A B; Roth, A E; Rees, M A

2016-05-01

We propose that some deceased donor (DD) kidneys be allocated to initiate nonsimultaneous extended altruistic donor chains of living donor (LD) kidney transplants to address, in part, the huge disparity between patients on the DD kidney waitlist and available donors. The use of DD kidneys for this purpose would benefit waitlisted candidates in that most patients enrolled in kidney paired donation (KPD) systems are also waitlisted for a DD kidney transplant, and receiving a kidney through the mechanism of KPD will decrease pressure on the DD pool. In addition, a LD kidney usually provides survival potential equal or superior to that of DD kidneys. If KPD chains that are initiated by a DD can end in a donation of an LD kidney to a candidate on the DD waitlist, the quality of the kidney allocated to a waitlisted patient is likely to be improved. We hypothesize that a pilot program would show a positive impact on patients of all ethnicities and blood types. © Copyright 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.

Minority Organ Donation: The Power of an Educated Community

PubMed Central

Callender, Clive O; Miles, Patrice V

2010-01-01

Background In 1978 - Washington, DC, we became aware of the scarcity of minority donors especially African Americans. Study Design From then until now 4 decades later, we have been involved in a grass roots effort emphasizing community education and empowerment combined with the use of mass media which has successfully increased minority donation rates exponentially. This program was initiated with a $500 grant from Howard University and subsequently funded by the National Institutes of Health grants and other funding totaling more than $10 million between 1993 and 2008. Results Between 1990 and 2008 minority donations percentages have doubled (15%-30%). African American organ donors per million (O.D.M.) have quadrupled from 8 O.D.M. - 53 O.D.M between 1982 and 2008. Conclusions While the investment of $10 million may seem substantial, when we look at the cost benefit ratio associated with the cost savings of $135,000 per donor, it is small when compared to the more than $200 million saved by kidney donors alone associated with the expected increase in minority donors percentage to 35% by 2010 or the equivalent of 1750 minority donors. PMID:20421035

[Histocompatibility tests in a transplantation program].

PubMed

de-Leo-Cervantes, Claudia

2005-01-01

The importance of the role of the histocompatibility laboratory in solid organ transplantation is to perform HLA typing and determine the degree of HLA matching between recipient/donor. It is a useful tool to increase graft survival and decrease chronic rejection. HLA matching has a positive effect on kidney transplants and it has variable impact on other organ transplants. The crossmatch procedure is the most important test in a solid organ transplantation to evaluate the presence of recipient antibodies to antigens expressed on donor white cells. This test decreases the risk of hyperacute humoral rejection or early graft loss. Positive crossmatch is a contraindication for transplantation because it represents the existence of IgG recipient antibodies that will reath againts donor antigens. Antibody evaluation is important in donor-recipient selection and the responsability of the histocompatibility laboratory is to identify clinically relevant anti-donor HLA antibodies. This detection is useful to determine the degree of humoral alloimmunization, expressed as a percent panel reactive antibody (%PRA). This test also provides information about the antibody specificity and can be used for evaluate a patient's immune status providing a significant correlation in selecting donors.

[Kidney transplant experience at the Specialty Hospital Bernardo Sepulveda National Medical Center Century XXI, Mexican Institute of Social Security].

PubMed

Gracida-Juárez, Carmen; Espinoza-Pérez, Ramón; Cancino-López, Jorge David; Ibarra-Villanueva, Araceli; Cedillo-López, Urbano; Villegas-Anzo, Fernando; Martínez-Alvarez, Julio

2011-09-01

The first kidney transplant in Mexico was done on October 22, 1963 at the General Hospital of National Medical Center (CMN) of the Mexican Institute of Social Security. After the earthquake in 1985, the transplantation activity was continued at the Specialty Hospital of National Medical Center Century XXI. Our program has a continue activity for almost 48 years and a total of 2019 kidney transplants from October 1963 to December 2010. We describe our experience in 20 years. Retrospective cohort study that includes all kidney transplants performed in the period from January 1991 to December 2010. Descriptive statistics were used. The survival analysis was performed using the Kaplan Meier method. We show the patient survival, graft survival censored for death with functional graft and total graft survival (uncensored). We analyzed a total of 1544 kidney transplants. The percentage of living donor was 82.9 vs. deceased donor of 17.1%. Patient survival at 1, 5, 10, 15 and 20 years was 95.0, 91.8, 87.2, 81.1 and 70.1%, respectively; allograft survival rate censored for death with functional allograft at 1, 5, 10, 15 and 20 years was 93.0, 86.2, 76.2, 63.7 and 50.9%, respectively. Our Transplant center also take care of around 1300 living donors in the long term, looking for morbidities as risk factors for the unique kidney as metabolic syndrome, diabetes, hypertension and others. In our program, the main source of renal allografts was living donors. Our transplant center has to increase the organ procurement from deceased donors. An important contribution of our center has been the long follow up of living donors according to international consensus.

Lung transplant of extrahospitalary donor after cardiac death.

PubMed

Mateos Rodríguez, Alonso A; Navalpotro Pascual, José Maria; del Río Gallegos, Francisco

2013-04-01

Non-heart-beating donors (NHBDs) have to meet the predefined criteria for organ donation including death from irreversible cessation of the beating heart. The Maastricht conference defined 4 NHBD categories to differentiate their viability and ethical-legal support. In Spain, NHBDs who originate from an out-of-hospital setting correspond to type II donors. These are patients who have had a cardiac arrest outside hospital and, after failed CPR attempts, are transferred with hemodynamic support measures to the hospital for organ donation. The Hospital Clínico San Carlos also has a lung donation program in collaboration with the Hospital Puerta de Hierro in Madrid and the Hospital Marques de Valdecilla in Santander. The objective of this study is to describe the results of lung transplantation of after cardiac death program, specifically the section regarding lung extraction donation. Twenty potential lung donors were obtained during the study. Most patients were male (19 cases), with a mean age of 42 years (36.5-49.5 years). A total of 33 lungs were donated (18 right and 15 left lungs). Most extractions were multiorganic (19 cases). One liver, 19 kidneys, 2 pancreas, and 19 corneas were obtained from these donors; bone tissue was obtained from all donors. The transplantation was bipulmonary in 13 cases and unipulmonary in 7. Thirty days after transplantation, 2 recipients died, 1 died of stroke associated with bilateral pneumonia and 1 died of hypovolemic shock resulting from hemothorax. The remaining 18 patients were progressing well at 30 days. Our data suggest that lung transplantation from patients after extrahospitalary cardiac death is feasible. Copyright © 2013 Elsevier Inc. All rights reserved.

Tobacco smoke exposure in either the donor or recipient before transplantation accelerates cardiac allograft rejection, vascular inflammation, and graft loss.

PubMed

Khanna, Ashwani K; Xu, Jianping; Uber, Patricia A; Burke, Allen P; Baquet, Claudia; Mehra, Mandeep R

2009-11-03

Tobacco exposure in cardiac transplant recipients, before and after transplantation, may increase the risk of cardiac allograft vasculopathy and allograft loss, but no direct evidence for this phenomenon is forthcoming. In this experimental study, we investigated early consequences of tobacco smoke exposure in cardiac transplant donors and recipients with an emphasis on alloinflammatory mediators of graft outcome. Using heterotopic rat cardiac transplantation, we tested the effects of donor or recipient tobacco smoke exposure in 6 groups of animals (rat heterotopic cardiac transplantation) as follows: tobacco-naïve allogeneic rejecting controls (n=6), tobacco-naïve nonrejecting controls (n=3; killed on day 5 to simulate survival times of tobacco-treated animals), isografts (n=3), both donor and recipient rats exposed to tobacco smoke (n=4), only donor rats exposed to tobacco smoke (n=7), and only recipient rats exposed to tobacco smoke (n=6). Polymerase chain reaction studies of tissue and peripheral (systemic) protein expression were performed to evaluate inflammatory (tumor necrosis factor-alpha, interferon-gamma, interleukin-6) and alloimmune (interleukin-1 receptor 2, programmed cell death-1, and stromal cell-derived factor-1) pathways, as was histological analysis of the cardiac allografts. Our experiments reveal that pretransplantation tobacco exposure in donors and/or recipients results in heightened systemic inflammation and increased oxidative stress, reduces posttransplantation cardiac allograft survival by 33% to 57%, and increases intragraft inflammation (tumor necrosis factor-alpha, interferon-gamma, interleukin-6) and alloimmune activation (CD3, interleukin-1 receptor 2, programmed cell death-1, and stromal cell-derived factor-1) with consequent myocardial and vascular destruction. These sentinel findings confirm that tobacco smoke exposure in either donors or recipients leads to accelerated allograft rejection, vascular inflammation, and graft loss. Molecular pathways that intersect as arbiters in this phenomenon include instigation of alloimmune activation associated with tobacco smoke-induced inflammation.

Reproductive technologies combine well with genomic selection in dairy breeding programs.

PubMed

Thomasen, J R; Willam, A; Egger-Danner, C; Sørensen, A C

2016-02-01

The objective of the present study was to examine whether genomic selection of females interacts with the use of reproductive technologies (RT) to increase annual monetary genetic gain (AMGG). This was tested using a factorial design with 3 factors: genomic selection of females (0 or 2,000 genotyped heifers per year), RT (0 or 50 donors selected at 14 mo of age for producing 10 offspring), and 2 reliabilities of genomic prediction. In addition, different strategies for use of RT and how strategies interact with the reliability of genomic prediction were investigated using stochastic simulation by varying (1) number of donors (25, 50, 100, 200), (2) number of calves born per donor (10 or 20), (3) age of donor (2 or 14 mo), and (4) number of sires (25, 50, 100, 200). In total, 72 different breeding schemes were investigated. The profitability of the different breeding strategies was evaluated by deterministic simulation by varying the costs of a born calf with reproductive technologies at levels of €500, €1,000, and €1,500. The results confirm our hypothesis that combining genomic selection of females with use of RT increases AMGG more than in a reference scheme without genomic selection in females. When the reliability of genomic prediction is high, the effect on rate of inbreeding (ΔF) is small. The study also demonstrates favorable interaction effects between the components of the breeder's equation (selection intensity, selection accuracy, generation interval) for the bull dam donor path, leading to higher AMGG. Increasing the donor program and number of born calves to achieve higher AMGG is associated with the undesirable effect of increased ΔF. This can be alleviated, however, by increasing the numbers of sires without compromising AMGG remarkably. For the major part of the investigated donor schemes, the investment in RT is profitable in dairy cattle populations, even at high levels of costs for RT. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

[Marketing role of corneal graft tissue donation to an eye bank and donors' socioeconomic profile].

PubMed

Farias, Roberta Jansen de Mello; Sousa, Luciene Barbosa de

2008-01-01

Penetrating keratoplasty has been the leading and the most successful type of transplant in the world, however corneal deficiency is a commom problem usually presented to corneal surgeons. Impact evaluation of the number of corneal graft donations to the Sorocaba Eye Bank after the implementation of a corneal graft procurement system; to draw the socioeconomic profile of corneal graft donors of the Sorocaba Eye Bank (SEB). Retrospective study on donations to SEB from its creation and after the development of media marketing. Prospective analysis of the socioeconomic profile of corneal graft donors by a questionnaire sent as letters to the families of the donors in a certain month. SEB began its work in 1971 by spreading need of organ donation through lectures in churches, shopping malls, community meetings, radio programs, television programs, etc. In the 70s, the number of retrieved corneal grafts was 1 or 2/month. Between 1984 - 1989 a procurement coordination team was trained to act in mortuaries and by 2000 they also began to work in public hospitals. In 1984 only 260 corneal grafts were retrieved. This number has been increasing to 2,778 corneal graft donations in 2004. The questionnaire was answered by 76 of the 93 donor families, with a response rate of 81.7%. Donor age had a mean of 65.1 +/- 14.7 y/o, forty-two (55.3%) were men. Educational level of the donor families was an important factor for organ donation, once 36.8% had concluded high school and 34.2% completed university. The great majority, sixty-three (82.9%) of the corneal grafts were donated through the efforts of the procurement coordination team. The role of the media and institutional credibility are mandatory for public commitment to organ donation. The proficiency of the procurement coordination team requires intensive training, as the results show that 82.9% donations were made thanks to their efforts.

Willingness of Directed Living Donors and Their Recipients to Participate in Kidney Paired Donation Programs.

PubMed

Hendren, Elizabeth; Gill, Jagbir; Landsberg, David; Dong, Jianghu; Rose, Caren; Gill, John S

2015-09-01

Participation of compatible living donors and recipients in kidney paired donation (KPD) could double the number of KPD transplants. We determined the willingness of previous directed donors and their recipients to participate in KPD and identified the association of various factors, including financial incentives, with willingness to participate. Survey of previous directed living kidney donors and their recipients in a single Canadian center between 2001 and 2009. Among 207 of 222 eligible living donors contacted, 86 (42%) completed the anonymous survey: 93% (78/86) of donors indicated willingness to participate in KPD if this option had been provided at the time of donation. An increased willingness to participate was reported among the majority of respondents if reimbursements for lost wages and travel expenses were provided; however, cash payments between $5 000 and $50 000 had little impact on willingness. Willingness was also increased with an advantage to the recipient (younger donor or better human leukocyte antigen match), whereas delays beyond 3 months and donor travel were associated with reduced willingness to participate. Among 38 recipients approached during routine clinical follow-up visits over a 3-month period, 100% completed the survey, and 36 of 38 (92%) reported they would have been willing to participate in KPD. Over 90% of directed donors and recipients were willing to participate in KPD. Reimbursement for the costs of participation and improved efficiency of KPD (i.e., eliminating travel and reducing transplant times), but not cash payments, may increase participation of compatible donors and recipients in KPD.

National Marrow Donor Program

DTIC Science & Technology

2008-11-17

Accepted for oral presentation. o Bojesen SE, Malkki M, Gooley T, Zhao LP, Selvakumar A, Spellman S, Petersdorf E, Hansen JA and Dupont B. Genetic allelic...Oudshoorn M, Petersdorf E, Setterholm M, Champlin R and de Lima M. The clinical significance of matching for alleles at the low expression HLA loci...Reaction DMSO Dimethylsulphoxide PSA Public Service Announcement DNA Deoxyribonucleic Acid QC Quality control D/ R Donor/Recipient RCC Renal Cell

POTENTIAL IMPACT ON BLOOD AVAILABILITY AND DONOR IRON STATUS OF CHANGES TO DONOR HEMOGLOBIN CUTOFF AND INTERDONATION INTERVALS

PubMed Central

Spencer, Bryan R.; Johnson, Bryce; Wright, David J.; Kleinman, Steven; Glynn, Simone A.; Cable, Ritchard G.

2016-01-01

BACKGROUND A minimum male hemoglobin (Hb) of 13.0 g/dL will become an FDA requirement in May 2016. In addition, extending whole blood (WB) interdonation intervals (IDIs) beyond 8 weeks has been considered in order to reduce iron depletion in repeat blood donors. This study estimates the impact these changes might have on blood availability and donor iron status. STUDY DESIGN AND METHODS Six blood centers participating in REDS-II collected information on all donation visits from 2006–09. Simulations were developed from these data using a multi-stage approach that first sought to adequately reproduce the patterns of donor return, Hb and ferritin levels, and outcomes of a donor’s visit (successful single or double RBC donation, deferral for low Hb) observed in REDS-II datasets. Modified simulations were used to predict the potential impact on the blood supply and donor iron status under different Hb cutoff and IDI qualification criteria. RESULTS More than 10% of WB donations might require replacement under many simulated scenarios. Longer IDIs would reduce the proportion of donors with iron depletion, but 80% of these donors may remain iron-depleted if minimal IDIs increased to 12 or 16 weeks. CONCLUSION Higher Hb cutoffs and longer IDIs are predicted to have a potentially large impact on collections but only a modest impact on donor iron depletion. Efforts to address iron depletion should be targeted to at-risk donors, such as iron supplementation programs for frequent donors, and policy makers should try to avoid broadly restrictive donation requirements that could substantially reduce blood availability. PMID:27237451

Creation of a solid organ transplant program in an underdeveloped country: Mexico's General Hospital transplantation program.

PubMed

García Covarrubias, L; Rossano García, A; Cicero Lebrija, A; Luque Hernández, A; Hinojosa Heredia, H; Fernández Ángel, D; Córdova, J; García Covarrubias, A; Bautista Olayo, R; Diliz Perez, H S

2013-05-01

With a population of >112 million persons, all Mexicans are entitled to receive medical care by the state and more than half have limited access to healthcare. From January 1985 to March 2009, 40 renal transplants were performed from living donors with a high percentage of complications. In April 2009, a new Solid Organ Transplantation Program was started; herein, we present this enterprise to the international community and briefly present a perspective on the Mexican transplant situation. We performed a retrospective chart review of kidney and liver transplant recipients from April 2009 to November 2011, including demographic features, immunosuppression, complications as well as initial and 1 month function. We performed 68 kidney (59 living and 9 deceased donors) and 5 liver transplants (cadaveric donors). The kidney transplant recipients were 73.5% males and showed an overall mean age of 29.77 years (range, 18-60). The donor mean age was 34.08 years. Mean recipient creatinine pretransplant was 13.32 mg/dL, while at day 5 it was 2.33 and at month one, 1.32 mg/dL. Five grafts were lost (7.3%): 4 due to death with a functioning graft and 1 due to acute pyelonephritis. Five patients experienced delayed graft function Basiliximab induction was required in all but one who received thymoglobulin owing to a high panel reactive antibody. Maintenance therapy included a calcineurin inhibitor, mycophenolate mofetil (MMF), and prednisone. Liver transplant recipients were 83.6% women. The etiologies were alcoholic cirrhosis (n = 2), primary billiary cirrhosis (n = 1) and hepatitis C virus infection (n = 2). Complications included: reperfusion syndrome (n = 1), convulsive crisis (medication; n = 1), acute respiratory distress syndrome (n = 1), and death (n = 1). Their Model for End-Stage Liver Disease scopes were 10-21. After basiliximab induction, they had maintenance therapy with tacrolimus, MMF, and steroids. The donor mean age was 26.2 years. All survivors show normal liver function tests currently. From 1985 to 2009, 40 kidney transplants were performed, with multiple complications including donor deaths. Our current results were comparable to international standards, with <15% complication rate. Copyright © 2013 Elsevier Inc. All rights reserved.

The history of organ donation and transplantation in Iran.

PubMed

Ghods, Ahad J

2014-03-01

The first kidney transplant in Iran was performed in 1967, and this was the first organ transplant in countries that are current members of the Middle East Society for Organ Transplantation. In 1988, in response to the long waiting list at the Iranian Ministry of Health for kidney transplant, a state-regulated living-unrelated donor kidney transplant program was adopted. By 1999, the kidney transplant waiting list in Iran was eliminated. In 1989, a fatwa (religious approval) from the Supreme Religious Leader was obtained that recognized brain death and allowed deceased-donor organ transplant. Subsequently, transplant centers began performing deceased-donor kidney, liver, and heart transplants. In 2000, the Brain Death and Organ Transplantation Act was passed by the Iranian parliament, legalizing deceased-donor organ transplant. The transplant team at Shiraz began performing more deceased-donor kidney and liver transplants and became a successful deceased-donor organ transplant model in the country. By the end of 2012, there were 34166 kidney (including 4436 deceased-donor) and 2021 liver (including 1788 deceased-donor), 482 heart, 147 pancreas, 63 lung, and several intestine and multiorgan transplants performed in Iran. In 2011, there were 2771 solid-organ transplants performed in Iran (37 transplants per million population), and Iran ranked as number 33 among the 50 most active countries worldwide. In 2011 and 2012, Iran was ahead of all country members of the Middle East Society for Organ Transplantation in performing deceased-donor kidney and liver transplants.

Lung donor treatment protocol in brain dead-donors: A multicenter study.

PubMed

Miñambres, Eduardo; Pérez-Villares, Jose Miguel; Chico-Fernández, Mario; Zabalegui, Arturo; Dueñas-Jurado, Jose María; Misis, Maite; Mosteiro, Fernando; Rodriguez-Caravaca, Gil; Coll, Elisabeth

2015-06-01

The shortage of lung donors for transplantation is the main limitation among patients awaiting this type of surgery. We previously demonstrated that an intensive lung donor-treatment protocol succeeded in increasing the lung procurement rate. We aimed to validate our protocol for centers with or without lung transplant programs. A quasi-experimental study was performed to compare lung donor rate before (historical group, 2010 to 2012) and after (prospective group, 2013) the application of a lung management protocol for donors after brain death (DBDs) in six Spanish hospitals. Lung donor selection criteria remained unchanged in both periods. Outcome measures for lung recipients were early survival and primary graft dysfunction (PGD) rates. A total of 618 DBDs were included: 453 in the control period and 165 in the protocol period. Donor baseline characteristics were similar in both periods. Lung donation rate in the prospective group was 27.3%, more than twice that of the historical group (13%; p < 0.001). The number of lungs retrieved, grafts transplanted, and transplants performed more than doubled over the study period. No differences in early recipients' survival between groups were observed (87.6% vs. 84.5%; p = 0.733) nor in the rate of PGD. Implementing our intensive lung donor-treatment protocol increases lung procurement rates. This allows more lung transplants to be performed without detriment to either early survival or PGD rate. Copyright © 2015 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Donor human milk bank data collection in north america: an assessment of current status and future needs.

PubMed

Brownell, Elizabeth A; Lussier, Mary M; Herson, Victor C; Hagadorn, James I; Marinelli, Kathleen A

2014-02-01

The Human Milk Banking Association of North America (HMBANA) is a nonprofit association that standardizes and facilitates the establishment and operation of donor human milk (DHM) banks in North America. Each HMBANA milk bank in the network collects data on the DHM it receives and distributes, but a centralized data repository does not yet exist. In 2010, the Food and Drug Administration recognized the need to collect and disseminate systematic, standardized DHM bank data and suggested that HMBANA develop a DHM data repository. This study aimed to describe data currently collected by HMBANA DHM banks and evaluate feasibility and interest in participating in a centralized data repository. We conducted phone interviews with individuals in different HMBANA milk banks and summarized descriptive statistics. Eight of 13 (61.5%) sites consented to participate. All respondents collected donor demographics, and half (50%; n = 4) rescreened donors after 6 months of continued donation. The definition of preterm milk varied between DHM banks (≤ 32 to ≤ 40 weeks). The specific computer program used to house the data also differed. Half (50%; n = 4) indicated that they would consider participation in a centralized repository. Without standardized data across all HMBANA sites, the creation of a centralized data repository is not yet feasible. Lack of standardization and transparency may deter implementation of donor milk programs in the neonatal intensive care unit setting and hinder benchmarking, research, and quality improvement initiatives.

Where will the money come from? Alternative mechanisms to HIV donor funding.

PubMed

Katz, Itamar; Routh, Subrata; Bitran, Ricardo; Hulme, Alexandra; Avila, Carlos

2014-09-16

Donor funding for HIV programs has flattened out in recent years, which limits the ability of HIV programs worldwide to achieve universal access and sustain current progress. This study examines alternative mechanisms for resource mobilization. Potential non-donor funding sources for national HIV responses in low- and middle-income countries were explored through literature review and Global Fund documentation, including data from 17 countries. We identified the source, financing agent, magnitude of resources, frequency of availability, as well as enabling and risk factors. Four non-donor funding sources for HIV programs were identified: earmarked levy for HIV from country budgets; risk-pooling schemes such as health insurance; debt conversion, in which the creditor country reduces the debt of the debtor country and allocates at least a part of that reduction to health; and concessionary loans from international development banks, which unlike grants, must be repaid. The first two are recurring sources of funding, while the latter two are usually one-time sources, and, if very large, might negatively affect the debtor country's economy. Insurance schemes in five African countries covered less than 6.1% of the HIV expenditure, while social health insurance in four Latin American countries covered 8-11% of the HIV expenditure; in Colombia and Chile, it covered 69% and 60%, respectively. Most low-income countries will find concessionary loans hard to repay, as their HIV programs cost 0.5-4% of GDP. Even in a middle-income country like India, a US$255 million concessionary loan to be repaid over 25 years provided only 7.8% of a 5-year HIV budget. Earmarked levies provided only 15% of the annual HIV funding needs in Zimbabwe and Kenya. Debt conversion provided the same share in Indonesia, but in Pakistan it was much higher - the equivalent of 45% of the annual cost of the national HIV program. Domestic sources of funding are important alternatives to consider and might be able to replace donor HIV funding in specific country contexts, coupled with effective prioritization and efficiency measures. Successful resource mobilization design and implementation require close collaboration with other sectors, particularly with the Ministry of Finance, to make sure that the new financing mechanism is fully synchronized with economic growth and that HIV investments yield returns in the form of higher social benefits.

Report of the clinical donor case workshop of the European Association of Tissue Banks annual meeting 2012.

PubMed

Beele, Hilde; van Wijk, Marja J; Parker, Robert; Sánchez-Ibáňez, Jacinto; Brubaker, Scott A; Wulff, Birgit; Richters, Cornelia D; Cox, Mike; Warwick, Ruth M; Eastlund, Ted

2013-12-01

The European Association of Tissue Banks (EATB) donor case workshop is a forum held within the program of the EATB annual congress. The workshop offers an opportunity to discuss and evaluate approaches taken to challenging situations regarding donor selection, it promotes consensus development in deciding tissue donor acceptability when donor health issues are not addressed in standards and regulations, and serves to strengthen the professional tissue banking networks across Europe and beyond. This report reflects some of the discussion at the workshop during the annual congress in Vienna in 2012. The cases presented dealt with problems encountered by tissue bank facilities concerning idiopathic thrombocytopenia and auto-immune disorders, hemodilution and blood sample identification, premalignant and malignant lesions, and Huntington's disease. The discussions during the workshop demonstrate that the implications on the safety of tissue transplantation of various tissue donor illnesses, physical findings and behaviours, and the preventive measures taken by tissue facilities, may not always be agreed by tissue facility medical directors and other professionals. Moreover, they reveal that operating procedures, regulations and standards cannot comprehensively cover all tissue donor findings, medical histories and circumstances surrounding the cause of death. For many of the issues raised, there is a need for scientific research to provide a better evidence base for future deliberations about the suitability and eligibility of tissue allograft donors.

Enhancement in Organic Photovoltaic Efficiency through the Synergistic Interplay of Molecular Donor Hydrogen Bonding and -Stacking

DOE PAGES

Shewmon, Nathan; Watkins, Davita; Galindo, Johan; ...

2015-07-20

For organic photovoltaic (OPV) cells based on the bulk heterojunction (BHJ) structure, it remains challenging to rationally control the degree of phase separation and percolation within blends of donors and acceptors to secure optimal charge separation and transport. Reported is a bottom-up, supramolecular approach to BHJ OPVs wherein tailored hydrogen bonding (H-bonding) interactions between π-conjugated electron donor molecules encourage formation of vertically aligned donor π-stacks while simultaneously suppressing lateral aggregation; the programmed arrangement facilitates fine mixing with fullerene acceptors and efficient charge transport. The approach is illustrated using conventional linear or branched quaterthiophene donor chromophores outfitted with terminal functional groupsmore » that are either capable or incapable of self-complementary H-bonding. When applied to OPVs, the H-bond capable donors yield a twofold enhancement in power conversion efficiency relative to the comparator systems, with a maximum external quantum efficiency of 64%. H-bond promoted assembly results in redshifted absorption (in neat films and donor:C 60 blends) and enhanced charge collection efficiency despite disparate donor chromophore structure. Both features positively impact photocurrent and fill factor in OPV devices. Film structural characterization by atomic force microscopy, transmission electron microscopy, and grazing incidence wide angle X-ray scattering reveals a synergistic interplay of lateral H-bonding interactions and vertical π-stacking for directing the favorable morphology of the BHJ.« less

Hepatocellular carcinoma developed in a living donor after left lobe donation: a case for caution.

PubMed

Ikegami, Toru; Yoshizumi, Tomoharu; Kawasaki, Junji; Shimagaki, Tomonari; Uchiyama, Hideaki; Soejima, Yuji; Maehara, Yoshihiko

2017-06-01

Although it has been recognized that those who are positive for anti-hepatitis B core antibody (anti-HBcAb) and negative for hepatitis B surface antigen (HBsAg) with normal liver function could be donors for living donor liver transplantation under appropriate prophylaxis, the negative impact of positive HBcAb on such donors themselves has not been reported. We present a case of a living donor with positive HBcAb, who donated his left lobe for his sister with unresectable giant hepatic hemangioma, and the donor himself developed a de novo hepatocellular carcinoma (HCC) 10 years after donation. He had been lost from the follow-up program since 1 year after donation. Imaging studies showed a heterogeneously enhanced mass compatible with HCC, which was 9 cm in size with portal invasion into the anterior portal vein of the remnant liver. Re-laparotomy for hepatectomy with the removal of the tumor thrombus in the anterior portal vein of the remnant liver was carried out, and he is free from recurrence 6 months after surgery on prophylactic sorafenib. At our institute, 58 (9.6%) donors among the 603 living donors were anti-HBcAb positive and anti-HBsAg negative, and we started regular HCC surveillance using sonogram every 6 months for these patients. © 2016 The Japan Society of Hepatology.

High prevalence of HIV p24 antigen among HIV antibody negative prospective blood donors in Ile-Ife, Nigeria.

PubMed

Japhet, Margaret Oluwatoyin; Adewumi, Moses Olubusuyi; Adesina, Olufisayo Adeyemi; Donbraye, Emmanuel

2016-01-01

Blood transfusion service centers in Nigeria screen donated blood for markers of HIV infection using antibody- (Ab) based rapid test and in some centers, positives are re-tested using Ab-based ELISA. Paucity of data exists on p24 antigen prevalence among HIV Ab-negative donors in Nigeria. This study aims at detecting HIV p24 antigen among prospective blood donors in Osun State, Nigeria. Prospective blood donors negative for HIV antibodies using Determine test kit were re-tested using BIORAD GENSCREEN Ultra Ag-Ab ELISA kit, a fourth-generation ELISA kit that detects HIV antibodies/p24 antigen. Of the 169 HIV Ab-negative prospective donors, 10 (5.9%) were positive for HIV p24 antigen and 70% (7/10) of them were in the age range 18-30 years. Results of this study show that blood transfusion is still one of the major routes of HIV transmission in Nigeria and a higher proportion is among youth. Inclusion of p24 antigen testing into the blood donor screening will help reduce transfusion associated HIV in Nigeria if Nucleic Acid Testing (NAT) of all blood donor samples is not affordable; also, HIV enlightenment programs tailored toward youth may help reduce this rate among donors since more young people donate blood in low/middle-income countries than in high-income countries.

Using EasyMatch® to anticipate the identification of an HLA identical unrelated donor: A validated efficient time and cost saving method.

PubMed

Dubois, Valérie; Detrait, Marie; Sobh, Mohamad; Morisset, Stéphane; Labussière, Hélène; Giannoli, Catherine; Nicolini, Franck; Moskovtchenko, Philippe; Mialou, Valérie; Ducastelle, Sophie; Rey, Sylvie; Thomas, Xavier; Barraco, Fiorenza; Tedone, Nathalie; Marry, Evelyne; Garnier, Federico; Bertrand, Yves; Michallet, Mauricette

2016-11-01

In the absence of an HLA matched familial donor, a search for an unrelated donor or cord blood unit is initiated through worldwide registries. Although a first look-up on available HLA information of donors in the "book" at BMDW (Bone Marrow Donor Worldwide) can provide a good estimation of the number of compatible donors, the variety of resolution typing levels requires confirmatory typing (CT) which are expensive and time consuming. In order to help recipient centers in their work. The French donor registry (France Greffe de Moelle/Agence de la Biomedecine) has recently developed a software program called "EasyMatch®" that uses haplotype frequencies to compute the likelihood of phenotypic match in donors according to various typing resolution levels. The goal of our study is to report a single monocentric user-experience with EasyMatch®, demonstrating that its routine use reduced the cost and the delay of the donor search in our center, allowing the definition of a new strategy to search compatible unrelated donors. The strategy was first established on a retrospective cohort of 217 recipients (185 adults and 32 children=before score) and then validated on a prospective cohort of 171 recipients (160 adults and 11 children=after score). For all patients, we calculated the delay between the registration day and the donor identification day, and the number of CT requested to the donor centre. Considering both groups, we could observe a significant decrease of the number of CT from 8 to 2 (p<0,001), and a significant decrease of the median delay to identify a suitable donor from 43 to 31days (p<0.0001). EasyMatch® estimates the number of potentially identical donors, but doesn't foresee availability of the donors. It provides us an easy tracking of mismatches, an estimation of the number of potential donors, the selection of population following ethnic origin of patients and a high prediction when probability is high or low. It affords a new approach of donor search in our daily work and improves the efficiency in the great challenge of the compatible donor identification. Copyright © 2016 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved.

Building 4-H Program Capacity and Sustainability through Collaborative Fee-Based Programs

ERIC Educational Resources Information Center

Pellien, Tamara

2016-01-01

Shrinking budgets and increased demands for services and programs are the norm for today's Extension professional. The tasks of procuring grants, developing fund raisers, and pursuing donors require a large investment of time and can lead to mission drift in the pursuit of funding. Implementing a collaborative fee-based program initiative can fund…

Written informed consent for living liver donor evaluation: compliance with Centers for Medicare and Medicaid Services and Organ Procurement and Transplantation Network Guidelines and alibi offers.

PubMed

Thiessen, Carrie; Kim, Yunsoo A; Yoo, Peter S; Rodriguez-Davalos, Manuel; Mulligan, David; Kulkarni, Sanjay

2014-04-01

We examined written informed consent forms for living liver donor evaluations to determine whether they incorporated elements required by the Centers for Medicare and Medicaid Services (CMS) and suggested by the Organ Procurement and Transplantation Network (OPTN). We contacted each of the 41 US centers that performed at least 1 living donor liver transplant in 2011; 37 centers reported active living donor evaluation programs. Twenty-six centers shared their consent form for living donor evaluation (response rate = 70%). Each document was double-coded for consent element content. We found that 57% of the centers included the 9 mandated CMS elements. Although the OPTN guidelines are non-binding, 78% of the centers used consent forms that addressed at least two-thirds of the elements recommended by OPTN. Only 17% of the centers provided written offers of an alibi to donors who withdrew from the evaluation. On the basis of our findings, we offer suggestions that may be relevant to ongoing revisions to the OPTN living liver donor consent policy and may help centers to improve the clarity of their written consent forms. © 2014 American Association for the Study of Liver Diseases.

Development of the National Transplant Program Has Significantly Decreased but Not Ended Transplant Tourism in Montenegro.

PubMed

Ratkovic, M; Basic Jukic, N; Kastelan, Z; Radunovic, D; Kavaric, P; Brezak, J; Topalovic Grkovic, M; Hudolin, T; Prelevic, V

2018-06-01

Organ transplantation has prolonged and improved the lives of many patients around the world. However, a widespread shortage of donors remains the main factor that has led to organ trafficking and transplant tourism. To stop transplant tourism and to provide optimal treatment for its citizens with end-stage renal disease, Montenegro started performing renal transplantations in September 2012. Thirty-five transplantations have been performed since that time, 34 from living donors and only 1 from a deceased donor. This practice has significantly decreased but not ended transplant tourism in Montenegro. Copyright © 2018 Elsevier Inc. All rights reserved.

Ethical controversies in public solicitations for organs.

PubMed

Wright, Linda

2008-07-01

The increased shortage of organs for transplantation has led to a widening of the living donor pool and to innovations in how and where people seek living donors. Transplant programs are being asked to reconsider practice in light of new situations. Public solicitations for organs have grown as people have become more desperate to find organs. The expansion of the media, particularly the Internet, into our everyday lives has offered an additional method for the dissemination of information and requests for organs. This article discusses public solicitations from living kidney donors, examines the ethical issues therein, and makes suggestions as to how transplant teams might consider addressing this issue.

Safe and ethical living kidney donation in Qatar: A national health system's approach.

PubMed

Asim, Muhammad; Al-Maslamani, Yousuf; Al-Malki, Hassan

2017-01-01

The increasing incidence of end-stage kidney disease in Qatar has led to growing demand for donor kidneys. The deceased donor kidney program has yet to achieve its full potential; hence, living kidney donation has been widely adopted as an appropriate alternative. The reliance on living kidney donors however, raises a number of social, ethical, and legal concerns surrounding informed consent, voluntarism, psychosocial evaluation, perioperative care, and long-term follow-up of living kidney donors. Many of these concerns become heightened in a multicultural, multilingual society within a Gulf country such as Qatar. This article provides an insight into the challenges that living kidney donation poses in a multiethnic society with significant socioeconomic divides. It also discusses the remedial measures that the Qatari government, healthcare authorities, and transplant community have adopted to address these issues.

Safe and ethical living kidney donation in Qatar: A national health system's approach

PubMed Central

Asim, Muhammad; Al-Maslamani, Yousuf; Al-Malki, Hassan

2017-01-01

The increasing incidence of end-stage kidney disease in Qatar has led to growing demand for donor kidneys. The deceased donor kidney program has yet to achieve its full potential; hence, living kidney donation has been widely adopted as an appropriate alternative. The reliance on living kidney donors however, raises a number of social, ethical, and legal concerns surrounding informed consent, voluntarism, psychosocial evaluation, perioperative care, and long-term follow-up of living kidney donors. Many of these concerns become heightened in a multicultural, multilingual society within a Gulf country such as Qatar. This article provides an insight into the challenges that living kidney donation poses in a multiethnic society with significant socioeconomic divides. It also discusses the remedial measures that the Qatari government, healthcare authorities, and transplant community have adopted to address these issues. PMID:28795019

Current status of organ transplant in Islamic countries.

PubMed

Ghods, Ahad J

2015-04-01

The Organization of Islamic Cooperation consists of 57 member states whose people are mainly followers of the Islamic religion. During the past several decades, organ transplants have been increasingly used for the treatment of end-stage organ failures worldwide. This study is to investigate the current status of organ transplant in Islamic countries. For data collection a literature, review was carried out. Information from international registries was used and key persons from some countries were contacted. In all 5 Islamic countries of North Africa, living-donor kidney transplant was performed. Tunisia was the only country with deceased-donor organ transplant in North Africa. In 22 Islamic countries of sub-Saharan Africa, living-donor kidney transplant was performed only in Sudan and Nigeria. Deceased-donor organ transplant was illegal and nonexistent in this region. In all 14 Islamic countries of the Middle East, living-donor kidney transplant was an established practice. Turkey, Iran, and Saudi Arabia had the highest rates of organ transplant activity. In 2013, Turkey performed the highest rate of living-donor kidney and liver transplants, and Iran performed the highest rate of deceased-donor kidney and liver transplants. For 7 Islamic countries of Central Asia, organ transplant was nonexistent in Afghanistan and Turkmenistan; in the other 5 countries, a limited number of living-donor kidney or liver transplants were performed. In all 6 countries located in South and Southeast Asia, living-donor kidney transplant was performed. Only Malaysia had a limited-scale deceased-donor transplant program. Albania in the Balkans, and 2 countries (Suriname and Guyana) in South America, were also member states of the Organization of Islamic Cooperation; in these countries, only few living-donor kidney transplants were performed. The organ transplant rates, especially for deceased-donor transplant, in most Islamic countries were less than expected. Some of the causes of low transplant activity included lack of public education and awareness, lack of approval and support by Islamic scholars, and lack of government infrastructure and financial resources.

Restricting liver transplant recipients to younger donors does not increase the wait-list time or the dropout rate: the hepatitis C experience.

PubMed

Flemming, Jennifer A; Vagefi, Parsia A; Freise, Chris E; Yao, Francis Y; Terrault, Norah A

2014-10-01

Older donor age is associated with lower graft and patient survival among all recipients of liver transplantation (LT). Among patients with hepatitis C virus (HCV), donor age is one of the strongest predictors of fibrosis severity and graft loss. We evaluated the implementation of a donor age restriction policy for LT patients with HCV at a single center and the effects that this policy had on wait-list (WL) and post-LT outcomes for HCV and non-HCV patients. This was a cohort study of 2388 WL patients and 1015 LT recipients between March 2002 and January 2013 and reflected 3 different eras of donor age policies. With the donor age restriction, the median donor age was reduced in LT recipients with HCV versus LT recipients without HCV (30 versus 48 years, P < 0.001) without differences in the WL time (10.6 versus 8.0 months, P = 0.23). According to a competing risks regression, those with HCV and those without HCV had lower subhazard ratios (SHRs) of dropout or death on the WL during the donor age restriction era versus the era without donor age restriction [SHR = 0.68 (P < 0.01) and SHR = 0.64 (P = 0.01), respectively]. No differences were seen in early post-LT survival for patients with or without HCV between eras (P = 0.7 and P = 0.88, respectively). In conclusion, we show that donor age restriction for HCV results in a lower donor age for HCV recipients without obvious adverse WL consequences. Although additional studies are needed, our results demonstrate the feasibility of donor age restriction for LT recipients with HCV, and such information may be relevant to programs with limited access to new antiviral therapies for which modifying the risk of severe disease remains of paramount importance. © 2014 American Association for the Study of Liver Diseases.

BLOODR: blood donor and requester mobile application

PubMed Central

Tatikonda, Vamsi Krishna

2017-01-01

Background With rapid increase in the usage of social networks sites across the world, there is also a steady increase in blood donation requests as being noticed in the number of posts on these sites such as Facebook and twitter seeking blood donors. Finding blood donor is a challenging issue in almost every country. There are some blood donor finder applications in the market such as Blood app by Red Cross and Blood Donor Finder application by Neologix. However, more reliable applications that meet the needs of users are prompted. Methods Several software technologies including languages and framework are used to develop our blood-donor web application known as BLOODR application. These technologies comprise Ruby programming language (simply known as Ruby) along with JavaScript and PostgreSQL for database are used. Ruby on Rails (simply known as Rails) is an open source Web framework that makes it possible to quickly and easily create data-based web applications. Results We show screenshots for the BLOODR application for different types of users including requester, donor, and administrator. Various features of the application are described and their needs of use are analyzed. If a patient needs a blood at a clinic, blood donors in vicinity can be contacted through using a clinic management service provided in this application. Registered donors will get notification for the blood requests only if their blood group is compatible with the requested blood type and in the same city/region. Then matching blood donors can go to the requesting clinic and donate. Conclusions BLOODR application provides a reliable platform to connect local blood donors with patients. BLOODR creates a communication channel through authenticated clinics whenever a patient needs blood donation. It is a useful tool to find compatible blood donors who can receive blood request posts in their local area. Clinics can use this web application to maintain the blood donation activity. Future improvement of the BLOODR is explained. PMID:29184892

BLOODR: blood donor and requester mobile application.

PubMed

Tatikonda, Vamsi Krishna; El-Ocla, Hosam

2017-01-01

With rapid increase in the usage of social networks sites across the world, there is also a steady increase in blood donation requests as being noticed in the number of posts on these sites such as Facebook and twitter seeking blood donors. Finding blood donor is a challenging issue in almost every country. There are some blood donor finder applications in the market such as Blood app by Red Cross and Blood Donor Finder application by Neologix. However, more reliable applications that meet the needs of users are prompted. Several software technologies including languages and framework are used to develop our blood-donor web application known as BLOODR application. These technologies comprise Ruby programming language (simply known as Ruby) along with JavaScript and PostgreSQL for database are used. Ruby on Rails (simply known as Rails) is an open source Web framework that makes it possible to quickly and easily create data-based web applications. We show screenshots for the BLOODR application for different types of users including requester, donor, and administrator. Various features of the application are described and their needs of use are analyzed. If a patient needs a blood at a clinic, blood donors in vicinity can be contacted through using a clinic management service provided in this application. Registered donors will get notification for the blood requests only if their blood group is compatible with the requested blood type and in the same city/region. Then matching blood donors can go to the requesting clinic and donate. BLOODR application provides a reliable platform to connect local blood donors with patients. BLOODR creates a communication channel through authenticated clinics whenever a patient needs blood donation. It is a useful tool to find compatible blood donors who can receive blood request posts in their local area. Clinics can use this web application to maintain the blood donation activity. Future improvement of the BLOODR is explained.

Post-transplant outcomes of patients with and without hepatitis C virus infection according to donor age and gender matching.

PubMed

Grąt, Michał; Kornasiewicz, Oskar; Lewandowski, Zbigniew; Ligocka, Joanna; Grąt, Karolina; Wronka, Karolina Maria; Zieniewicz, Krzysztof; Krawczyk, Marek

2013-12-23

The purpose of this study was to evaluate the impact of donor age and donor-recipient gender matching on liver transplantation outcomes, focusing on differences between patients with and without hepatitis C virus (HCV) infection. This retrospective cohort study evaluated 622 liver transplantation recipients. HCV (n=164) and non-HCV (n=458) patients were subdivided by donor age (≤ 30, 31-50, and >50 years) and donor-recipient gender configurations. Five-year patient survival (PS) and graft survival (GS) were set as outcome measures. Five-year PS was 83.1% for HCV-positive and 81.6% for HCV-negative patients (p=0.614), with the corresponding GS rates of 81.2% and 79.3% (p=0.538), respectively. In HCV patients, transplantations from donors older than 50 years were associated with lower PS (p=0.035) and GS (p=0.006) than those from donors aged 31-50 years. This difference was not observed among non-HCV recipients (PS, p=0.994; GS, p=0.878). Regarding donor-recipient gender configurations, outcomes were similar in HCV (PS, p=0.751; GS, p=0.592) and non-HCV patients (PS, p=0.217; GS, p=0.249), except for a tendency toward lower PS for male-to-female transplantations than female-to-female transplantations in non-HCV patients (p=0.064). Outcomes of HCV patients were superior to those of non-HCV patients after transplantation from donors aged 31-50 years (PS, p=0.080; GS, p=0.026). Avoiding the transplantation of grafts from donors aged over 50 years to patients with HCV infection might improve the general outcomes of liver transplantation programs. There is no specific rationale for gender matching with respect to HCV status.

The TALKS study to improve communication, logistical, and financial barriers to live donor kidney transplantation in African Americans: protocol of a randomized clinical trial.

PubMed

Strigo, Tara S; Ephraim, Patti L; Pounds, Iris; Hill-Briggs, Felicia; Darrell, Linda; Ellis, Matthew; Sudan, Debra; Rabb, Hamid; Segev, Dorry; Wang, Nae-Yuh; Kaiser, Mary; Falkovic, Margaret; Lebov, Jill F; Boulware, L Ebony

2015-10-09

Live donor kidney transplantation (LDKT), an optimal therapy for many patients with end-stage kidney disease, is underutilized, particularly by African Americans. Potential recipient difficulties initiating and sustaining conversations about LDKT, identifying willing and medically eligible donors, and potential donors' logistical and financial hurdles have been cited as potential contributors to race disparities in LDKT. Few interventions specifically targeting these factors have been tested. We report the protocol of the Talking about Living Kidney Donation Support (TALKS) study, a study designed to evaluate the effectiveness of behavioral, educational and financial assistance interventions to improve access to LDKT among African Americans on the deceased donor kidney transplant recipient waiting list. We adapted a previously tested educational and social worker intervention shown to improve consideration and pursuit of LDKT among patients and their family members for its use among patients on the kidney transplant waiting list. We also developed a financial assistance intervention to help potential donors overcome logistical and financial challenges they might face during the pursuit of live kidney donation. We will evaluate the effectiveness of these interventions by conducting a randomized controlled trial in which patients on the deceased donor waiting list receive 1) usual care while on the transplant waiting list, 2) the educational and social worker intervention, or 3) the educational and social worker intervention plus the option of participating in the financial assistance program. The primary outcome of the randomized controlled trial will measure potential recipients' live kidney donor activation (a composite rate of live donor inquiries, completed new live donor evaluations, or live kidney donation) at 1 year. The TALKS study will rigorously assess the effectiveness of promising interventions to reduce race disparities in LDKT. NCT02369354.

Gender bias in Iranian living kidney transplantation program: a national report.

PubMed

Taheri, Saeed; Alavian, Seyed M; Einollahi, Behzad; Nafar, Mohsen

2010-01-01

Strong challenges exist about living kidney transplantation practices worldwide. One of these concerns is based on the observation that in many places women constitute the majority of living kidney donors but the minority of recipients. We studied this issue in Iran by using national data for kidney transplantation. Data of the Iranian national registry for kidney transplantation which comprises data of all renal transplantations performed in the country during a 22 yr period were included in the study. Data of 16,672 living donors (living related [LR]=16%, living unrelated [LUR]=86%) were analyzed. Males received 62.2% of all kidney transplants. From 16,672 living donors, 20% and 80% were women and men, respectively. Recipients were more likely to receive kidney allograft from their own gender groups (p<0.05). In living related donations, mothers, brothers and sons were significantly more often donors than their counterparts of opposite gender. In contrast with previous reports from other countries, this study of Iranian national data revealed that in Iran, most related and unrelated living kidney donors are male and the percentage of recipients who are female exceeds the percentage of donors who are female. Considering previous reports from other countries, our findings suggest that Iran is the only country in which females are more likely to be recipients of a kidney allograft than donors. The reason for the predominance of male kidney donors in Iran is probably multifactorial and associated with economical, social and cultural issues. The financial incentives paid to living unrelated donors may be an attraction for males to donate a kidney although, even in living related donations, males constitute the majority of donors. © 2009 John Wiley & Sons A/S.

African American kidney transplant patients’ perspectives on challenges in the living donation process

PubMed Central

Sieverdes, John C.; Nemeth, Lynne S.; Magwood, Gayenell S.; Baliga, Prabhakar K.; Chavin, Kenneth D.; Ruggiero, Ken J.; Treiber, Frank A.

2015-01-01

Context The increasing shortage of deceased donor kidneys suitable for African Americans highlights the critical need to increase living donations among African Americans. Little research has addressed African American transplant recipients’ perspectives on challenges and barriers related to the living donation process. Objective To understand the perspectives of African American recipients of deceased and living donor kidney transplants on challenges, barriers, and educational needs related to pursuing such transplants. Participants and Design A mixed-method design involved 27 African American kidney recipients (13 male) in 4 focus groups (2 per recipient type: 16 African American deceased donor and 11 living donor recipients) and questionnaires. Focus group transcripts were evaluated with NVivo 10.0 (QSR, International) by using inductive and deductive qualitative methods along with crystallization to develop themes of underlying barriers to the living donor kidney transplant process and were compared with the questionnaires. Results Four main themes were identified from groups: concerns, knowledge and learning, expectations of support, and communication. Many concerns for the donor were identified (eg, process too difficult, financial burden, effect on relationships). A general lack of knowledge about the donor process and lack of behavioral skills on how to approach others was noted. The latter was especially evident among deceased donor recipients. Findings from the questionnaires on myths and perceptions supported the lack of knowledge in a variety of domains, including donors’ surgical outcomes risks, costs of surgery, and impact on future health. Participants thought that an educational program led by an African American recipient of a living donor kidney transplant, including practice in approaching others, would increase the likelihood of transplant-eligible patients pursuing living donor kidney transplant. PMID:26107278

D-immunized blood donors who are female and who possess at least one HLA-DRB1*15 allele show a propensity for high serum RhIG production.

PubMed

Tan, Joanne C G; Yuan, Fang Fang; Daley, Jackie; Marks, Katherine; Flower, Robert L; Dyer, Wayne B

2018-05-01

D- individuals with previous D-incompatible pregnancies and/or blood transfusions, as well as those who are actively immunized with small-volume D+ red blood cells (RBCs), are stimulated to produce RhIG. Many factors could influence the stimulation of immunoglobulin production in response to foreign antigen (such as antigen immunogenicity and genetic factors), and it is unknown whether genetic markers could potentially identify responder anti-D donors. Anti-D donors were assigned a responder profile based on their serum RhIG levels (n = 431). A subset of donors (n = 272) had DNA extracted for polymerase chain reaction genotyping assays for target genes in antigen presentation and pathogen recognition receptors (TLR2, TLR4, CD14, FcγRIIA, and the MHC Class II locus HLA-DRB1). Statistical tests for associations between anti-D donor responder profiles and genetic factors were performed. A large proportion of our donors (38.7%) were classified as nonresponder donors, despite receiving multiple D+ RBC immunizations, whereas female sex was significantly associated with an all-responder profile (p < 0.001). The presence of the DRB1*15 allele and absence of the DRB1*04 allele were more likely to be associated with a responder anti-D donor, although not significantly after Bonferroni correction. A combination of the DRB1*15 allele and female sex was significantly associated with an anti-D donor responder profile. This study has identified female sex and the HLA-DRB1*15 allele as potentially useful markers that could be used to screen donors before entry into D immunization programs. © 2018 AABB.

The Living Donor Lost Wages Trial: Study Rationale and Protocol.

PubMed

Rodrigue, James R; Fleishman, Aaron; Carroll, Michaela; Evenson, Amy R; Pavlakis, Martha; Mandelbrot, Didier A; Baliga, Prabhakar; Howard, David H; Schold, Jesse D

2018-03-01

This paper describes the background, rationale, and design of an NIH-funded, single-center study to test the impact of offering reimbursement for donor lost wages incurred during the post-nephrectomy recovery period on the live donor kidney transplant (LDKT) rate in newly evaluated kidney transplant candidates, to examine whether offering reimbursement for donor lost wages reduces racial disparity in LDKT rates, and to determine whether higher reimbursement amounts lead to higher LDKT rates. LDKT is the optimal treatment for renal failure. However, living kidney donation has declined in the past decade, particularly among men, younger adults, blacks, and low-income adults. There is evidence that donation-related costs may deter both transplant candidates and potential donors from considering LDKT. Lost wages is a major source of financial loss for some living donors and, unlike travel and lodging expenses, is not reimbursed by financial assistance programs. The study addresses the transplant community's call to reduce the financial burden of living donation and examine its impact on LDKT rates. Findings have the potential to influence policy, clinical practice, LDKT access, and income-related and racial disparities in LDKT and living donation.

Giving That Doesn't Hurt

ERIC Educational Resources Information Center

Dunseth, William B.

1978-01-01

The annuity and trust income program (deferred giving) permits donors to give more than they thought they could. Suggestions for establishing and monitoring such programs are offered in this article, which is a condensation of remarks at the National Conference on Trusteeship. (Author/LBH)

A national program toward improving renal health: advancing organ donation awareness.

PubMed

Uriarte, R D B; Amarillo, M L; Ampil, R S; Manauis, M N T; Danguilan, R A; Ona, E T

2010-01-01

Despite the national advocacy campaign for kidney transplantation from deceased donors in the Philippines 96% of kidneys transplanted into 721 kidney transplants from 1999 to 2001 came from living donors. A national survey on the knowledge, attitudes and perceptions of Filipinos on organ donation in 2001 showed factors that disadvantaged deceased organ donation to be poor understanding of "brain death," religion, and fear of the operation. These concerns were addressed and another survey was conducted in 2005. To compare knowledge, attitudes, and perceptions of Filipinos on organ donation between 2001 and 2005, and compare the number of kidney transplants from deceased donors between 2001 until 2008. Two surveys in 15 regions of the Philippines were conducted using multistage sampling. Using a structured questionnaire there were 2000 respondents in 2001, and 2140 in 2005. Analysis was performed using chi-square analysis. The majority of respondents knew about kidney donation. Between 2001 and 2005, there was increased awareness that transplants came from both living and deceased donors (37% to 41%) and a decline in those believing transplants came only from deceased donors (14% to 9%). Willingness to become a living (59% to 87%) or a deceased donor (35% to 49%) increased. The increase in transplantation from deceased donors from an average of 10 per year from 1999 to 2001 to 31 per year from 2006 to 2008. Increased awareness about kidney donation among Filipinos, improved consent to become an organ donor, and an increase in kidney transplantation from deceased donors occurred from 2001 to 2008.

Living unrelated donor kidney transplantation--a fourteen-year experience.

PubMed

Ignjatović, Ljiljana; Jovanović, Dragan; Kronja, Goran; Dujić, Aleksandar; Marić, Mihailo; Ignjatović, Dragan; Hrvacević, Rajko; Kovacević, Zoran; Petrović, Milija; Elaković, Dejan; Marenović, Tomislav; Lukić, Zoran; Trkuljić, Miroljub; Stanković, Bratislav; Maksić, Doko; Butorajac, Josip; Colić, Miodrag; Drasković-Pavlović, Biljana; Kapulica-Kuljić, Nada; Drasković, Nada; Misović, Sidor; Stijelja, Borislav; Milović, Novak; Tosevski, Perica; Filipović, Nikola; Romić, Predrag; Jevtić, Miodrag; Drasković, Miroljub; Vavić, Neven; Rabrenović, Violeta; Paunić, Zoran; Radojević, Milorad; Bjelanović, Zoran; Tomić, Aleksandar; Aleksić, Predrag; Kosević, Branko; Mocović, Dejan; Bancević, Vladimir; Magić, Zvonko; Vojvodić, Danilo; Balint, Bela; Ostojić, Gordana; Tukić, Ljiljana; Murgić, Jadranka; Pervulov, Svetozar; Rusović, Sinisa; Sjenicić, Goran; Vesna, Bućan; Milavić-Vujković, Merica; Jandrić, Dusan; Raicević, Ranko; Mijusković, Mirjana; Obrencević, Katarina; Pilcević, Dejan; Cukić, Zoran; Petrović, Marijana; Petrović, Milica; Tadić, Jelena; Terzić, Brankica; Karan, Zeljko; Bokonjić, Dubravko; Dobrić, Silva; Antunović, Mirjana; Bokun, Radmila; Dimitrijević, Jovan; Vukomanović-Djurdjević, Biserka

2010-12-01

In countries without a national organization for retrieval and distribution of organs of the deceased donors, problem of organ shortage is still not resolved. In order to increase the number of kidney transplantations we started with the program of living unrelated - spousal donors. The aim of this study was to compare treatment outcome and renal graft function in patients receiving the graft from spousal and those receiving ghe graft from living related donors. We retrospectively identified 14 patients who received renal allograft from spousal donors between 1996 and 2009 (group I). The control group consisted of 14 patients who got graft from related donor retrieved from the database and matched than with respect to sex, age, kidney disease, immunological and viral pretransplant status, the initial method of the end stage renal disease treatment and ABO compatibility. In the follow-up period of 41 +/- 38 months we recorded immunosuppressive therapy, surgical complications, episodes of acute rejection, CMV infection and graft function, assessed by serum creatinine levels at the beginning and in the end of the follow-up period. All patients had pretransplant negative cross-match. In ABO incompatible patients pretransplant isoagglutinine titer was zero. The patients with a spousal donor had worse HLA matching. There were no significant differences between the groups in surgical, infective, immunological complications and graft function. Two patients from the group I returned to hemodialysis after 82 and 22 months due to serious comorbidities. In spite of the worse HLA matching, graft survival and function of renal grafts from spousal donors were as good as those retrieved from related donors.

Spirituality as a predictive factor for signing an organ donor card.

PubMed

Bortz, Anat Peles; Ashkenazi, Tamar; Melnikov, Semyon

2015-01-01

To examine differences in spirituality, purpose in life, and attitudes toward organ donation between people who signed and those who did not sign an organ donor card. A descriptive cross-sectional survey conducted in Israel with a sample of 312 respondents from the general population, of whom 220 (70.5%) signed an organ donor card. Data were collected during April-June 2013. Participants completed a paper questionnaire and a Web-based questionnaire consisting of four sections: spiritual health, purpose in life, attitudes toward organ donation, and social-demographic questions. Descriptive statistics, t test, chi-square test, and a logistic regression analysis were performed. Differences in mean scores between respondents who signed an organ donor card and those who did not were indicated in transcendental spirituality (p < .01), purpose in life (p < .05), and attitudes toward organ donation (p < .01). No statistically significant difference was found between the groups in the overall spirituality mean score. The spiritual transcendental dimension, individual's purpose in life, and attitudes toward organ donation explained 34.3% of the variance of signing an organ donor card. Signing an organ donor card was found to be correlated with high purpose in life, positive attitudes toward organ donation, and low level of transcendental spirituality. Nurses should assess the patient's spiritual needs in order to construct appropriate programs for promoting signing an organ donor card. Nurses who signed an organ donor card should be encouraged to share this information with their patients. © 2014 Sigma Theta Tau International.

Genetic variation in Southern USA rice genotypes for seedling salinity tolerance

PubMed Central

De Leon, Teresa B.; Linscombe, Steven; Gregorio, Glenn; Subudhi, Prasanta K.

2015-01-01

The success of a rice breeding program in developing salt tolerant varieties depends on genetic variation and the salt stress response of adapted and donor rice germplasm. In this study, we used a combination of morphological and physiological traits in multivariate analyses to elucidate the phenotypic and genetic variation in salinity tolerance of 30 Southern USA rice genotypes, along with 19 donor genotypes with varying degree of tolerance. Significant genotypic variation and correlations were found among the salt injury score (SIS), ion leakage, chlorophyll reduction, shoot length reduction, shoot K+ concentration, and shoot Na+/K+ ratio. Using these parameters, the combined methods of cluster analysis and discriminant analysis validated the salinity response of known genotypes and classified most of the USA varieties into sensitive groups, except for three and seven varieties placed in the tolerant and moderately tolerant groups, respectively. Discriminant function and MANOVA delineated the differences in tolerance and suggested no differences between sensitive and highly sensitive (HS) groups. DNA profiling using simple sequence repeat markers showed narrow genetic diversity among USA genotypes. However, the overall genetic clustering was mostly due to subspecies and grain type differentiation and not by varietal grouping based on salinity tolerance. Among the donor genotypes, Nona Bokra, Pokkali, and its derived breeding lines remained the donors of choice for improving salinity tolerance during the seedling stage. However, due to undesirable agronomic attributes and photosensitivity of these donors, alternative genotypes such as TCCP266, Geumgangbyeo, and R609 are recommended as useful and novel sources of salinity tolerance for USA rice breeding programs. PMID:26074937

Analysis of the Factors Affecting the Interval between Blood Donations Using Log-Normal Hazard Model with Gamma Correlated Frailties.

PubMed

Tavakol, Najmeh; Kheiri, Soleiman; Sedehi, Morteza

2016-01-01

Time to donating blood plays a major role in a regular donor to becoming continues one. The aim of this study was to determine the effective factors on the interval between the blood donations. In a longitudinal study in 2008, 864 samples of first-time donors in Shahrekord Blood Transfusion Center,  capital city of Chaharmahal and Bakhtiari Province, Iran were selected by a systematic sampling and were followed up for five years. Among these samples, a subset of 424 donors who had at least two successful blood donations were chosen for this study and the time intervals between their donations were measured as response variable. Sex, body weight, age, marital status, education, stay and job were recorded as independent variables. Data analysis was performed based on log-normal hazard model with gamma correlated frailty. In this model, the frailties are sum of two independent components assumed a gamma distribution. The analysis was done via Bayesian approach using Markov Chain Monte Carlo algorithm by OpenBUGS. Convergence was checked via Gelman-Rubin criteria using BOA program in R. Age, job and education were significant on chance to donate blood (P<0.05). The chances of blood donation for the higher-aged donors, clericals, workers, free job, students and educated donors were higher and in return, time intervals between their blood donations were shorter. Due to the significance effect of some variables in the log-normal correlated frailty model, it is necessary to plan educational and cultural program to encourage the people with longer inter-donation intervals to donate more frequently.

Hidden Treasures.

ERIC Educational Resources Information Center

Greene, Karen L.

1996-01-01

College alumni who are corporate directors have significant fund-raising potential. Charitable award programs allow corporate directors to designate nonprofit organizations to receive gifts when they die or retire; employee stock ownership programs can provide a private stock market for a potential donor seeking philanthropic opportunity and tax…

Relay kidney transplantation in Korea--legal, ethical and medical aspects.

PubMed

Park, Jong-Hyun; Park, Joong-Won; Koo, Young-Mo; Kim, Jang Han

2004-07-01

Living kidney transplantations constitute the majority of kidney transplantations in Korea. Recently, relay kidney transplantation, which is a modified form of both 'exchange transplantation' and 'living anonymous donation', has become at issue. After a living anonymous donor makes the initial donation, the next donor, who is related to the first recipient, makes the second donation; the third donor, who is related to the second recipient, makes the third donation; and so on. In relay kidney transplantation, organ trafficking, coercion of donation, assessment order, breach of agreement, and recipient burden should be evaluated with respect to ethical, legal and medical considerations. Despite these problems, a non-governmental body, the Korean Organ and Tissue Donor Program, has been promoting relay kidney transplantations to address the shortage of cadaveric kidney donations. Acceptance of the method of relay kidney transplantation requires the institution of supplementary measures to minimize the related problems.

Development of Medical Technology for Contingency Response to Marrow Toxic Agents

DTIC Science & Technology

2014-05-06

Development of Medical Technology for Contingency Response to Marrow Toxic Agents - Final Performance/Technical Report for January 01, 2011 to...Enhancing HLA Data for Selected Donors 44 IIB.1.6 Maintain a Quality Control Program 44 IIB.2.1 Collection of Primary Data 45 IIB.2.2 Validation of...Receptor Donor Selection KORI Korean LD Linkage Disequilibrium LTA Lymphotoxin Alpha MALDI-TOF Matrix-Assisted Laser Desorption/Ionization – Time Of

Factors influencing the decision to donate: racial and ethnic comparisons.

PubMed

Glynn, Simone A; Schreiber, George B; Murphy, Edward L; Kessler, Debra; Higgins, Martha; Wright, David J; Mathew, Sunitha; Tu, Yongling; King, Melissa; Smith, James W

2006-06-01

Understanding factors that encourage different racial and ethnic groups to donate is crucial for donor recruitment and retention. A 28-item self-administered questionnaire was completed in 2003 by 1862 Asian, 1479 black, 1641 Hispanic, and 2940 White US donors who had given whole blood within the past year. With a 1 to 5 scale, donors were asked to rate the importance of 17 factors in their last donation decision. Logistic regression was conducted to compare the odds of a factor being important or very important (score of 4 or 5) in one's decision to donate between race or ethnic groups, stratified by first-time and repeat status. More than 90 percent of each respondent group cited a desire, responsibility, or perceived duty to help others as an important or very important motivator. Being asked to donate at work was also an important motivator for all race and ethnic groups (56-70%). Getting the results of a health screen appealed to many (approx. 30% found it important or very important) and was most important to Black and Hispanic donors (odds ratios of 1.3-1.9 compared to White donors; p<0.003). Recruitment and retention programs should build on people's sense of social responsibility. Direct requests to donate are particularly effective motivators. Of a variety of incentives evaluated, offering more comprehensive health screens may motivate many donors, especially Black and Hispanic donors.

Deceased donor organ transplantation with expanded criteria donors: a single-center experience from India.

PubMed

Goplani, K R; Firoz, A; Ramakrishana, P; Shah, P R; Gumber, M R; Patel, H V; Vanikar, A V; Trivedi, H L

2010-01-01

Deceased donor organ transplantation (DDOT) accounts for <4% of renal transplants in India. Many volunteers come forth for organ donation with increasing awareness; unfortunately, the majority are marginal donors, but their rejection would hamper the DDOT program. Judicious use of marginal organs is a challenge for developing countries. We performed 29 renal transplants from 21 expanded criteria donors (ECD) out of 115 DDOT between January 2006 to April 2009-10 dual (DKT) and 19 single (SKT). Fourteen donors had hypertension, a cerebrovascular accident as the cause of death, 9 had both, and 4 had diabetes. Mean donor age was 70.3 +/- 8.9 years. Decisions on the procedure were based upon frozen section biopsy in 13 of 21 donors. Mean DKT donor age was 76 +/- 9.7 years versu 64 +/- 5.7 years of SKT donors. The native kidney diseases were chronic glomerulonephritis (n = 14), diabetic nephropathy (n = 7), tubulointerstitial nephritis (n = 4) and polycystic kidney disease, focal segmental glomerulosclerosis, lupus nephritis and patchy cortical necrosis, (n = 1 each). Mean recipient age of DKT versus SKT was 43.5 versus 42.3 years. All recipients received rabbit anti-thymocyte globulin, followed by steroid, mycophenolate mofetil/calcinueurin inhibitor. Over a mean follow-up of 341 days, the mean serum creatinine (SCr) of 25/29 patients was 1.60 mg/dL (range, 1.0-2.6). The mean SCr of SKT patients was 1.59 +/- 0.63 mg/dL and of DKT, 1.62 +/- 0.48 mg/dL. Ten patients had delayed graft function and 11 had biopsy proven acute tubular necrosis. Seven (24%) patients had rejection (grade 3 Banff update '05, type IA; 4, type 2A); 6 responded to antirejection; 1 graft was lost at 7 months due to chronic rejection. Three (10.3%) patients were lost, 1 each due to AMI, sepsis, and CMV disease. In the circumstances of organ shortage, DDOT with expanded criteria donor is a feasible option.

Towards a global system of vigilance and surveillance in unrelated donors of haematopoietic progenitor cells for transplantation.

PubMed

Shaw, B E; Chapman, J; Fechter, M; Foeken, L; Greinix, H; Hwang, W; Phillips-Johnson, L; Korhonen, M; Lindberg, B; Navarro, W H; Szer, J

2013-11-01

Safety of living donors is critical to the success of blood, tissue and organ transplantation. Structured and robust vigilance and surveillance systems exist as part of some national entities, but historically no global systems are in place to ensure conformity, harmonisation and the recognition of rare adverse events (AEs). The World Health Assembly has recently resolved to require AE/reaction (AE/R) reporting both nationally and globally. The World Marrow Donor Association (WMDA) is an international organisation promoting the safety of unrelated donors and progenitor cell products for use in haematopoietic progenitor cell (HPC) transplantation. To address this issue, we established a system for collecting, collating, analysing, distributing and reacting to serious adverse events and reactions (SAE/R) in unrelated HPC donors. The WMDA successfully instituted this reporting system with 203 SAE/R reported in 2011. The committee generated two rapid reports, reacting to specific SAE/R, resulting in practice changing policies. The system has a robust governance structure, formal feedback to the WMDA membership and transparent information flows to other agencies, specialist physicians and transplant programs and the general public.

Did parents have it right all along? Parents, risk, and living kidney donation: Revisiting the arguments for and against parental living donation of kidneys.

PubMed

Freeman, M A; Wightman, A G

2018-05-01

Historically, living kidney donation has been justified in part by our belief that living donors face minimal risks of subsequent disease. Recent research has brought that presumption into question, particularly for younger donors including parents. In light of this finding, we re-examine many of the traditional arguments both for and against the practice of parental living kidney donation. We then propose an alternative framework in which the burden of having a child with end-stage kidney disease can be considered as an illness experienced by the potential donor parent. We believe this allows a more straightforward, as well as more accurate, assessment of the risks and benefits of donation for the potential parental donor. This assessment might then be used to best inform the decision whether or not to proceed with kidney donation using a shared decision-making model, while reflecting the appropriate ethical roles of both the potential donor and the transplantation program. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Electron donor concentrations in sediments and sediment properties at the agricultural chemicals team research site near New Providence, Iowa, 2006-07

USGS Publications Warehouse

Maharjan, Bijesh; Korom, Scott F.; Smith, Erik A.

2013-01-01

The concentrations of electron donors in aquifer sediments are important to the understanding of the fate and transport of redox-sensitive constituents in groundwater, such as nitrate. For a study by the U.S. Geological Survey National Water-Quality Assessment Program, 50 sediment samples were collected from below the water table from 11 boreholes at the U.S. Geological Survey Agricultural Chemicals Team research site near New Providence, Iowa, during 2006-07. All samples were analyzed for gravel, sand (coarse, medium, and fine), silt, clay, Munsell soil color, inorganic carbon content, and for the following electron donors: organic carbon, ferrous iron, and inorganic sulfide. A subset of 14 sediment samples also was analyzed for organic sulfur, but all of these samples had concentrations less than the method detection limit; therefore, the presence of this potential electron donor was not considered further. X-ray diffraction analyses provided important semi-quantitative information of well-crystallized dominant minerals within the sediments that might be contributing electron donors.

2017 TRIAD Small Business Advisory Panel

DTIC Science & Technology

2017-10-11

government service in 2007 as the Science & Technology (S&T) Project Manager for the United States Navy’s Unmanned Maritime Systems Program Office...National Renewable Energy Laboratory (NREL) as a Program Manager for over 110 energy and water projects on military installations. He worked... management , project management , program management , donor relation service, contract and subcontract policy development and implementation, data integrity

Regional restoration benchmarks for Acropora cervicornis

NASA Astrophysics Data System (ADS)

Schopmeyer, Stephanie A.; Lirman, Diego; Bartels, Erich; Gilliam, David S.; Goergen, Elizabeth A.; Griffin, Sean P.; Johnson, Meaghan E.; Lustic, Caitlin; Maxwell, Kerry; Walter, Cory S.

2017-12-01

Coral gardening plays an important role in the recovery of depleted populations of threatened Acropora cervicornis in the Caribbean. Over the past decade, high survival coupled with fast growth of in situ nursery corals have allowed practitioners to create healthy and genotypically diverse nursery stocks. Currently, thousands of corals are propagated and outplanted onto degraded reefs on a yearly basis, representing a substantial increase in the abundance, biomass, and overall footprint of A. cervicornis. Here, we combined an extensive dataset collected by restoration practitioners to document early (1-2 yr) restoration success metrics in Florida and Puerto Rico, USA. By reporting region-specific data on the impacts of fragment collection on donor colonies, survivorship and productivity of nursery corals, and survivorship and productivity of outplanted corals during normal conditions, we provide the basis for a stop-light indicator framework for new or existing restoration programs to evaluate their performance. We show that current restoration methods are very effective, that no excess damage is caused to donor colonies, and that once outplanted, corals behave just as wild colonies. We also provide science-based benchmarks that can be used by programs to evaluate successes and challenges of their efforts, and to make modifications where needed. We propose that up to 10% of the biomass can be collected from healthy, large A. cervicornis donor colonies for nursery propagation. We also propose the following benchmarks for the first year of activities for A. cervicornis restoration: (1) >75% live tissue cover on donor colonies; (2) >80% survivorship of nursery corals; and (3) >70% survivorship of outplanted corals. Finally, we report productivity means of 4.4 cm yr-1 for nursery corals and 4.8 cm yr-1 for outplants as a frame of reference for ranking performance within programs. Such benchmarks, and potential subsequent adaptive actions, are needed to fully assess the long-term success of coral restoration and species recovery programs.

Ovum pick up, in vitro embryo production, and pregnancy rates from a large-scale commercial program using Nelore cattle (Bos indicus) donors.

PubMed

Pontes, J H F; Melo Sterza, F A; Basso, A C; Ferreira, C R; Sanches, B V; Rubin, K C P; Seneda, M M

2011-06-01

The objective was to clarify in vitro production of bovine embryos in Brazil. Data from 656 ovum pick-up/in vitro production (OPU/IVP) procedures, performed on 317 Nelore (Bos indicus) donors, without hormone stimulation or control of ovarian follicular waves, were analysed. Donors were subjected to OPU from one to nine times (no specific schedule), with < 15 d between consecutive procedures. There were 20,848 oocytes, of which 15,747 (75.53%) were considered viable, 5,446 embryos were obtained, 5,398 embryos were immediately transferred, resulting in 1,974 pregnancies (36.57%) at Day 30 and 1,788 (33.12%) pregnancies at Day 60. The average number of total and viable oocytes produced per OPU session was (mean ± SEM) 30.84 ± 0.88 and 23.35 ± 0.7 (average of 8.1 ± 0.3 embryos and 3.0 ± 0.1 pregnancies per OPU-IVP procedure). Since oocyte production varied widely among donor, they were designated as very high, high, intermediate, and low, with 58.94 ± 2.04, 32.61 ± 0.50, 22.13 ± 0.50, and 10.26 ± 0.57 oocytes, respectively, produced by 78, 80, 79, and 80 donors. The number of viable oocytes recovered ranged from 0 to 128; since donors with numerous viable oocytes produced many viable embryos and pregnancies, oocyte production was useful for donor selection. However, there was no significant effect of the number of OPU sessions per donor on mean numbers of oocytes produced. In conclusion, we confirmed field reports of high oocyte production by some Nelore donors and demonstrated individual variation in oocyte yield, which was associated with embryo production and pregnancy rates. Copyright © 2011 Elsevier Inc. All rights reserved.

Whole Blood Donation Affects the Interpretation of Hemoglobin A1c

PubMed Central

Lenters-Westra, Erna; de Kort, Wim; Bokhorst, Arlinke G.; Bilo, Henk J. G.; Slingerland, Robbert J.; Vos, Michel J.

2017-01-01

Introduction Several factors, including changed dynamics of erythrocyte formation and degradation, can influence the degree of hemoglobin A1c (HbA1c) formation thereby affecting its use in monitoring diabetes. This study determines the influence of whole blood donation on HbA1c in both non-diabetic blood donors and blood donors with type 2 diabetes. Methods In this observational study, 23 non-diabetic blood donors and 21 blood donors with type 2 diabetes donated 475 mL whole blood and were followed prospectively for nine weeks. Each week blood samples were collected and analyzed for changes in HbA1c using three secondary reference measurement procedures. Results Twelve non-diabetic blood donors (52.2%) and 10 (58.8%) blood donors with type 2 diabetes had a significant reduction in HbA1c following blood donation (reduction >-4.28%, P < 0.05). All non-diabetic blood donors with a normal ferritin concentration predonation had a significant reduction in HbA1c. In the non-diabetic group the maximum reduction was -11.9%, in the type 2 diabetes group -12.0%. When eligible to donate again, 52.2% of the non-diabetic blood donors and 41.2% of the blood donors with type 2 diabetes had HbA1c concentrations significantly lower compared to their predonation concentration (reduction >-4.28%, P < 0.05). Conclusion Patients with type 2 diabetes contributing to whole blood donation programs can be at risk of falsely lowered HbA1c. This could lead to a wrong interpretation of their glycemic control by their general practitioner or internist. PMID:28118412

Evolution of Organ Transplantation in Poland 1966 to 2014: Dates and Numbers.

PubMed

Czerwiński, J; Czapiewski, W; Danielewska, E; Milaniak, I; Milecka, A; Patrzałek, D; Sekta, S; Saucha, W; Danek, T; Zając, K; Ostrowski, K; Malanowski, P

2016-06-01

Several events inspired us to collect data on organ transplantation in Poland (2016: the 50th anniversary of the first transplantation and the 20th anniversary of Polish Transplant Coordinating Center Poltransplant). The paper aims at presenting comprehensive data on all organ transplants, beginning with the first in 1966 (deceased kidney) until the end of 2014. Source documents were reports published in Poltransplant Bulletin, a website registry managed by Poltransplant, reports by the Transplantation Council and by the Transplantation Institute of Warsaw. A source data enabled us to establish a preliminary report, presented for verification during the 12th Congress of the Polish Transplantation Society. By the end of 2014, the total number of organ transplants was 26,691. Kidney transplantation is the most common (total number = 19,812). The number of living kidney transplants is low, about 50 per year. The number of liver part transplants from living donors is relatively high, 20 to 30 annually. The program of deceased liver transplantation results in more than 300 transplants yearly. The first heart transplantation was in 1985, but the number of these procedures has been decreasing. No significant increase in the number of lung transplantations was noted. The number of organ transplantations from deceased donors places Poland in the middle among European countries. The number of living donor kidney transplants is lower than in other countries; therefore a living donor liver transplantation program belongs to leading programs. Progress of lung transplantation has been slow. The development is highlighted by vascularized composite tissue transplantations of the hands and face. The strength of the report lies in its reliability and completeness. Numbers are the unique source of information to be used and referred to in the literature. Copyright © 2016 Elsevier Inc. All rights reserved.

Pediatric Renal Transplantation in Oman: A Single-center Experience

PubMed Central

Al Riyami, Mohamed S.; Al Saidi, Sulaiman; Al Ghaithi, Badria; Al Maskari, Anisa; Lala, Sadiq; Mohsin, Nabil; Hirshikesan, Lekha; Al Kalbani, Naifain

2018-01-01

Objectives This study sought to report 22 years experience in pediatric kidney transplantation in Oman. Methods Electronic charts of all Omani children below 13 years of age who received a kidney transplant from January 1994 to December 2015 were reviewed. Data collected included patient demographics, etiology of end-stage kidney disease, modality and duration of dialysis, donor type, complication of kidney transplantation (including surgical complications, infections, graft rejection) graft and patient survival, and duration of follow-up. Results During the study period transplantation from 27 living related donors (LRDs), 42 living unrelated donors (LURDs), also referred to as commercial transplant, and one deceased donor were performed. The median age at transplantation was nine years for both groups. The most common primary diagnosis was congenital anomalies of the kidney and urinary tract in 32.8% of patients followed by familial nephrotic syndrome in 20.0% and polycystic kidney disease in 18.5%. Almost half the patients were on hemodialysis before transplantation, 35.7% were on peritoneal dialysis, and 14.2% received preemptive renal transplantation. Children who received LURD kidneys had high surgical complications (42.8%) compared to the LRDs group (17.8%). Five patients from LURDs group had early graft nephrectomy and four patients developed non-graft function or delayed graft function. In addition, patients in the LURDs group had a higher incidence of hypertension and acute rejection. Graft and patient survival were both better in the LRDs than the LURDs group. Conclusions Although our pediatric kidney transplant program is a young program it has had successful patient outcomes comparable to international programs. Our study provides evidence that in addition to legal and ethical issues with commercial transplant, it also carries significantly higher morbidity and reduced graft and patient survival. PMID:29467993

Changing Donor Funding and the Challenges of Integrated HIV Treatment.

PubMed

Nattrass, Nicoli; Hodes, Rebecca; Cluver, Lucie

2016-07-01

Donor financing for HIV prevention and treatment has shifted from supporting disease-specific ("vertical") programs to health systems strengthening ("horizontal") programs intended to integrate all aspects of care. We examine the consequences of shifting resources from three perspectives: first, through a broad analysis of the changing policy context of health care financing; second, through an account of changing priorities for HIV treatment in South Africa; and third, through a description of some clinical consequences that the authors observed in a research study examining adherence to antiretroviral therapy (ART) and sexual health among adolescents. We note that AIDS responses are neither completely vertical nor horizontal but rather increasingly diagonal, as disease-specific protocols operate alongside integrated supply chain management, human resource development, and preventive screening. We conclude that health care programs are better conceived of as networks of policies requiring different degrees of integration into communities. © 2016 American Medical Association. All Rights Reserved. ISSN 2376-6980.

Rethinking the advantage of zero-HLA mismatches in unrelated living donor kidney transplantation: implications on kidney paired donation.

PubMed

Casey, Michael Jin; Wen, Xuerong; Rehman, Shehzad; Santos, Alfonso H; Andreoni, Kenneth A

2015-04-01

The OPTN/UNOS Kidney Paired Donation (KPD) Pilot Program allocates priority to zero-HLA mismatches. However, in unrelated living donor kidney transplants (LDKT)-the same donor source in KPD-no study has shown whether zero-HLA mismatches provide any advantage over >0 HLA mismatches. We hypothesize that zero-HLA mismatches among unrelated LDKT do not benefit graft survival. This retrospective SRTR database study analyzed LDKT recipients from 1987 to 2012. Among unrelated LDKT, subjects with zero-HLA mismatches were compared to a 1:1-5 matched (by donor age ±1 year and year of transplantation) control cohort with >0 HLA mismatches. The primary endpoint was death-censored graft survival. Among 32,654 unrelated LDKT recipients, 83 had zero-HLA mismatches and were matched to 407 controls with >0 HLA mismatches. Kaplan-Meier analyses for death-censored graft and patient survival showed no difference between study and control cohorts. In multivariate marginal Cox models, zero-HLA mismatches saw no benefit with death-censored graft survival (HR = 1.46, 95% CI 0.78-2.73) or patient survival (HR = 1.43, 95% CI 0.68-3.01). Our data suggest that in unrelated LDKT, zero-HLA mismatches may not offer any survival advantage. Therefore, particular study of zero-HLA mismatching is needed to validate its place in the OPTN/UNOS KPD Pilot Program allocation algorithm. © 2014 Steunstichting ESOT.

Global HIV/AIDS funding and health systems: Searching for the win-win.

PubMed

Levine, Ruth; Oomman, Nandini

2009-11-01

Donors, developing country governments, and NGOs are searching for ways to use funding for HIV/AIDS programs that strengthen the functioning of weak health systems. This is motivated both by the realization that a large share of donor funding for global health is and will continue to be dedicated to HIV/AIDS, and that the aims of more and better treatment, prevention, and care can be achieved only with attention to systemic capacities. For AIDS resources to strengthen health systems, decision makers should: (a) mitigate the risks that AIDS spending may weaken the ability of health systems to respond to other health problems; (b) find ways for procurement, supply chain, management information, and other systems that are created to support AIDS treatment to be broadened to serve other types of services; and (c) build upon the ways in which AIDS programs have overcome some demand-side barriers to use of services. In pursuing this agenda, donors should recognize that health system development is a function of the national and local political economy and place respect for national sovereignty as a central tenet of their policies and practices.

Counted Sb donors in Si quantum dots

NASA Astrophysics Data System (ADS)

Singh, Meenakshi; Pacheco, Jose; Bielejec, Edward; Perry, Daniel; Ten Eyck, Gregory; Bishop, Nathaniel; Wendt, Joel; Luhman, Dwight; Carroll, Malcolm; Lilly, Michael

2015-03-01

Deterministic control over the location and number of donors is critical for donor spin qubits in semiconductor based quantum computing. We have developed techniques using a focused ion beam and a diode detector integrated next to a silicon MOS single electron transistor to gain such control. With the diode detector operating in linear mode, the numbers of ions implanted have been counted and single ion implants have been detected. Poisson statistics in the number of ions implanted have been observed. Transport measurements performed on samples with counted number of implants have been performed and regular coulomb blockade and charge offsets observed. The capacitances to various gates are found to be in agreement with QCAD simulations for an electrostatically defined dot. This work was performed, in part, at the Center for Integrated Nanotechnologies, a U.S. DOE Office of Basic Energy Sciences user facility. The work was supported by Sandia National Laboratories Directed Research and Development Program. Sandia National Laboratories is a multi-program laboratory operated by Sandia Corporation, a Lockheed-Martin Company, for the U. S. Department of Energy under Contract No. DE-AC04-94AL85000.

Motivations to donate blood: demographic comparisons.

PubMed

Glynn, Simone A; Kleinman, Steven H; Schreiber, George B; Zuck, Thomas; Combs, Suzanne Mc; Bethel, James; Garratty, George; Williams, Alan E

2002-02-01

Understanding blood donor motivations is crucial to improving effectiveness of donor recruitment and retention programs. Data from a 1998 survey of 92,581 U.S. blood donors were used to evaluate factors influencing the decision to donate in various demographic groups. Data were weighted to adjust for response and sample design. Of 52,650 respondents, 45,588 gave whole-blood (WB) donations. Among all demographic groups, the major reasons to donate were altruism (75-87%) and awareness of the need for blood (34-43%). Except for first-time donors and those

Effects of granulocyte-colony-stimulating factor on potential normal granulocyte donors.

PubMed

McCullough, J; Clay, M; Herr, G; Smith, J; Stroncek, D

1999-10-01

The use of granulocyte-colony-stimulating factor (G-CSF) to increase the granulocyte count and the yield from leukapheresis in normal donors is leading to renewed interest in granulocyte transfusion. Therefore, it is important to understand the side effects of G-CSF. We studied the effect of G-CSF on peripheral blood counts and recorded the side effects experienced 24 hours after an injection of G-CSF in normal subjects donating peripheral blood progenitor cells for research. Following administration of G-CSF to 261 donors, the neutrophil count increased to 20.6 to 24.5 x 10(9) per microL depending on the dose of G-CSF. This represented a 6.2 to 7.4-fold increase over the neutrophil count before G-CSF administration. Of all donors, 69 percent experienced one or more side effects. The most common effects were: muscle and bone pain, headache, fatigue, and nausea. There was a relationship between the dose of G-CSF and the likelihood of experiencing a side effect. Most side effects were mild, but about 75 percent of donors took analgesics because of them. In a granulocyte donation program involving G-CSF stimulation, about two-thirds of donors would experience one or more side effects, but these would usually be mild and well tolerated.

Prevalence of human T-cell lymphotropic virus types 1 and 2 in blood donors of the Caruaru Blood Center (Hemope).

PubMed

de Lima, Waleska Mayara Gomes; Esteves, Fabrício Andrade Martins; Torres, Maria do Carmo Morais Rodrigues; Pires, Edna Suely Feitosa

2013-01-01

There is difficulty in gathering data on the prevalence of human T-cell lymphotropic virus in blood donors as confirmatory testing is not mandatory in Brazil. This suggests there may be an underreporting of the prevalence. To estimate the prevalence of human T-cell lymphotropic virus types 1 and 2 in donors of a blood bank in Caruaru, Brazil. This was an observational, epidemiological, descriptive, longitudinal and retrospective study with information about the serology of donors of the Caruaru Blood Center, Fundação de Hematologia e Hemoterapia de Pernambuco (Hemope) from May 2006 to December 2010. The data were analyzed using the Excel 2010 computer program (Microsoft Office(®)). Of 61,881 donors, 60 (0.096%) individuals were identified as potential carriers of human T-cell lymphotropic virus types 1 and 2. Of these, 28 (0.045%) were positive and 32 (0.051%) had inconclusive results in the serological screening. Forty-five (0.072%) were retested; 17 were positive (0.027%) and 3 inconclusive (0.005%). After confirmatory tests, 8 were positive (0.013%). Six (75%) of the confirmed cases were women. Epidemiological surveys like this are very important in order to create campaigns to attract donors and reduce the costs of laboratory tests.

[Liver transplantation with living donor : current aspects, perspectives and significance in Germany].

PubMed

Settmacher, U; Bauschke, A; Malessa, C; Scheuerlein, H; Zanow, J; Rauchfuß, F

2013-05-01

More than 20 years ago living donor liver transplantation was introduced into clinical practice. Specifics of this method were developed initially for children and later on for adults particularly in regions where a liver transplantation program using deceased donors was not readily available. The most sensitive aspect of living donation, namely the danger to a healthy relative in order to perform the transplantation is immanent in the system and, thus, it is definitively a secondary option as compared to deceased organ donation. Following worldwide initial euphoria the numbers have markedly decreased in the western world since the start of the new millennium. In Asian countries in particular, much work has been done to optimize the procedure so that the donor safety and the outcome quality for the recipient have been impressively demonstrated in large patient populations. There is still a severe donor organ shortage and the option to allocate an optimal (partial) organ on an individual basis by living donation has given new impact to the discussion about a further rise in the profile of living donations here as well. The new version of the German transplantation legislation implemented in summer 2012 requires a number of conditions with respect to insurance for living donors. The current state and perspectives are presented here.

Testing blood donors for Chagas disease in the Paris area, France: first results after 18 months of screening.

PubMed

El Ghouzzi, Marie-Hélène; Boiret, Elisabeth; Wind, Françoise; Brochard, Claudine; Fittere, Sébastien; Paris, Luc; Mazier, Dominique; Sansonetti, Nicole; Bierling, Philippe

2010-03-01

Chagas disease is endemic in Latin America (LA). Currently 10 million people are infected despite World Health Organization efforts aimed at preventing domestic transmission. However, with the migration of infected asymptomatic individuals to nonendemic countries, transmission of Chagas disease by transfusion may become a worldwide problem. The observation that the number of cases of Chagas disease has increased over the past 10 years in French Guiana, together with the results of a previous hospital-based study in the Paris area, confirms the transmission of Chagas disease from patients coming from LA. For these reasons, the French authorities stopped the collection of blood in French Guiana in 2005 and began screening blood donors in the French Caribbean islands and, in 2007, in continental France. Data on birth place, mother's birth place, and travel in LA were recorded for at-risk donors. These subjects were tested using two enzyme-linked immunosorbent assays (ELISAs). Of the 312,458 individuals who gave blood in the Paris area during an 18-month period, 30,837 were tested. Of these, 972 were born in LA, three of whom were positive for the two ELISAs and immunofluorescence tests. The prevalence of Trypanosoma cruzi-positive donors was 9.7 in 100,000 tested donors, but 0.31% among donors born in LA. Serology tests gave discrepant results in 1.02% of the samples. The efficiency of blood donor screening programs could be improved by screening only blood donors who were born in LA or who have traveled in LA for extended periods, using a single enzyme immunoassay.

Improving Donor Conversion Rates at a Level One Trauma Center: Impact of Best Practice Guidelines.

PubMed

Alban, Rodrigo F; Gibbons, Bobby L; Bershad, Vanessa L

2016-11-22

Organ availability is a consistently limiting factor in transplant surgery. A primary driver of this limitation is donor conversion rate, which is defined as the percentage of eligible donors for whom procurement is actually performed. An alternative way to increase organ availability is through improved utilization of organs from donors after cardiac death (DCD). Recently, a concerted, multidisciplinary effort has been made within our system to improve conversion rates and DCD utilization, thus increasing organ availability. Retrospective analysis of a prospectively collected database from TransLife, our local organ procurement organization (OPO), as well as the Orlando Regional Medical Center (ORMC) trauma registry, from 2009-2012 (up to 2013 for DCD). During which time, this organization implemented best practice guidelines to improve conversions and DCD utilization. We analyzed yearly conversion rates, DCD donations and population demographics before and after implementation of these policies. During the study period, donor conversion rates significantly improved from 58% in 2009 to 82% percent in 2012 hospital-wide (P<0.05); and from 50% in 2009 to 81% in 2012 among trauma patients alone (P<0.05). In addition, total organs transplanted increased from 13 to 31 organs (P<0.05) after implementation of best practice guidelines. No significant differences in trauma population demographics were noted during the study period. Based on our experience, the establishment of best practice policies for referral of potential donors, coupled with programs to educate hospital staff on the existence and importance of these policies, leads to significant improvement in donor conversion rates and increased utilization of DCD donors.

Outcomes of Kidney Transplantations Under the Philippine Health Insurance Corporation's Type Z Benefit Package at the National Kidney and Transplant Institute, Philippines.

PubMed

Pamugas, G E P; Arakama, M-H I; Danguilan, R A; Ledesma, D

2016-04-01

Under the Universal Health Care Program of the Department of Health, the Philippine Health Insurance Corporation (PHIC) launched the Case Type Z benefit package for kidney transplantation, providing the largest amount (USD $13,300.00) for any single medical procedure. The objective of this study was to describe under the PHIC Case Type Z Benefit Package for kidney transplantation at the National Kidney and Transplant Institute and kidney transplantation outcomes under this package. Included in the benefit were standard risk recipients between 10 and 70 years of age with at least 1 human leukocyte antigen (HLA) DR match with the donor, panel-reactive antibody (PRA) less than 20%, and absence of donor-specific antibody (DSA). Previous transplantations, malignancy, hepatitis B and C, human immunodeficiency virus (HIV) positivity, cytomegalovirus (CMV) R-/D+, congestive heart failure, and liver cirrhosis were exclusion criteria. Patients were evaluated by a medical social worker according to their family's financial status. Since June 2012, a total of 261 patients have received the benefit, with 44 under service, 37 with fixed co-pay and 180 with variable co-pay. Of the living donor kidney transplants, 98% had immediate graft function, with 2.3% (6/261) acute rejection rates at 1 year. The total cost of hospitalization was within the benefit for living donor kidney transplants (less than USD 8000.00) but exceeded it in all cases of deceased donor kidney transplants. The successful use of and excellent outcomes under the Case Type Z benefit demonstrated how collaboration among government agencies, health care providers, and pharmaceutical companies could result in a program that improved the access to health care for Filipino patients with end-stage renal disease. Copyright © 2016 Elsevier Inc. All rights reserved.

Evaluation of the new continuous mononuclear cell collection protocol versus an older version on two different apheresis machines.

PubMed

Spoerl, Silvia; Wäscher, Dagmar; Nagel, Stefanie; Peschel, Christian; Verbeek, Mareike; Götze, Katharina; Krackhardt, Angela M

2018-05-06

Cell separators are routinely used to collect CD34 + blood stem cells in the context of customized stem cell transplantation procedures. The Spectra Optia (Terumo BCT) is a novel development of the precursor instrument, the Cobe Spectra (Terumo BCT). In this report, 146 autologous and 42 allogeneic donors undergoing apheresis on the Cobe Spectra using the mononuclear cell (MNC) program 4.7 or on the Spectra Optia using the new continuous mononuclear cell (cMNC) program 11.2 are compared. Viability of cells and collection efficacy within the apheresis products was comparable for autologous and allogeneic products collected with the MNC or cMNC method. However, we found a reduced duration of the apheresis procedure and lower hematocrit within the apheresis products when using the cMNC in autologous and allogeneic donors. Moreover, allogeneic donors collected substantially more CD34 + cells per kilogram of body weight when using the cMNC method. Differences in platelets before and after apheresis were substantially smaller in this cohort when compared to the cohort collected with the MNC method. Neutrophil and platelet engraftment after autologous or allogeneic transplantation with a product collected with the MNC procedure was comparable to a transplantation with a product processed according to the cMNC method. Comparison of the MNC (Cobe Spectra) and the cMNC (Spectra Optia) methods demonstrated an equal performance and outcome. However, advantages were present using the cMNC method with respect to apheresis duration and hematocrit within the apheresis product (autologous/allogeneic donors) and numbers of CD34 + cells collected, especially in allogeneic donors. © 2018 AABB.

[Need and demand of kidneys for transplantation in Venezuela].

PubMed

Milanés, C L; Bellorín-Font, E; Weisinger, J; Pernalete, N; Urbina, D; Paz-Martínez, V

1993-01-01

The number of cadaveric kidneys available for transplantation has become insufficient around the world. Despite concerted efforts, we have been unsuccessful in greatly improve the supply of organ donors, and consequently the number of end stage renal failure patients awaiting for kidney transplantation continues to increase. The primary objective of this paper is to quantify the need and supply of kidneys for transplant in Venezuela. An overview of the current level of kidney transplant activity in Venezuela is presented, observing that the activity with cadaveric donors had been predominant since 1983, although not to an optimal level. The annual activity in kidney transplant between 1989-1991 remained stable in 6 transplants/million people, but went sharply down to 4.6 in 1992. An estimate of the current need is around 10 donors/million people. This is in contrast with an effective donation rate of only 2.01 and 1.92 donors/million achieved in 1990 and 1991 respectively. The most frequent cause for no donation was the lack of familiar consent. Based on an analysis of the factors involved in the shortage of donor supply in Venezuela, we present some recommendations to increase the availability of cadaveric organ donors in the country. These measures include an improvement of education and legal regulation in the field of organ donation and transplantation, and following the Spanish model, the creation of a program of hospital transplant coordinators that can detect and evaluate potential organ donors as well as coordinate the logistical aspects of transplantation.

Diphtheria toxin IgG levels in military and civilian blood donors in Rio de Janeiro, Brazil.

PubMed

Speranza, F A B; Ishii, S K; Hirata, R; Mattos-Guaraldi, A L; Milagres, L G

2010-01-01

Serologic data on diseases that are preventable by vaccines are necessary to evaluate the success of immunization programs and to identify susceptible subgroups. In the present study, we determined serum IgG levels against diphtheria toxin of military and civilian blood donors (N = 75; 69.3% males and 30.7% females) aged 18-64 years, from the Brazilian Army Biology Institute, Rio de Janeiro, using a commercial diphtheria kit (Diphtheria IgG ELISA; IBL, Germany). Most (63%) unprotected military donors were from the older age group of 41 to 64 years. In contrast, the majority (71%) of young military donors (18 to 30 years) were fully protected. About half of the military donors aged 31 to 40 years were protected against diphtheria. Among the civilians, about 50% of persons aged 18 to 30 years and 31 to 40 years had protective antibody levels against diphtheria as also did 64% of individuals aged 41 to 64 years. All civilians had a similar antibody response (geometric mean = 0.55 IU/mL) independent of age group. Military donors aged 18-30 years had higher IgG levels (geometric mean = 0.82 IU/mL) than military donors of 41-64 years (geometric mean = 0.51 IU/mL; P > 0.05). In conclusion, the existence of a considerable proportion of susceptible adults supports the position that reliable data on the immune status of the population should be maintained routinely and emphasizes the importance of adequate immunization during adulthood.

Heart Transplantation for Congenital Heart Disease in the First Year of Life

PubMed Central

Chinnock, Richard E; Bailey, Leonard L

2011-01-01

Successful infant heart transplantation has now been performed for over 25 years. Assessment of long term outcomes is now possible. We report clinical outcomes for322 patients who received their heart transplant during infancy. Actuarial graft survival for newborn recipients is 59% at 25 years. Survival has improved in the most recent era. Cardiac allograft vasculopathy is the most important late cause of death with an actuarial incidence at 25 years of 35%. Post-transplant lymphoma is estimated to occur in 20% of infant recipients by25 years. Chronic kidney disease grade 3 or worse is present in 31% of survivors. The epidemiology of infant heart transplantation has changed through the years as the results for staged repair improved and donor resources remained stagnant. Most centers now employ staged repair for hypoplastic left heart syndrome and similar extreme forms of congenital heart disease. Techniques for staged repair, including the hybrid procedure, are described. The lack of donors is described with particular note regarding decreased donors due to newer programs for appropriate infant sleep positioning and infant car seats. ABO incompatible donors are a newer resource for maximizing donor resources, as is donation after circulatory determination of death and techniques to properly utilize more donors by expanding the criteria for what is an acceptable donor. An immunological advantage for the youngest recipients has long been postulated, and evaluation of this phenomenon may provide clues to the development of accommodation and/or tolerance. PMID:22548030

A Study to Develop a Methodology Determining the Feasibility of Establishing a Blood Collection Program in an Army Healthcare Facility

DTIC Science & Technology

1985-05-01

minimal. The risk of acquiring syphilis through blood transfusions is so rare that American Association of Blood Bank Standards have dropped the...requirement to test for syphilis , although Federal regulations still require it. Malaria can be effectively screened out by excluding potential donors. 2 9 The...murmur or repair of a congenital defect medical director. Listed below are some does not necessarily disqualify a donor. drugs and medical conditions

African Security Challenges: Now and Over the Horizon Improving African Security Through the Use of Non/Less-Than -Lethal Force: Challenges , Issues and Approaches

DTIC Science & Technology

2010-05-01

donor funding is no longer available. For instance, Brazil and Colombia were unable to sustain their CP programs when funding from donors to establish...forces. Other more advanced forms of non/less-than-lethal weapons which are common in the West, such as Tasers , are far less common on the continent...31 As part of this discussion, several experts discussed Tasers , in particular, though one expert also mentioned

Characteristics Of Likely Precision Medicine Initiative Participants Drawn From A Large Blood Donor Population.

PubMed

Bloss, Cinnamon S; Stoler, Justin; Schairer, Cynthia E; Rosenthal, Sara B; Cheung, Cynthia; Rus, Holly M; Block, Jessica L; Yang, Jiue-An Jay; Morton, Doug; Bixenman, Helen; Wellis, David

2018-05-01

A goal of the Precision Medicine Initiative All of Us Research Program (AoURP) is recruitment of participants who reflect the diversity of the US. Recruitment from among blood bank donors, which may better reflect the demographic makeup of local communities, is one proposed strategy. We evaluated this strategy by analyzing the results of a survey of San Diego Blood Bank donors conducted in November 2015. Whites were more likely than nonwhites to respond to the survey (7.1 percent versus 3.9 percent). However, race was not a significant predictor of interest in participating in precision medicine research. Using census data linked to donors' ZIP codes, we also found that people who indicated interest in research participation were more likely to come from regions with higher educational attainment. Although blood banks represent a viable recruitment strategy for AoURP, our findings indicate that bias toward inclusion of whites and more highly educated people persists.

The role of extracorporeal membrane oxygenation in patients after irreversible cardiac arrest as potential organ donors

PubMed Central

Puślecki, Mateusz; Zieliński, Marcin; Mandecki, Michał; Ligowski, Marcin; Stefaniak, Sebastian; Dąbrowski, Marek; Karczewski, Marek; Gąsiorowski, Łukasz; Sip, Maciej; Dąbrowska, Agata; Telec, Wojciech; Perek, Bartłomiej; Jemielity, Marek

2017-01-01

The number of people waiting for a kidney or liver transplant is growing systematically. Due to the latest advances in transplantation, persons after irreversible cardiac arrest and confirmation of death have become potential organ donors. It is estimated that they may increase the number of donations by more than 40%. However, without good organization and communication between pre-hospital care providers, emergency departments, intensive care units and transplantation units, it is almost impossible to save the organs of potential donors in good condition. Various systems, including extracorporeal membrane oxygenation (ECMO), supporting perfusion of organs for transplantation play a key role. In 2016 the “ECMO for Greater Poland” program was established. Although its main goal is to improve the survival rate of patients suffering from life-threatening cardiopulmonary conditions, one of its branches aims to increase the donation rate in patients with irreversible cardiac arrest. In this review, the role of ECMO in the latter group as the potential organ donors is presented. PMID:29354178

Transmission of Tropical and Geographically Restricted Infections during Solid-Organ Transplantation

PubMed Central

Martín-Dávila, P.; Fortún, J.; López-Vélez, R.; Norman, F.; Montes de Oca, M.; Zamarrón, P.; González, M. I.; Moreno, A.; Pumarola, T.; Garrido, G.; Candela, A.; Moreno, S.

2008-01-01

In recent years, the increasing number of donors from different regions of the world is providing a new challenge for the management and selection of suitable donors. This is a worldwide problem in most countries with transplantation programs, especially due to the increase in immigration and international travel. This paper elaborates recommendations regarding the selection criteria for donors from foreign countries who could potentially transmit tropical or geographically restricted infections to solid-organ transplant recipients. For this purpose, an extensive review of the medical literature focusing on viral, fungal, and parasitic infections that could be transmitted during transplantation from donors who have lived or traveled in countries where these infections are endemic has been performed, with special emphasis on tropical and imported infections. The review also includes cases described in the literature as well as risks of transmission during transplantation, microbiological tests available, and recommendations for each infection. A table listing different infectious agents with their geographic distributions and specific recommendations is included. PMID:18202437

IPPF firm reconciles money with mission.

PubMed

1991-01-01

Despite its seemingly conflicting goals, the Family Health Management Service (FHMS) has become an important middleman agency for contraceptives. A for-profit subsidiary of the International Planned Parenthood Federation (IPPF), FHMS has established itself by helping fill the funding gap left by large international donor agencies. FHMS acts as consulting and procurement firm of contraceptives for smaller family planning programs around the world. These organizations, whether government or private, are generally too small to qualify extensive assistance from major donor groups. Although FHMS is a for-profit organization, its leadership stresses that its main goal is to make family planning knowledge and skills available to everyone. FHMS makes a determination whether the organization seeking contraceptives is a charitable or commercial enterprise. If the organization is charitable, FHMS charges only a handling fee. If the organization is commercial, FHMS adds a percentage to make the cost of the contraceptive reflect the market value. Since it begun operating in 1988, FHMS has assisted hundreds of customers. When Action Aid needed 6000 contraceptive products (a figure too small to attract funding from large donor organizations but too large to buy in the open market) for its rural development program in sierra Leone, FHMS procured them at an affordable cost. Last year, the organization spent about $1 million in procuring, shipping, and managing contraceptive sales, and netted a profit of about $45,000. All profits are channeled back to IPPF's altruistic programs.

National variation in use of Immunosuppression for kidney transplantation: A call for evidence-based regimen selection

PubMed Central

Axelrod, David; Naik, Abhijit S.; Schnitzler, Mark A.; Segev, Dorry L.; Dharnidharka, Vikas R.; Brennan, Daniel C.; Bae, Sunjae; Chen, Jiajing; Massie, Allan; Lentine, Krista L.

2017-01-01

Immunosuppression management in kidney transplantation has evolved to include an increasingly diverse choice of medications. While informed by patient and donor characteristics, choice of immunosuppression regimen varies widely across transplant programs. Using a novel database integrating national transplant registry and pharmacy fill records, immunosuppression use 6–12 and 12–24 months post-transplant was evaluated for 22,453 patients transplanted at 249 U.S. programs in 2005–2010. Use of triple immunosuppression comprising tacrolimus, mycophenolic acid or azathioprine, and steroids varied widely (0–100% of patients per program), as did use of steroid-sparing regimens (0–77%), in sirolimus-based regimens (0–100%) and cyclosporine-based regimens (0–78%). Use of triple therapy was more common in highly sensitized patients, women, and recipients with dialysis duration > 5 years. Sirolimus use appeared to diminish over the study period. Overall, patient and donor characteristics explained only a limited amount of the observed variation in regimen use, while center choice explained 30–46% of the use of non-triple therapy immunosuppression. The majority of patients who received triple therapy (79%), cyclosporine-based (87.6%) and sirolimus-based regimens (84.3%) continued these regimens in the second year post-transplant. This population-based study of immunosuppression practice demonstrates substantial variation in center practice beyond that is explained by differences in patient and donor characteristics. PMID:26901466

[Cost of a renal transplant: medico-economic analysis of the amount reimbursed by the French national health program to finance renal transplantation].

PubMed

Sainsaulieu, Yoël; Sambuc, Cléa; Logerot, Hélène; Bongiovanni, Isabelle; Couchoud, Cécile

2014-07-01

Successful organ transplantation relies on several ancillary activities such as the identification of a compatible donor, organ allocation and procurement and the coordination of the transplant process. No existing study of the overall costs, in France, of these additional transplantation activities could be identified. This study determines the total additional costs of ancillary transplantation activities by comparing the costs of kidney transplantations with living donors against those using deceased donors. The data used are drawn from the 2013 public healthcare tariff calculations, PMSI recorded activity and transplant activity in 2012 as assessed and reported by the Agence de la biomédecine. The results show that, in 2012, additional transplant costs varied from 13835.44 € to 20050.67 € for a deceased donor and were 13601.66 € for a living donor. In conclusion, this study demonstrates that all the costs covered by National Health Insurance need to be taken into account in the economic impact evaluation of renal transplantation and during the development of this national priority activity. Copyright © 2014 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

Should pediatric patients wait for HLA-DR-matched renal transplants?

PubMed

Gritsch, H A; Veale, J L; Leichtman, A B; Guidinger, M K; Magee, J C; McDonald, R A; Harmon, W E; Delmonico, F L; Ettenger, R B; Cecka, J M

2008-10-01

Graft survival rates from deceased donors aged 35 years or less among all primary pediatric kidney transplant recipients in the United States between 1996 and 2004 were retrospectively examined to determine the effect of HLA-DR mismatches on graft survival. Zero HLA-DR-mismatched kidneys had statistically comparable 5-year graft survival (71%), to 1-DR-mismatched kidneys (69%) and 2-DR-mismatched kidneys (71%). When compared to donors less than 35 years of age, the relative rate of allograft failure was 1.32 (p = 0.0326) for donor age greater than or equal to age 35. There was no statistical increase in the odds of developing a panel-reactive antibody (PRA) greater than 30% at the time of second waitlisting, based upon the degree of HLA-A, -B or -DR mismatch of the first transplant, nor was there a 'dose effect' when more HLA antigens were mismatched between the donor and recipient. Therefore, pediatric transplant programs should utilize the recently implemented Organ Procurement and Transplantation Network's (OPTN)allocation policy, which prioritizes pediatric recipients to receive kidneys from deceased donors less than 35 years of age, and should not turn down such kidney offers to wait for a better HLA-DR-matched kidney.

Living unrelated-commercial-kidney transplantation: when there is no chance to survive.

PubMed

Sever, Mehmet Sukru

2006-10-01

Transplantation is the best treatment of end-stage renal disease (ESRD); however, organ shortage is a reality. Deceased donor organ donation is inadequate; hence, the number of patients on the waiting lists is increasing progressively. Since many ESRD patients do not have living genetically related donors, living unrelated transplantation is considered. These transplantations offer excellent graft and patient survival rates if practiced in conventional situations, while the results are not so favorable or even poor in unconventional transplantations, which mostly take place in developing countries. Ethical aspects of living unrelated transplantation are more complicated than the medical side due to concern of commercialization. Making payment to the donors has been considered strictly as nonethical by many authors, while some others suggest reopening previous debates for kidney sales. The latter claim that if exploitation of donors is avoided, the reward (or payment) to the donor can be morally justified. Apart from these controversies, it is uniformly accepted that commercial transplantation is certainly unethical when brokers are involved or the aim is just profit for transplant physicians, because the main reason in favor of organ sales is improving the quality of life of the patients and the donors, not the brokers or the physicians. All these theoretical ethical arguments in the Western countries turn out to become vital concerns in developing countries, because transplantation is the cheapest renal replacement therapy. Recently, it has been suggested that organ shortage problems can partly be solved by establishing controlled donor compensation programs in these countries, which may also prevent exploitation of the donors. However, it is impossible to suggest a uniform solution for all countries because of deep differences in economical status as well as social and cultural values. Thus, every country should build its own ethical standards for commercial transplantation.

Attitude to blood donation in Saudi Arabia

PubMed Central

Abdel Gader, Abdel Galil M.; Osman, Abdel Moniem A.; Al Gahtani, Furgah H.; Farghali, Mohamed N.; Ramadan, Ali H.; Al-Momen, Abdel Kareem M.

2011-01-01

Background and Objectives: The blood donor system in the Kingdom of Saudi Arabia depends on a combination of voluntary and involuntary donors. The aim of this study is to explore the attitudes, beliefs and motivations of Saudis toward blood donation. Materials and Methods: The study was conducted at the Donor Centers at King Khalid University Hospital (KKUH) Blood Bank and King Saud University Students Health Center, Riyadh. A self-administered questionnaire was distributed to donors (n = 517) and nondonors (n = 316), between February and June 2008. All were males. Results: Ninety-nine percent of the respondents showed positive attitude toward blood donations and its importance for patients care, and object the importation of blood from abroad. Blood donors: Ninety-one percent agree that that blood donation is a religious obligation, 91% think no compensation should be given, 63% will accept a token gift, 34% do not object to donating six times/year and 67% did not mind coming themselves to the donor center to give blood. Nondonors: Forty-six percent were not asked to give blood and those who were asked mentioned fear (5%) and lack of time (16%) as their main deterrents. Reasons for rejection as donors include underweight and age (71%) and health reasons (19%). Seventy-five percent objected to money compensation but 69% will accept token gifts and 92% will donate if a relative/friend needs blood. Conclusion: These results reflect an encouraging strong positive attitude toward blood donation. Further future planning with emphasis on educational/publicity programs and careful organization of donor recruitment campaigns could see the dream of total voluntary nonremunerated blood donations should not take long to be true. PMID:21897588

Dual-kidney transplants as an alternative for very marginal donors: long-term follow-up in 63 patients.

PubMed

De Serres, Sacha A; Caumartin, Yves; Noël, Réal; Lachance, Jean-Guy; Côté, Isabelle; Naud, Alain; Fradet, Yves; Mfarrej, Bechara G; Agharazii, Mohsen; Houde, Isabelle

2010-11-27

Organ shortage has led to the use of dual-kidney transplant (DKT) of very marginal donors into a single recipient to increase the use of marginal organs. To date, few data are available about the long-term outcome of DKT and its usefulness to increase the pool of available organ. We conducted a single-center cohort study of DKTs with longitudinal follow-up over an 8-year period. Between 1999 and 2007, 63 DKTs were performed. All kidneys from donors younger than 75 years refused by all centers for single transplantation, and kidneys from donors aged 75 years or older were routinely evaluated based on preimplantation glomerulosclerosis. Renal function, patient or graft survival, and perioperative complications were compared with 66 single kidneys from expanded criteria donors (ECD) and 63 ideal kidney donors. After a median follow-up of 56 months, patient or graft survival was similar between the three groups. Twelve-, 36-, and 84-month creatinine clearance were similar for DKT and ECD (12 months: 58 and 59 mL/min; 36 months: 54 and 60 mL/min; and 84 months: 62 and 51 mL/min, respectively). For the study period, the routine evaluation of very marginal kidneys for DKT in our center has led to an increase of 47% in the transplants from donors aged 50 years or older, which represent 12% at the level of our organ procurement organization. DKT patients can expect long-term results comparable with single kidney ECD. The implementation of a DKT program in our unit safely increased the pool of organs from marginal donors.

Improving Donor Conversion Rates at a Level One Trauma Center: Impact of Best Practice Guidelines

PubMed Central

Gibbons, Bobby L; Bershad, Vanessa L

2016-01-01

Background Organ availability is a consistently limiting factor in transplant surgery. A primary driver of this limitation is donor conversion rate, which is defined as the percentage of eligible donors for whom procurement is actually performed. An alternative way to increase organ availability is through improved utilization of organs from donors after cardiac death (DCD). Recently, a concerted, multidisciplinary effort has been made within our system to improve conversion rates and DCD utilization, thus increasing organ availability. Study design Retrospective analysis of a prospectively collected database from TransLife, our local organ procurement organization (OPO), as well as the Orlando Regional Medical Center (ORMC) trauma registry, from 2009-2012 (up to 2013 for DCD). During which time, this organization implemented best practice guidelines to improve conversions and DCD utilization. We analyzed yearly conversion rates, DCD donations and population demographics before and after implementation of these policies. Results During the study period, donor conversion rates significantly improved from 58% in 2009 to 82% percent in 2012 hospital-wide (P<0.05); and from 50% in 2009 to 81% in 2012 among trauma patients alone (P<0.05). In addition, total organs transplanted increased from 13 to 31 organs (P<0.05) after implementation of best practice guidelines. No significant differences in trauma population demographics were noted during the study period. Conclusions Based on our experience, the establishment of best practice policies for referral of potential donors, coupled with programs to educate hospital staff on the existence and importance of these policies, leads to significant improvement in donor conversion rates and increased utilization of DCD donors. PMID:28018761

End-of-life practices in patients with devastating brain injury in Spain: implications for organ donation.

PubMed

Domínguez-Gil, B; Coll, E; Pont, T; Lebrón, M; Miñambres, E; Coronil, A; Quindós, B; Herrero, J E; Liébanas, C; Marcelo, B; Sanmartín, A M; Matesanz, R

2017-04-01

To describe end-of-life care practices relevant to organ donation in patients with devastating brain injury in Spain. A multicenter prospective study of a retrospective cohort. 1 November 2014 to 30 April 2015. Sixty-eight hospitals authorized for organ procurement. Patients dying from devastating brain injury (possible donors). Age: 1 month-85 years. Type of care, donation after brain death, donation after circulatory death, intubation/ventilation, referral to the donor coordinator. A total of 1,970 possible donors were identified, of which half received active treatment in an Intensive Care Unit (ICU) until brain death (27%), cardiac arrest (5%) or the withdrawal of life-sustaining therapy (19%). Of the rest, 10% were admitted to the ICU to facilitate organ donation, while 39% were not admitted to the ICU. Of those patients who evolved to a brain death condition (n=695), most transitioned to actual donation (n=446; 64%). Of those who died following the withdrawal of life-sustaining therapy (n=537), 45 (8%) were converted into actual donation after circulatory death donors. The lack of a dedicated donation after circulatory death program was the main reason for non-donation. Thirty-seven percent of the possible donors were not intubated/ventilated at death, mainly because the professional in charge did not consider donation alter discarding therapeutic intubation. Thirty-six percent of the possible donors were never referred to the donor coordinator. Although deceased donation is optimized in Spain, there are still opportunities for improvement in the identification of possible donors outside the ICU and in the consideration of donation after circulatory death in patients who die following the withdrawal of life-sustaining therapy. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

Nucleic acid testing: Is it the only answer for safe Blood in India?

PubMed Central

Naidu, N. K.; Bharucha, Z. S.; Sonawane, Vandana; Ahmed, Imran

2016-01-01

Background: With the implementation of NAT in countries around the world, there is a growing pressure on the transfusion services in India to adopt NAT testing. India has about 2545 licensed Blood Centres. The Transfusion Services in India are fragmented, poorly regulated and the quality standards are poorly implemented. Blood Centres are still dependent on replacement/family donors and in most places laboratory testing for Transfusion transmitted infections is not quality assured, laboratory equipment are not calibrated and maintained, and validation of results is not carried out. Against the current scenario introducing NAT for screening of blood donors in India would pose a challenge. Aim: To study the prudence of universal NAT testing in India. Materials and Methods: A retrospective study of 5 years from 2008-2012 was undertaken to study the true reactivity of donors using WHO strategy II and III and therefore the true seroprevalence of TTI infections in the donor populations. Results: The true reactivity of the donors was much less as compared to the initially reactive donors due to the use of a well designed testing algorithm. In addition having a total voluntary blood collection along with good pre-donation counseling program also reduces the transmission of infections. Conclusions: What India essentially needs to do is religiously implement the strategies outlined in the WHO Aide-memoire. The blood should be collected only from voluntary non remunerative and repeat donors, there should be stringent donor selection with pre-donation counseling instituted. Strict implementation of quality management system, development of well defined testing startegies and strong haemovigilance system could take us a step in the right direction. PMID:27011677

One System for Blood Program Information Management

PubMed Central

Gero, Michael G.; Klickstein, Judith S.; Hurst, Timm M.

1980-01-01

A system which integrates the diverse functions of a Blood Program within one structure is being assembled at the American National Red Cross Blood Services, Northeast Region. When finished, it will provide technical support for collection scheduling, donor recruitment, recordkeeping, laboratory processing, inventory management, HLA typing and matching, distribution, and administration within the Program. By linking these applications, a reporting structure useful to top management will be provided.

[Multiorgan transplantation program at the Hospital de Especialidades 71, Unidad Médica de Alta Especialidad 134, Instituto Mexicano del Seguro Social in Torreon].

PubMed

Juárez-de-la-Cruz, Federico Javier; Barrios-Reyes, Carmen Yolanda; Cano-López-de-nava, Laura; Adalid-Sainz, Carmen

2011-09-01

This is the experience in a program of multiorgan transplant at the Hospital de Especialidades 71 in Torreon, Coahuila. It is a historical overview of the beginning and development of the transplant program. Describes the logistics of the study of patients for transplantation and the test to be carried out in the laboratory of histocompatibility. We analyzed the records of the patients were transplanted in the period from January 1987 until June 2011. We found 2538 in total, of which 1940 were renal (76.4%). The 53% were male and 47% female. Average age of 37 +/- 15 years. The 82% was adult population and 18% pediatric. The most frequent cause of CRF was the chronic glomerulonephritis and 15% of the patients are diabetic. 73.5% were living donor and 26.5% were deceased donor. 7% of recipients of living donor have domino transplants. The incidence of acute rejection was 7.5%. 15% of the patients had infections and 60% was urinary. The immunosuppressive scheme most widely used is tacrolimus + mycophenolate mofetil + prednisone. The overall survival of the patient was 100, 90 and 87% to the first, third and fifth year after the transplant. The overall survival of the graft was 98, 87 and 83% in the first, third and fifth years post-transplant. It has been developed a multiple organ transplant program in Torreon that currently is one of the most important in Mexico with similar results to those obtained at the international level.

[The contribution of persuasion social psychology to the retention of donors: the impact of labelling the previous donation].

PubMed

Callé, N; Plainfossé, C; Georget, P; Sénémeaud, C; Rasonglès, P

2011-12-01

The supply of blood cell products requires from the National French Blood Institute (Établissement Français du Sang - EFS) to rely upon regular blood donors. Contact with donors, tailored to individuals as much as possible, helps them to donate on a regular basis. Within the context of a research program conducted with the Psychology Department of the Université de Caen Basse-Normandie, persuasive theoretical models from social psychology have been tested. These models allow adapting messages according to the motivation of donors. The content is centred on the previous donation, differently labelled according to two types of labelling: functional labelling and social labelling. Functional labelling points out the efficiency of what "has been done" (the previous blood donation), whereas social labelling emphasizes the social value of the individual. Different types of mailing invitations have been sent to 1917 donors from the Normandy database, invited to three different blood collections. Every experimental letter worked better than the standard EFS letter (which was used as the "control" letter) in terms of effective blood donation after reception of the letter. Some of the letters are more efficient in motivating donors than other ones. The letters labelling the previous blood donation as functional (efficiency of the donation) appeared more efficient than those with social label (social value) in whichever motivation induced. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Prevalence of human T-cell lymphotropic virus types 1 and 2 in blood donors of the Caruaru Blood Center (Hemope)

PubMed Central

de Lima, Waleska Mayara Gomes; Esteves, Fabrício Andrade Martins; Torres, Maria do Carmo Morais Rodrigues; Pires, Edna Suely Feitosa

2013-01-01

Background There is difficulty in gathering data on the prevalence of human T-cell lymphotropic virus in blood donors as confirmatory testing is not mandatory in Brazil. This suggests there may be an underreporting of the prevalence. Objective To estimate the prevalence of human T-cell lymphotropic virus types 1 and 2 in donors of a blood bank in Caruaru, Brazil. Methods This was an observational, epidemiological, descriptive, longitudinal and retrospective study with information about the serology of donors of the Caruaru Blood Center, Fundação de Hematologia e Hemoterapia de Pernambuco (Hemope) from May 2006 to December 2010. The data were analyzed using the Excel 2010 computer program (Microsoft Office®). Results Of 61,881 donors, 60 (0.096%) individuals were identified as potential carriers of human T-cell lymphotropic virus types 1 and 2. Of these, 28 (0.045%) were positive and 32 (0.051%) had inconclusive results in the serological screening. Forty-five (0.072%) were retested; 17 were positive (0.027%) and 3 inconclusive (0.005%). After confirmatory tests, 8 were positive (0.013%). Six (75%) of the confirmed cases were women. Conclusion Epidemiological surveys like this are very important in order to create campaigns to attract donors and reduce the costs of laboratory tests. PMID:24106445

[Joint application of mathematic models in assessing the residual risk of hepatitis C virus transmitted through blood transfusion].

PubMed

Wang, Xun; Jia, Yao; Xie, Yun-zheng; Li, Xiu-mei; Liu, Xiao-ying; Wu, Xiao-fei

2011-09-01

The practicable and effective methods for residual risk assessment on transfusion-transmitted disease was to establish the mathematic models. Based on the characteristics of the repeat donors which donated their blood on a regular base, a model of sero-conversion during the interval of donations was established to assess the incidence of the repeat donors. Based on the characteristics of the prevalence in the population, a model of 'prevalence increased with the age of the donor' was established to assess the incidence of those first-time donors. And based on the impact of the windows period through blood screening program, a model of residual risk associated with the incidence and the length of the windows period was established to assess the residual risk of blood transfusion. In this paper, above said 3 kinds of mathematic models were jointly applied to assess the residual risk of hepatitis C virus (HCV) which was transmitted through blood transfusion in Shanghai, based on data from the routine blood collection and screening program. All the anti-HCV unqualified blood donations were confirmed before assessment. Results showed that the residual risk of HCV transmitted through blood transfusion during Jan. 1(st), 2007 to Dec. 31(st), 2008 in Shanghai was 1:101 000. Data showed that the results of residual risk assessment with mathematic models was valuable. The residual risk of transfusion-transmitted HCV in Shanghai was at a safe level, according to the results in this paper.

Infectious Disease Transmission during Organ and Tissue Transplantation

PubMed Central

Kuehnert, Matthew J.; Fishman, Jay A.

2012-01-01

Infectious disease transmission through organ and tissue transplantation has been associated with severe complications in recipients. Determination of donor-derived infectious risk associated with organ and tissue transplantation is challenging and limited by availability and performance characteristics of current donor epidemiologic screening (e.g., questionnaire) and laboratory testing tools. Common methods and standards for evaluating potential donors of organs and tissues are needed to facilitate effective data collection for assessing the risk for infectious disease transmission. Research programs can use advanced microbiological technologies to define infectious risks posed by pathogens that are known to be transplant transmissible and provide insights into transmission potential of emerging infectious diseases for which transmission characteristics are unknown. Key research needs are explored. Stakeholder collaboration for surveillance and research infrastructure is required to enhance transplant safety. PMID:22840823

77 FR 62518 - Proposed Collection; Comment Request: Recipient Epidemiology and Donor Evaluation Study-III (REDS...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-15

..., translational, and clinical research to improve the benefits of transfusion while reducing its risks. The... Institute (NHLBI) REDS programs have proven to be the premier research programs in blood collection and... successes that this research network has realized over the years while being responsive to changing research...

Fermilab Friends for Science Education | Programs | Past Donors

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the U.S. Trust Company of New York AT&T Bell Laboratories Aurora Foundation, The Batavia Schools Teachers of Mathematics Illinois Department of Natural Resources Illinois State Board of Education Science Literacy Program Joyce Foundation, The Kane County Board of Education Kane County Riverboat Fund Marmon

Donor-Derived Regulatory Dendritic Cell Infusion Maintains Donor-Reactive CD4+CTLA4hi T Cells in Non-Human Primate Renal Allograft Recipients Treated with CD28 Co-Stimulation Blockade.

PubMed

Ezzelarab, Mohamed B; Lu, Lien; Shufesky, William F; Morelli, Adrian E; Thomson, Angus W

2018-01-01

Donor-derived regulatory dendritic cell (DCreg) infusion before transplantation, significantly prolongs renal allograft survival in non-human primates. This is associated with enhanced expression of the immunoregulatory molecules cytotoxic T-lymphocyte-associated antigen (Ag) 4 (CTLA4) and programmed cell death protein 1 (PD1) by host donor-reactive T cells. In rodents and humans, CD28 co-stimulatory pathway blockade with the fusion protein CTLA4:Ig (CTLA4Ig) is associated with reduced differentiation and development of regulatory T cells (Treg). We hypothesized that upregulation of CTLA4 by donor-reactive CD4 + T cells in DCreg-infused recipients treated with CTLA4Ig, might be associated with higher incidences of donor-reactive CD4 + T cells with a Treg phenotype. In normal rhesus monkeys, allo-stimulated CD4 + CTLA4 hi , but not CD4 + CTLA4 med/lo T cells exhibited a regulatory phenotype, irrespective of PD1 expression. CTLA4Ig significantly reduced the incidence of CD4 + CTLA4 hi , but not CD4 + CTLA4 med/lo T cells following allo-stimulation, associated with a significant reduction in the CD4 + CTLA4 hi /CD4 + CTLA4 med/lo T cell ratio. In CTLA4Ig-treated renal allograft recipient monkeys, there was a marked reduction in circulating donor-reactive CD4 + CTLA4 hi T cells. In contrast, in CTLA4Ig-treated monkeys with DCreg infusion, no such reduction was observed. In parallel, the donor-reactive CD4 + CTLA4 hi /CD4 + CTLA4 med/lo T cell ratio was reduced significantly in graft recipients without DCreg infusion, but increased in those given DCreg. These observations suggest that pre-transplant DCreg infusion promotes and maintains donor-reactive CD4 + CTLA4 hi T cells with a regulatory phenotype after transplantation, even in the presence of CD28 co-stimulation blockade.

Donor-Derived Regulatory Dendritic Cell Infusion Maintains Donor-Reactive CD4+CTLA4hi T Cells in Non-Human Primate Renal Allograft Recipients Treated with CD28 Co-Stimulation Blockade

PubMed Central

Ezzelarab, Mohamed B.; Lu, Lien; Shufesky, William F.; Morelli, Adrian E.; Thomson, Angus W.

2018-01-01

Donor-derived regulatory dendritic cell (DCreg) infusion before transplantation, significantly prolongs renal allograft survival in non-human primates. This is associated with enhanced expression of the immunoregulatory molecules cytotoxic T-lymphocyte-associated antigen (Ag) 4 (CTLA4) and programmed cell death protein 1 (PD1) by host donor-reactive T cells. In rodents and humans, CD28 co-stimulatory pathway blockade with the fusion protein CTLA4:Ig (CTLA4Ig) is associated with reduced differentiation and development of regulatory T cells (Treg). We hypothesized that upregulation of CTLA4 by donor-reactive CD4+ T cells in DCreg-infused recipients treated with CTLA4Ig, might be associated with higher incidences of donor-reactive CD4+ T cells with a Treg phenotype. In normal rhesus monkeys, allo-stimulated CD4+CTLA4hi, but not CD4+CTLA4med/lo T cells exhibited a regulatory phenotype, irrespective of PD1 expression. CTLA4Ig significantly reduced the incidence of CD4+CTLA4hi, but not CD4+CTLA4med/lo T cells following allo-stimulation, associated with a significant reduction in the CD4+CTLA4hi/CD4+CTLA4med/lo T cell ratio. In CTLA4Ig-treated renal allograft recipient monkeys, there was a marked reduction in circulating donor-reactive CD4+CTLA4hi T cells. In contrast, in CTLA4Ig-treated monkeys with DCreg infusion, no such reduction was observed. In parallel, the donor-reactive CD4+CTLA4hi/CD4+CTLA4med/lo T cell ratio was reduced significantly in graft recipients without DCreg infusion, but increased in those given DCreg. These observations suggest that pre-transplant DCreg infusion promotes and maintains donor-reactive CD4+CTLA4hi T cells with a regulatory phenotype after transplantation, even in the presence of CD28 co-stimulation blockade. PMID:29520267

Volumetry-based selection of right posterior sector grafts for adult living donor liver transplantation.

PubMed

Kim, Bong-Wan; Xu, Weiguang; Wang, Hee-Jung; Park, Yong-Keun; Lee, Kwangil; Kim, Myung-Wook

2011-09-01

To determine the feasibility of volumetric criteria without anatomic exclusion for the selection of right posterior sector (RPS) grafts for adult-to-adult living donor liver transplantation (LDLT), we reviewed and compared our transplant data for RPS grafts and right lobe (RL) grafts. Between January 2008 and September 2010, adult-to-adult LDLT was performed 65 times at our institute; 13 of the procedures (20%) were performed with RPS grafts [the posterior sector (PS) group], and 39 (60%) were performed with RL grafts (the RL group). The volumetry of the 13 RPS donor livers showed that the RPS volume was 39.8% ± 7.6% of the total liver volume. Ten of the 13 donors had to donate RPS grafts because the left liver volume was inadequate. All donor procedures were performed successfully, and all donors recovered from hepatectomy. However, longer operative times were required for the procurement of RPS grafts versus RL grafts (418 ± 40 versus 345 ± 48 minutes, P < 0.001). The postoperative recovery of liver function was smoother for the donors of the PS group versus the donors of the RL group. The RPS grafts had significantly smaller hepatic artery and bile duct openings than the RL grafts. All recipients with RPS grafts survived LDLT. No recipients experienced vascular graft complications or small-for-size graft dysfunction. There were no significant differences in the incidence of posttransplant complications between the donors and recipients of the PS and RL groups. The 3-year graft survival rates were favorable in both groups (100% in the PS group versus 91% in the RL group). In conclusion, the selection of RPS grafts by volume criteria is a feasible strategy for an adult-to-adult LDLT program. Copyright © 2011 American Association for the Study of Liver Diseases.

Silver-coated nylon dressing plus active DC microcurrent for healing of autogenous skin donor sites.

PubMed

Malin, Edward W; Galin, Chaya M; Lairet, Kimberley F; Huzar, Todd F; Williams, James F; Renz, Evan M; Wolf, Steven E; Cancio, Leopoldo C

2013-11-01

Burn wounds are a significant cause of morbidity and mortality, and improved outcomes are demonstrated with early closure of both primary burn wounds and skin donor sites. Thus, technology that decreases the healing time of burns and donor sites would be potentially lifesaving. We present the results of a single-center, prospective, double-blinded, randomized controlled trial to evaluate the efficacy of silver-coated dressing with active microcurrent in comparison to silver-coated dressing with sham microcurrent on wound-closure time for autogenous skin donor sites. Four hundred five patients were screened for treatment of their donor sites using a silver-coated nylon dressing with either sham or active microcurrent stimulation. Thirty patients were enrolled in the study and then randomized. Of these, 5 patients were removed from analysis due to protocol deviations. Differences in time-to-closure were analyzed using Kaplan-Meier analysis and the proportional hazard regression model. Subjective verbal pain rating scores (0-10; 0, no pain; 10, worst pain) were also recorded. All devices were blinded and programmed at an outside facility, so that every patient had either an active or sham device. The study was unblinded only after the final patient's donor site had healed. All patients achieved donor-site healing before postoperative day 20. The 14 patients in the active microcurrent group [mean, 10.8 (2.9) days; range, 7-15 days] experienced no difference in time to wound healing as compared to the remaining patients in the sham microcurrent group [mean, 11.1 (2.0) days; range, 8-14 days; P = 0.75]. There were no differences in pain from one group compared to the other. None of the donor sites exhibited clinical signs of infection. In a sample size of 25 burn patients, the addition of direct microcurrent to silver-nylon dressings did not decrease time to wound closure of skin donor sites, and it did not show a difference in reported pain levels.

Prediction models of donor arrest and graft utilization in liver transplantation from maastricht-3 donors after circulatory death.

PubMed

Davila, D; Ciria, R; Jassem, W; Briceño, J; Littlejohn, W; Vilca-Meléndez, H; Srinivasan, P; Prachalias, A; O'Grady, J; Rela, M; Heaton, N

2012-12-01

Shortage of organs for transplantation has led to the renewed interest in donation after circulatory-determination of death (DCDD). We conducted a retrospective analysis (2001-2009) and a subsequent prospective validation (2010) of liver Maastricht-Category-3-DCDD and donation-after-brain-death (DBD) offers to our program. Accepted and declined offers were compared. Accepted DCDD offers were divided into donors who went on to cardiac arrest and those who did not. Donors who arrested were divided into those producing grafts that were transplanted or remained unused. Descriptive comparisons and regression analyses were performed to assess predictor models of donor cardiac arrest and graft utilization. Variables from the multivariate analysis were prospectively validated. Of 1579 DCDD offers, 621 were accepted, and of these, 400 experienced cardiac arrest after withdrawal of support. Of these, 173 livers were transplanted. In the DCDD group, donor age < 40 years, use of inotropes and absence of gag/cough reflexes were predictors of cardiac arrest. Donor age >50 years, BMI >30, warm ischemia time >25 minutes, ITU stay >7 days and ALT ≥ 4× normal rates were risk factors for not using the graft. These variables had excellent sensitivity and specificity for the prediction of cardiac arrest (AUROC = 0.835) and graft use (AUROC = 0.748) in the 2010 prospective validation. These models can feasibly predict cardiac arrest in potential DCDDs and graft usability, helping to avoid unnecessary recoveries and healthcare expenditure. © Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons.

Systematic donor selection review process improves cardiac transplant volumes and outcomes.

PubMed

Smith, Jason W; O'Brien, Kevin D; Dardas, Todd; Pal, Jay D; Fishbein, Daniel P; Levy, Wayne C; Mahr, Claudius; Masri, Sofia C; Cheng, Richard K; Stempien-Otero, April; Mokadam, Nahush A

2016-01-01

Heart transplant remains the definitive therapy for advanced heart failure patients but is limited by organ availability. We identified a large number of donor hearts from our organ procurement organization (OPO) being exported to other regions. We engaged a multidisciplinary team including transplant surgeons, cardiologists, and our OPO colleagues to identify opportunities to improve our center-specific organ utilization rate. We performed a retrospective analysis of donor offers before and after institution of a novel review process. Each donor offer made to our program was reviewed on a monthly basis from July 2013 to June 2014 and compared with the previous year. This review process resulted in a transplant utilization rate of 28% for period 1 versus 49% for period 2 (P = .007). Limiting the analysis to offers from our local OPO changed our utilization rate from 46% to 75% (P = .02). Transplant volume increased from 22 to 35 between the 2 study periods. Thirty-day and 1-year mortality were unchanged over the 2 periods. A total of 58 hearts were refused by our center and transplanted at other centers. During period 1, the 30-day and 1-year survival rates for recipients of those organs were 98% and 90%, respectively, comparable with our historical survival data. The simple process of systematically reviewing donor turndown events as a group tended to reduce variability, increase confidence in expanded criteria for donors, and resulted in improved donor organ utilization and transplant volumes. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Distinctive gene expression profiles characterize donor biopsies from HCV-positive kidney donors.

PubMed

Mas, Valeria R; Archer, Kellie J; Suh, Lacey; Scian, Mariano; Posner, Marc P; Maluf, Daniel G

2010-12-15

Because of the shortage of organs for transplantation, procurement of kidneys from extended criteria donors is inevitable. Frequently, donors infected with hepatitis C virus (HCV) are used. To elucidate an initial compromise of molecular pathways in HCV graft, gene expression profiles were evaluated. Twenty-four donor allograft biopsies (n=12 HCV positive (+) and n=12 HCV negative (-)) were collected at preimplantation time and profiled using microarrays. Donors were age, race, gender, and cold and warm ischemia time matched between groups. Probe level data were read into the R programming environment using the affy Bioconductor package, and the robust multiarray average method was used to obtain probe set expression summaries. To identify probe sets exhibiting differential expression, a two sample t test was performed. Molecular and biologic functions were analyzed using Interaction Networks and Functional Analysis. Fifty-eight probe sets were differentially expressed between HCV (+) versus HCV (-) donors (P<0.001). The molecular functions associated with the two top scored networks from the analysis of the differentially expressed genes were connective tissue development and function and tissue morphology (score 34), cell death, cell signaling, cellular assembly, and organization (score 32). Among the differentially affected top canonical pathways, we found the role of RIG1-like receptors in antiviral innate immunity (P<0.001), natural killer cell signaling (P=0.007), interleukin-8 signaling (P=0.048), interferon signaling (P=0.0 11; INFA21, INFGR1, and MED14), ILK signaling (P=0.001), and apoptosis signaling. A unique gene expression pattern was identified in HCV (+) kidney grafts. Innate immune system and inflammatory pathways were the most affected.

Association of ABO and Rh Blood Groups to Blood-Borne Infections among Blood Donors in Tehran-Iran

PubMed Central

MOHAMMADALI, Fatemeh; POURFATHOLLAH, Aliakbar

2014-01-01

Abstract Background The aim of this study was to investigate the prevalence of hepatitis B, hepatitis C, HIV and syphilis infections in blood donors referred to Tehran Blood Transfusion Center (TBTC), and determine any association between blood groups and blood- borne infections between the years of 2005 and 2011. Methods This was a retrospective study conducted at TBTC. All of the donor serum samples were screened for HBV, HCV, HIV and syphilis by using third generation ELISA kits and RPR test. Initial reactive samples were tested in duplicate. Confirmatory tests were performed on all repeatedly reactive donations. Blood group was determined by forward and reverse blood grouping. The results were subjected to chi square analysis for determination of statistical difference between the values among different categories according to SPSS program. Results Overall, 2031451 donor serum samples were collected in 2005-2011. Totally, 10451 were positive test for HBV, HCV, HIV and syphilis. The overall seroprevalence of HBV, HCV, HIV, and syphilis was 0.39%, 0.11%, 0.005%, and 0.010%, respectively. Hepatitis B and HIV infections were significantly associated with blood group of donors (P <0.05) ; percentage of HIV Ag/Ab was higher in donors who had blood group “A” and percentage of HBs Ag was lower in donors who had blood group O. There was no significant association between Hepatitis C and syphilis infections with ABO and Rh blood groups (P>0.05). Conclusion Compared with neighboring countries and the international standards, prevalence of blood-borne infections is relatively low. PMID:25909065

Association of ABO and Rh Blood Groups to Blood-Borne Infections among Blood Donors in Tehran-Iran.

PubMed

Mohammadali, Fatemeh; Pourfathollah, Aliakbar

2014-07-01

The aim of this study was to investigate the prevalence of hepatitis B, hepatitis C, HIV and syphilis infections in blood donors referred to Tehran Blood Transfusion Center (TBTC), and determine any association between blood groups and blood- borne infections between the years of 2005 and 2011. This was a retrospective study conducted at TBTC. All of the donor serum samples were screened for HBV, HCV, HIV and syphilis by using third generation ELISA kits and RPR test. Initial reactive samples were tested in duplicate. Confirmatory tests were performed on all repeatedly reactive donations. Blood group was determined by forward and reverse blood grouping. The results were subjected to chi square analysis for determination of statistical difference between the values among different categories according to SPSS program. Overall, 2031451 donor serum samples were collected in 2005-2011. Totally, 10451 were positive test for HBV, HCV, HIV and syphilis. The overall seroprevalence of HBV, HCV, HIV, and syphilis was 0.39%, 0.11%, 0.005%, and 0.010%, respectively. Hepatitis B and HIV infections were significantly associated with blood group of donors (P <0.05) ; percentage of HIV Ag/Ab was higher in donors who had blood group "A" and percentage of HBs Ag was lower in donors who had blood group O. There was no significant association between Hepatitis C and syphilis infections with ABO and Rh blood groups (P>0.05). Compared with neighboring countries and the international standards, prevalence of blood-borne infections is relatively low.

Report on SARS backfit evaluation, Exxon Donor Solvent Plant, Baytown, Texas

DOE Office of Scientific and Technical Information (OSTI.GOV)

Meyer, A.F. Jr.

1980-07-02

This report provides information on observations, findings, and conclusions arising from a site visit to the Exxon Donor Solvent Plant, Baytown, Texas. That visit was to provide technical assistance and professional services to the DOE/ASFE/OPTA Project Officer regarding verification of his initial determination that this pilot plant is exempt from the SARS backfit requirement (DOE Order 5481.1). A secondary purpose was to obtain further information regarding the occupational safety and health plans and procedures at this new pilot plant facility. It is concluded that a well planned and implemented occupational safety and health program exists at the Exxon Donor Solventmore » Plant. Excellent manuals regarding general safety requirements and protection against carcinogens have been prepared and distributed. A Safe Operations Committee is in effect as is a Risk Management Committee. Adequate safety and industrial hygiene staff has been assigned and an excellent medical surveillance program has been established. Adequate compliance with environmental codes, standards, and regulations is being achieved. Although this plant is not subject to SARS because of the nature of the contract, adequate documentation exists in any case to exempt it from the SARS backfit requirement.« less

Positive impact of a clinical goal-directed protocol on reducing cardiac arrests during potential brain-dead donor maintenance.

PubMed

Westphal, Glauco A; Coll, Elisabeth; de Souza, Rafael L; Wagner, Silvana; Montemezzo, Artur; Cani de Souza, Fernanda Carolina; Torres, Gabriel; Halla, Stefan; Carnin, Tiago C; Machado, Míriam C; Berbigier, Eduardo; Busetto, Fernando; Bittencourt, Ivonei; Gerent, Karine; de Souza, Bruno S; Tassinari, Manoel; de Andrade, Joel

2016-10-11

The disproportion between the large organ demand and the low number of transplantations performed represents a serious public health problem worldwide. Reducing the loss of transplantable organs from deceased potential donors as a function of cardiac arrest (CA) may contribute to an increase in organ donations. Our purpose was to test the hypothesis that a goal-directed protocol to guide the management of deceased donors may reduce the losses of potential brain-dead donors (PBDDs) due to CA. The quality improvement project included 27 hospitals that reported deceased donors prospectively to the Transplant Center of the State of Santa Catarina, Brazil. All deceased donors reported prospectively between May 2012 and April 2014 were analyzed. Hospitals were encouraged to use the VIP approach checklist during the management of PBDDs. The checklist was composed of the following goals: protocol duration 12-24 hours, temperature > 35 °C, mean arterial pressure ≥ 65 mmHg, diuresis 1-4 ml/kg/h, corticosteroids, vasopressin, tidal volume 6-8 ml/kg, positive end-expiratory pressure 8-10 cmH 2 O, sodium < 150 mEq/L, and glycemia < 180 mg/dl. A logistic regression model was used to identify predictors of CA. There were 726 PBDD notifications, of which 324 (44.6) were actual donors, 141 (19.4 %) CAs, 226 (31.1 %) family refusals, and 35 (4.8 %) contraindications. Factors associated with CA reduction included use of the checklist (odds ratio (OR) 0.43, p < 0.001), maintenance performed inside the ICU (OR 0.49, p = 0.013), and vasopressin administration (OR 0.56, p = 0.04). More than three interventions had association with less CAs (OR 0.19, p < 0.001). After 24 months, CAs decreased from 27.3 % to 14.6 % (p = 0.002), reaching 12.1 % in the following two 4-month periods (p < 0.001). Simultaneous increases in organ recovered per donor and in actual donors were observed. A quality improvement program based on education and the use of a goal checklist for the management of potential donors inside the ICU is strongly associated with a decrease in donor losses and an increase in organs recovered per donor.

Management practices to support donor transition: lessons from Avahan, the India AIDS Initiative.

PubMed

Bennett, Sara; Rodriguez, Daniela; Ozawa, Sachiko; Singh, Kriti; Bohren, Meghan; Chhabra, Vibha; Singh, Suneeta

2015-06-13

During 2009-2012, Avahan, a large donor funded HIV/AIDS prevention program in India was transferred from donor support and operation to government. This transition of approximately 200 targeted interventions (TIs), occurred in three tranches in 2009, 2011 and 2012. This paper reports on the management practices pursued in support of a smooth transition of the program, and addresses the extent to which standard change management practices were employed, and were useful in supporting transition. We conducted structured surveys of a sample of 80 TIs from the 2011 and 2012 rounds of transition. One survey was administered directly before transition and the second survey 12 month after transition. These surveys assessed readiness for transition and practices post-transition. We also conducted 15 case studies of transitioning TIs from all three rounds, and re-visited 4 of these 1-3 years later. Considerable evolution in the nature of relationships between key actors was observed between transition rounds, moving from considerable mistrust and lack of collaboration in 2009 toward a shared vision of transition and mutually respectful relationships between Avahan and government in later transition rounds. Management practices also evolved with the gradual development of clear implementation plans, establishment of the post of "transition manager" at state and national levels, identified budgets to support transition, and a common minimum programme for transition. Staff engagement was important, and was carried out relatively effectively in later rounds. While the change management literature suggests short-term wins are important, this did not appear to be the case for Avahan, instead a difficult first round of transition seemed to signal the seriousness of intentions regarding transition. In the Avahan case a number of management practices supported a smooth transition these included: an extended and sequenced time frame for transition; co-ownership and planning of transition by both donor and government; detailed transition planning and close attention to program alignment, capacity development and communication; engagement of staff in the transition process; engagement of multiple stakeholders post transition to promote program accountability and provide financial support; signaling by actors in charge of transition that they were committed to specified time frames.

Monitoring and evaluating transition and sustainability of donor-funded programs: Reflections on the Avahan experience.

PubMed

Bennett, Sara; Ozawa, Sachiko; Rodriguez, Daniela; Paul, Amy; Singh, Kriti; Singh, Suneeta

2015-10-01

In low and middle-income countries, programs funded and implemented by international donors frequently transition to local funding and management, yet such processes are rarely evaluated. We reflect upon experience evaluating the transition of a large scale HIV/AIDS prevention program in India, known as Avahan, in order to draw lessons about transition evaluation approaches and implementation challenges. In terms of conceptualizing the transition theory, the evaluation team identified tensions between the idea of institutionalizing key features of the Avahan program, and ensuring program flexibility to promote sustainability. The transition was planned in three rounds allowing for adaptations to transition intervention and program design during the transition period. The assessment team found it important to track these changes in order to understand which strategies and contextual features supported transition. A mixed methods evaluation was employed, combining semi-structured surveys of transitioning entities (conducted pre and post transition), with longitudinal case studies. Qualitative data helped explain quantitative findings. Measures of transition readiness appeared robust, but we were uncertain of the robustness of institutionalization measures. Finally, challenges to the implementation of such an evaluation are discussed. Given the scarceness of transition evaluations, the lessons from this evaluation may have widespread relevance. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Kidney and liver transplants from donors after cardiac death: initial experience at the London Health Sciences Centre.

PubMed

Hernandez-Alejandro, Roberto; Caumartin, Yves; Chent, Cameron; Levstik, Mark A; Quan, Douglas; Muirhead, Norman; House, Andrew A; McAlister, Vivian; Jevnikar, Anthony M; Luke, Patrick P W; Wall, William

2010-04-01

The disparity between the number of patients waiting for an organ transplant and availability of donor organs increases each year in Canada. Donation after cardiac death (DCD), following withdrawal of life support in patients with hopeless prognoses, is a means of addressing the shortage with the potential to increase the number of transplantable organs. We conducted a retrospective, single-centre chart review of organs donated after cardiac death to the Multi-Organ Transplant Program at the London Health Sciences Centre between July 2006 and December 2007. In total, 34 solid organs (24 kidneys and 10 livers) were procured from 12 DCD donors. The mean age of the donors was 38 (range 18-59) years. The causes of death were craniocerebral trauma (n = 7), cerebrovascular accident (n = 4) and cerebral hypoxia (n = 1). All 10 livers were transplanted at our centre, as were 14 of the 24 kidneys; 10 kidneys were transplanted at other centres. The mean renal cold ischemia time was 6 (range 3-9.5) hours. Twelve of the 14 kidney recipients (86%) experienced delayed graft function, but all kidneys regained function. After 1-year follow-up, kidney function was good, with a mean serum creatinine level of 145 (range 107-220) micromol/L and a mean estimated creatinine clearance of 64 (range 41-96) mL/min. The mean liver cold ischemia time was 5.8 (range 5.5-8) hours. There was 1 case of primary nonfunction requiring retransplantation. The remaining 9 livers functioned well. One patient developed a biliary anastomotic stricture that resolved after endoscopic stenting. All liver recipients were alive after a mean follow-up of 11 (range 3-20) months. Since the inception of this DCD program, the number of donors referred to our centre has increased by 14%. Our initial results compare favourably with those from the transplantation of organs procured from donors after brain death. Donation after cardiac death can be an important means of increasing the number of organs available for transplant, and its widespread implementation in Canada should be encouraged.

Rare successful pregnancy in a patient with Swyer Syndrome.

PubMed

Taneja, Jyoti; Ogutu, David; Ah-Moye, Michael

2016-10-01

To report a rare successful pregnancy after fertility treatment in a patient with Swyer syndrome. Case report. Herts & Essex Fertility Centre, Cheshunt, UK. A 36-year-old patient with 46, XY gonadal dysgenesis. 31 year old husband with normal sperm analysis. Chromosomal analysis, Saline infusion sonography, Pipelle endometrial scratch, ICSI using donor eggs, Embryo Transfer, and Caesarean delivery. Successful pregnancy and live birth. Successful treatment with donor eggs, pregnancy, and delivery. A patient with 46, XY gonadal dysgenesis in a specially tailored fertility program, can maintain a normal pregnancy and delivery.

Brain donation for schizophrenia research: gift, consent, and meaning

PubMed Central

Boyes, M; Ward, P

2003-01-01

The Neuroscience Institute of Schizophrenia and Allied Disorders's (NISAD) "Gift of Hope" Tissue Donor Program is a volunteer programme for people who wish to donate their brain when they die for neuroscience research into schizophrenia. Organ donation for purposes of research differs from transplant donation in a number of ways, most notably the absence of a single recipient. Within a particular community, however, (people with schizophrenia and their carers) the single recipient is replaced by a sense of shared experience and preventing suffering in others. Donors have an investment in the research. PMID:12796437

Family Caregiver Alliance

MedlinePlus

... content Search form Search About FCA Mission and Values Programs and Services Overview Board and Staff Grants and Awards FCA Donors FCA History Jobs at FCA Caregiver Education Health Conditions Caregiving Issues and Strategies Fact and ...

PEPFAR Transitions to Country Ownership: Review of Past Donor Transitions and Application of Lessons Learned to the Eastern Caribbean

PubMed Central

Vogus, Abigail; Graff, Kylie

2015-01-01

The US President’s Emergency Plan for AIDS Relief (PEPFAR) has shifted from an emergency response to a sustainable, country-owned response. The process of transition to country ownership is already underway in the Eastern Caribbean; the Office of the US Global AIDS Coordinator (OGAC) has advised the region that PEPFAR funding is being redirected away from the Eastern Caribbean toward Caribbean countries with high disease burden to strengthen services for key populations. This article seeks to highlight and apply lessons learned from other donor transitions to support a successful transition of HIV programs in the Eastern Caribbean. Based on a rapid review of both peer-reviewed and gray literature on donor transitions to country ownership in family planning, HIV, and other areas, we identified 48 resources that addressed key steps in the transition process and determinants of readiness for transition. Analysis of the existing literature revealed 6 steps that could help ensure successful transition, including developing a clear roadmap articulated through high-level diplomacy; investing in extensive stakeholder engagement; and supporting monitoring and evaluation during and after the transition to adjust course as needed. Nine specific areas to assess a country’s readiness for transition include: leadership and management capacity, political and economic factors, the policy environment, identification of alternative funding sources, integration of HIV programs into the wider health system, the institutionalization of processes, the strength of procurement and supply chain management, identification of staffing and training needs, and engagement of civil society and the private sector. In the Caribbean, key areas requiring strengthening to ensure countries in the region can maintain the gains made under PEPFAR include further engaging civil society and the private sector, building the capacity of NGOs to take on essential program functions, and maintaining donor support for targeted capacity building and long-term monitoring and evaluation efforts. PMID:26085023

The policies of organ transplantation in Europe: issues and problems.

PubMed

Defever, M

1990-11-01

Transplantation has evolved from an experiment to a routinely performed procedure for a widening range of organs. Transplantation in Europe is dominated by the scarcity of organs from deceased donors leading to problems of selection criteria for recipients, of legal protection for donors and of the empowerment of agencies for allocative decisions. Although public involvement is very emotional, there has been a benign neglect in several European countries by policy makers, accepting implicitly organ transplantation leading to a variety of programs for diffusion, organization, and financing of transplantation. Non-transplanting hospitals play a key role in organ procurement and transplant centers are increasingly subject to quality assessment, whereby the issue of the relation between improved outcome at higher volumes comes to the forefront. International cooperation is critical for the development of effective transplant programs in Europe.

Hematopoietic Cell Transplantation in 2020: Summary of Year 2 Recommendations of the National Marrow Donor Program’s System Capacity Initiative

PubMed Central

Denzen, Ellen M.; Majhail, Navneet S.; Ferguson, Stacy Stickney; Anasetti, Claudio; Bracey, Arthur; Burns, Linda; Champlin, Richard; Chell, Jeffrey; Leather, Helen; Lill, Michael; Maziarz, Richard T.; Medoff, Erin; Neumann, Joyce; Schmit-Pokorny, Kim; Snyder, Edward L.; Wiggins, Laura; Yolin Raley, Deborah S.; Murphy, Elizabeth A.

2013-01-01

The National Marrow Donor Program, in partnership with the American Society for Blood and Marrow Transplantation, sponsored and organized a series of symposia to identify complex issues affecting the delivery of hematopoietic cell transplantation (HCT) and to collaboratively develop options for solutions. “Hematopoietic Cell Transplantation in 2020: A System Capacity Initiative” used a deliberative process model to engage professional organizations, experts, transplant centers, and stakeholders in a national collaborative effort. Year 2 efforts emphasized data analysis and identification of innovative ideas to increase HCT system efficiency, address future capacity requirements, and ensure adequate reimbursement for HCT programs to meet the projected need for HCT. This report highlights the deliberations and recommendations of Year 2 and the associated symposium held in September 2011. PMID:23078785

Revisiting double kidney transplantation: two kidneys provide better graft survival than one.

PubMed

Cruzado, J M; Fernandez, L; Riera, L; Bestard, O; Carrera, M; Torras, J; Gil Vernet, S; Melilli, E; Ngango, L; Grinyó, J M

2011-01-01

Double kidney transplantation is an accepted strategy to increase the donor pool. Regarding older donor kidneys, protocols for deciding to perform a dual or a single transplantation are mainly based on preimplantation biopsies. The aim of our study was to evaluate the long-term graft and patient survivals of our "Dual Kidney Transplant program." Patients who lost one of their grafts peritransplantation were used as controls. A total of 203 patients underwent kidney transplantation from December 1996 to January 2008 in our "old for old" renal transplantation program. We excluded 21 patients because of a nonfunctioning kidney, hyperacute rejection, or patient death with a functioning graft within the first month. Seventy-nine among 182 kidney transplantation the "old for old" program were dual kidney transplantation (DKT). Fifteen of 79 patients lost one of their kidney grafts (the uninephrectomized (UNX) UNX group). At 1 year, renal function was lower and proteinuria greater among the UNX than the DKT group. Patient survival was similar in both groups. However, death-censored graft survival was lower in UNX than DKT patients. The 5-year graft survival rate was 70% in UNX versus 93% in DKT cohorts (P = .04). In conclusion, taking into account the kidney shortage, our results may question whether the excellent transplant outcomes with DKT counter balance the reduced donor pool obviating acceptable transplant outcomes for more patients with single kidney transplantation. Copyright © 2011 Elsevier Inc. All rights reserved.

A Cost Analysis of Kidney Replacement Therapy Options in Palestine

PubMed Central

Jabr, Samer; Al-Khatib, Abdallah; Forgione, Dana; Hartmann, Michael; Kisa, Adnan

2015-01-01

This study provides a cost analysis of kidney replacement therapy options in Palestine. It informs evidence-based resource allocation decisions for government-funded kidney disease services where transplant donors are limited, and some of the common modalities, i.e., peritoneal dialysis (PD) and home hemodialysis (HD), are not widely available due to shortages of qualified staff, specialists, and centers to follow the patient cases, provide training, make home visits, or provide educational programs for patients. The average cost of kidney transplant was US$16 277 for the first year; the estimated cost of HD per patient averaged US$16 085 per year—nearly as much as a transplant. Consistent with prior literature and experience, while live, related kidney donors are scarce, we found that kidney transplant was more adequate and less expensive than HD. These results have direct resource allocation implications for government-funded kidney disease services under Palestinian Ministry of Health. Our findings strongly suggest that investing in sufficient qualified staff, equipment, and clinical infrastructure to replace HD services with transplantation whenever medically indicated and suitable kidney donors are available, as well as deploying PD programs and Home HD programs, will result in major overall cost savings. Our results provide a better understanding of the costs of kidney disease and will help to inform Ministry of Health and related policy makers as they develop short- and long-term strategies for the population, in terms of both cost savings and enhanced quality of life. PMID:25765018

A cost analysis of kidney replacement therapy options in Palestine.

PubMed

Younis, Mustafa; Jabr, Samer; Al-Khatib, Abdallah; Forgione, Dana; Hartmann, Michael; Kisa, Adnan

2015-01-01

This study provides a cost analysis of kidney replacement therapy options in Palestine. It informs evidence-based resource allocation decisions for government-funded kidney disease services where transplant donors are limited, and some of the common modalities, i.e., peritoneal dialysis (PD) and home hemodialysis (HD), are not widely available due to shortages of qualified staff, specialists, and centers to follow the patient cases, provide training, make home visits, or provide educational programs for patients. The average cost of kidney transplant was US$16,277 for the first year; the estimated cost of HD per patient averaged US$16,085 per year--nearly as much as a transplant. Consistent with prior literature and experience, while live, related kidney donors are scarce, we found that kidney transplant was more adequate and less expensive than HD. These results have direct resource allocation implications for government-funded kidney disease services under Palestinian Ministry of Health. Our findings strongly suggest that investing in sufficient qualified staff, equipment, and clinical infrastructure to replace HD services with transplantation whenever medically indicated and suitable kidney donors are available, as well as deploying PD programs and Home HD programs, will result in major overall cost savings. Our results provide a better understanding of the costs of kidney disease and will help to inform Ministry of Health and related policy makers as they develop short- and long-term strategies for the population, in terms of both cost savings and enhanced quality of life. © The Author(s) 2015.

[Current program of in-vitro fertilization at the Erasmus Hospital: initial results and original ethical aspects].

PubMed

Englert, Y; Van den Bergh, M; Rodesch, C; Van der Vorst, P; Berberoglugil, P; Laruelle, C; Biramane, J; Gervy, C; Schwers, J

1991-10-01

The clinical results including all in vitro fertilization (IVF) cycles with oocyte pick-up in 1990 are presented. Different types of treatment including classical IVF and embryo transfer, laparoscopic replacement of zygotes in the fallopian tube (ZIFT), IVF with donor sperm (IVF-D), cross fertilization test, embryo freezing, oocyte donation and IVF with epididymal sperm were performed. The total pregnancy rate obtained reaches 38% per oocyte pick-up, 30% of clinical pregnancies (including 4 pregnancies obtained with frozen and thawed embryos). The anticipated "Take Home Baby Rate" will be around 25% per oocyte pick-up, 26 of these 40 pregnancies being today over 20 weeks of gestation. Particular ethical aspects of the program are presented: a study on couple's attitudes regarding embryo freezing as well as the final destination of possibly remaining supernumerary embryos will stress the importance of a precise clear decision on that matter before entering IVF treatment. Indeed the couple's idea on embryo destiny were very precise but also very different. The oocyte donation program has the originality of preserving the donor's anonymity by exchanging the donors recruited by the patients. It will be stressed that this kind of approach combines higher pregnancy chances for the patients, respect of ethical principles linked to gamete donation and gives satisfaction to the patients. The global normalized pregnancy cumulative curve shows that 60% of the couples entering IVF treatment will obtain a child within the first three pick-up cycles.

Should We Formulate an Incentivized Model Facilitating Kidney Donation from Living Donors? A Focus on Turkey's Current System.

PubMed

Avci, Ercan

2018-04-23

Kidney transplantation is a lifesaving medical treatment. However, very high demand for kidneys with low kidney donation causes a black market that exploits patients' desperation and donors' vulnerability. The current kidney donation programs fail to produce promising results to avoid illegal and unethical kidney trafficking and commercialism. Even though the primary goal of kidney donation is to increase the number of deceased organ donations, in some countries, like Turkey, due to religious or cultural concerns, it is impossible to supply adequate deceased kidney donations. In this view, the aim of this paper is to examine kidney trafficking in the scope of Turkey's current organ donation system and propose a new model, named the Incentivized Kidney Donation Model (IKDM), to increase kidney donation from living donors. The model encompasses the following benefits offered to kidney donors; lifetime health insurance, exemptions from copayments/contribution shares, priority when receiving an organ, priority when finding a job, income tax exemptions for salaried employees, and free or discounted public utilities. This normative model has the potential to promote donors' altruistic acts as well as the solidarity and loyalty among members of a society without violating ethical values and internationally accepted principles. © 2018 John Wiley & Sons Ltd.

Thalassemia and Hemoglobin E in Southern Thai Blood Donors

PubMed Central

Kruachan, Kwanta; Sengking, Warachaya; Horpet, Dararat; Sungyuan, Ubol

2014-01-01

Thalassemia and hemoglobin E (Hb E) are common in Thailand. Individuals with thalassemia trait usually have a normal hemoglobin concentration or mild anemia. Therefore, thalassemic individuals who have minimum acceptable Hb level may be accepted as blood donors. This study was aimed at determining the frequency of α-thalassemia 1 trait, β-thalassemia trait, and Hb E-related syndromes in Southern Thai blood donors. One hundred and sixteen voluntary blood donors, Southern Thailand origin, were recruited for thalassemia and Hb E screening by red blood cell indices/dichlorophenolindophenol precipitation test. β-Thalassemia and Hb E were then identified by high performance liquid chromatography and 4 common α-thalassemia deletions were characterized by a single tube-multiplex gap-polymerase chain reaction. Overall frequency of hemoglobinopathies was 12.9%, classified as follows: homozygous α-thalassemia 2 (1.7%), heterozygous α-thalassemia 1 (1.7%), heterozygous β-thalassemia without α-thalassemia (0.9%), heterozygous Hb E without α-thalassemia (5.2%), double heterozygotes for Hb E/α-thalassemia 1 (1.7%), homozygous Hb E without α-thalassemia (0.9%), and homozygous Hb E with heterozygous α-thalassemia 2 (0.9%). The usefulness of thalassemia screening is not only for receiving highly effective red blood cells in the recipients but also for encouraging the control and prevention program of thalassemia in blood donors. PMID:25050123

Seroprevalence of transfusion transmissible infections (TTI), in first time blood donors in Abeokuta, Nigeria.

PubMed

Motayo, Babatunde Olanrewaju; Faneye, Adedayo Omotayo; Udo, Usen Asuquo; Olusola, Babatunde Adebiyi; Ezeani, Isreal; Ogiogwa, Joseph Iruobe

2015-03-01

Transfusion transmissible infections, such as HIV, HBV, HCV and syphilis are on the rise and pose a threat to blood safety. To determine prevalence and demographic profiles of TTI's among first time blood donors in Abeokuta, Nigeria. The study was conducted between February to November 2013; 130 first time blood donors were tested for the presence of HIV, HBsAg, HCV antibodies and Treponema palidium antibodies using EIA based rapid immunochromatographic kits. Data analysis was done using SPSS with a level of significance of p<0.05. Prevalence rates to HIV, HBsAg, HCV antibody, were 6.2% (n=8), 10% (n=13) and 1.5% (n=2), there was 0% prevalence to Treponema palidium antibodies. Group specific prevalence rates revealed that educational status was associated with HBsAg positivity (p = 0.028), donors with a history of previous blood transfusion was also statistically associated with HIV sero-reactivity (p = 0.013). High levels of HBsAg and HIV were observed, there is need to revise the donor testing algorithm in Nigeria in line with the prevalence of TTI's. We also advocate that a National surveillance system for TTI's be established through our National blood transfusion service (NBTS) program, a second serological test is also suggested to reduce the risk of occult HBV infection in Nigeria.

Toward a Conceptualization of the Content of Psychosocial Screening in Living Organ Donors: An Ethical Legal Psychological Aspects of Transplantation Consensus.

PubMed

Ismail, Sohal Y; Duerinckx, Nathalie; van der Knoop, Marieke M; Timmerman, Lotte; Weimar, Willem; Dobbels, Fabienne; Massey, Emma K; Busschbach, Jan J J V

2015-11-01

Across Europe, transplant centers vary in the content of the psychosocial evaluation for eligible living organ donors. To identify whether a common framework underlies this variation in this evaluation, we studied which psychosocial screening items are most commonly used and considered as most important in current psychosocial screening programs of living organ donors. A multivariate analytic method, concept mapping, was used to generate a visual representation of the "psychosocial" screening items of living kidney and liver donors. A list of 75 potential screening items was derived from a systematic literature review and sorted and rated for their importance and commonness by multidisciplinary affiliated health care professionals from across Europe. Results were discussed and fine-tuned during a consensus meeting. The analyses resulted in a 6-cluster solution. The following clusters on psychosocial screening items were identified, listed from most to least important: (1) personal resources, (2) motivation and decision making, (3) psychopathology, (4) social resources, (5) ethical and legal factors, and (6) information and risk processing. We provided a conceptual framework of the essential elements in psychosocial evaluation of living donors which can serve as a uniform basis for the selection of relevant psychosocial evaluation tools, which can be further tested in prospective studies.

Impact of organ donation education on US undergraduate nursing students.

PubMed

Kurz, Jane McCausland

2014-06-01

Experts advocate educational programs addressing misinformation regarding donation decisions to increase the potential donor pool. However, few researchers have measured outcomes with nursing students. The purpose of this study was to evaluate the impact of an educational intervention on nursing students' knowledge, attitudes, registering as an organ donor, and family discussions. This quasi-experimental study used a pretest-posttest design with a control group. The research group consisted of 42 volunteers and the control group consisted of 73 volunteers. The written survey included 15 true-false knowledge items and 8 Likert items asking about attitude toward donation, registering as an organ donor, and family discussion. Normally distributed data showed no significant differences between groups on the pretest. The research group had no change in knowledge level 3 months later, but the control group had a significantly decreased knowledge level at that point. More members of the research group than the control group registered as organ donors after the intervention (χ2 = 4.5, P= .03). The control group had no change in registering as an organ donor between the pretest and posttest. Family discussions did not differ significantly from pretest to posttest in either group. One lecture/laboratory experience did make a difference in registering as an organ donor but not in discussing the decision with family members. Students can learn about organ donation from more than one specific class. Recommendations for educators and future research are provided.

Changes in the organ procurement system in South Korea: effects on brain-dead donor numbers.

PubMed

Lee, S D; Kim, J H

2009-11-01

In Korea, the Organ Transplantation Act came into effect in 2000, establishing the Korean Network for Organ Sharing (KONOS) with centralized authority for organ procurement as well as for approval of donors and recipients to ensure fair organ allocation. However, the number of brain-dead donors decreased sharply, and the organ allocation system proved inefficient. The government revised the Organ Transplantation Act in August 2002, introducing an incentive system. If a transplantation hospital formed a Committee for Brain Death Evaluation and a Hospital Organ Procurement Organization, it could receive a kidney from a brain dead-donor as an incentive to foster organ procurement regardless of the KONOS wait list. The government also launched a pilot brain-dead donor registry program to strengthen Hospital Organ Procurement Organization activity. If local hospitals collaborated with specialized hospitals in organ procurement, local hospitals obtained financial incentives. But because the organ shortage problem has not been resolved, the government has proposed four initiatives: first, broadening the incentive system, which makes it possible to give each specialized hospital a choice of one of eight organs from each donor as an incentive; second, development of an Independent Organ Procurement Organization; third introduction of an opt-out system; and last, improvement of the Committee for Brain Death Evaluation system. It is uncertain which initiatives will be adopted, but changes in organ procurement systems are nonetheless considered a key to solve the organ shortage problem in Korea.

Exploring Motivations, Awareness of Side Effects, and Attitudes among Potential Egg Donors

PubMed Central

Gezinski, Lindsay B.; Karandikar, Sharvari; Carter, James; White, Melinda

2016-01-01

This research study surveyed prospective egg donors at orientation to (a) understand women’s motivations to donate eggs, (b) assess awareness and knowledge of egg donation prior to entry into the egg donation program, and (c) explore attitudes toward egg donation. Ninety-two women completed the questionnaire at one fertility clinic located in the Midwest between August 2011 and August 2012. Descriptive and inferential statistics as well as textual analysis were used to analyze the data. Three themes emerged regarding participant motivations: (1) altruistic, (2) financial, and (3) desire to pass on genetic material. The majority of participants were unconcerned with potential physical and psychological side effects; however, differences emerged based on motherhood status and educational level. Although potential donors felt recipients should receive some information about the donor, they tended to value privacy regarding information giving to resultant offspring. This research study has implications for social work practice, policy, and future research. It is crucial that women receive adequate procedural and side effect information prior to engaging in egg donation. PMID:27263197

Organ and tissue donation: are minorities willing to donate?

PubMed

Daniels, D E; Smith, K; Parks-Thomas, T; Gibbs, D; Robinson, J

1998-01-01

The Task Force on Organ Transplantation (DHHS,1986) addressed the issue of increasing organ donation. The Report of the Task Force recommended that "educational efforts aimed at increasing organ donation among minority populations be developed and implemented, so that the donor population will more closely reflect the ethnicity of potential transplant recipients, in order to gain the advantage of improved donor and recipient immunologic matching (DHHS,1986). Donor rates for minorities has increased as follows: 16% in 1988 to 23% in 1995 among cadaveric donors and 24% in 1988 to 28% in 1995 among living donors. The improvement in donor rates among minorities may positively affect the transplantation success rate experienced by organ recipients of the same race. Strategies must be implemented that will increase the effectiveness and frequency of communication between minority patients and the medical community. An increase in the effectiveness of communication between potential minority donor families and the health care community will contribute to the process of Consciousness Raising as discussed by Prochasksa. The result of increased awareness of the organ donation and transplantation process may have a favorable impact on organ donation. The media has, through public service announcements, paid advertising and entertainment programming, attempted to promote discussion of organ donation in the community and within families. Johnson et al. discussed Mexican-American and Anglo-American Attitudes Toward Organ Donation. The primary impediment contributing to the disparity of consent rates between Mexican-American and Anglo-American population occurs with regard to the donation of organs of relatives. Johnson stated that this impediment to organ donation can be effectively addressed by promoting family discussion. Communication within families will inform surviving next of kin of the desire of the deceased to be an organ donor and hence improve the likelihood of the donor family consenting to organ donation (Johnson et al., 1988). The promotion of communication within families must continue to be a goal of the transplant community regardless of race/ethnicity. Despite the efforts of the government, the transplant community, the media and the corporate sector to address the critical shortage of donors in the United States, the reality is that no community has the supply of donor organs suitable to meet the need.

Organ donation video messaging in motor vehicle offices: results of a randomized trial.

PubMed

Rodrigue, James R; Fleishman, Aaron; Fitzpatrick, Sean; Boger, Matthew

2015-12-01

Since nearly all registered organ donors in the United States signed up via a driver's license transaction, motor vehicle (MV) offices represent an important venue for organ donation education. To evaluate the impact of organ donation video messaging in MV offices. A 2-group (usual care vs usual care+video messaging) randomized trial with baseline, intervention, and follow-up assessment phases. Twenty-eight MV offices in Massachusetts. Usual care comprised education of MV clerks, display of organ donation print materials (ie, posters, brochures, signing mats), and a volunteer ambassador program. The intervention included video messaging with silent (subtitled) segments highlighting individuals affected by donation, playing on a recursive loop on monitors in MV waiting rooms. Aggregate monthly donor designation rates at MV offices (primary) and percentage of MV customers who registered as donors after viewing the video (secondary). Controlling for baseline donor designation rate, analysis of covariance showed a significant group effect for intervention phase (F=7.3, P=.01). The usual-care group had a significantly higher aggregate monthly donor designation rate than the intervention group had. In the logistic regression model of customer surveys (n=912), prior donor designation (β=-1.29, odds ratio [OR]=0.27 [95% CI=0.20-0.37], P<.001), white race (β=0.57 OR=1.77 [95% CI=1.23-2.54], P=.002), and viewing the intervention video (β=0.73, OR=1.54 [95% CI=1.24-2.60], P=.01) were statistically significant predictors of donor registration on the day of the survey. The relatively low uptake of the video intervention by customers most likely contributed to the negative trial finding.

Midterm Results of Renal Transplantation From Controlled Cardiac Death Donors Are Similar to Those From Brain Death Donors.

PubMed

Lafuente, O; Sánchez-Sobrino, B; Pérez, M; López-Sánchez, P; Janeiro, D; Rubio, E; Huerta, A; Marques, M; Llópez-Carratala, M R; Rubio, J J; Portolés, J

2016-11-01

The systematic use of grafts from controlled donors after cardiac death (cDCD) started in our country in 2012 and expanded with the strategic support of National Transplant Organization. We present our experience in kidney transplantation with organs from cDCD donors with a mean follow-up of 3 years. Observational prospective study of all transplants performed in our center in 2012-2013 followed to 2016. The immunosuppression protocols were triple therapy for low-risk recipients from a standard brain death donor (DBD), adding basiliximab or thymoglobulin induction for extended-criteria donor or high-risk recipient, respectively, and thymoglobulin induction plus triple therapy for all cDCD recipients. A total of 42 donors were included (84 grafts in total, but 1 discarded due to multiple cysts); 25 DBD and 17 cDCD without differences in age or sex. The graft use rate was 98.9% for cDCD; 55 grafts were implanted in our hospital (26 DBD and 29 cDCD), and the remaining 28 grafts were transferred to other centers. There were no differences in primary failure (3.4% cDCD vs 7.4% DBD), but the cDCD organs had a higher incidence of delayed graft function (51.7% vs 25.9%). Despite that, graft and patient survivals, as well as glomerular filtration rate (66.3 vs 59.6 mL/min) were similar in both groups. Only 1 patient died at home with a functioning graft in the cDCD group. Despite a higher rate of delayed graft function with cDCD, the midterm outcomes are at least similar to those with DBD. The cDCD programs should be promoted to increase the chances of a transplant in our patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Hands-On Skills for Caregivers

MedlinePlus

... content Search form Search About FCA Mission and Values Programs and Services Overview Board and Staff Grants and Awards FCA Donors FCA History Jobs at FCA Calendar Caregiver Education Learning Center Health Conditions Caregiving Issues and Strategies ...

Social Responsibility: How Companies Become Involved in Their Communities.

ERIC Educational Resources Information Center

Lawrence, Melanie

1982-01-01

Examines the reality of corporate involvement in community and social welfare in light of the Reagan administration's emphasis on private sector philanthropy. Describes specific company programs and provides advice for corporate donors. (SK)

Blood Donor Test-Seeking Motivation and Prior HIV Testing Experiences in São Paulo, Brazil.

PubMed

Truong, Hong-Ha M; Blatyta, Paula F; Santos, Fernanda M; Montebello, Sandra; Esposti, Sandra P D; Hangai, Fatima N; Salles, Nanci Alves; Mendrone, Alfredo; Sabino, Ester C; McFarland, Willi; Gonçalez, Thelma T

2015-09-01

HIV test-seeking behavior among blood donors has been observed worldwide and may pose a threat to the safety of the blood supply. We evaluated current test-seeking motivations and prior alternative HIV testing experiences among blood donors in São Paulo, Brazil. All candidate or potential blood donors were consecutively approached and recruited to participate in the study upon presentation at Fundação Pró-Sangue Hemocentro, the largest blood bank in Brazil. Participants were recruited between August 2012 and May 2013 after they were screened for donor eligibility. Questionnaires were administered through audio computer-assisted self-interview. Among 11,867 donors, 38 % previously tested for HIV apart from blood donation, of whom 47.7 % tested at public facilities and 2.7 % acknowledged getting tested for HIV as the primary reason for donating. Dissatisfaction with prior alternative testing experience was reported by 2.5 % of donors. Current test-seeking motivation was associated with dissatisfaction with prior alternative testing experience and testing at a public alternative facility. The most common reasons for dissatisfaction were too long of a wait to get tested and for results, counseling was too long, lack of privacy, and low confidence in the equipment and accuracy of the test. Lack of awareness about the availability of free and confidential public HIV testing services as well as dissatisfaction with past HIV testing and counseling experiences motivate some individuals to test at blood banks. Test-seeking behavior among blood donors may be best addressed by improving alternative testing programs, particularly with respect to time delays, privacy and perceptions about test accuracy. Educational campaigns on safe blood donation and HIV testing for diagnosis, risk counseling and referral to care are also needed for the general public and for health care providers.

Exchange donor transplantation: ethical option for living renal transplantation.

PubMed

Gürkan, A; Kaçar, S; Varılsuha, C; Tilif, S; Turunç, V; Doǧan, M; Dheir, H; Sahin, S

2011-04-01

Taking in consideration the opinion of our team, which necessitates obligation of a relative relation between donors and recipients (genetic or matrimonial), we performed donor exchanges as an ethical alternative in living donor transplantations. We reviewed the outcomes of our exchange series. Between July 2003 and August 2010 we performed 110 exchange donor transplantations in four hospitals: one four-way, two three-way, and 100 two-way cases. Donors were mostly spouses (n = 71) or mothers (n = 15). The mean age of the donors was 48.8 (range = 23-69) and the recipients 41.4 years (range = 5-66). Two were transplanted preemptively and the others had a mean dialysis duration of 43 months (range = 1-120). Among 110 patients, three compatible pairs joined the group voluntarily; 71, due to ABO incompatibility and 36, due to crossmatch positivity. Induction therapy was used in 92 patients. HLA mismatches (MM) were: one MM in three; two MM in three; three MM in 18, four MM in 36; five MM in 34; and six MM in 18. Among 90 patients tested for panel-reactive antibodies PRA, five showed class I and 10, class II positivity. In 11 patients, B-cell positivity was detected by flow cytometry. Delayed graft function (n = 2), acute rejection (n = 11), BK virus infection (n = 1), and cytomegalovirus infection (n = 3) were seen postoperatively. Three (2.7%) patients died due to sepsis. Five patients returned to dialysis program due to interstitial fibrosis tubular atrophy (IFTA) (n = 2), renal vein thrombosis (n = 1), de novo glomerulopathy (n = 1), or primary nonfunction (n = 1). The 1- and 5-year patient and graft survival rates were 96% and 96%, 95% and 89%, respectively. We believe that exchange donor transplantation is as successful as direct transplants; it is a good, ethical alternative to unrelated living transplantations. Copyright © 2011 Elsevier Inc. All rights reserved.

A systematic review and meta-analysis of antecedents of blood donation behavior and intentions.

PubMed

Bednall, Timothy C; Bove, Liliana L; Cheetham, Ali; Murray, Andrea L

2013-11-01

This meta-analysis sought to identify the strongest antecedents of blood donation behavior and intentions. It synthesized the results of 24 predictive correlational studies of donation behavior and 37 studies of donation intentions. The antecedents were grouped into six research programs: (1) the Theory of Planned Behavior (TPB) and its extensions, (2) prosocial motivation, (3) affective expectations, (4) donor site experience, (5) past donation behavior, and (6) donor demographics. Antecedent categories were cross-validated by multiple coders, and combined effect sizes were analyzed using a random-effects model. For donation behavior, medium positive associations were found with five of the constructs from the extended TPB: intentions to donate, perceived behavioral control, attitude toward donation, self-efficacy and donor role identity. Other antecedents displaying a positive association with donation behavior included anticipated regret for not donating, number of past donations and donor age. Donor experiences at the collection site in the form of temporary deferral or adverse reactions had a medium negative association with behavior. For donation intentions, strong positive associations were observed for perceived behavioral control, attitude, self-efficacy, role identity and anticipated regret. Medium positive associations were observed for personal moral norm, subjective norm, satisfaction, and service quality. All other potential antecedents had weak or non-significant associations with behavior and intentions. Several of these associations were moderated by between-study differences, including donor experience, the period of data collection in which donation behavior was observed, and the use of a nominal (yes/no return) versus a ratio measure of donation behavior. Collectively, the results underscore the importance of enhancing donors' attitudes towards donation and building their perceived behavioral control and self-efficacy to donate. Further, minimizing the risk of adverse reactions and enacting re-recruitment policies for temporarily deferred donors will help protect future donation behavior. Implications of these findings for blood collection agencies and researchers are discussed. Copyright © 2013 Elsevier Ltd. All rights reserved.

A Focused Educational Program after Religious Services to Improve Organ Donation in Hispanic Americans

PubMed Central

Salim, Ali; Berry, Cherisse; Ley, Eric J; Schulman, Danielle; Navarro, Sonia; Zheng, Ling; Chan, Linda S

2012-01-01

Religion is an important determinant in Hispanic Americans (HA) becoming organ donors as HA often believe religion forbids donation. We investigated the effect of an educational program targeting HA organ donation in places of worship. A prospective observational study was conducted at four Catholic churches with a high percentage of HA. A 45 minute ‘culturally sensitive’ educational program, conducted in Spanish, was implemented. Organ donation awareness, knowledge, perception and beliefs, as well as the intent to become an organ donor, were measured before and after the intervention. Differences between before and after the intervention were analyzed. A total of 182 surveys were collected before and 159 surveys were collected after the educational program. A significant increase was observed in organ donation knowledge (54% vs. 70%, p<0.0001), perception (43% vs. 58%, p<0.0001) and beliefs (50% vs. 60%, p=0.0001). However, no significant difference was found in the willingness to discuss donation with family, intent-to-donate, or registering to donate after the intervention. This study demonstrates that a focused educational program in places of worship can significantly improve HA knowledge, perceptions, and beliefs regarding organ donation. Further work is needed to understand why intent-to-donate does not increase despite the increase in organ donation awareness. PMID:23106648

A focused educational program after religious services to improve organ donation in Hispanic Americans.

PubMed

Salim, Ali; Bery, Cherisse; Ley, Eric J; Schulman, Danielle; Navarro, Sonia; Zheng, Ling; Chan, Linda S

2012-01-01

Religion is an important determinant in Hispanic Americans (HA) becoming organ donors as HA often believe religion forbids donation. We investigated the effect of an educational program targeting HA organ donation in places of worship. A prospective observational study was conducted at four Catholic churches with a high percentage of HA. A 45-min "culturally sensitive" educational program, conducted in Spanish, was implemented. Organ donation awareness, knowledge, perception, and beliefs, as well as the intent to become an organ donor, were measured before and after the intervention. Differences between before and after the intervention were analyzed. A total of 182 surveys were conducted before and 159 surveys were conducted after the educational program. A significant increase was observed in organ donation knowledge (54% vs. 70%, p<0.0001), perception (43% vs. 58%, p<0.0001), and beliefs (50% vs. 60%, p=0.0001). However, no significant difference was found in the willingness to discuss donation with family, intent-to-donate, or registering to donate after the intervention. This study demonstrates that a focused educational program in places of worship can significantly improve HA knowledge, perceptions, and beliefs regarding organ donation. Further work is needed to understand why intent-to-donate does not increase despite the increase in organ donation awareness. © 2012 John Wiley & Sons A/S.

Special Issues Related to Hematopoietic Stem Cell Transplantation in the Eastern Mediterranean Region and the First Regional Activity Report

PubMed Central

Aljurf, Mahmoud; Zaidi, Syed Z; El Solh, Hassan; Hussain, Fazal; Ghavamzadeh, Ardeshir; Mahmoud, Hossam Kamel; Shamsi, Tahir; Othman, Tarek Ben; Sarhan, Mahmoud M.; Dennison, David; Ibrahim, Ahmad; Benchekroun, Said; Chaudhri, Naeem; Labar, Boris; Horowitz, Mary; Niederwieser, Dietger; Gratwohl, Alois

2012-01-01

Although several centers are now performing allogeneic HSCT in the Eastern Mediterranean (EM) region, the availability is still limited. Special issues including compatible donor availability and potential for alternate donor programs are discussed. In comparison to Europe & North America, differences in pattern of diseases and pre-HSCT general status particularly for patients with BM failure are described. Other differences including high seropositivity for CMV, Hepatitis B and C infection and specific observations about GVHD with its relation to genetically homogeneous community are also discussed. We report that a total of 17 HSCT programs (performing 5 or more HSCTs annually) exist in 9 countries of the EM region. Only 6 programs are currently reporting to EBMT or IBMTR. A total of 7617 HSCTs have been performed by these programs including 5701 allogeneic HSCTs. Due to low HSCT team density (1.5583 teams/10 million inhabitants vs. 14.4333 in Europe) and very low HSCT team distribution (0.2729 teams/10,000 sq km area vs. <1 to 6 teams in Europe). GNI/capita had no clear association with low HSCT activity; however improvement in infrastructure & formation of EM regional HSCT registry are needed. PMID:19043456

Sulfur dioxide alleviates programmed cell death in barley aleurone by acting as an antioxidant

PubMed Central

Yang, Feng; Huang, Zhong-Qin; Tang, Jun; Hu, Kang-Di

2017-01-01

Sulfur dioxide (SO2), a gaseous signaling molecule in animal cells, has recently been found to play a physiological role in plants. Here we studied the role of SO2 in gibberellic acid (GA3)-induced programmed cell death (PCD) in barley (Hordeum vulgare L.) aleurone layers. The application of the SO2 donor (NaHSO3/Na2SO3, 1:3 M/M) effectively alleviated PCD in barley aleurone layers in a dose-dependent manner with an optimal concentration of 50 μM. Further investigations showed that SO2 reduced the accumulation of hydrogen peroxide (H2O2), superoxide anion (⋅O2−) and malondialdehyde (MDA) in aleurone layers. Moreover, the activities of antioxidant enzymes such as superoxide dismutase (SOD), catalase (CAT), ascorbate peroxidase (APX), glutathione reductase (GR) and guaiacol peroxidase (POD) were enhanced by SO2 donor treatment. Meanwhile, lipoxygenase (LOX) activity was attenuated by SO2 donor treatment. Furthermore, an induction of endogenous H2S and NO were also observed in SO2-treated aleurone layers, suggesting interactions of SO2 with other well-known signaling molecules. Taken together, we show that SO2 negatively regulated PCD by acting as an antioxidant to scavenge excessive reactive oxygen species (ROS) generated during PCD. PMID:29155872

Misalignment between perceptions and actual global burden of disease: evidence from the US population.

PubMed

Siegel, Karen R; Feigl, Andrea B; Kishore, Sandeep P; Stuckler, David

2011-05-09

Significant funding of health programs in low-income countries comes from external sources, mainly private donors and national development agencies of high-income countries. How these external funds are allocated remains a subject of ongoing debate, as studies have revealed that external funding may misalign with the underlying disease burden. One determinant of the priorities set by both private donors and development agencies is the perceptions of populations living in high-income countries about which diseases are legitimate for global health intervention. While research has been conducted on the priorities expressed by recipient communities, relatively less has been done to assess those of the donating country. To investigate people's beliefs about the disease burden in high-income countries, we compared publicly available data from U.S. surveys of people's perceptions of the leading causes of death in developing countries against measures of the actual disease burden from the World Health Organization. We found little correlation between the U.S. public's perception and the actual disease burden, measured as either mortality or disability-adjusted life years. While there is potential for reverse causality, so that donor programs drive public perceptions, these findings suggest that increasing the general population's awareness of the true global disease burden could help better align global health funding with population health needs.

Activity of transplant coordination in Uruguay.

PubMed

Mizraji, R; Pérez, S; Alvarez, I

2007-03-01

The purpose of this study was to analyze the evolution of donation and organ transplantation in Uruguay, after the initiation of a program of transplant coordination, which began in 2000. The total number of effective donors increased from 28.7 per million people (pmp) in 2000 to 48.1 pmp in 2005, which constituted an increase of 75%. The number of real donors also increased from 10 pmp in 2000 to 20.6 pmp in 2005, more than a 100% increase, with a cadaveric renal transplantation rate of 36 pmp (2005). The conversion of effective to real donors (RD/ED) increased from 0.125 to 0.42. Familial refusal decreased from 62.1% in 2000 to 19% in 2005, which constituted a decrease of 70%. We concluded that implementation of transplant coordinators and involvement of intensive care medical doctors in coordination have had a strong impact on these results.

SSATP progress report 2004

DOT National Transportation Integrated Search

2005-07-01

there were a number of problems and delays, by the time the year drew to a close implementation : was well underway, donor promises had been transformed into hard cash. Most importantly, new : recruits were joining the Program Management Team (PMT) g...

Living donor liver transplantation in India

PubMed Central

2016-01-01

Liver transplantation is currently in its golden period in India. The number of transplants being performed and the steady increase in the new programs that have emerged over the last decade is a testimony to it. The growth was not smooth, especially in the early years. But a multipronged approach in developing infrastructure and the involvement of multidisciplinary teams in the management of transplant patients has had a major positive impact on the outcome and as a result a positive impetus to the growth of this specialty in India. To date, the majority of transplants performed in India are live donor liver transplants. Deceased donation is more sporadic and concentrated in a couple of regions. With phenomenal increase in transplant activity in India, there is huge potential for streamlining data sharing among programs in India and with the rest of the world to ultimately benefit the transplant community. PMID:27115006

Case Report: Successful Lung Transplantation from a Donor Seropositive for Trypanosoma cruzi Infection (Chagas Disease) to a Seronegative Recipient.

PubMed

Salvador, Fernando; Sánchez-Montalvá, Adrián; Sulleiro, Elena; Berastegui, Cristina; Jauregui, Alberto; Pont, Teresa; Los-Arcos, Ibai; Len, Óscar; Gavaldà, Joan; Molina, Israel

2017-10-01

The increasing shortage of organs for transplantation has prompted transplant programs to investigate the use of extended criteria donors, such as those with transmissible infectious diseases. Successful cases of organ transplantation (mostly kidney and liver) from Trypanosoma cruzi seropositive donors to seronegative recipients have been reported. We present a case of lung transplantation from a donor serologically positive for Chagas disease to a seronegative recipient, and provide a review of the literature. Left single lung transplantation was performed in a 44-year-old Spanish woman presenting with interstitial lung disease in February 2016. The deceased donor was a Colombian immigrant living in Spain who was serologically positive for Chagas disease. Oral administration of 5 mg/kg/day benznidazole divided in three doses for 60 days was given for specific Chagas disease prophylaxis after transplantation. Periodic follow-up with serological reverse transcription polymerase chain reaction to detect T. cruzi DNA were performed until 6 months after the end of treatment. All results were negative, indicating that transmission of T. cruzi had not occurred. In a review of the literature, two similar cases were identified in Argentina and the United States. In both cases T. cruzi infection was detected posttransplant in the recipients, after which they were treated with benznidazole. The course of the patient described herein confirms that lungs from donors with chronic T. cruzi infection can be used successfully as allografts, and that posttransplant prophylaxis with benznidazole may reduce the probability of transmission of T. cruzi to the recipient.

[The contribution of persuasion social psychology to the retention of donors: models to elaborate mailing to the donors].

PubMed

Callé, N; Plainfossé, C; Georget, P; Sénémeaud, C; Rasonglès, P

2011-12-01

The supply of blood cell products required from the National French Blood Institute (Établissement français du sang [EFS]) relies upon regular blood donors. Contact with donors, tailored to individuals as much as possible, helps them to donate on a regular basis. To communicate as efficiently as possible, the content of the mailings has to be adapted to individuals, each according to his/her motivation and the way he or she perceives and processes the information. Within the context of a research program conducted with the Psychology Department of the University of Caen Basse-Normandie, persuasive theoretical models from social psychology have been tested. These models allow adapting messages according to various combinations of types of information processing, motivations and content of the messages. Different types of mailing invitations have been sent to 1987 donors from the Normandy database, requesting them to donate blood. Every experimental letter worked better than the standard EFS letter (which was used as the "control" letter) in terms of effective blood donation after reception of the letter. Some of the letters are more efficient in motivating donors than others. When the systematic type of processing (deep and thorough processing) is activated it appears important to supply elaborate content. On the contrary, when a heuristic type of processing (fast and superficial) is activated, adaptation of the content is less essential. Last but not least, the nearness of the last blood donation plays a key role. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

The weekend effect alters the procurement and discard rates of deceased donor kidneys in the United States

PubMed Central

Mohan, Sumit; Foley, Karl; Chiles, Mariana C; Dube, Geoffrey K; Patzer, Rachel E; Pastan, Stephen; Crew, R John; Cohen, David; Ratner, Lloyd

2016-01-01

Factors contributing to the high rate of discard among deceased donor kidneys remain poorly understood and the influence of resource limitations of weekends on kidney transplantation is unknown. To quantify this we used data from the Scientific Registry of Transplant Recipients and assembled a retrospective cohort of 181,799 deceased donor kidneys recovered for transplantation from 2000-2013. We identified the impact of the day of the week on the procurement and subsequent utilization or discard of deceased donor kidneys in the United States, as well as report the geographic variation on the impact of weekends on transplantation. Compared to weekday kidneys, organs procured on weekends were significantly more likely to be discarded than transplanted (odds ratio: 1.16; 95% confidence interval 1.13 – 1.19), even after adjusting for organ quality (adjusted odds ratio: 1.13; 95% confidence interval 1.10 – 1.17). Weekend discards were of a significantly higher quality than weekday discards (kidney donor profile index: 76.5 vs 77.3%). Considerable geographic variation was noted in the proportion of transplants that occurred over the weekend. Kidneys available for transplant over the weekend were significantly more likely to be used at larger transplant centers, be shared without payback, and experienced shorter cold ischemia times. Thus, factors other than kidney quality are contributing to the discard of deceased donor kidneys, particularly during weekends. Policy prescriptions, administrative or organizational solutions within transplant programs may potentially mitigate against the recent increase in kidney discards. PMID:27182001

AIDS Treatment In Brazil: Impacts And Challenges

PubMed Central

Nunn, Amy Stewart; Fonseca, Elize Massard da; Bastos, Francisco I.; Gruskin, Sofia

2009-01-01

Brazil has one of the developing world's largest, and arguably most successful, AIDS treatment programs. In this paper we review the treatment program, including controversial policies that Brazil has used to promote widespread local and global access to AIDS treatment. We also examine the lessons learned from this program and highlight the challenges Brazil faces, including the rising costs of AIDS treatment and changes in donors' funding priorities. Finally, we explore the relevance of Brazil's treatment program for other countries and its broad implications for global AIDS and health policy. PMID:19597210

Representation of Nucleation Mode Microphysics in a Global Aerosol Model with Sectional Microphysics

NASA Technical Reports Server (NTRS)

Lee, Y. H.; Pierce, J. R.; Adams, P. J.

2013-01-01

In models, nucleation mode (1 nm

Roll-to-Roll printed large-area all-polymer solar cells with 5% efficiency based on a low crystallinity conjugated polymer blend

NASA Astrophysics Data System (ADS)

Gu, Xiaodan; Zhou, Yan; Gu, Kevin; Kurosawa, Tadanori; Yan, Hongping; Wang, Cheng; Toney, Micheal; Bao, Zhenan

The challenge of continuous printing in high efficiency large-area organic solar cells is a key limiting factor for their widespread adoption. We present a materials design concept for achieving large-area, solution coated all-polymer bulk heterojunction (BHJ) solar cells with stable phase separation morphology between the donor and acceptor. The key concept lies in inhibiting strong crystallization of donor and acceptor polymers, thus forming intermixed, low crystallinity and mostly amorphous blends. Based on experiments using donors and acceptors with different degree of crystallinity, our results showed that microphase separated donor and acceptor domain sizes are inversely proportional to the crystallinity of the conjugated polymers. This methodology of using low crystallinity donors and acceptors has the added benefit of forming a consistent and robust morphology that is insensitive to different processing conditions, allowing one to easily scale up the printing process from a small scale solution shearing coater to a large-scale continuous roll-to-roll (R2R) printer. We were able to continuously roll-to-roll slot die print large area all-polymer solar cells with power conversion efficiencies of 5%, with combined cell area up to 10 cm2. This is among the highest efficiencies realized with R2R coated active layer organic materials on flexible substrate. DOE BRIDGE sunshot program. Office of Naval Research.

Reassessing marketing of kidneys from the 2008 perspective.

PubMed

Friedman, Eli A; Friedman, Amy L

2009-01-01

Progressive improvements in all aspects of the kidney transplant regimen establish this form of renal replacement therapy as superior to peritoneal or hemodialysis in terms of extent of rehabilitation and long-term recipient survival. Continuous growth in the number of patients with kidney failure sustained by dialytic therapy has not been associated with substantially increased deceased donor kidney contributions, causing intensified stressful waiting periods for potential recipients lacking a live kidney donor. Neither public relation campaigns nor local government efforts have substantially increased kidney donation. Buying a donor kidney is illegal and condemned as fostering exploitation of poor people by the wealthy. Widely publicized examples of coercion of unwilling donors create a negative image of harmful, inhumane conduct deployed to obtain kidneys sold and transplanted under unsavory circumstances. Yet efforts to establish and test governmental programs to supervise and sustain acceptable standards for the sale and implantation of kidneys from fully informed, medically evaluated and protected, fairly compensated donors have been resisted and frustrated by those who consider such compensation loathsome. Accordingly, while selling kidneys is prohibited by law, pressure from those wanting to quench the number of deaths of wait-listed dialysis patients continues forcing reexamination of an issue that, like prohibition of the possession and sale of alcohol in the United States in 1920, places the will of a people in opposition to unreasonably restrictive laws. The debate continues.

Kidney Exchange to Overcome Financial Barriers to Kidney Transplantation.

PubMed

Rees, M A; Dunn, T B; Kuhr, C S; Marsh, C L; Rogers, J; Rees, S E; Cicero, A; Reece, L J; Roth, A E; Ekwenna, O; Fumo, D E; Krawiec, K D; Kopke, J E; Jain, S; Tan, M; Paloyo, S R

2017-03-01

Organ shortage is the major limitation to kidney transplantation in the developed world. Conversely, millions of patients in the developing world with end-stage renal disease die because they cannot afford renal replacement therapy-even when willing living kidney donors exist. This juxtaposition between countries with funds but no available kidneys and those with available kidneys but no funds prompts us to propose an exchange program using each nation's unique assets. Our proposal leverages the cost savings achieved through earlier transplantation over dialysis to fund the cost of kidney exchange between developed-world patient-donor pairs with immunological barriers and developing-world patient-donor pairs with financial barriers. By making developed-world health care available to impoverished patients in the developing world, we replace unethical transplant tourism with global kidney exchange-a modality equally benefitting rich and poor. We report the 1-year experience of an initial Filipino pair, whose recipient was transplanted in the United states with an American donor's kidney at no cost to him. The Filipino donor donated to an American in the United States through a kidney exchange chain. Follow-up care and medications in the Philippines were supported by funds from the United States. We show that the logistical obstacles in this approach, although considerable, are surmountable. © 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.

Legal and ethical aspects of organ donation and transplantation

PubMed Central

Shroff, Sunil

2009-01-01

The legislation called the Transplantation of Human Organ Act (THO) was passed in India in 1994 to streamline organ donation and transplantation activities. Broadly, the act accepted brain death as a form of death and made the sale of organs a punishable offence. With the acceptance of brain death, it became possible to not only undertake kidney transplantations but also start other solid organ transplants like liver, heart, lungs, and pancreas. Despite the THO legislation, organ commerce and kidney scandals are regularly reported in the Indian media. In most instances, the implementation of the law has been flawed and more often than once its provisions have been abused. Parallel to the living related and unrelated donation program, the deceased donation program has slowly evolved in a few states. In approximately one-third of all liver transplants, the organs have come from the deceased donor program as have all the hearts and pancreas transplants. In these states, a few hospitals along with committed NGOs have kept the momentum of the deceased donor program. The MOHAN Foundation (NGO based in Tamil Nadu and Andhra Pradesh) has facilitated 400 of the 1,300 deceased organ transplants performed in the country over the last 14 years. To overcome organ shortage, developed countries are re-looking at the ethics of unrelated programs and there seems to be a move towards making this an acceptable legal alternative. The supply of deceased donors in these countries has peaked and there has been no further increase over the last few years. India is currently having a deceased donation rate of 0.05 to 0.08 per million population. We need to find a solution on how we can utilize the potentially large pool of trauma-related brain deaths for organ donation. This year in the state of Tamil Nadu, the Government has passed seven special orders. These orders are expected to streamline the activity of deceased donors and help increase their numbers. Recently, on July 30, 2008, the Government brought in a few new amendments as a Gazette with the purpose of putting a stop to organ commerce. The ethics of commerce in organ donation and transplant tourism has been widely criticized by international bodies. The legal and ethical principles that we follow universally with organ donation and transplantation are also important for the future as these may be used to resolve our conflicts related to emerging sciences such as cloning, tissue engineering, and stem cells. PMID:19881131

Annual Report, 1968-1969

ERIC Educational Resources Information Center

Continuous Learning, 1969

1969-01-01

The Canadian Association for Adult Education (CAAE) president's speech on the adult education profession; national and provincial CAAE staff and officers; the balance sheet as of April 30, 1969; donors and organizational members; organizational and professional activities; special programs; and membership statistics. (LY)

The HLA Dictionary 2004: a summary of HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1 alleles and their association with serologically defined HLA-A, -B, -C, -DR and -DQ antigens.

PubMed

Schreuder, G M Th; Hurley, C K; Marsh, S G E; Lau, M; Fernandez-Vina, M; Noreen, H J; Setterholm, M; Maiers, M

2005-01-01

This report presents serologic equivalents of human leucocyte antigen (HLA)-A, -B, -C, -DRB1, -DRB3, -DRB4, -DRB5 and -DQB1 alleles. The dictionary is an update of the one published in 2001. The data summarize equivalents obtained by the World Health Organization Nomenclature Committee for factors of the HLA System, the International Cell Exchange, the National Marrow Donor Program, recent publications and individual laboratories. This latest update of the dictionary is enhanced by the inclusion of results from studies performed during the 13th International Histocompatibility Workshop and from neural network analyses. A summary of the data as recommended serologic equivalents is presented as expert assigned types. The tables include remarks for alleles, which are or may be expressed as antigens with serologic reaction patterns that differ from the well-established HLA specificities. The equivalents provided will be useful in guiding searches for unrelated hematopoietic stem cell donors in which patients and/or potential donors are typed by either serology or DNA-based methods. The serological DNA equivalent dictionary will also aid in typing and matching procedures for organ transplant programs whose waiting lists of potential donors and recipients comprise of mixtures of serologic and DNA-based typings. The tables with HLA equivalents and a questionnaire for submission of serologic reaction patterns for poorly identified allelic products will be made available through the WMDA web page: www.worldmarrow.org. and in the near future also in a searchable form on the IMGT/HLA database.

Four decades of kidney transplantation in Cuba.

PubMed

Alfonzo, Jorge P

2013-01-01

This article describes the background, beginnings, development, evolution and outcomes of kidney transplantation in Cuba. Nephrology as a medical specialty in Cuba began in 1962 and was formalized in 1966. Conditions were created to implement renal replacement therapy (including transplants), bring nephrology care to the entire country and train human resources who would assume this responsibility, making Cuba one of the first countries with a comprehensive program for renal patient care. After three unsuccessful cadaveric-donor kidney transplantations in 1968-69, the ensuing history of kidney transplantation can be summarized in the following three stages. 1970-1975: In January 1970, cadaveric-donor kidney transplantation began at the Nephrology Institute. That year, 17 kidney transplantations were performed; four of these patients lived with functional kidneys for 15-25 years; 10-year graft survival was 23.5% (Kaplan-Meier survival curve); HLA typing began in 1974. By December 1975, 170 grafts had been done in three hospitals. 1976-1985: Seven transplantation centers performed 893 grafts during this period. HLA-DR typing was introduced in 1976 and the National Histocompatibility Laboratory Network was founded in 1978. The first related living-donor kidney transplantation was done in 1979. 1986-2011: The National Kidney Transplantation Coordinating Center and the National Kidney Transplantation Program were created in 1986; the first combined kidney-pancreas transplantation was performed the same year. In 1990, cyclosporine and the Cuban monoclonal antibody IOR-T3 were introduced for immunosuppression to prevent rejection, as were other Cuban products (hepatitis B vaccine and recombinant human erythropoietin) for transplant patients. By December 2011, the cumulative number of transplants was 4636 (384 from related living donors). With over 40 years of experience, kidney transplantation is now well established in Cuba; it is free and universally accessible, on the basis of need and appropriateness.

A Decade of Experience With Renal Transplantation in African-Americans

PubMed Central

Foster, Clarence E.; Philosophe, Benjamin; Schweitzer, Eugene J.; Colonna, John O.; Farney, Alan C.; Jarrell, Bruce; Anderson, Leslie; Bartlett, Stephen T.

2002-01-01

Objective To evaluate the strategies instituted by the authors’ center to decrease the time to transplantation and increase the rate of transplantation for African-Americans, consisting of a formal education program concerning the benefits of living organ donation that is oriented to minorities; a laparoscopic living donation program; use of hepatitis C-positive donors in documented positive recipients; and encouraging vaccination for hepatitis B, allowing the use of hepatitis B core Ab-positive donors. Summary Background Data The national shortage of suitable kidney donor organs has disproportional and adverse effects on African-Americans for several reasons. Type II diabetes mellitus and hypertension, major etiologic factors for end-stage renal disease, are more prevalent in African-Americans than in the general population. Once kidney failure has developed, African-Americans are disadvantaged for the following reasons: this patient cohort has longer median waiting times on the renal transplant list; African-Americans have higher rates of acute rejection, which affects long-term allograft survival; and once they are transplanted, the long-term graft survival rates are lower in this population than in other groups. Methods From March 1990 to November 2001 the authors’ center performed 2,167 renal transplants; 944 were in African-Americans (663 primary cadaver renal transplants and 253 primary Living donor renal transplants). The retransplants consisted of 83 cadaver transplants and 17 living donor transplants. Outcome measures of this retrospective analysis included median waiting time, graft and patient survival rates, and the rate of living donation in African-Americans and comparable non-African-Americans. Where applicable, data are compared to United Network for Organ Sharing national statistics. Statistical analysis employed appropriate SPSS applications. Results One- and 5-year patient survival rates for living donor kidneys were 97.1% and 91.3% for non-African-Americans and 96.8% and 90.4% for African-Americans. One- and 5-year graft survival rates were 95.1% and 89.1% for non-African-Americans and 93.1% and 82.9% for African-Americans. One- and 4-year patient survival rates for cadaver donor kidneys were 91.4% and 78.7% for non-African-Americans and 92.4% and 80.2% for African-Americans. One- and 5-year graft survival rates for cadaver kidneys were 84.6% and 73.7% for non-African-Americans and 84.6% and 68.9% for African-Americans. One- and 5-year graft and patient survival rates were identical for recipients of hepatitis C virus-positive and anti-HBc positive donors, with the exception of a trend to late graft loss in the African-American hepatitis C virus group due to higher rates of noncompliance, an effect that disappears with censoring of graft loss from that cause. The cadaveric renal transplant median waiting time for non-African-Americans was 391 days compared to 734 days nationally; the waiting time for African-Americans was 647 days compared to 1,335 days nationally. When looking at all patients, living and cadaver donor, the median waiting times are 220 days for non-African-Americans and 462 days for African-Americans. Conclusions Programs specifically oriented to improve volunteerism in African-Americans have led to a marked improvement in overall waiting time and in rates of living donation in this patient group. The median waiting times to cadaveric renal transplantation were also significantly shorter in the authors’ center, especially for African-American patients, by taking advantage of the higher rates of hepatitis C infection and encouraging hepatitis B vaccination. These policies can markedly improve end-stage renal disease care for African-Americans by halving the overall waiting time while still achieving comparable graft and patient survival rates. PMID:12454518

A decade of experience with renal transplantation in African-Americans.

PubMed

Foster, Clarence E; Philosophe, Benjamin; Schweitzer, Eugene J; Colonna, John O; Farney, Alan C; Jarrell, Bruce; Anderson, Leslie; Bartlett, Stephen T

2002-12-01

OBJECTIVE To evaluate the strategies instituted by the authors' center to decrease the time to transplantation and increase the rate of transplantation for African-Americans, consisting of a formal education program concerning the benefits of living organ donation that is oriented to minorities; a laparoscopic living donation program; use of hepatitis C-positive donors in documented positive recipients; and encouraging vaccination for hepatitis B, allowing the use of hepatitis B core Ab-positive donors. SUMMARY BACKGROUND DATA The national shortage of suitable kidney donor organs has disproportional and adverse effects on African-Americans for several reasons. Type II diabetes mellitus and hypertension, major etiologic factors for end-stage renal disease, are more prevalent in African-Americans than in the general population. Once kidney failure has developed, African-Americans are disadvantaged for the following reasons: this patient cohort has longer median waiting times on the renal transplant list; African-Americans have higher rates of acute rejection, which affects long-term allograft survival; and once they are transplanted, the long-term graft survival rates are lower in this population than in other groups. METHODS From March 1990 to November 2001 the authors' center performed 2,167 renal transplants; 944 were in African-Americans (663 primary cadaver renal transplants and 253 primary Living donor renal transplants). The retransplants consisted of 83 cadaver transplants and 17 living donor transplants. Outcome measures of this retrospective analysis included median waiting time, graft and patient survival rates, and the rate of living donation in African-Americans and comparable non-African-Americans. Where applicable, data are compared to United Network for Organ Sharing national statistics. Statistical analysis employed appropriate SPSS applications. RESULTS One- and 5-year patient survival rates for living donor kidneys were 97.1% and 91.3% for non-African-Americans and 96.8% and 90.4% for African-Americans. One- and 5-year graft survival rates were 95.1% and 89.1% for non-African-Americans and 93.1% and 82.9% for African-Americans. One- and 4-year patient survival rates for cadaver donor kidneys were 91.4% and 78.7% for non-African-Americans and 92.4% and 80.2% for African-Americans. One- and 5-year graft survival rates for cadaver kidneys were 84.6% and 73.7% for non-African-Americans and 84.6% and 68.9% for African-Americans. One- and 5-year graft and patient survival rates were identical for recipients of hepatitis C virus-positive and anti-HBc positive donors, with the exception of a trend to late graft loss in the African-American hepatitis C virus group due to higher rates of noncompliance, an effect that disappears with censoring of graft loss from that cause. The cadaveric renal transplant median waiting time for non-African-Americans was 391 days compared to 734 days nationally; the waiting time for African-Americans was 647 days compared to 1,335 days nationally. When looking at all patients, living and cadaver donor, the median waiting times are 220 days for non-African-Americans and 462 days for African-Americans. CONCLUSIONS Programs specifically oriented to improve volunteerism in African-Americans have led to a marked improvement in overall waiting time and in rates of living donation in this patient group. The median waiting times to cadaveric renal transplantation were also significantly shorter in the authors' center, especially for African-American patients, by taking advantage of the higher rates of hepatitis C infection and encouraging hepatitis B vaccination. These policies can markedly improve end-stage renal disease care for African-Americans by halving the overall waiting time while still achieving comparable graft and patient survival rates.

Consent and consensus-ethical perspectives on obtaining bodies for anatomical dissection.

PubMed

Winkelmann, Andreas

2016-01-01

Biomedical research and education benefit from the use of human cadavers. These are usually acquired from donors who have willed their body to science during their lifetime. This concept of donation through "informed consent" respects the personal autonomy of the donor and the dignity of the dead body (extended from the dignity of the living person). The concept of informed consent is taken from research on living human subjects regulated in the Helsinki Declaration. This transfer to the domain of anatomical donation, however, has several problems. For example, the dead cannot speak for themselves and the ethical status of the human cadaver remains ambiguous. It is therefore suggested that an element of consensus is added to the concept of consent, a consensus between donors, relatives, anatomists, and the wider community. A consensus can give difficult decisions surrounding body donation and dissection a broader basis and can help bridge the gap between donors and families on the one side and anatomists, researchers and students on the other side. This approach can help to establish relationships of trust with local communities, on which body donation programs depend. © 2015 Wiley Periodicals, Inc.

Database Comparison of the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL) and the SRTR U.S. Transplant Registry1,2,3

PubMed Central

Gillespie, BW; Merion, RM; Ortiz-Rios, E; Tong, L; Shaked, A; Brown, RS; Ojo, AO; Hayashi, PH; Berg, CL; Abecassis, MM; Ashworth, AS; Friese, CE; Hong, JC; Trotter, JF; Everhart, JE

2010-01-01

Data submitted by transplant programs to the Organ Procurement and Transplantation Network (OPTN) are used by the Scientific Registry of Transplant Recipients (SRTR) for policy development, performance evaluation, and research. This study compared OPTN/SRTR data with data extracted from medical records by research coordinators from the nine-center A2ALL study. A2ALL data were collected independently of OPTN data submission (48 data elements among 785 liver transplant candidates/recipients; 12 data elements among 386 donors). At least 90% agreement occurred between OPTN/SRTR and A2ALL for 11/29 baseline recipient elements, 4/19 recipient transplant or follow-up elements, and 6/12 donor elements. For the remaining recipient and donor elements, >10% of values were missing in OPTN/SRTR but present in A2ALL, confirming that missing data were largely avoidable. Other than variables required for allocation, the percentage missing varied widely by center. These findings support an expanded focus on data quality control by OPTN/SRTR for a broader variable set than those used for allocation. Center-specific monitoring of missing values could substantially improve the data. PMID:20199501

Outcome of referrals for deceased organ donation to the government organ procurement organization.

PubMed

Suguitan, G A; Cabanayan-Casasola, C B; Danguilan, R A; Jaro, J M A

2014-05-01

The Human Organ Preservation Effort is a government organ procurement organization that pioneered the Deceased Organ Donation Program in the Philippines. Deceased organ donation comprises only 20% of kidney transplantation in the Philippines in the last 3 years. Various measures were implemented to improve deceased organ donor referrals and organ retrieval. To compare outcome of deceased organ donor referrals from 2002 to 2008 and 2009 to 2012 in the Philippines. This retrospective study reviewed the deceased organ donor referrals from 2002 to 2008 and 2009 to 2012. There were 437 referrals for potential deceased organ donors from 2009 to 2012, compared to 434 referrals from 2002 to 2008. Referrals were mainly trauma victims (76%) followed by those with cerebrovascular accidents (12%). In the recent cohort, 81% were approached and 60% consented for donation, but only 23% were retrieved and transplanted. Among those not retrieved, the majority (19%) were medically unsuitable and 6% retracted their consent. Although there was an increasing trend of organ donation referrals in the last 4 years, only 25% were procured. The reasons for nonprocurement should be addressed. Copyright © 2014 Elsevier Inc. All rights reserved.

Nonaltruistic kidney donations in contemporary Jewish law and ethics.

PubMed

Grazi, Richard V; Wolowelsky, Joel B

2003-01-27

In 2000, the Consensus Statement on the Live Organ Donor reported that "direct financial compensation for an organ from a living donor remains controversial and illegal in the United States" and took note of the position of the Transplantation Society that "Organs and tissue should be given without commercial consideration or commercial profit." Christian authorities insist that organ donors must not accrue economic advantage, and "selling" organs deprives the donation of its ethical quality. The writings of major contemporary authorities of Jewish law and ethics whose halakhic positions on bioethical issues are regularly considered by Orthodox, Conservative, and Reform ethicists were reviewed. Their positions on this issue were contrasted with those of various contemporary secular and religious authorities. These Jewish authorities reject the notion that generosity and charity, rather than monetary gain and greed, must serve as the exclusive basis for donation of functioning organs. Although nonaltruistic sale of kidneys may be theoretically ethical, ultimately its ethical status in Jewish ethics and law is inextricably connected to solving a series of pragmatic programs, such as creating a system that ensures that potential vendors and donors are properly informed and not exploited. Lacking such arrangements, ethical nonaltruistic kidney donations remain but a theoretical possibility.

Risk assessment for the reintroduction of anadromous salmonids upstream of Chief Joseph and Grand Coulee Dams, Northeastern Washington

USGS Publications Warehouse

Hardiman, Jill M.; Breyta, Rachel B.; Haskell, Craig A.; Ostberg, Carl O.; Hatten, James R.; Connolly, Patrick J.

2017-09-12

The Upper Columbia United Tribes (UCUT; Spokane, Colville, Kootenai, Coeur d’Alene, and Kalispel Tribes) and Washington Department of Fish and Wildlife want to reintroduce anadromous salmonids to their historical range to restore ecosystem function and lost cultural and spiritual relationships in the upper Columbia River, northeastern Washington. The UCUT contracted with the U.S. Geological Survey to assess risks to resident taxa (existing fish populations in the reintroduction area upstream of Chief Joseph and Grand Coulee Dams) and reintroduced salmon associated with reintroduction. We developed a risk assessment framework for reintroduction of anadromous salmonids upstream of Chief Joseph and Grand Coulee Dams. To accomplish this goal, we applied strategies identified in previous risk assessment frameworks for reintroduction. The risk assessment is an initial step towards an anadromous reintroduction strategy. An initial list of potential donor sources for reintroduction species was developed from previous published sources for Chinook Salmon (Oncorhynchus tshawytscha) donors in the Transboundary Reach of the Columbia River, British Columbia; an ecological risk assessment of upper Columbia River hatchery programs on non-target taxa of concern; and a review of existing hatchery programsDuring two workshops, we further identified and ranked potential donor sources of anadromous Redband Trout (steelhead; O. mykiss), Chinook Salmon, Sockeye Salmon (O. nerka), and Coho Salmon (O. kisutch). We also identified resident fish populations of interest and their primary habitat, location, status, and pathogen concerns to determine the potential risks of reintroduction. Species were deemed of interest based on resource management and potential interactions (that is, genetics, competition, and predation) with introduced species. We developed tables of potential donors by species and characterized potential sources (hatchery and natural origins), populations (individual runs), broodstock management and history, and potential constraints (that is, Endangered Species Act [ESA] listing, Evolutionarily Significant Unit concerns, pathogens, and availability). During the workshops, a group of regional fisheries and topic experts subjectively ranked the relative risks of pathogens, genetic effects, predation, and competition to resident fish and reintroduced salmonids. We assessed the pathogen risk of each potential donor for introducing new pathogens and the increased burden to existing pathogens for resident species upstream of the dams. We considered genetic risks to resident and downstream conspecifics and ecological impacts, including competition for food and space, predator-prey interactions, and ecosystem benefits/impacts. Each reintroduced species donor source was ranked based on abundance/viability (demographic risk to source and feasibility of collection), ancestral/genetic similarity (evolutionary similarity to historical populations), local adaptation (geographic proximity/similarity of source conditions to reintroduction conditions), and life history compatibility (including migration; spawn timing; and relative usage of reservoir, main-stem, or tributary habitats) with environmental conditions in the reintroduction area. We synthesized this information by species for all potential donors, in which an overall score and ranking system was established for decision support in donor selection for reintroduction into the upper Columbia River. We also provided information outside the ranking process by:Identifying predator-prey interactions and competition for food and space among species,Developing a decision support framework for donor selection, andProviding decision support for reintroduction strategies.

The National Marrow Donor Program and Be The Match Registry | NIH MedlinePlus the Magazine

MedlinePlus

... Registry Past Issues / Summer 2011 Table of Contents Creating connections. Saving lives. Founded in 1987 by the ... The Match Registry are nonprofit organizations dedicated to creating an opportunity for all patients to receive the ...

EXXON donor solvent coal liquefaction process

NASA Technical Reports Server (NTRS)

Epperly, W. R.; Swabb, L. E., Jr.; Tauton, J. W.

1978-01-01

A solvent coal liquefaction process to produce low-sulfur liquid products from a wide range of coals is described. An integrated program of laboratory and engineering research and development in conjunction with operation of a 250 T/D pilot plant is discussed.

The forgotten French: The 'heroic' era of kidney transplantation.

PubMed

Cooper, David Kc

2017-11-01

The efforts in the late 1940s to 1960s of two Parisian pioneers in kidney transplantation, René Kűss, a surgeon, and Jean Hamburger, a nephrologist, have largely been forgotten. Küss developed the operation that is basically unchanged today. Both groups initiated clinical transplant programs in January 1951, and both were among the first to carry out kidney transplantation (i) without immunosuppressive therapy, (ii) between living-related and unrelated donors, (iii) with organs from deceased donors, (iv) with irradiation and immunosuppressive drugs, and (v) with long-term survival. In the opinion of many, the French did not receive full credit for their work internationally.

PEPFAR Transitions to Country Ownership: Review of Past Donor Transitions and Application of Lessons Learned to the Eastern Caribbean.

PubMed

Vogus, Abigail; Graff, Kylie

2015-06-17

The US President's Emergency Plan for AIDS Relief (PEPFAR) has shifted from an emergency response to a sustainable, country-owned response. The process of transition to country ownership is already underway in the Eastern Caribbean; the Office of the US Global AIDS Coordinator (OGAC) has advised the region that PEPFAR funding is being redirected away from the Eastern Caribbean toward Caribbean countries with high disease burden to strengthen services for key populations. This article seeks to highlight and apply lessons learned from other donor transitions to support a successful transition of HIV programs in the Eastern Caribbean. Based on a rapid review of both peer-reviewed and gray literature on donor transitions to country ownership in family planning, HIV, and other areas, we identified 48 resources that addressed key steps in the transition process and determinants of readiness for transition. Analysis of the existing literature revealed 6 steps that could help ensure successful transition, including developing a clear roadmap articulated through high-level diplomacy; investing in extensive stakeholder engagement; and supporting monitoring and evaluation during and after the transition to adjust course as needed. Nine specific areas to assess a country's readiness for transition include: leadership and management capacity, political and economic factors, the policy environment, identification of alternative funding sources, integration of HIV programs into the wider health system, the institutionalization of processes, the strength of procurement and supply chain management, identification of staffing and training needs, and engagement of civil society and the private sector. In the Caribbean, key areas requiring strengthening to ensure countries in the region can maintain the gains made under PEPFAR include further engaging civil society and the private sector, building the capacity of NGOs to take on essential program functions, and maintaining donor support for targeted capacity building and long-term monitoring and evaluation efforts. © Vogus et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/3.0/

Crises in national leadership?

PubMed

Mahathir, M

1998-01-01

In Asia, an economic crisis has occurred simultaneously with an immense increase in the prevalence of HIV/AIDS fueled by inadequate responses to the epidemic. This response has been further weakened by sudden budget cuts and changes in government priorities, and the situation has been exacerbated by its suddenness and by the fact that large numbers of people are at risk and are unemployed. Also, Asian countries are now seeking entry into the pool of countries where donors support HIV/AIDS prevention and treatment programs just as donors are reducing their aid budgets. Prevention programs are being severely compromised even before they became effective, and efforts to secure treatment are hindered by high prices, by devalued national currencies, and by an increasing trend towards the privatization of health care. In the long run, efforts to restore economic stability will be hindered by the socioeconomic impact of the HIV/AIDS pandemic. In order to improve future prospects, the leadership of all national AIDS programs must reexamine the cost effectiveness of their priorities. Such a move would target marginalized groups, reduce use of expensive mass media campaigns, increase international cooperation over issues dealing with migrant workers, create programs recognizing the crucial role of women, increase the involvement of infected people in prevention programs, recognize the long-term socioeconomic benefits of providing adequate and equitable care and treatment, and recognize the benefits of prioritizing HIV/AIDS funding.

FY2010 Supplemental for Wars, Disaster Assistance, Haiti Relief, and Other Programs

DTIC Science & Technology

2010-08-06

efforts to administer and oversee grants awarded under the Broadband Technology Opportunity Program, fully offset from within the Department of...Economic opportunity : $8.6 million to expand credit union services, including Islamic-compliant financing. The INCLE account is implemented by the...growth and provide services and opportunities outside of Port-au- Prince. The Haitian government and donors agreed that the current crisis provides an

The silence of Good Samaritan kidney donation in Australia: a survey of hospital websites.

PubMed

Bramstedt, Katrina A; Dave, Sameer

2013-01-01

It is common for living donor candidates to use the Internet as a tool to enhance their decision-making process. Specifically, the websites of transplant hospitals can potentially be a vital source of information for those contemplating living donation. In an effort to explore the low incidence of Good Samaritan kidney donation (donations to strangers) in Australia, two raters conducted a nine-attribute website content analysis for all hospitals which participate in these transplants (n = 15). Overall, the concept of living donation is relatively silent on Australian hospital websites. Only four hospitals mention their living donor program, and only one mentions their Good Samaritan program. No site linked directly to Australia's AKX Paired Kidney Exchange Program - the only program which facilitates pair and chain transplants in Australia. Further, information about deceased donation is nearly absent as well. An individual with the altruistic desire to donate will generally find scant or absent information about donation at the website of their local transplant hospital, although this information could easily be present as an educational tool which supports the consent process. Using a hospital website to educate the public about a clinical service should not be viewed as ethically problematic (solicitation), but rather an ethical essential. © 2013 John Wiley & Sons A/S.

Correlation Between Corneal Button Size and Intraocular Pressure During Femtosecond Laser-Assisted Keratoplasty.

PubMed

Choi, Mihyun; Lee, Yong Eun; Whang, Woong-Joo; Yoo, Young-Sik; Na, Kyung-Sun; Joo, Choun-Ki

2016-03-01

To evaluate changes in intraocular pressure (IOP) in recipient and donor eyes during femtosecond laser-assisted keratoplasty (FLAK) and to assess for differences in the diameter of trephinated corneal buttons according to changes in pressure. Twenty porcine whole eyes (recipient model) and 20 porcine-corneoscleral rims (donor model) were prepared, and anterior chamber pressures were measured using a fiberoptic sensing device (Opsens, Quebec, Canada) during the femtosecond laser corneal cutting process. To determine the diameter of corneal buttons, 10 porcine whole eyes (recipient model) and 12 corneoscleral rims (donor model) of each baseline IOP were cut with the femtosecond laser programmed to the following pattern: "vertical side cut"; 1200 μm (depth), 8 mm (diameter). Digital photographs were obtained using microscopy and subsequently analyzed. The IOP (mean ± SD) for the recipient model was 10.2 (±0.9) mm Hg at baseline and ranged from 96.6 (±4.5) to ∼138.4 (±3.8) mm Hg during the corneal cutting process. This shows that the maximum IOP during FLAK increased 13.5 times compared with baseline. In the donor model, the mean pressure elevation from baseline artificial anterior chamber (AAC) pressure to corneal cutting was 15.8 (±5.4) mm Hg. This showed a positive correlation with baseline IOP [correlation coefficient (CC) = 0.827, P = 0.006]. As the baseline IOP in the recipient eye increased, trephinated corneal button size was reduced by up to 3.9% in diameter (CC = -0.945, P = 0.015). In addition, in donor eyes, the diameter was decreased by up to 11.7% as the baseline AAC pressure increased (CC = -0.934, P = 0.006). During the FLAK procedure, the IOP increases in both recipient and donor eyes. The diameter of the trephinated donor and recipient corneal buttons was decreased as the initial baseline IOP increased. Ophthalmic surgeons can determine the AAC pressure based on the baseline IOP in the recipient patient.

Understanding disparities in donor behavior: race and gender differences in willingness to donate blood and cadaveric organs.

PubMed

Boulware, L Ebony; Ratner, Lloyd E; Cooper, Lisa A; Sosa, Julie Ann; LaVeist, Thomas A; Powe, Neil R

2002-02-01

Recent efforts to recruit blood and organ donors have only marginally improved demographic disparities in willingness to donate. Few studies have examined which factors are most important in explaining race and gender disparities in willingness to donate. To assess race and gender differences in willingness to donate blood and cadaveric organs, and to determine the extent to which several factors (including sociodemographic characteristics and attitudes about religion and mistrust of hospitals) might explain differences in willingness to donate. Cross-sectional telephone survey of Maryland households contacted via random-digit dialing. Past blood donation, organ-donor status on driver's license, and measures of medical mistrust and religious and spiritual salience. Persons age 18 to 75 living in the Baltimore, Maryland metropolitan area. Of 385 respondents (84% of randomized households), 114 were black females, 46 were black males, 110 were white females, and 69 were white males. Before adjustment, black females were least willing to donate blood (41%), and black males were least willing to become cadaveric donors (19%) among all race-gender groups. Adjustment for respondent concerns about mistrust of hospitals and discrimination in hospitals explained most differences in willingness to donate blood, whereas adjustment for respondents' beliefs regarding the importance of spirituality and religion explained most differences in willingness to donate cadaveric organs. Both race and gender are important identifiers of those less willing to donate. To maximize efficiency, donor recruitment efforts should focus on race-gender groups with lowest levels of willingness. Potential donor concerns regarding mistrust in hospitals and religion/spirituality may serve as important issues to address when developing programs to improve donation rates.

Four-Way Kidney Exchange Transplant With Desensitization Increases Access to Living-Donor Kidney Transplant: First Report From India.

PubMed

Kute, Vivek B; Patel, Himanshu V; Shah, Pankaj R; Modi, Pranjal R; Shah, Veena R; Kasat, Govind S; Patil, Mayur V; Patel, Jaydeep C; Kumar, Deepak P; Trivedi, Hargovind L

2017-09-26

This study reports our experience of the first 4-way kidney exchange transplant combined with desensitization in India, which allows increased access to living-donor kidney transplant for sensitized patients. Four-way kidney exchange transplant procedures were approved by the ethics committee of our institution and the Organ Transplantation Authorization Committee of state governments of India (as per the Transplantation of Human Organs Act of India). The protocols conformed to Declaration of Istanbul principles and the ethical guidelines of the 1975 Helsinki Declaration. Written informed consent was obtained from patients, donors, and their guardians. In April 2016, our transplant team completed simultaneous 4-way kidney exchange transplant procedures without any medical (rejection and infections) or surgical complications. Reasons for being included for kidney exchange transplant were ABO incom-patible (2 recipients) and sensitization (2 recipients). All 4 recipients had stable graft function with no proteinuria and donor-specific antibody at 11-month follow-up on standard triple immunosup-pression. Patient and graft survival rates were both 100%. To the best of our knowledge, this is the first single-center report of 4-way kidney exchange transplant combined with desensitization from India. This procedure has the potential to expand living-donor kidney transplant in disadvantaged groups (eg, sensitized patients). Recipients who are hard to match due to high panel reactive antibody and difficult to desensitize due to strong donor-specific antibodies can receive a transplant with a combination of kidney exchange and desensitization. Our study suggests that 4-way kidney exchange transplant can be performed in developing countries (India) similar to that shown in programs in developed countries with team work, kidney exchange registry, and counseling.

Comparison of two apheresis systems for the collection of CD14+ cells intended to be used in dendritic cell culture.

PubMed

Strasser, Erwin F; Berger, Thomas G; Weisbach, Volker; Zimmermann, Robert; Ringwald, Jürgen; Schuler-Thurner, Beatrice; Zingsem, Jürgen; Eckstein, Reinhold

2003-09-01

Monocytes collected by leukapheresis are increasingly used for dendritic cell (DC) culture in cell factories suitable for DC vaccination in cancer. Using modified MNC programs on two apheresis systems (Cobe Spectra and Fresenius AS.TEC204), leukapheresis components collected from 84 patients with metastatic malignant melanoma and from 31 healthy male donors were investigated. MNCs, monocytes, RBCs, and platelets (PLTs) in donors and components were analyzed by cell counters, WBC differential counts, and flow cytometry. In 5-L collections, Astec showed better results regarding monocyte collection rates (11.0 vs. 7.4 x 10(6)/min, p = 0.04) and efficiencies (collection efficiency, 51.9 vs. 31.9%; p < 0.001). Both devices resulted in monocyte yields at an average of 1 x 10(9) (donors) and 2.5 x 10(9) (patients), whereas Astec components contained high residual RBCs. Compared to components with low residual PLTs, high PLT concentration resulted in higher monocyte loss (48 vs. 20%, p < 0.0001) before DC culture. The Astec is more efficient in 5-L MNC collections compared to the Spectra. Components with high residual PLTs result in high MNC loss by purification procedures. Thus, optimizing MNC programs is essential to obtain components with high MNC yields and low residual cells as prerequisite for high DC yields.

Race, Ethnicity and Ancestry in Unrelated Transplant Matching for the National Marrow Donor Program: A Comparison of Multiple Forms of Self-Identification with Genetics

PubMed Central

Hollenbach, Jill A.; Saperstein, Aliya; Albrecht, Mark; Vierra-Green, Cynthia; Parham, Peter; Norman, Paul J.; Maiers, Martin

2015-01-01

We conducted a nationwide study comparing self-identification to genetic ancestry classifications in a large cohort (n = 1752) from the National Marrow Donor Program. We sought to determine how various measures of self-identification intersect with genetic ancestry, with the aim of improving matching algorithms for unrelated bone marrow transplant. Multiple dimensions of self-identification, including race/ethnicity and geographic ancestry were compared to classifications based on ancestry informative markers (AIMs), and the human leukocyte antigen (HLA) genes, which are required for transplant matching. Nearly 20% of responses were inconsistent between reporting race/ethnicity versus geographic ancestry. Despite strong concordance between AIMs and HLA, no measure of self-identification shows complete correspondence with genetic ancestry. In certain cases geographic ancestry reporting matches genetic ancestry not reflected in race/ethnicity identification, but in other cases geographic ancestries show little correspondence to genetic measures, with important differences by gender. However, when respondents assign ancestry to grandparents, we observe sub-groups of individuals with well- defined genetic ancestries, including important differences in HLA frequencies, with implications for transplant matching. While we advocate for tailored questioning to improve accuracy of ancestry ascertainment, collection of donor grandparents’ information will improve the chances of finding matches for many patients, particularly for mixed-ancestry individuals. PMID:26287376

Effect of community educational interventions on rate of organ donation among Hispanic Americans.

PubMed

Salim, Ali; Ley, Eric J; Berry, Cherisse; Schulman, Danielle; Navarro, Sonia; Zheng, Ling; Chan, Linda S

2014-09-01

The need for suitable organs for transplantation is especially pronounced in minority populations such as Hispanic Americans owing to disproportionately high rates of diabetes mellitus and kidney disease. Considerable barriers exist for Hispanic Americans consent to donation, resulting in significantly lower donation rates compared with white individuals. To investigate the effect of an aggressive outreach intervention during a 5-year period aimed at improving organ donation rates among Hispanic Americans. Prospective longitudinal observation study of organ donors treated at a major metropolitan level I trauma center. The center provides most of the medical care to the 4 Southern California neighborhoods with a high percentage of Hispanic Americans that were included in the study. Television and radio media campaigns and culturally sensitive educational programs implemented at high schools, churches, and medical clinics in the target neighborhoods. Consent rate for organ donation recorded during the study. Outreach interventions started in 2007 and were completed by 2012. Of 268 potential donors, 155 total donors (106 Hispanic Americans) provided consent during this time. A significant increase in consent rate was noted among Hispanic Americans, from 56% in 2005 to 83%in 2011 (P = .004); this increase was not evident in the population that was not Hispanic (67%in 2005 and 79% in 2011; P = .21). Aggressive outreach programs can reduce the disparity between organ supply and demand by improving the consent rate among the target group.

[Are patients in the postpartum period potential egg donors?].

PubMed

Cabry-Goubet, R; Lombart, M; Scheffler-Garhieni, F; Lourdel, E; Carette, F; Devaux, A; Copin, H; Benkhalifa, M; Merviel, P

2014-12-01

In France, oocyte donation program is still underdeveloped because of lack of donors and this situation entails an important wave of cross border medical tourism to different European countries mainly Spain and Greece. In 2011, the General inspection of social affairs report recommended to the biomedicine agency to promote spontaneous oocyte donation via different channels of information to develop this national program. The main objective of this study is to assess the knowledge of women after baby delivery about oocyte donation. The second objective is the identification of ways to assure better information and to promote oocyte donation. We conducted a prospective study with anonymous questionnaire distribution to women after delivery at obstetrics/gynecology department of the Regional University Hospital and Maternity-Children Unit "Victor-Pauchet" of Amiens, from December 2012 to January 2013. Two hundred and fifty-five questionnaires were distributed and 242 of them were analyzed (94.9%). About oocyte donation knowledge: 28% did not know it was possible, 45% did not know it was legal in France, 54% did not know who was concerned and 36% know that a treatment is necessary, 9% think that oocyte donation is paid and 10% it is non-anonymous. If 67% seems to be favorable to this initiative, only 35% could accept to realize it. About information efficiency, 88% think not to receive enough information, 64% would like to have more information. The health care professional wanted to give this information is an obstetrician (51%), a midwife (37%) and a nurse (12%). Oocyte donation program is misoriented due to a lack of information. Obstetricians and midwives have an important educational and informative role to support oocyte donation. Specific strategy of communication and valuable targeted information are needed to motivate potential donor and achieve the objectives of the program. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

[Transplant coordination and logistics of intra and extra-hospital cadaver donor tissue. "The Pamplona Model". Sequence of tasks performed from 1992-2006].

PubMed

Maraví-Poma, E; Martín, A; Maraví-Aznar, A; Iturralde, O; Compains, E; Álvarez, J; Cabal, S; Maraví-Aznar, E; Teijeira, R; Unzué, J J; González, R

2006-01-01

Tissue and organ donations are the only option for many patients. Cerebral death (CD) facilitates this approach. However, hospitals that do not provide CD donors have to adapt in order to obtain donors, referred to as tissue donors (TD), who have died from cardiac arrest. Is this paper it descripte the model for coordination and donation of intra and extra-hospital TD in the Autonomous Community of Navarra. It creats a program for detection, donation and extractions called the Pamplona Model, from 1992-2006. In 1990, a transplant team was created by an Intensive Medicine Physician of HVC, INML and SOS-Navarra. In 1996, VCH Transplant Coordination is defined as a reference centre for the Tissue Transplant Programme in the Autonomous Community of Navarra. Consensus protocols for "intra and extra-hospital detection" of persons having died from cardiac arrest are developed: - Alerts from NHS-O hospitals, SOS-Navarra; judges and INML forensic pathologists. - Criteria for selection, search and contacts with relatives. - Alert serology, extraction and transport teams. - Logistics and distribution of tissue. - Agreed incentives: Economic, administrative and relevant regulations. The Pamplona Model, with the Virgen Del Camino hospital has made important contributions and is unique in the world. Intra and extra-hospital coordination of cadaver donor from a referred hospital, it is a scientific and organizational advance to have in it counts for the creation of extraction and transplant tissues teams.

Living donor transplantation--the real gift of life. Procurement and the ethical assessment.

PubMed

Banasik, Mirosław

2006-01-01

It has been observed during the past 10-15 years a greater disparity between the supply of kidneys for transplantation and the demand of patients on waiting lists. The number of cadaveric kidneys available for transplantation have not increased in many countries. Countries and their societies are faced with a choice, let patients with the end- stage renal disease stay on, dialysis giving a faster death and a lower quality of life, or decide to introduce the more active living donation program. There are countries, historically Scandinavian countries, the U.S.A. and U.K., which decided to change medical, social and ethical attitudes to help their citizens and patients on dialysis. For many other countries approval of the new approach of their donation seems to cause difficulties. The main problem for medical staff is the principle Primum non nocere (First do no harm), removal of a living kidney conflicts with this principle. From the other point of view is the human right of an individual to autonomy for donation of a kidney. The donor is completely informed for the risks involved in donation of a kidney to an awaiting recipient. The donors reasons for donation of the kidney must be understood and family pressure excluded. Where is the borderline between the paternalistic approach of the medical personnel preventing the altruistic attitude of the donor? How far is the role of the medical staff to extend in the assessment of the altruistic nature and goodwill of the donors?

Profile of Rh, Kell, Duffy, Kidd, and Diego blood group systems among blood donors in the Southwest region of the Paraná state, Southern Brazil.

PubMed

Zacarias, Joana Maira Valentini; Langer, Ieda Bernadete Volkweis; Visentainer, Jeane Eliete Laguila; Sell, Ana Maria

2016-12-01

The aim of this study was to assess the distribution of alleles and genotypes of the blood group systems Rh, Kell, Duffy, Kidd, and Diego in 251 regular blood donors registered in the hemotherapy unit of the Southwestern region of Paraná, Southern Brazil. The frequencies were obtained by direct counting on a spreadsheet program and statistical analyses were conducted in order to compare them with other Brazilian populations using chi-squared with Yates correction on OpenEpi software. The frequencies of RHD* negative, RHCE*c/c and RHCE*e/e were higher than expected for the Caucasian population. A difference was also observed for FY alleles, FY*01/FY*01 genotype and FY*02N.01 -67T/C (GATA Box mutation). Two homozygous individuals were defined as a low frequency phenotype K + k- (KEL*01.01/KEL*01.01) and, for Diego blood group system the rare DI*01 allele was found in ten blood donors, of which one was DI*01/DI* 01 (0.4%). The allele and genotype frequencies of Kidd blood group system were similar to expected to Caucasians. The results showed the direction in which to choose donors, the importance of extended genotyping in adequate blood screening and the existence of rare genotypes in Brazilian regular blood donors. Copyright © 2016 Elsevier Ltd. All rights reserved.

Liver transplantation in the Nordic countries – An intention to treat and post-transplant analysis from The Nordic Liver Transplant Registry 1982–2013

PubMed Central

Fosby, Bjarte; Melum, Espen; Bjøro, Kristian; Bennet, William; Rasmussen, Allan; Andersen, Ina Marie; Castedal, Maria; Olausson, Michael; Wibeck, Christina; Gotlieb, Mette; Gjertsen, Henrik; Toivonen, Leena; Foss, Stein; Makisalo, Heikki; Nordin, Arno; Sanengen, Truls; Bergquist, Annika; Larsson, Marie E.; Soderdahl, Gunnar; Nowak, Greg; Boberg, Kirsten Muri; Isoniemi, Helena; Keiding, Susanne; Foss, Aksel; Line, Pål-Dag; Friman, Styrbjörn; Schrumpf, Erik; Ericzon, Bo-Göran; Höckerstedt, Krister; Karlsen, Tom H.

2015-01-01

Abstract Aim and background. The Nordic Liver Transplant Registry (NLTR) accounts for all liver transplants performed in the Nordic countries since the start of the transplant program in 1982. Due to short waiting times, donor liver allocation has been made without considerations of the model of end-stage liver disease (MELD) score. We aimed to summarize key outcome measures and developments for the activity up to December 2013. Materials and methods. The registry is integrated with the operational waiting-list and liver allocation system of Scandiatransplant (www.scandiatransplant.org) and accounted at the end of 2013 for 6019 patients out of whom 5198 were transplanted. Data for recipient and donor characteristics and relevant end-points retransplantation and death are manually curated on an annual basis to allow for statistical analysis and the annual report. Results. Primary sclerosing cholangitis, acute hepatic failure, alcoholic liver disease, primary biliary cirrhosis and hepatocellular carcinoma are the five most frequent diagnoses (accounting for 15.3%, 10.8%, 10.6%, 9.3% and 9.0% of all transplants, respectively). Median waiting time for non-urgent liver transplantation during the last 10-year period was 39 days. Outcome has improved over time, and for patients transplanted during 2004–2013, overall one-, five- and 10-year survival rates were 91%, 80% and 71%, respectively. In an intention-to-treat analysis, corresponding numbers during the same time period were 87%, 75% and 66%, respectively. Conclusion. The liver transplant program in the Nordic countries provides comparable outcomes to programs with a MELD-based donor liver allocation system. Unique features comprise the diagnostic spectrum, waiting times and the availability of an integrated waiting list and transplant registry (NLTR). PMID:25959101

Liver transplantation in the Nordic countries - An intention to treat and post-transplant analysis from The Nordic Liver Transplant Registry 1982-2013.

PubMed

Fosby, Bjarte; Melum, Espen; Bjøro, Kristian; Bennet, William; Rasmussen, Allan; Andersen, Ina Marie; Castedal, Maria; Olausson, Michael; Wibeck, Christina; Gotlieb, Mette; Gjertsen, Henrik; Toivonen, Leena; Foss, Stein; Makisalo, Heikki; Nordin, Arno; Sanengen, Truls; Bergquist, Annika; Larsson, Marie E; Soderdahl, Gunnar; Nowak, Greg; Boberg, Kirsten Muri; Isoniemi, Helena; Keiding, Susanne; Foss, Aksel; Line, Pål-Dag; Friman, Styrbjörn; Schrumpf, Erik; Ericzon, Bo-Göran; Höckerstedt, Krister; Karlsen, Tom H

2015-06-01

The Nordic Liver Transplant Registry (NLTR) accounts for all liver transplants performed in the Nordic countries since the start of the transplant program in 1982. Due to short waiting times, donor liver allocation has been made without considerations of the model of end-stage liver disease (MELD) score. We aimed to summarize key outcome measures and developments for the activity up to December 2013. The registry is integrated with the operational waiting-list and liver allocation system of Scandiatransplant (www.scandiatransplant.org) and accounted at the end of 2013 for 6019 patients out of whom 5198 were transplanted. Data for recipient and donor characteristics and relevant end-points retransplantation and death are manually curated on an annual basis to allow for statistical analysis and the annual report. Primary sclerosing cholangitis, acute hepatic failure, alcoholic liver disease, primary biliary cirrhosis and hepatocellular carcinoma are the five most frequent diagnoses (accounting for 15.3%, 10.8%, 10.6%, 9.3% and 9.0% of all transplants, respectively). Median waiting time for non-urgent liver transplantation during the last 10-year period was 39 days. Outcome has improved over time, and for patients transplanted during 2004-2013, overall one-, five- and 10-year survival rates were 91%, 80% and 71%, respectively. In an intention-to-treat analysis, corresponding numbers during the same time period were 87%, 75% and 66%, respectively. The liver transplant program in the Nordic countries provides comparable outcomes to programs with a MELD-based donor liver allocation system. Unique features comprise the diagnostic spectrum, waiting times and the availability of an integrated waiting list and transplant registry (NLTR).

Open-source LIMS in Vietnam: The path toward sustainability and host country ownership.

PubMed

Landgraf, Kenneth M; Kakkar, Reshma; Meigs, Michelle; Jankauskas, Paul T; Phan, Thi Thu Huong; Nguyen, Viet Nga; Nguyen, Duy Thai; Duong, Thanh Tung; Nguyen, Thi Hoa; Bond, Kyle B

2016-09-01

The objectives of this case report are as follows: to describe the process of establishing a national laboratory information management system (LIMS) program for clinical and public health laboratories in Vietnam; to evaluate the outcomes and lessons learned; and to present a model for sustainability based on the program outcomes that could be applied to diverse laboratory programs. This case report comprises a review of program documentation and records, including planning and budgetary records of the donor, monthly reports from the implementer, direct observation, and ad-hoc field reports from technical advisors and governmental agencies. Additional data on program efficacy and user acceptance were collected from routine monitoring of laboratory policies and operational practices. LIMS software was implemented at 38 hospital, public health and HIV testing laboratories in Vietnam. This LIMS was accepted by users and program managers as a useful tool to support laboratory processes. Implementation cost per laboratory and average duration of deployment decreased over time, and project stakeholders initiated transition of financing (from the donor to local institutions) and of system maintenance functions (from the implementer to governmental and site-level staff). Collaboration between the implementer in Vietnam and the global LIMS user community was strongly established, and knowledge was successfully transferred to staff within Vietnam. Implementing open-sourced LIMS with local development and support was a feasible approach towards establishing a sustainable laboratory informatics program that met the needs of health laboratories in Vietnam. Further effort to institutionalize IT support capacity within key government agencies is ongoing. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Organ Donation in the 50+ Age Demographic: Survey Results on Decision Rationale and Information Preferences.

PubMed

Tartaglia, Alexander; Dodd-McCue, Diane; Myer, Kevin A; Mullins, Andrew

2016-09-01

The rate of organ donation by older potential donors is significantly declining even though recent studies show positive clinical outcomes with organs transplanted from older donors. This study examined the 50+ age demographic to identify the rationale for donation decisions, preferred media methods of donation information delivery, and responsiveness to an age-tailored donation message. Results from 579 surveys, 87% from the 50+ age demographic, found respondents prone to self-select themselves as medically ineligible based on current medication and health status, even though they might be medically suitable donors. Their incentive to pursue additional information on donation is limited except when motivated by personal accounts within their families and communities. In addition, even when computer literate, they continue to favor the printed or spoken word for donation information delivery. The results suggest an opportunity for those working with older adults to develop more personalized, localized donation education programs targeting this age demographic. © The Author(s) 2014.

Registry of the Japanese Society of Lung and Heart-Lung Transplantation: the official Japanese lung transplantation report 2008.

PubMed

Shiraishi, Takeshi; Okada, Yoshinori; Sekine, Yasuo; Chida, Masayuki; Bando, Toru; Minami, Masato; Oto, Takahiro; Nagayasu, Takeshi; Date, Hiroshi; Kondo, Takashi

2009-08-01

The year 2008 marked the 10th anniversary of the Japanese lung transplantation program started in accordance with the Japanese Organ Transplant Law, which took effect in 1997. A total of 105 lung transplantations, including 39 deceased-donor transplants and 66 living-related transplants, had been performed as of the end of 2007. This article is the 2008 official report of the Japanese Society of Lung and Heart-Lung Transplantation. It summarizes the data for clinical lung transplantation during the period 1998-2007 and discusses the current status of Japanese lung transplantation. The overall 5-year survival rate was 67.0%: including 53.4% and 74.6% for deceased-donor lung transplantation and living-donor lobar lung transplantation groups, respectively. The total operation-related and 1-month mortality rates after surgery were 3.8% and 10.4%, respectively. These data are better, or at least acceptable, in comparison with the international registry data.

The effect of prior transfusion history on blood donor anti-hepatitis C virus antibody.

PubMed

Mazda, T; Nakata, K; Ota, K; Kaminuma, Y; Katayama, T

1993-01-01

In Japan, the major transfusion-associated disease is non-A, non-B hepatitis. We studied the relationship between transfusion history and blood donor antibodies to hepatitis C virus (HCV). The positive rate of antibodies to the HCV nonstructural protein (c100-3) depended on age and the time elapsed since transfusion. The anti-c100-3 ratio for subjects with transfusions made prior to 20 years ago was high. One quarter century ago, a change occurred in national blood policy from paid to non-paid voluntary donations. We also have studied the anti-HCV positive rate among donors with prior transfusion using a second generation HCV test kit which includes anti-HCV core antibody detection. The anti-HCV positive rate for the second generation test was higher than that for the anti-c100-3 test. Introduction of the second generation test is therefore more useful in screening than the anti-c100-3 test for blood programs.

Solar Decathlon 2017: Final Report and Lessons Learned

DOE Office of Scientific and Technical Information (OSTI.GOV)

Incorporated, Energetics

This final report introduces the Solar Decathlon 2017 Program Administrator, Core Advisory Committee, event sponsors and donors, and regional stakeholders that were integral to the success of Solar Decathlon 2017. The substantial balance of this report presents evaluative metrics and lessons learned about the primary aspects of administering Solar Decathlon 2017, including Project Management, Competition and Site Management, Stakeholder Engagement, Communications, Sponsor Management, Education Programming, and Volunteer Coordination. Several appendices compliment the discussion.

Con: pediatric anesthesia training in developing countries is best achieved by out of country scholarships.

PubMed

Walker, Isabeau A

2009-01-01

Medical migration is damaging health systems in developing countries and anesthesia delivery is critically affected, particularly in sub-Saharan Africa. 'Within country' postgraduate anesthesia training needs to be supported to encourage more doctors into the specialty. Open-ended training programs to countries that do not share the same spectrum of disease should be discouraged. Donor agencies have an important role to play in supporting sustainable postgraduate training programs.

Choline, Other Methyl-Donors and Epigenetics

PubMed Central

Zeisel, Steven H.

2017-01-01

Choline dietary intake varies such that many people do not achieve adequate intakes. Diet intake of choline can modulate methylation because, via betaine homocysteine methyltransferase (BHMT), this nutrient (and its metabolite, betaine) regulate the concentrations of S-adenosylhomocysteine and S-adenosylmethionine. Some of the epigenetic mechanisms that modify gene expression without modifying the genetic code depend on the methylation of DNA or of histones; and diet availability of choline and other methyl-group donors influences both of these methylations. Examples of methyl-donor mediated epigenetic effects include the changes in coat color and body weight in offspring when pregnant agouti mice are fed high choline, high methyl diets; the changes in tail kinking in offspring when pregnant Axin(Fu) mice are fed high choline, high methyl diets; the changes in Cdkn3 methylation and altered brain development that occurs in offspring when pregnant rodents are fed low choline diets. When choline metabolism is disrupted by deleting the gene Bhmt, DNA methylation is affected (especially in a region of chromosome 13), expression of specific genes is suppressed, and liver cancers develop. Better understanding of how nutrients such as choline and methyl-donors influence epigenetic programs has importance for our understanding of not only developmental abnormalities but also for understanding the origins of chronic diseases. PMID:28468239

Choline, Other Methyl-Donors and Epigenetics.

PubMed

Zeisel, Steven

2017-04-29

Choline dietary intake varies such that many people do not achieve adequate intakes. Diet intake of choline can modulate methylation because, via betaine homocysteine methyltransferase (BHMT), this nutrient (and its metabolite, betaine) regulate the concentrations of S-adenosylhomocysteine and S-adenosylmethionine. Some of the epigenetic mechanisms that modify gene expression without modifying the genetic code depend on the methylation of DNA or of histones; and diet availability of choline and other methyl-group donors influences both of these methylations. Examples of methyl-donor mediated epigenetic effects include the changes in coat color and body weight in offspring when pregnant agouti mice are fed high choline, high methyl diets; the changes in tail kinking in offspring when pregnant Axin(Fu) mice are fed high choline, high methyl diets; the changes in Cdkn3 methylation and altered brain development that occurs in offspring when pregnant rodents are fed low choline diets. When choline metabolism is disrupted by deleting the gene Bhmt, DNA methylation is affected (especially in a region of chromosome 13), expression of specific genes is suppressed, and liver cancers develop. Better understanding of how nutrients such as choline and methyl-donors influence epigenetic programs has importance for our understanding of not only developmental abnormalities but also for understanding the origins of chronic diseases.

Hybrid Donor-Dot Devices made using Top-down Ion Implantation for Quantum Computing

NASA Astrophysics Data System (ADS)

Bielejec, Edward; Bishop, Nathan; Carroll, Malcolm

2012-02-01

We present progress towards fabricating hybrid donor -- quantum dots (QD) for quantum computing. These devices will exploit the long coherence time of the donor system and the surface state manipulation associated with a QD. Fabrication requires detection of single ions implanted with 10's of nanometer precision. We show in this talk, 100% detection efficiency for single ions using a single ion Geiger mode avalanche (SIGMA) detector integrated into a Si MOS QD process flow. The NanoImplanter (nI) a focused ion beam system is used for precision top-down placement of the implanted ion. This machine has a 10 nm resolution combined with a mass velocity filter, allowing for the use of multi-species liquid metal ion sources (LMIS) to implant P and Sb ions, and a fast blanking and chopping system for single ion implants. The combination of the nI and integration of the SIGMA with the MOS QD process flow establishes a path to fabricate hybrid single donor-dot devices. Sandia National Laboratories is a multi-program laboratory managed and operated by Sandia Corporation, a wholly owned subsidiary of Lockheed Martin Corporation, for the U.S. Department of Energy's National Nuclear Security Administration under contract DE-AC04-94AL85000.

Nuclear-driven electron spin rotations in a coupled silicon quantum dot and single donor system

NASA Astrophysics Data System (ADS)

Harvey-Collard, Patrick; Jacobson, Noah Tobias; Rudolph, Martin; Ten Eyck, Gregory A.; Wendt, Joel R.; Pluym, Tammy; Lilly, Michael P.; Pioro-Ladrière, Michel; Carroll, Malcolm S.

Single donors in silicon are very good qubits. However, a central challenge is to couple them to one another. To achieve this, many proposals rely on using a nearby quantum dot (QD) to mediate an interaction. In this work, we demonstrate the coherent coupling of electron spins between a single 31P donor and an enriched 28Si metal-oxide-semiconductor few-electron QD. We show that the electron-nuclear spin interaction can drive coherent rotations between singlet and triplet electron spin states. Moreover, we are able to tune electrically the exchange interaction between the QD and donor electrons. The combination of single-nucleus-driven rotations and voltage-tunable exchange provides all elements for future all-electrical control of a spin qubit, and requires only a single dot and no additional magnetic field gradients. This work was performed, in part, at the Center for Integrated Nanotechnologies, an Office of Science User Facility operated for the U.S. Department of Energy (DOE) Office of Science. Sandia National Laboratories is a multi-program laboratory managed and operated by Sandia Corporation, a wholly owned subsidiary of Lockheed Martin Corporation, for the U.S. DOE's National Nuclear Security Administration under Contract DE-AC04-94AL85000.

Report of the clinical donor case workshop of the European Association of Tissue Banks Annual Congress 2013.

PubMed

van Wijk, Marja J; Beele, Hilde; Brubaker, Scott A; Navarro, Aurora; Wulff, Birgit; Warwick, Ruth M

2015-09-01

The European Association of Tissue Banks (EATB) Donor Case Workshop is a forum held within the program of the EATB Annual Congress. The workshop offers an opportunity to discuss and evaluate approaches taken to challenging donor selection and donation ethics, and it strengthens networking between tissue banking professionals. The workshops actively engage participants from a wide array of international expertise, in an informal, secure and enjoyable setting in which learning from peers and finding potential solutions for submitted cases are facilitated. This report reflects some of the discussion at the Donor Case Workshop during the EATB Annual Congress in Brussels in 2013. The presented cases demonstrate that the findings, their interpretation, the resulting actions and preventive measures in the different tissue facilities are not always predictable. The varied responses from participants and lack of consensus corroborate this and clearly indicate that operating procedures do not comprehensively cover or prepare for all eventualities. For many of the issues raised there is no relevant information in the published literature. By publication of a summary of the discussions we hope to reach a wider audience, to provide information gathered at the workshop and to stimulate individuals and institutions to undertake further literature reviews or to undertake research in order to gather evidence concerning the discussed topics.

Imaging screening of catastrophic neurological events using a software tool: preliminary results.

PubMed

Fernandes, A P; Gomes, A; Veiga, J; Ermida, D; Vardasca, T

2015-05-01

In Portugal, as in most countries, the most frequent organ donors are brain-dead donors. To answer the increasing need for transplants, donation programs have been implemented. The goal is to recognize virtually all the possible and potential brain-dead donors admitted to hospitals. The aim of this work was to describe preliminary results of a software application designed to identify devastating neurological injury victims who may progress to brain death and can be possible organ donors. This was an observational, longitudinal study with retrospective data collection. The software application is an automatic algorithm based on natural language processing for selected keywords/expressions present in the cranio-encephalic computerized tomography (CE CT) scan reports to identify catastrophic neurological situations, with e-mail notification to the Transplant Coordinator (TC). The first 7 months of this application were analyzed and compared with the standard clinical evaluation methodology. The imaging identification tool showed a sensitivity of 77% and a specificity of 66%; predictive positive value (PPV) was 0.8 and predictive negative value (PNV) was 0.7 for the identification of catastrophic neurological events. The methodology proposed in this work seems promising in improving the screening efficiency of critical neurological events. Copyright © 2015 Elsevier Inc. All rights reserved.

Financial incentives to increase Canadian organ donation: quick fix or fallacy?

PubMed

Gill, John S; Klarenbach, Scott; Barnieh, Lianne; Caulfield, Timothy; Knoll, Greg; Levin, Adeera; Cole, Edward H

2014-01-01

Unlike the United States, the potential to increase organ donation in Canada may be sufficient to meet the need for transplantation. However, there has been no national coordinated effort to increase organ donation. Strategies that do not involve payment for organs, such as investment in health care resources to support deceased donor organ donation and introduction of a remuneration framework for the work of deceased organ donation, should be prioritized for implementation. Financial incentives that may be permitted under existing legislation and that pose little risk to existing donation sources should be advanced, including the following: payment of funeral expenses for potential donors who register their decision on organ donation during life (irrespective of the decision to donate or actual organ donation) and removal of disincentives for directed and paired exchange living donation, such as payment of wages, payment for pain and suffering related to the donor surgery, and payment of directed living kidney donors for participation in Canada's paired exchange program. In contrast, it would be premature to contemplate a regulated system of organ sales that would require a paradigm shift in the current approach to organ donation and legislative change to implement. Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

The Mass Function of GX 339-4 from Spectroscopic Observations of Its Donor Star

NASA Astrophysics Data System (ADS)

Heida, M.; Jonker, P. G.; Torres, M. A. P.; Chiavassa, A.

2017-09-01

We obtained 16 VLT/X-shooter observations of GX 339-4 in quiescence during the period 2016 May-September and detected absorption lines from the donor star in its NIR spectrum. This allows us to measure the radial velocity curve and projected rotational velocity of the donor for the first time. We confirm the 1.76 day orbital period and we find that K 2 = 219 ± 3 km s-1, γ = 26 ± 2 km s-1, and v\\sin I = 64 ± 8 km s-1. From these values we compute a mass function f(M) = 1.91 ± 0.08 {M}⊙ , a factor ˜3 lower than previously reported, and a mass ratio q = 0.18 ± 0.05. We confirm the donor is a K-type star and estimate that it contributes ˜ 4 % {--}50 % of the light in the J- and H-bands. We constrain the binary inclination to 37° < I < 78° and the black hole (BH) mass to 2.3 {M}⊙ < {M}{BH} < 9.5 {M}⊙ . GX 339-4 may therefore be the first BH to fall in the “mass-gap” of 2-5 M ⊙. Based on ESO program IDs 097.D-0915 and 297.D-5048.

Educating for Sustainability in Developing Countries: The Need for Environmental Education Support.

ERIC Educational Resources Information Center

Hale, Monica

1993-01-01

The Earth Summit in Rio de Janeiro emphasized the need for both the developing and developed world to work toward sustainable development. This paper reviews environmental education, sustainable development, and environmental strategies for aid donors to integrate into their programs. (Author/MDH)

EBMT transplant centers with FACT-JACIE accreditation have significantly better compliance with related donor care standards

PubMed Central

Anthias, Chloe; O'Donnell, Paul V; Kiefer, Deidre M; Yared, Jean; Norkin, Maxim; Anderlini, Paolo; Savani, Bipin N; Diaz, Miguel A; Bitan, Menachem; Halter, Joerg P; Logan, Brent R; Switzer, Galen E; Pulsipher, Michael A; Confer, Dennis L; Shaw, Bronwen E

2016-01-01

Previous studies have identified healthcare practices that may place undue pressure on related donors (RDs) of hematopoietic cell products, and an increase in serious adverse events associated with morbidities in this population. As a result, specific requirements to safeguard RD health have been introduced to FACT-JACIE Standards, but the impact of accreditation on RD care has not previously been evaluated. A survey of transplant program directors of EBMT member centers was conducted by the Donor Health and Safety Working Committee of the Center for International Blood and Marrow Transplant Research (CIBMTR) to test the hypothesis that RD care in FACT-JACIE accredited centers is more closely aligned with international consensus donor care recommendations than RD care delivered in centers without accreditation. Responses were received from 39% of 304 centers. Our results show that practice in accredited centers was much closer to recommended standards as compared to non-accredited centers. Specifically, a higher percentage of accredited centers use eligibility criteria to assess RDs (93% versus 78%; P=0.02) and a lower percentage have a single physician simultaneously responsible for a RD and their recipient (14% versus 35%; P=0.008). In contrast, where regulatory standards do not exist, both accredited and non-accredited centers fell short of accepted best practice. These results raise concerns that despite improvements in care, current practice can place undue pressure on donors, and may increase the risk of donation-associated adverse events. We recommend measures to address these issues through enhancement of regulatory standards as well as national initiatives to standardize RD care. PMID:26597079

Donation after cardiac death as a strategy to increase deceased donor liver availability.

PubMed

Merion, Robert M; Pelletier, Shawn J; Goodrich, Nathan; Englesbe, Michael J; Delmonico, Francis L

2006-10-01

This study examines donation after cardiac death (DCD) practices and outcomes in liver transplantation. Livers procured from DCD donors have recently been used to increase the number of deceased donors and bridge the gap between limited organ supply and the pool of waiting list candidates. Comprehensive evaluation of this practice and its outcomes has not been previously reported. A national cohort of all DCD and donation after brain-death (DBD) liver transplants between January 1, 2000 and December 31, 2004 was identified in the Scientific Registry of Transplant Recipients. Time to graft failure (including death) was modeled by Cox regression, adjusted for relevant donor and recipient characteristics. DCD livers were used for 472 (2%) of 24,070 transplants. Annual DCD liver activity increased from 39 in 2000 to 176 in 2004. The adjusted relative risk of DCD graft failure was 85% higher than for DBD grafts (relative risk, 1.85; 95% confidence interval, 1.51-2.26; P < 0.001), corresponding to 3-month, 1-year, and 3-year graft survival rates of 83.0%, 70.1%, and 60.5%, respectively (vs. 89.2%, 83.0%, and 75.0% for DBD recipients). There was no significant association between transplant program DCD liver transplant volume and graft outcome. The annual number of DCD livers used for transplant has increased rapidly. However, DCD livers are associated with a significantly increased risk of graft failure unrelated to modifiable donor or recipient factors. Appropriate recipients for DCD livers have not been fully characterized and recipient informed consent should be obtained before use of these organs.

Maternal program of apoptosis activated shortly after midblastula transition by overexpression of S-adenosylmethionine decarboxylase in Xenopus early embryos.

PubMed

Shiokawa, K; Kai, M; Higo, T; Kaito, C; Yokoska, J; Yasuhiko, Y; Kajita, E; Nagano, M; Yamada, Y; Shibata, M; Muto, T; Shinga, J; Hara, H; Takayama, E; Fukamachi, H; Yaoita, Y; Igarashi, K

2000-06-01

When we studied polyamine metabolism in Xenopus embryos, we cloned the cDNA for Xenopus S-adenosylmethionine decarboxylase (SAMDC), which converts SAM (S-adenosylmethionine), the methyl donor, into decarboxylated SAM (dcSAM), the aminopropyl donor, and microinjected its in vitro transcribed mRNA into Xenopus fertilized eggs. We found here that the mRNA injection induces a SAM deficient state in early embryos due to over-function of the overexpressed SAMDC, which in turn induces inhibition of protein synthesis. Such embryos developed quite normally until blastula stage, but stopped development at the early gastrula stage, due to induction of massive cell dissociation and cell autolysis, irrespective of the dosage and stage of the mRNA injection. We found that the dissociated cells were TUNEL-positive, contained fragmented nuclei with ladder-forming DNA, and furthermore, rescued completely by coinjection of Bcl-2 mRNA. Thus, overexpression of SAMDC in Xenopus embryos appeared to switch on apoptotic program, probably via inhibition of protein synthesis. Here, we briefly review our results together with those reported from other laboratories. After discussing the general importance of this newly discovered apoptotic program, we propose that the maternal program of apoptosis serves as a surveillance mechanism to eliminate metabolically severely-damaged cells and functions as a 'fail-safe' mechanism for normal development in Xenopus embryos.

Nitric Oxide Inhibits Al-Induced Programmed Cell Death in Root Tips of Peanut (Arachis hypogaea L.) by Affecting Physiological Properties of Antioxidants Systems and Cell Wall

PubMed Central

Pan, Chun-Liu; Yao, Shao-Chang; Xiong, Wei-Jiao; Luo, Shu-Zhen; Wang, Ya-Lun; Wang, Ai-Qin; Xiao, Dong; Zhan, Jie; He, Long-Fei

2017-01-01

It has been reported that nitric oxide (NO) is a negative regulator of aluminum (Al)-induced programmed cell death (PCD) in peanut root tips. However, the inhibiting mechanism of NO on Al-induced PCD is unclear. In order to investigate the mechanism by which NO inhibits Al-induced PCD, the effects of co-treatment Al with the exogenous NO donor or the NO-specific scavenger on peanut root tips, the physiological properties of antioxidants systems and cell wall (CW) in root tip cells of NO inhibiting Al-induced PCD were studied with two peanut cultivars. The results showed that Al exposure induced endogenous NO accumulation, and endogenous NO burst increased antioxidant enzyme activity in response to Al stress. The addition of NO donor sodium nitroprusside (SNP) relieved Al-induced root elongation inhibition, cell death and Al adsorption in CW, as well as oxidative damage and ROS accumulation. Furthermore, co-treatment with the exogenous NO donor decreased MDA content, LOX activity and pectin methylesterase (PME) activity, increased xyloglucan endotransglucosylase (XET) activity and relative expression of the xyloglucan endotransglucosylase/hydrolase (XTH-32) gene. Taken together, exogenous NO alleviated Al-induced PCD by inhibiting Al adsorption in CW, enhancing antioxidant defense and reducing peroxidation of membrane lipids, alleviating the inhibition of Al on root elongation by maintaining the extensibility of CW, decreasing PME activity, and increasing XET activity and relative XTH-32 expression of CW. PMID:29311970

Nitric Oxide Inhibits Al-Induced Programmed Cell Death in Root Tips of Peanut (Arachis hypogaea L.) by Affecting Physiological Properties of Antioxidants Systems and Cell Wall.

PubMed

Pan, Chun-Liu; Yao, Shao-Chang; Xiong, Wei-Jiao; Luo, Shu-Zhen; Wang, Ya-Lun; Wang, Ai-Qin; Xiao, Dong; Zhan, Jie; He, Long-Fei

2017-01-01

It has been reported that nitric oxide (NO) is a negative regulator of aluminum (Al)-induced programmed cell death (PCD) in peanut root tips. However, the inhibiting mechanism of NO on Al-induced PCD is unclear. In order to investigate the mechanism by which NO inhibits Al-induced PCD, the effects of co-treatment Al with the exogenous NO donor or the NO-specific scavenger on peanut root tips, the physiological properties of antioxidants systems and cell wall (CW) in root tip cells of NO inhibiting Al-induced PCD were studied with two peanut cultivars. The results showed that Al exposure induced endogenous NO accumulation, and endogenous NO burst increased antioxidant enzyme activity in response to Al stress. The addition of NO donor sodium nitroprusside (SNP) relieved Al-induced root elongation inhibition, cell death and Al adsorption in CW, as well as oxidative damage and ROS accumulation. Furthermore, co-treatment with the exogenous NO donor decreased MDA content, LOX activity and pectin methylesterase (PME) activity, increased xyloglucan endotransglucosylase (XET) activity and relative expression of the xyloglucan endotransglucosylase/hydrolase ( XTH-32 ) gene. Taken together, exogenous NO alleviated Al-induced PCD by inhibiting Al adsorption in CW, enhancing antioxidant defense and reducing peroxidation of membrane lipids, alleviating the inhibition of Al on root elongation by maintaining the extensibility of CW, decreasing PME activity, and increasing XET activity and relative XTH-32 expression of CW.

Age Modulates Attitudes to Whole Body Donation among Medical Students

ERIC Educational Resources Information Center

Perry, Gary F.; Ettarh, Raj R.

2009-01-01

Managing a whole body donor program is necessary for facilitating a traditional dissection-based anatomy curriculum in medicine and health sciences. Factors which influence body donations to medical science can therefore affect dissection-based anatomy teaching. In order to determine whether age influences the attitudes of medical students to…

42 CFR 121.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Definitions. 121.2 Section 121.2 Public Health... PROCUREMENT AND TRANSPLANTATION NETWORK § 121.2 Definitions. As used in this part— Act means the Public Health..., transplant recipient, or organ donor. OPTN computer match program means a set of computer-based instructions...

42 CFR 121.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Definitions. 121.2 Section 121.2 Public Health... PROCUREMENT AND TRANSPLANTATION NETWORK § 121.2 Definitions. As used in this part— Act means the Public Health..., transplant recipient, or organ donor. OPTN computer match program means a set of computer-based instructions...

National Marrow Donor Program

DTIC Science & Technology

2010-11-05

from power or Internet outages to severe weather. • Received 50 mobile broadband air cards at minimal cost to the organization and ONR to allow for...CLlA CME CMF COG CREG CSS CT CTA DC DHHS-ASPR DIY DKMS DMSO DoD DNA DIR EBMT EM EMDIS ENS ERSI FBI QUARTER PROGRESS REPORT

10 CFR 26.109 - Urine specimen quantity.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 1 2014-01-01 2014-01-01 false Urine specimen quantity. 26.109 Section 26.109 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Collecting Specimens for Testing § 26.109 Urine... shall encourage the donor to drink a reasonable amount of liquid (normally, 8 ounces of water every 30...

10 CFR 26.109 - Urine specimen quantity.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 1 2013-01-01 2013-01-01 false Urine specimen quantity. 26.109 Section 26.109 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Collecting Specimens for Testing § 26.109 Urine... shall encourage the donor to drink a reasonable amount of liquid (normally, 8 ounces of water every 30...

10 CFR 26.109 - Urine specimen quantity.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 1 2012-01-01 2012-01-01 false Urine specimen quantity. 26.109 Section 26.109 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Collecting Specimens for Testing § 26.109 Urine... shall encourage the donor to drink a reasonable amount of liquid (normally, 8 ounces of water every 30...

10 CFR 26.105 - Preparing for urine collection.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 1 2012-01-01 2012-01-01 false Preparing for urine collection. 26.105 Section 26.105 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Collecting Specimens for Testing § 26.105 Preparing for urine collection. (a) The collector shall ask the donor to remove any unnecessary outer...

10 CFR 26.105 - Preparing for urine collection.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 1 2014-01-01 2014-01-01 false Preparing for urine collection. 26.105 Section 26.105 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Collecting Specimens for Testing § 26.105 Preparing for urine collection. (a) The collector shall ask the donor to remove any unnecessary outer...

10 CFR 26.105 - Preparing for urine collection.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 1 2013-01-01 2013-01-01 false Preparing for urine collection. 26.105 Section 26.105 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Collecting Specimens for Testing § 26.105 Preparing for urine collection. (a) The collector shall ask the donor to remove any unnecessary outer...

Charity Begins at Home or, how to Combine a Charitable Gift Annuity with the Donation of a Remainder Interest in a Home.

ERIC Educational Resources Information Center

Finestone, William; Meyer, Roger

1990-01-01

The life estate gift annuity program, which can benefit both the donor and the institution of higher education, is explained; the legal aspects are discussed; and the potential advantages and disadvantages to both parties are outlined. (MSE)

The Business Value Web: Resourcing Business Processes and Solutions in Higher Education

ERIC Educational Resources Information Center

Norris, Donald M.; Olson, Mark A.

2003-01-01

Value is the benefit derived from an enterprise's assets by its stakeholders. For colleges and universities, value is derived by students, faculty, staff, other knowledge seekers, alumni, donors, suppliers, and stakeholders. They derive value through experiencing the institution's programs, services, knowledge assets, and other resources. This…

10 CFR 26.105 - Preparing for urine collection.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Preparing for urine collection. 26.105 Section 26.105 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Collecting Specimens for Testing § 26.105 Preparing for urine collection. (a) The collector shall ask the donor to remove any unnecessary outer...

10 CFR 26.105 - Preparing for urine collection.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Preparing for urine collection. 26.105 Section 26.105 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Collecting Specimens for Testing § 26.105 Preparing for urine collection. (a) The collector shall ask the donor to remove any unnecessary outer...

Homegrown Talent

ERIC Educational Resources Information Center

Masterson, Kathryn

2008-01-01

The University of Michigan at Ann Arbor is offering a development internship program that is designed to give students real-world experience working in development jobs and the chance to meet major donors and network with alumni. Its goals are lofty: to create a pipeline of young people for the development profession; diversify the fund-raising…

Factors for Success: Academic Library Development Survey Results.

ERIC Educational Resources Information Center

Hoffman, Irene M.; Smith, Amy; DiBona, Leslie

2000-01-01

Discusses the results of a nationwide survey (57 survey questions) of academic libraries that investigated fund-raising programs, including personnel involved; goals and costs of fund-raising; library donors, friends, and advisory groups; priorities; and factors of success, including involvement of the director and time on task. A copy of the…

Educating Girls: Strategies To Increase Access, Persistence, and Achievement.

ERIC Educational Resources Information Center

Tietjen, Karen; Prather, Cynthia, Ed.

This document reviews the interventions, such as policies, programs, and projects, that have been implemented by governments, donors, and other institutions to increase girls' access, persistence, and achievement at the primary school level. It examines both the formal system of primary education and nontraditional, alternative approaches to reach…

Promoting Girls' and Women's Education: Lessons from the Past. Working Paper Series 715.

ERIC Educational Resources Information Center

Bellew, Rosemary; King, Elizabeth M.

Expanding education, especially basic education, has been an object of education policy in developing countries over the past two decades. Identifying approaches undertaken by governments, non-governmental organizations, donor agencies, and communities to raise girls' and women's attendance in educational programs, this paper discusses the…

HLA-A, B and DRB1 allele and haplotype frequencies in volunteer bone marrow donors from the north of Parana State.

PubMed

Bardi, Marlene Silva; Jarduli, Luciana Ribeiro; Jorge, Adylson Justino; Camargo, Rossana Batista Oliveira Godoy; Carneiro, Fernando Pagotto; Gelinski, Jair Roberto; Silva, Roseclei Assunção Feliciano; Lavado, Edson Lopes

2012-01-01

Knowledge of allele and haplotype frequencies of the human leukocyte antigen (HLA) system is important in the search for unrelated bone marrow donors. The Brazilian population is very heterogeneous and the HLA system is highly informative of populations because of the high level of polymorphisms. The aim of this study was to characterize the immunogenetic profile of ethnic groups (Caucasians, Afro-Brazilians and Asians) in the north of Parana State. A study was carried out of 3978 voluntary bone marrow donors registered in the Brazilian National Bone Marrow Donor Registry and typed for the HLA-A, B and DRB1 (low resolution) loci. The alleles were characterized by the polymerase chain reaction sequence-specific oligonucleotides method using the LabType SSO kit (One Lambda, CA, USA). The ARLEQUIN v.3.11 computer program was used to calculate allele and haplotype frequencies The most common alleles found in Caucasians were HLA-A*02, 24, 01; HLA-B*35, 44, 51; DRB1*11, 13, 07; for Afro-Brazilians they were HLA-A*02, 03, 30; HLA-B*35, 15, 44; DRB1*13, 11, 03; and for Asians they were: HLA-A*24, 02, 26; HLA-B*40, 51, 52; DRB1*04, 15, 09. The most common haplotype combinations were: HLA-A*01, B*08, DRB1*03 and HLA-A*29, B*44, DRB1*07 for Caucasians; HLA-A*29, B*44, DRB1*07 and HLA-A*01, B*08 and DRB1*03 for Afro-Brazilians; and HLA-A*24, B*52, DRB1*15 and HLA-A*24, B*40 and DRB1*09 for Asians. There is a need to target and expand bone marrow donor campaigns in the north of Parana State. The data of this study may be used as a reference by the Instituto Nacional de Cancer/Brazilian National Bone Marrow Donor Registry to evaluate the immunogenetic profile of populations in specific regions and in the selection of bone marrow donors.

HLA-A, B and DRB1 allele and haplotype frequencies in volunteer bone marrow donors from the north of Parana State

PubMed Central

Bardi, Marlene Silva; Jarduli, Luciana Ribeiro; Jorge, Adylson Justino; Camargo, Rossana Batista Oliveira Godoy; Carneiro, Fernando Pagotto; Gelinski, Jair Roberto; Silva, Roseclei Assunção Feliciano; Lavado, Edson Lopes

2012-01-01

Background Knowledge of allele and haplotype frequencies of the human leukocyte antigen (HLA) system is important in the search for unrelated bone marrow donors. The Brazilian population is very heterogeneous and the HLA system is highly informative of populations because of the high level of polymorphisms. Aim The aim of this study was to characterize the immunogenetic profile of ethnic groups (Caucasians, Afro-Brazilians and Asians) in the north of Parana State. Methods A study was carried out of 3978 voluntary bone marrow donors registered in the Brazilian National Bone Marrow Donor Registry and typed for the HLA-A, B and DRB1 (low resolution) loci. The alleles were characterized by the polymerase chain reaction sequence-specific oligonucleotides method using the LabType SSO kit (One Lambda, CA, USA). The ARLEQUIN v.3.11 computer program was used to calculate allele and haplotype frequencies Results The most common alleles found in Caucasians were HLA-A*02, 24, 01; HLA-B*35, 44, 51; DRB1*11, 13, 07; for Afro-Brazilians they were HLA-A*02, 03, 30; HLA-B*35, 15, 44; DRB1*13, 11, 03; and for Asians they were: HLA-A*24, 02, 26; HLA-B*40, 51, 52; DRB1*04, 15, 09. The most common haplotype combinations were: HLA-A*01, B*08, DRB1*03 and HLA-A*29, B*44, DRB1*07 for Caucasians; HLA-A*29, B*44, DRB1*07 and HLA-A*01, B*08 and DRB1*03 for Afro-Brazilians; and HLA-A*24, B*52, DRB1*15 and HLA-A*24, B*40 and DRB1*09 for Asians. Conclusion There is a need to target and expand bone marrow donor campaigns in the north of Parana State. The data of this study may be used as a reference by the Instituto Nacional de Cancer/Brazilian National Bone Marrow Donor Registry to evaluate the immunogenetic profile of populations in specific regions and in the selection of bone marrow donors PMID:23049380

Radiofrequency catheter ablation in patients with symptomatic atrial flutter/tachycardia after orthotopic heart transplantation.

PubMed

Li, Yi-gang; Grönefeld, Gerian; Israel, Carsten; Lu, Shang-biao; Wang, Qun-shan; Hohnloser, Stefan H

2006-12-20

Atrial tachycardia or flutter is common in patients after orthotopic heart transplantation. Radiofrequency catheter ablation to treat this arrhythmia has not been well defined in this setting. This study was conducted to assess the incidence of various symptomatic atrial arrhythmias and the efficacy and safety of radiofrequency catheter ablation in these patients. Electrophysiological study and catheter ablation were performed in patients with symptomatic tachyarrhythmia. One Halo catheter with 20 poles was positioned around the tricuspid annulus of the donor right atrium, or positioned around the surgical anastomosis when it is necessary. Three quadripolar electrode catheters were inserted via the right or left femoral vein and positioned in the recipient atrium, the bundle of His position, the coronary sinus. Programmed atrial stimulation and burst pacing were performed to prove electrical conduction between the recipient and the donor atria and to induce atrial arrhythmias. Out of 55 consecutive heart transplantation patients, 6 males [(58 +/- 12) years] developed symptomatic tachycardias at a mean of (5 +/- 4) years after heart transplantation. Electrical propagation through the suture line between the recipient and the donor atrium was demonstrated during atrial flutter or during recipient atrium and donor atrium pacing in 2 patients. By mapping around the suture line, the earliest fragmented electrogram of donor atrium was assessed. This electrical connection was successfully ablated in the anterior lateral atrium in both patients. There was no electrical propagation through the suture line in the other 4 patients. Two had typical atrial flutter in the donor atrium which was successfully ablated by completing a linear ablation between the tricuspid annulus and the inferior vena cava. Two patients had atrial tachycardia which was ablated in the anterior septal and lateral donor atrium. There were no procedure-related complications. Patients were free of recurrent atrial tachyarrhythmias after a follow-up of (8 +/- 7) months. Four electrophysiological mechanisms have been found to contribute to the occurrence of symptomatic supraventricular arrhythmias following heart transplantation. Radiofrequency catheter ablation in patients with atrial flutter/tachycardia is feasible and safe after heart transplantation.

Factors affecting the efficiency of foal production in a commercial oocyte transfer program.

PubMed

Riera, Fernando L; Roldán, Jaime E; Gomez, José; Hinrichs, Katrin

2016-04-01

Transfer of donor oocytes to the oviducts of inseminated recipient mares (oocyte transfer, OT) presents a valuable method for production of foals from otherwise infertile mares. Little information is available, however, on factors affecting success of OT in a clinical setting. We report the findings over three breeding seasons in a commercial OT program developed at an equine embryo transfer center in Argentina. Overall, 25 mares were enrolled, and 197 follicle aspiration procedures were performed. The average mare age was 23 years. Follicle aspiration was performed with a needle placed through the flank; the oocyte recovery rate per follicle aspirated was 149 of 227 (66%). Induction of donor ovulation with deslorelin + hCG resulted in a significantly higher oocyte recovery rate than did induction with deslorelin alone (75% vs. 58%). There was no significant effect of mare age (17-20, 21-24, or 25-27 years) on oocyte recovery rate. Twelve oocytes were degenerating or lost during handling; transfer of the remaining 137 oocytes resulted in 42 pregnancies (31%) at 14 days. Of these, 32 (23% per transfer) went on to produce a foal or ongoing pregnancy. Transfer of oocytes recovered with a compact cumulus, without donor follicle induction, or less than 20 hours after induction was associated with a significantly reduced pregnancy rate (1/16, 6%), as was use of noncycling, hormone-treated recipients (2/22, 9%). To evaluate management factors affecting pregnancy rate, noncycling, hormone-treated recipients were disregarded, and only procedures using mature (expanded cumulus) oocytes recovered and transferred on the standard schedule (n = 99) were included. Mare age did not significantly affect rates of pregnancy or pregnancy loss. Similar pregnancy rates were obtained using recipients inseminated from 1 to 27 hours before transfer. Counterintuitively, insemination of recipients immediately (1-2 hours) after aspiration of the recipient follicle was associated with a high pregnancy rate (10/12, 83%). There was no significant effect on pregnancy rate of donor induction agent, the time the oocyte was in culture (2-20 hours) before transfer, time from recipient insemination to transfer, or total time from donor induction to transfer (32-45 hours). These findings establish that OT is robust, in that it is effective over a wide variation in timing of the different components involved, and can be successfully developed in a private embryo transfer practice. Copyright © 2016 Elsevier Inc. All rights reserved.

HLA-mismatched stem-cell microtransplantation as postremission therapy for acute myeloid leukemia: long-term follow-up.

PubMed

Guo, Mei; Hu, Kai-Xun; Liu, Guang-Xian; Yu, Chang-Lin; Qiao, Jian-Hui; Sun, Qi-Yun; Qiao, Jun-Xiao; Dong, Zheng; Sun, Wan-Jun; Sun, Xue-Dong; Zuo, Hong-Li; Man, Qiu-Hong; Liu, Zhi-Qing; Liu, Tie-Qiang; Zhao, Hong-Xia; Huang, Ya-Jing; Wei, Li; Liu, Bing; Wang, Juan; Shen, Xu-Liang; Ai, Hui-Sheng

2012-11-20

Despite best current therapies, approximately half of patients with acute myeloid leukemia in first complete remission (AML-CR1) with no HLA-identical donors experience relapse. Whether HLA-mismatched stem-cell microtransplantation as a novel postremission therapy in these patients will improve survival and avoid graft-versus-host disease (GVHD) is still unknown. One hundred one patients with AML-CR1 (9 to 65 years old) from four treatment centers received programmed infusions of G-CSF-mobilized HLA-mismatched donor peripheral-blood stem cells after each of three cycles of high-dose cytarabine conditioning without GVHD prophylaxis. Donor chimerism and microchimerism and WT1+CD8+ T cells were analyzed. The 6-year leukemia-free survival (LFS) and overall survival (OS) rates were 84.4% and 89.5%, respectively, in the low-risk group, which were similar to the rates in the intermediate-risk group (59.2% and 65.2%, respectively; P=.272 and P=.308). The 6-year LFS and OS were 76.4% and 82.1%, respectively, in patients who received a high dose of donor CD3+ T cells (≥1.1×10(8)/kg) in each infusion, which were significantly higher than the LFS and OS in patients who received a lower dose (<1.1×10(8)/kg) of donor CD3+ T cells (49.5% and 55.3%, respectively; P=.091 and P=.041). No GVHD was observed in any of the patients. Donor microchimerism (2 to 1,020 days) was detected in 20 of the 23 female patients who were available for Y chromosome analysis. A significant increase in WT1+CD8+ T cells (from 0.2% to 4.56%) was observed in 33 of 39 patients with positive HLA-A*02:01 antigen by a pentamer analysis. Microtransplantation as a postremission therapy may improve outcomes and avoid GVHD in patients with AML-CR1.

Liver transplantation in the United Kingdom.

PubMed

Neuberger, James

2016-08-01

Liver transplantation (LT) services in the United Kingdom are provided by 7 designated transplant centers for a population of approximately 64 million. The number of deceased organ donors has grown, and in 2014-2015 it was 1282 (570 donation after circulatory death and 772 donation after brain death). Donor risk is increasing. In 2014-2015, there were 829 LTs from deceased and 38 from living donors. The common causes for transplantation are liver cell cancer, viral hepatitis, and alcohol-related liver disease. Livers are allocated first nationally to super-urgent listed patients and then on a zonal basis. The United Kingdom will be moving toward a national allocation scheme. The median interval between listing and transplantation is 152 days for adults awaiting their first elective transplant. Of the adults listed for the first elective transplant, 68% underwent transplantation at < 1 year; 17% are waiting; and 4% and 11% were removed or died, respectively. The 1- and 5-year adult patient survival rate from listing is 81% and 68%, respectively, and from transplantation is 92% and 80%, respectively. The transplant program is funded through general taxation and is free at the point of care to those who are eligible for National Health Service (NHS) treatment; some have to pay for medication (up to a maximum payment of US $151/year). The competent authority is the Human Tissue Authority which licenses donor characterization, retrieval, and implantation; transplant units are commissioned by NHS England and NHS Scotland. National Health Service Blood and Transplant (NHSBT) promotes organ donation, maintains the organ donor register, obtains consent, and undertakes donor characterization and offering. NHSBT also maintains the national waiting list, develops and applies selection and allocation policies, monitors outcomes, and maintains the UK National Transplant Registry and commissions a national organ retrieval service. Liver Transplantation 22 1129-1135 2016 AASLD. © 2016 American Association for the Study of Liver Diseases.

Medicare and state health care programs: fraud and abuse; electronic health records safe harbor under the anti-kickback statute. Final rule.

PubMed

2013-12-27

In this final rule, the Office of Inspector General (OIG) amends the safe harbor regulation concerning electronic health records items and services, which defines certain conduct that is protected from liability under the Federal anti-kickback statute, section 1128B(b) of the Social Security Act (the Act). Amendments include updating the provision under which electronic health records software is deemed interoperable; removing the electronic prescribing capability requirement; extending the sunset provision until December 31, 2021; limiting the scope of protected donors to exclude laboratory companies; and clarifying the condition that prohibits a donor from taking any action to limit or restrict the use, compatibility, or interoperability of the donated items or services.

Development of Medical Technology for Contingency Response to Marrow Toxic Agents

DTIC Science & Technology

2013-10-30

NUMBER N/A 5b. GRANT NUMBER N00014-12-1-0142 5c. PROGRAM ELEMENT NUMBER N/A 6. AUTHOR( S ) Spellman, Stephen 5d. PROJECT NUMBER N/A 5e. TASK...NUMBER Project 1, 2, 3, 4 5f. WORK UNIT NUMBER N/A 7. PERFORMING ORGANIZATION NAME( S ) AND ADDRESS(ES) National Marrow Donor Program 3001 Broadway...St., N.E., Ste. 500 Minneapolis, MN 55413 8. PERFORMING ORGANIZATION REPORT NUMBER N/A 9. SPONSORING/MONITORING AGENCY NAME( S ) AND ADDRESS(ES

Ten-Year Experience of Renal Transplantation at the Northwest National Medical Center, Sonora Mexico: A Survival Study.

PubMed

Ma, M A; Laguna-Teniente, I R

2016-03-01

To improve survival after kidney transplantation, it is important to identify the variables that affect it. The aim of this work was to determine the survival of renal grafts from living and cadaveric donors and the survival of patients with graft failure in a tertiary medical unit in northwest Mexico. We performed a retrospective cohort study of patients who received transplants since 2004 at the center. Database and medical records of patients were reviewed. The data were captured in a database previously designed in the SPSS v21.1 program for statistical processing. A descriptive analysis with frequencies and percentages and numeric variables measure of central tendency and dispersion was conducted. The survival analysis was made with the Kaplan-Meier method to estimate the graft survive. A total of 412 transplantations were performed during the 2004-2013 period. We analyzed 331 records, and the 10-year survival rates of donor allografts from living and cadaveric donors were 86.64% and 72.78%, respectively. Copyright © 2016 Elsevier Inc. All rights reserved.

A crucial role for maternal dietary methyl donor intake in epigenetic programming and fetal growth outcomes.

PubMed

McGee, Meghan; Bainbridge, Shannon; Fontaine-Bisson, Bénédicte

2018-06-01

The fetal origins of health and disease framework has identified extremes in fetal growth and birth weight as factors associated with the lifelong generation of chronic diseases such as obesity, diabetes, cardiovascular disease, and hypertension. Maternal nutrition plays a critical role in fetal and placental development, in part by providing the methyl groups required to establish the fetus's genome structure and function, notably through DNA methylation. The goal of this narrative review is to describe the role of maternal dietary methyl donor (methionine, folate, and choline) and cofactor (zinc and vitamins B2, B6, and B12) intake in one-carbon metabolism and DNA methylation in the fetus and placenta, as well as their impacts on fetal growth and lifelong health outcomes, with specific examples in animals and humans. Based on the available evidence, it is concluded that intake of different amounts of dietary methyl donors and cofactors during pregnancy may alter fetal growth and development, thus establishing a major link between early environmental exposure and disease development in the offspring later in life.

Modeling coverage gaps in haplotype frequencies via Bayesian inference to improve stem cell donor selection.

PubMed

Louzoun, Yoram; Alter, Idan; Gragert, Loren; Albrecht, Mark; Maiers, Martin

2018-05-01

Regardless of sampling depth, accurate genotype imputation is limited in regions of high polymorphism which often have a heavy-tailed haplotype frequency distribution. Many rare haplotypes are thus unobserved. Statistical methods to improve imputation by extending reference haplotype distributions using linkage disequilibrium patterns that relate allele and haplotype frequencies have not yet been explored. In the field of unrelated stem cell transplantation, imputation of highly polymorphic human leukocyte antigen (HLA) genes has an important application in identifying the best-matched stem cell donor when searching large registries totaling over 28,000,000 donors worldwide. Despite these large registry sizes, a significant proportion of searched patients present novel HLA haplotypes. Supporting this observation, HLA population genetic models have indicated that many extant HLA haplotypes remain unobserved. The absent haplotypes are a significant cause of error in haplotype matching. We have applied a Bayesian inference methodology for extending haplotype frequency distributions, using a model where new haplotypes are created by recombination of observed alleles. Applications of this joint probability model offer significant improvement in frequency distribution estimates over the best existing alternative methods, as we illustrate using five-locus HLA frequency data from the National Marrow Donor Program registry. Transplant matching algorithms and disease association studies involving phasing and imputation of rare variants may benefit from this statistical inference framework.

Broken Chains and Reneging: A Review of 1748 Kidney Paired Donation Transplants.

PubMed

Cowan, N; Gritsch, H A; Nassiri, N; Sinacore, J; Veale, J

2017-09-01

Concerns regarding the potential for broken chains and "reneges" within kidney paired donation (KPD) and its effect on chain length have been raised previously. Although these concerns have been tested in simulation studies, real-world data have yet to be evaluated. The purpose of this study was to evaluate the actual rate and causes of broken chains within a large KPD program. All patients undergoing renal transplantation through the National Kidney Registry from 2008 through May 2016 were included for analysis. Broken chains and loops were identified. A total of 344 chains and 78 loops were completed during the study period, yielding a total of 1748 transplants. Twenty broken chains and one broken loop were identified. The mean chain length (number of transplants) within broken chains was 4.8 compared with 4.6 of completed chains (p = 0.78). The most common causes of a broken chain were donor medical issues incurred while acting as a bridge donor (n = 8), donors electing not to proceed (n = 6), and kidneys being declined by the recipient surgeon (n = 4). All recipients involved in a broken chain subsequently received a transplant. Based on the results, broken chains are infrequent, are rarely due to lack of donor motivation, and have no significant impact on chain length. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

Encoding of low-quality DNA profiles as genotype probability matrices for improved profile comparisons, relatedness evaluation and database searches.

PubMed

Ryan, K; Williams, D Gareth; Balding, David J

2016-11-01

Many DNA profiles recovered from crime scene samples are of a quality that does not allow them to be searched against, nor entered into, databases. We propose a method for the comparison of profiles arising from two DNA samples, one or both of which can have multiple donors and be affected by low DNA template or degraded DNA. We compute likelihood ratios to evaluate the hypothesis that the two samples have a common DNA donor, and hypotheses specifying the relatedness of two donors. Our method uses a probability distribution for the genotype of the donor of interest in each sample. This distribution can be obtained from a statistical model, or we can exploit the ability of trained human experts to assess genotype probabilities, thus extracting much information that would be discarded by standard interpretation rules. Our method is compatible with established methods in simple settings, but is more widely applicable and can make better use of information than many current methods for the analysis of mixed-source, low-template DNA profiles. It can accommodate uncertainty arising from relatedness instead of or in addition to uncertainty arising from noisy genotyping. We describe a computer program GPMDNA, available under an open source licence, to calculate LRs using the method presented in this paper. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Accounting for variations in ART program sustainability outcomes in health facilities in Uganda: a comparative case study analysis.

PubMed

Zakumumpa, Henry; Bennett, Sara; Ssengooba, Freddie

2016-10-18

Uganda implemented a national ART scale-up program at public and private health facilities between 2004 and 2009. Little is known about how and why some health facilities have sustained ART programs and why others have not sustained these interventions. The objective of the study was to identify facilitators and barriers to the long-term sustainability of ART programs at six health facilities in Uganda which received donor support to commence ART between 2004 and 2009. A case-study approach was adopted. Six health facilities were purposively selected for in-depth study from a national sample of 195 health facilities across Uganda which participated in an earlier study phase. The six health facilities were placed in three categories of sustainability; High Sustainers (2), Low Sustainers (2) and Non- Sustainers (2). Semi-structured interviews with ART Clinic managers (N = 18) were conducted. Questionnaire data were analyzed (N = 12). Document review augmented respondent data. Based on the data generated, across-case comparative analyses were performed. Data were collected between February and June 2015. Several distinguishing features were found between High Sustainers, and Low and Non-Sustainers' ART program characteristics. High Sustainers had larger ART programs with higher staffing and patient volumes, a broader 'menu' of ART services and more stable program leadership compared to the other cases. High Sustainers associated sustained ART programs with multiple funding streams, robust ART program evaluation systems and having internal and external program champions. Low and Non Sustainers reported similar barriers of shortage and attrition of ART-proficient staff, low capacity for ART program reporting, irregular and insufficient supply of ARV drugs and a lack of alignment between ART scale-up and their for-profit orientation in three of the cases. We found that ART program sustainability was embedded in a complex system involving dynamic interactions between internal (program champion, staffing strength, M &E systems, goal clarity) and external drivers (donors, ARVs supply chain, patient demand). ART program sustainability contexts were distinguished by the size of health facility and ownership-type. The study's implications for health systems strengthening in resource-limited countries are discussed.

Donor cycle and donor segmentation: new tools for improving blood donor management.

PubMed

Veldhuizen, I; Folléa, G; de Kort, W

2013-07-01

An adequate donor population is of key importance for the entire blood transfusion chain. For good donor management, a detailed overview of the donor database is therefore imperative. This study offers a new description of the donor cycle related to the donor management process. It also presents the outcomes of a European Project, Donor Management IN Europe (DOMAINE), regarding the segmentation of the donor population into donor types. Blood establishments (BEs) from 18 European countries, the Thalassaemia International Federation and a representative from the South-Eastern Europe Health Network joined forces in DOMAINE. A questionnaire assessed blood donor management practices and the composition of the donor population using the newly proposed DOMAINE donor segmentation. 48 BEs in 34 European countries were invited to participate. The response rate was high (88%). However, only 14 BEs could deliver data on the composition of their donor population. The data showed large variations and major imbalances in the donor population. In 79% of the countries, inactive donors formed the dominant donor type. Only in 21%, regular donors were the largest subgroup, and in 29%, the proportion of first-time donors was higher than the proportion of regular donors. Good donor management depends on a thorough insight into the flow of donors through their donor career. Segmentation of the donor database is an essential tool to understand the influx and efflux of donors. The DOMAINE donor segmentation helps BEs in understanding their donor database and to adapt their donor recruitment and retention practices accordingly. Ways to use this new tool are proposed. © 2013 International Society of Blood Transfusion.

The Belgian commitment to pharmaceutical quality: a model policy to improve quality assurance of medicines available through humanitarian and development programs.

PubMed

Ravinetto, Raffaella; Roosen, Tim; Dujardin, Catherine

2018-01-01

Today, a combination of globalization of pharmaceutical production, lack of regulatory harmonization, and weakness of Medicines Regulatory Authorities, creates the "perfect conditions" for poor-quality medicine to circulate in the global market and to penetrate the less-regulated countries. Medicines regulation is the responsibility of the national regulatory authorities in the recipient country, but in the poorer countries, in practice, the responsibility of supply of quality-assured medicines is often taken by Non-Governmental Organizations and other implementers. But with some notable exceptions, many donors lack a pharmaceutical procurement policy with adequate quality requirements; and many implementers lack the skills and expertise needed to orient themselves in the complex web of global pharmaceutical supply. Thus, patients served by humanitarian or development programs may remain exposed to the risk of poor-quality medicines. When public money is used to purchase medicines for medical programs to be carried out overseas, adequate policies should be in place to assure that the same quality requirements are set that would be required for medicines marketed in the "donor" country. We will describe here a policy recently adopted in Belgium, i.e. the "Commitment to Quality Assurance for Pharmaceutical Products", signed in October 2017 by the Vice Prime Minister and Minister for Development Cooperation and 19 Belgian implementing agencies. By signing the new policy, the counterparts committed to ensure quality of medicines in the programs funded by Belgium's Official Development Assistance, and to build quality-assurance capacity in the recipient countries. Implementers are requested to integrate in their financing applications a section for pharmaceutical quality assurance, with a justified budget. They are also invited to consider how costs could be rationalized and mutualized by aligning the strengths of the various implementers. This model policy has the potential to be considered for adoption by other donors, to help to reduce the current multiple standards in pharmaceutical quality, and to contribute to protect vulnerable communities from the plague of poor-quality medicines. The online version of this article (10.1186/s40545-018-0136-z) contains an additional file, which is available to authorized users.

Turf Tales

ERIC Educational Resources Information Center

DiConsiglio, John

2009-01-01

When it comes to raising money for college and university athletic programs, every professional knows how the game is played. Tickets drive the bus. In exchange for gifts, donors typically pay seat-licensing fees. This kind of "quid pro quo" giving--where generous contributions put one in position to buy good tickets--is a very common model," says…

Measuring the Child Quality of Life: Issues and Options.

ERIC Educational Resources Information Center

Arboleda, Jairo; Levinger, Beryl

A Child Quality of Life Index (CQLI) should be developed in order to realize three objectives: (1) to raise the consciousness of decision makers, prospective donors, field workers, and community members concerning the needs of children; (2) to assist field workers and community members in planning specific programs to meet the priority needs of…

10 CFR 26.103 - Determining a confirmed positive test result for alcohol.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 1 2013-01-01 2013-01-01 false Determining a confirmed positive test result for alcohol. 26.103 Section 26.103 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Collecting... fitness indicates that the donor is fit to safely and competently perform his or her duties. ...

10 CFR 26.117 - Preparing urine specimens for storage and shipping.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 1 2013-01-01 2013-01-01 false Preparing urine specimens for storage and shipping. 26.117 Section 26.117 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Collecting Specimens for Testing § 26.117 Preparing urine specimens for storage and shipping. (a) Both the donor and the collector...

10 CFR 26.117 - Preparing urine specimens for storage and shipping.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 1 2014-01-01 2014-01-01 false Preparing urine specimens for storage and shipping. 26.117 Section 26.117 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Collecting Specimens for Testing § 26.117 Preparing urine specimens for storage and shipping. (a) Both the donor and the collector...

10 CFR 26.117 - Preparing urine specimens for storage and shipping.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 1 2012-01-01 2012-01-01 false Preparing urine specimens for storage and shipping. 26.117 Section 26.117 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Collecting Specimens for Testing § 26.117 Preparing urine specimens for storage and shipping. (a) Both the donor and the collector...

10 CFR 26.103 - Determining a confirmed positive test result for alcohol.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 1 2014-01-01 2014-01-01 false Determining a confirmed positive test result for alcohol. 26.103 Section 26.103 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Collecting... fitness indicates that the donor is fit to safely and competently perform his or her duties. ...

10 CFR 26.107 - Collecting a urine specimen.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 1 2013-01-01 2013-01-01 false Collecting a urine specimen. 26.107 Section 26.107 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Collecting Specimens for Testing § 26.107 Collecting a urine specimen. (a) The collector shall direct the donor to go into the room or stall used for...

10 CFR 26.103 - Determining a confirmed positive test result for alcohol.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 1 2012-01-01 2012-01-01 false Determining a confirmed positive test result for alcohol. 26.103 Section 26.103 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Collecting... fitness indicates that the donor is fit to safely and competently perform his or her duties. ...

10 CFR 26.107 - Collecting a urine specimen.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 1 2012-01-01 2012-01-01 false Collecting a urine specimen. 26.107 Section 26.107 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Collecting Specimens for Testing § 26.107 Collecting a urine specimen. (a) The collector shall direct the donor to go into the room or stall used for...

10 CFR 26.107 - Collecting a urine specimen.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 1 2014-01-01 2014-01-01 false Collecting a urine specimen. 26.107 Section 26.107 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Collecting Specimens for Testing § 26.107 Collecting a urine specimen. (a) The collector shall direct the donor to go into the room or stall used for...

10 CFR 26.107 - Collecting a urine specimen.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Collecting a urine specimen. 26.107 Section 26.107 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Collecting Specimens for Testing § 26.107 Collecting a urine specimen. (a) The collector shall direct the donor to go into the room or stall used for...

10 CFR 26.107 - Collecting a urine specimen.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Collecting a urine specimen. 26.107 Section 26.107 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Collecting Specimens for Testing § 26.107 Collecting a urine specimen. (a) The collector shall direct the donor to go into the room or stall used for...

10 CFR 26.117 - Preparing urine specimens for storage and shipping.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Preparing urine specimens for storage and shipping. 26.117 Section 26.117 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Collecting Specimens for Testing § 26.117 Preparing urine specimens for storage and shipping. (a) Both the donor and the collector...

10 CFR 26.103 - Determining a confirmed positive test result for alcohol.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Determining a confirmed positive test result for alcohol. 26.103 Section 26.103 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Collecting... fitness indicates that the donor is fit to safely and competently perform his or her duties. ...

10 CFR 26.103 - Determining a confirmed positive test result for alcohol.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Determining a confirmed positive test result for alcohol. 26.103 Section 26.103 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Collecting... fitness indicates that the donor is fit to safely and competently perform his or her duties. ...

10 CFR 26.117 - Preparing urine specimens for storage and shipping.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Preparing urine specimens for storage and shipping. 26.117 Section 26.117 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Collecting Specimens for Testing § 26.117 Preparing urine specimens for storage and shipping. (a) Both the donor and the collector...

10 CFR 26.111 - Checking the acceptability of the urine specimen.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Checking the acceptability of the urine specimen. 26.111 Section 26.111 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Collecting Specimens for Testing § 26.111 Checking the acceptability of the urine specimen. (a) Immediately after the donor...

10 CFR 26.111 - Checking the acceptability of the urine specimen.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Checking the acceptability of the urine specimen. 26.111 Section 26.111 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Collecting Specimens for Testing § 26.111 Checking the acceptability of the urine specimen. (a) Immediately after the donor...

The Kalamazoo Promise and Perceived Changes in School Climate

ERIC Educational Resources Information Center

Miron, Gary; Jones, Jeffrey N.; Kelaher-Young, Allison J.

2011-01-01

The Kalamazoo Promise was announced in the fall of 2005, offering free college tuition at any public state college or university for graduates of the district who have gained acceptance to a postsecondary institution. This program was funded through the generous support of anonymous donors, and a federally-funded evaluation is underway to examine…

For Athletics, a Billion-Dollar Goal Line

ERIC Educational Resources Information Center

Wolverton, Brad

2009-01-01

The nation's biggest athletics departments are quietly trying to raise hundreds of millions of dollars for separate sports endowments, heating up the competition for donors and raising questions about institutional priorities during the economic crunch. At least eight programs hope to bring in more than $100-million each to defray the rising costs…

The Ignorant Donor: A Radical Reimagination of International Aid, Development, and Education

ERIC Educational Resources Information Center

Brehm, William C.; Silova, Iveta

2010-01-01

The logic behind international aid to development has typically centered on economics. Notwithstanding the variation in focus--from macroeconomic monetary and trade policies, to economic wealth programs aimed at creating jobs, to supply- and demand-side reforms--the central discourse on international aid has been dominated by a political…

An Australian Brain Bank: a critical investment with a high return!

PubMed Central

Garrick, T.; Dedova, I.; Hunt, C.; Miller, R.; Sundqvist, N.; Harper, C.

2012-01-01

Research into neuropsychiatric disorders, including alcohol-related problems, is limited in part by the lack of appropriate animal models. However, the development of new technologies in pathology and molecular biology means that many more questions can be addressed using appropriately stored human brain tissues. The New South Wales Tissue Resource Centre (TRC) in the University of Sydney (Australia) is a human brain bank that can provide tissues to the neuroscience research community studying alcohol-related brain disorders, schizophrenia, depression and bipolar disorders. Carefully standardised operational protocols and integrated information systems means that the TRC can provide high quality, accurately characterised, tissues for research. A recent initiative, the pre-mortem donor program called “Using our Brains”, encourages individuals without neuropsychiatric illness to register as control donors, a critical group for all research. Community support for this program is strong with over 2,000 people registering their interest. Discussed herein are the protocols pertaining to this multifaceted facility and the benefits of investment, both scientific and financial, to neuroscience researchers and the community at large. PMID:18543078

Four decades of the kidney transplantation program at the Institute Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in Mexico City.

PubMed

Morales-Buenrostro, Luis E; Marino-Vázquez, Lluvia A; Alberú, Josefina

2009-01-01

This is a retrospective study that includes four decades of kidney transplant program at our Institute, with a total of 923 kidney transplants in 872 recipients. In this report, the effect of variables in recipient, donor, and transplant on long-term graft survival was analyzed using the Kaplan Meier method with log-rank test for survival comparisons. Global graft survival at our center-analyzed by censoring for death-with-functioning-graft-for 1, 5 and 10 years was 93%, 83% and 74%, respectively, with median survival of 24.5 years. When analyzed for all-cause graft loss, 1, 5 and 10 year survival was 90%, 76% and 61%, with 12.8-year median survival. Variables associated with lower graft survival censored for death-with-functioning-graft were transplantation in an earlier decade, less histocompatibility, younger kidney transplant recipients, no induction therapy, and double drug initial immunosuppression. After Cox's regression multivariate analysis, the risk factors that remained associated with worse survival were younger recipient, earlier transplant decade, and deceased donor.

An Australian Brain Bank: a critical investment with a high return!

PubMed

Sheedy, D; Garrick, T; Dedova, I; Hunt, C; Miller, R; Sundqvist, N; Harper, C

2008-09-01

Research into neuropsychiatric disorders, including alcohol-related problems, is limited in part by the lack of appropriate animal models. However, the development of new technologies in pathology and molecular biology means that many more questions can be addressed using appropriately stored human brain tissues. The New South Wales Tissue Resource Centre (TRC) in the University of Sydney (Australia) is a human brain bank that can provide tissues to the neuroscience research community studying alcohol-related brain disorders, schizophrenia, depression and bipolar disorders. Carefully standardised operational protocols and integrated information systems means that the TRC can provide high quality, accurately characterised, tissues for research. A recent initiative, the pre-mortem donor program called "Using our Brains", encourages individuals without neuropsychiatric illness to register as control donors, a critical group for all research. Community support for this program is strong with over 2,000 people registering their interest. Discussed herein are the protocols pertaining to this multifaceted facility and the benefits of investment, both scientific and financial, to neuroscience researchers and the community at large.

The influence of viewing an entertainment-education program on cornea donation intention: a test of the theory of planned behavior.

PubMed

Bae, Hyuhn-Suhck; Kang, Seok

2008-01-01

This study was designed to examine the role of issue involvement and the 3 components of the theory of planned behavior in predicting intentions to sign a cornea donor card. This study also compares viewers and nonviewers of an entertainment-education program in terms of issue involvement and the theory of planned behavior. The breakdown of effects for the latent constructs confirms that issue involvement is an important intermediary in the persuasion process. Issue involvement is a common causal antecedent of attitude, subjective norm, and perceived behavioral control, the last 2 of which, in turn, predict intentions, whereas attitude does not. The revised path model confirms that involvement directly influences intentions. In the comparison of viewers with nonviewers, viewers exhibit a significantly higher degree of involvement, attitude toward cornea donation, subjective norm, perceived behavioral control, and intention to sign a cornea donor card. The overall findings of this study suggest that adding issue involvement in the theory of planned behavior enhances the explanatory power of the theory in predicting intentions.

‘Teach a Man to Fish’: The Doctrine of Sustainability and Its Effects on Three Strata of Malawian Society

PubMed Central

Swidler, Ann; Watkins, Susan Cotts

2009-01-01

This paper analyzes the social impacts of the commitment to “sustainability” in donor-funded AIDS programs. Using survey, interview, and ethnographic data from rural Malawi, we examine how efforts to mobilize and empower local communities affect three strata of Malawian society: the villagers these programs are meant to help, the insecure local elites whose efforts directly link programs to their intended beneficiaries, and, more briefly, national elites who implement AIDS policies and programs. We describe indirect effects of sustainability on the experiences, identities, and aspirations of Malawians—effects that are much broader and deeper than the direct impacts of funding. PMID:20161458

Condoms becoming more popular.

PubMed

Manuel, J

1993-05-01

Social marketing is a strategy which addresses a public health problem with private-sector marketing and sales techniques. In condom social marketing programs, condoms are often offered for sale to the public at low prices. 350 million condoms were sold to populations in developing countries through such programs in 1992, and another 650 million were distributed free through public clinics. The major donors of these condoms are the US Agency for International Development, the World Health Organization, the UN Population Fund, the International Planned Parenthood Federation, the World Bank, and the European Community. This marketing approach has promoted condom use as prevention against HIV transmission and has dramatically increased the number of condoms distributed and used throughout much of Africa, Latin America, and Asia. Donors are now concerned that they will not be able to provide condoms in sufficient quantities to keep pace with rapidly rising demand. Findings in selected countries, however, suggest that people seem willing to buy condoms which are well promoted and distributed. Increasing demand for condoms may therefore be readily met through greater dependence upon social marketing programs and condom sales. Researchers generally agree that a social marketing program must change for 100 condoms no more than 1% of a country's GNP in order to sell an amount of condoms equal to at least half of the adult male population. Higher prices may be charged for condoms in countries with relatively high per-capita incomes. Since prices charged tend to be too low to cover all promotional, packaging, distribution, and logistical management costs, most condom distribution programs will have to be subsidized on an ongoing basis.

Transitioning HIV care and treatment programs in southern Africa to full local management.

PubMed

Vermund, Sten H; Sidat, Mohsin; Weil, Lori F; Tique, José A; Moon, Troy D; Ciampa, Philip J

2012-06-19

Global AIDS programs such as the US President's Emergency Plan for AIDS Relief (PEPFAR) face a challenging health care management transition. HIV care must evolve from vertically-organized, externally-supported efforts to sustainable, locally controlled components that are integrated into the horizontal primary health care systems of host nations. We compared four southern African nations in AIDS care, financial, literacy, and health worker capacity parameters (2005 to 2009) to contrast in their capacities to absorb the huge HIV care and prevention endeavors that are now managed with international technical and fiscal support. Botswana has a relatively high national income, a small population, and an advanced HIV/AIDS care program; it is well poised to take on management of its HIV/AIDS programs. South Africa has had a slower start, given HIV denialism philosophies of the previous government leadership. Nonetheless, South Africa has the national income, health care management, and health worker capacity to succeed in fully local management. The sheer magnitude of the burden is daunting, however, and South Africa will need continuing fiscal assistance. In contrast, Zambia and Mozambique have comparatively lower per capita incomes, many fewer health care workers per capita, and lower national literacy rates. It is improbable that fully independent management of their HIV programs is feasible on the timetable being contemplated by donors, nor is locally sustainable financing conceivable at present. A tailored nation-by-nation approach is needed for the transition to full local capacitation; donor nation policymakers must ensure that global resources and technical support are not removed prematurely.

Transplant professionals' proposals for the implementation of an altruistic unbalanced paired kidney exchange program.

PubMed

Durand, Céline; Duplantie, Andrée; Fortin, Marie-Chantal

2014-10-15

Kidney recipients in the O blood group are at a disadvantage in kidney exchange programs (KEPs) because they can only receive an organ from O blood group donors. A way to remedy this unfair situation is through altruistic unbalanced paired kidney exchange (AUPKE) where a compatible pair (CP) consisting of an O donor and a non-O recipient is invited to participate in a KEP. There is no established AUPKE program in Canada. The aim of this study was to gather transplant professionals' views on the conditions necessary for the implementation of an AUPKE program. Nineteen Canadian transplant professionals took part in semistructured interviews. The content of these interviews was analyzed using a qualitative data analysis method. Respondents' recommendations focused on the following: (i) the logistics of AUPKE (e.g., not delaying the transplantation for the CP, retrieving organs locally, providing a good quality organ to the CP, and maintaining anonymity); (ii) the transplantation teams (e.g., establishing a consensus among members and ensuring sufficient resources); (iii) information provided to CPs; and (iv) research (e.g., looking into all transplant options for O recipients, studying all potential impacts of KEPs and AUPKE). The respondents in our study made the following recommendations for the implementation of an AUPKE program: (i) CPs should not be disadvantaged, (ii) measures should be taken to ensure that all transplant team members agree to participate and that there are sufficient resources for implementation, (iii) comprehensive information should be provided to the CP, and (iv) further research is needed on AUPKE.

Health research in the developing world: a gastroenterological view from Bangladesh.

PubMed

Hamilton, J R

1997-01-01

Ill health is a serious impediment to progress in most poor countries, yet health is not a high priority on foreign aid agendas. Health research, which provides the essential base for sustainable progressive health programs, is barely visible in developing countries. For example, in Bangladesh, one finds unacceptably high morbidity and mortality rates among infants and children, health programs that are struggling and a rudimentary health research establishment; for the huge foreign donor community in that country, health programs and research do not appear to warrant major investments. Diarrheal diseases are at the top of the list of killers in many poor nations including Bangladesh. Recent advances in our understanding of diarrhea suggest that when prevention may not be possible soon, improved active treatment can evolve from an aggressive research effort centered in a developing country and linked to appropriate international partners. Global agencies such as the World Health Organization have demonstrated a declining interest in health research, as reflected in the policies of their Diarrhoeal Disease Control Programme. Major donors to the developing world, the Canadian International Development Agency for example, have had a relatively minor involvement in health and little commitment to health research. University links with the west, private enterprises and specially targeted programs are involved in developing world health research but they have not been able to foster and leave behind sustainable, high quality research programs. The problem should be attacked directly by supporting focused, relevant health research centres in regions of the world where the burden of disease continues to impede progress and where the environment is conducive to high quality research that is well integrated with care delivery programs. An instructive model of this approach is the International Centre for Diarrhoeal Disease Research in Dhaka, Bangladesh.

MHC-mismatched mixed chimerism restores peripheral tolerance of noncross-reactive autoreactive T cells in NOD mice

PubMed Central

Zhang, Mingfeng; Racine, Jeremy J.; Lin, Qing; Liu, Yuqing; Tang, Shanshan; Qin, Qi; Qi, Tong; Riggs, Arthur D.; Zeng, Defu

2018-01-01

Autoimmune type 1 diabetes (T1D) and other autoimmune diseases are associated with particular MHC haplotypes and expansion of autoreactive T cells. Induction of MHC-mismatched but not -matched mixed chimerism by hematopoietic cell transplantation effectively reverses autoimmunity in diabetic nonobese diabetic (NOD) mice, even those with established diabetes. As expected, MHC-mismatched mixed chimerism mediates deletion in the thymus of host-type autoreactive T cells that have T-cell receptor (TCR) recognizing (cross-reacting with) donor-type antigen presenting cells (APCs), which have come to reside in the thymus. However, how MHC-mismatched mixed chimerism tolerizes host autoreactive T cells that recognize only self-MHC–peptide complexes remains unknown. Here, using NOD.Rag1−/−.BDC2.5 or NOD.Rag1−/−.BDC12-4.1 mice that have only noncross-reactive transgenic autoreactive T cells, we show that induction of MHC-mismatched but not -matched mixed chimerism restores immune tolerance of peripheral noncross-reactive autoreactive T cells. MHC-mismatched mixed chimerism results in increased percentages of both donor- and host-type Foxp3+ Treg cells and up-regulated expression of programmed death-ligand 1 (PD-L1) by host-type plasmacytoid dendritic cells (pDCs). Furthermore, adoptive transfer experiments showed that engraftment of donor-type dendritic cells (DCs) and expansion of donor-type Treg cells are required for tolerizing the noncross-reactive autoreactive T cells in the periphery, which are in association with up-regulation of host-type DC expression of PD-L1 and increased percentage of host-type Treg cells. Thus, induction of MHC-mismatched mixed chimerism may establish a peripheral tolerogenic DC and Treg network that actively tolerizes autoreactive T cells, even those with no TCR recognition of the donor APCs. PMID:29463744

Kidney allograft survival of African American and Caucasian American recipients with lupus.

PubMed

Contreras, G; Li, H; Gonzalez-Suarez, M; Isakova, T; Scialla, J J; Pedraza, F; Mattiazzi, A; Diaz-Wong, R; Sageshima, J; Brito, Y; Guerra, G; Acevedo, B; Sajid Ali, A; Kershaw, T J; Chen, L; Burke, G W; Kupin, W; Ciancio, G; Roth, D

2014-02-01

African Americans with lupus who receive kidney transplants have high prevalence of predictors of allograft failure, which can explain their poor outcomes. Of 1223 African Americans and 1029 Caucasian Americans with lupus who received kidney transplants from deceased donors between 1987 and 2006 with complete records in the UNOS program, 741 pairs were matched in 16 predictors employing a predicted probability of group membership. The primary outcome was allograft failure. Main secondary outcomes were rejection, allograft failure due to rejection, and mortality. Matched pairs were predominantly women (82%) with a mean age of 39 years. Twenty-four percent of recipients received kidneys from expanded criteria donors. African Americans and Caucasian Americans matched well (p ≥ 0.05): donor age, gender and race; recipient age, gender, education and insurance; dialysis prior to transplant, kidneys from expanded criteria donors, cold ischemia time, history of prior kidney transplant, panel reactive antibodies, human leukocyte antigens mismatch, blood type compatibility, transplant Era, and follow-up time. Contrary to the unmatched cohort with significantly higher allograft failure rate (events per 100 patient-years) in African Americans compared to Caucasian Americans (10.49 vs 6.18, p<0.001), matched pairs had similar allograft failure rates (8.41 vs 7.81, p=0.418). Matched pairs also had similar rates of rejections (9.82 vs 9.39, p=0.602), allograft failure due to rejection (6.19 vs 5.71, p=0.453), and mortality (2.79 vs 3.52, p=0.097). In lupus recipients of kidney transplants from deceased donors, African American and Caucasian Americans have similar allograft failure rates when predictors are matched between groups.

[Deceased donation in renal transplantation].

PubMed

Thuret, R; Kleinclauss, F; Terrier, N; Timsit, M O

2016-11-01

To review epidemiologic data's and medical results of deceased donation in renal transplantation. Relevant publications were identified through Medline (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) database using the following keywords, alone or in association, "brain death; cardiac arrest; deceased donation; organ procurement; transplantation". Articles were selected according to methods, language of publication and relevance. The reference lists were used to identify additional historical studies of interest. Both prospective and retrospective series, in French and English, as well as review articles and recommendations were selected. In addition, French national transplant and health agencies (http://www.agence-biomedecine.fr and http://www.has-sante.fr) databases were screened using identical keywords. A total of 2498 articles, 8 official reports and 17 newspaper articles were identified; after careful selection 157 publications were eligible for our review. Deceased donation may involve either brain death or non-heartbeating donors (NHBD). Organ shortage led to the procurement of organs from expanded-criteria donors, with an increased age at donation and extended vascular disease, leading to inferior results after transplantation and underlining the need for careful donor management during brain death or cardiac arrest. Evolution of French legislation covering bioethics allowed procurement from Maastricht categories II and recently III non-heartbeating donors. The increase of organ shortage emphasizes the need for a rigorous surgical technique during procurement to avoid loss of transplants. A history or current neoplasm in deceased-donors, requires attention to increase the pool of organs without putting the recipients at risk for cancer transmission. French NHBD program, especially from Maastricht category III, may stand for a potential source of valuable organs. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Transfer and detection of freshly isolated or cultured chicken (Gallus gallus) and exotic species' embryonic gonadal germ stem cells in host embryos.

PubMed

Imus, Nastassja; Roe, Mandi; Charter, Suellen; Durrant, Barbara; Jensen, Thomas

2014-06-01

The management of captive avian breeding programs increasingly utilizes various artificial reproductive technologies, including in ovo sexing of embryos to adjust population sex ratios. Currently, however, no attention has been given to the loss of genetic diversity following sex-selective incubation, even with respect to individuals from critically endangered species. This project evaluated the possibility of using xenotransfer of embryonic gonadal germline stem cells (GGCs) for future reintroduction of their germplasm into the gene pool. We examined and compared the host gonad colonization of freshly isolated and 3 day (3d) cultured donor GGCs from chicken and 13 species of exotic embryos. Following 3d-culture of GGCs, there was a significant increase in the percentage of stem cell marker (SSEA-1, -3, -4) positive cells. However, the percentage of positive host gonads with chicken donor-derived cells decreased from 68% (fresh) to 22% (3d), while the percentage of exotic species donor-cells positive host gonads decreased from 61% (fresh) to 49% (3d-cultured). Donor GGCs from both chicken and exotic species were localized within the caudal endoderm, including the region encompassing the gonadal ridge by 16 hours post-injection. Furthermore, donor-derived cells isolated from stage 36 host embryos were antigenic for anti SSEA-1, VASA/DDX4 and EMA-1 antibodies, presumably indicating maintenance of stem cell identity. This study demonstrates that GGCs from multiple species can migrate to the gonadal region and maintain presumed stemness following xenotransfer into a chicken host embryo, suggesting that germline stem cell migration is highly conserved in birds.

The assessment of renal cortex and parenchymal volume using automated CT volumetry for predicting renal function after donor nephrectomy.

PubMed

Mitsui, Yosuke; Sadahira, Takuya; Araki, Motoo; Wada, Koichiro; Tanimoto, Ryuta; Ariyoshi, Yuichi; Kobayashi, Yasuyuki; Watanabe, Masami; Watanabe, Toyohiko; Nasu, Yasutomo

2018-04-01

Contrast-enhanced CT is necessary before donor nephrectomy and is usually combined with a Tc-99m-mercapto-acetyltriglycine (MAG3) scan to check split renal function (SRF). However, all transplant programs do not use MAG3 because of its high cost and exposure to radiation. We examined whether CT volumetry of the kidney can be a new tool for evaluating SRF. Sixty-three patients underwent live donor nephrectomy. Patients without a 1.0 mm slice CT or follow-up for <12 months were excluded leaving 34 patients' data being analyzed. SRF was measured by MAG3. Split renal volume (SRV) was calculated automatically using volume analyzer software. The correlation between SRF and SRV was examined. The association between the donor's postoperative estimated glomerular filtration rate (eGFR) and predicted eGFR calculated by MAG3 or CT volumetry was analyzed at 1, 3, and 12 months post nephrectomy. Strong correlations were observed preoperatively in a Bland-Altman plot between SRF measured by MAG3 and either CT cortex or parenchymal volumetry. In addition, eGFR after donation correlated with SRF measured by MAG3 or CT volumetry. The correlation coefficients (R) for eGFR Mag3 split were 0.755, 0.615, and 0.763 at 1, 3 and 12 months, respectively. The corresponding R values for cortex volume split were 0.679, 0.638, and 0.747. Those for parenchymal volume split were 0.806, 0.592, and 0.764. Measuring kidney by CT volumetry is a cost-effective alternative to MAG3 for evaluating SRF and predicting postoperative donor renal function. Both cortex and parenchymal volumetry were similarly effective.

Retrospective evaluation of unexpected events during collection of blood donations performed with and without sedation in cats (2010-2013).

PubMed

Doolin, Kerry S; Chan, Daniel L; Adamantos, Sophie; Humm, Karen

2017-09-01

Describe unexpected events (UEs) that occurred during blood donation in cats with and without sedation. Retrospective observational study (2010-2013). University teaching hospital. Client-owned healthy cats enrolled in a blood donation program. None. Blood collection for transfusion was performed 115 times from 32 cats. Seventy donation events were in unsedated cats and 45 in sedated cats. For each collection, the anticipated blood volume to be collected, actual blood volume collected, sedation protocol, and any UE in the peridonation period were recorded. There were 6 categories of UEs: movement during donation, donor anxiety, inadequate collected blood volume, jugular vessel related UEs, additional sedation requirement, and cardiorespiratory distress. Fisher's exact test was used to compare the frequency of UEs between sedated and unsedated cats. UEs were recorded in 54 of 115 collections. In the donor population, movement was reported as an UE in 0 cats that donated under sedation and 24/70 (34.3%) cats that donated without sedation (P < 0.001). Donor anxiety occurred in 2/45 (4.4%) cats that donated under sedation and 14/70 (20.0%) cats that donated unsedated (P = 0.014). Unsedated donation did not increase the likelihood of inadequate donation volume, jugular vessel related UEs, or cardiorespiratory distress. Eight of 45 (17.8%) sedated donations required additional sedation. Movement during donation and signs of donor anxiety were more frequent in unsedated cats. These were considered minor issues, expected in unsedated cats being gently restrained. Blood collection from unsedated feline donors is a viable alternative to sedated donation. © Veterinary Emergency and Critical Care Society 2017.

Dystrophic serotonin axons in postmortem brains from young autism patients.

PubMed

Azmitia, Efrain C; Singh, Jorawer S; Hou, Xiao P; Wegiel, Jerzy

2011-10-01

Autism causes neuropathological changes in varied anatomical loci. A coherent neural mechanism to explain the spectrum of autistic symptomatology has not been proposed because most anatomical researchers focus on point-to-point functional neural systems (e.g., auditory and social networks) rather than considering global chemical neural systems. Serotonergic neurons have a global innervation pattern. Disorders Research Program, AS073234, Program Project (JW). Their cell bodies are found in the midbrain but they project their axons throughout the neural axis beginning in the fetal brain. This global system is implicated in autism by animal models and by biochemical, imaging, pharmacological, and genetics studies. However, no anatomical studies of the 5-HT innervation of autistic donors have been reported. Our review presents immunocytochemical evidence of an increase in 5-HT axons in postmortem brain tissue from autism donors aged 2.8-29 years relative to controls. This increase is observed in the principle ascending fiber bundles of the medial and lateral forebrain bundles, and in the innervation density of the amygdala and the piriform, superior temporal, and parahippocampal cortices. In autistic donors 8 years of age and up, several types of dystrophic 5-HT axons were seen in the termination fields. One class of these dystrophic axons, the thick heavily stained axons, was not seen in the brains of patients with neurodegenerative diseases. These findings provide morphological evidence for the involvement of serotonin neurons in the early etiology of autism, and suggest new therapies may be effective to blunt serotonin's trophic actions during early brain development in children. Copyright © 2011 Wiley-Liss, Inc.

Advances in Ethical, Social, and Economic Aspects of Chronic Renal Disease in Bolivia.

PubMed

Arze, S; Paz Zambrana, S

2016-03-01

Since 2005, great progress has been made in health care provision to patients with terminal renal failure in Bolivia. Access to dialysis and transplantation is regulated by the Ministry of Health, based on clinical criteria, applied equitably, without favoritism or discrimination based on race, sex, economic means, or political power. Until December 2013, there were no restrictions in dialysis and transplantation in Health Insurance institutions, but they covered only 30% of the population. Now the remaining 70% has access to free dialysis funded by the communities where patients live, with funds coming from the government and taxes on oil products. More than 2,231 people are getting dialysis, reaching a population growth of >60% annually. The number of hemodialysis units has increased by >200% (60 units), making access easier for end-stage renal failure patients. Treatment protocols have been drawn up to guarantee the best quality of life for the patients. The Law on Donation and Transplantation was enacted in 1996, and Supplementary Regulations were enacted in 1997 with various amendments over the past 5 years. A National Transplant Coordination Board, working under the National Renal Health Program, supervises and regulates transplants and promotes deceased-donor transplantation in an attempt to cover the demand for donors. Rules have been drawn up for accreditation of transplant centers and teams to guarantee the best possible conditions and maximum guaranties. Since January 2014, the National Renal Health Program has been providing free kidney transplants from living donors. Copyright © 2016 Elsevier Inc. All rights reserved.

Socioeconomic, demographic and policy comparisons of living and deceased kidney transplantation rates across 53 countries.

PubMed

Bendorf, Aric; Pussell, Bruce A; Kelly, Patrick J; Kerridge, Ian H

2013-09-01

There are more than 1.7 million sufferers of end stage kidney disease (ESKD) worldwide and for many a donated kidney provides the only chance of regaining independence from dialysis. Unfortunately, the demand for kidneys for transplantation far exceeds the available supply. It is important, therefore, that we understand the factors that may influence kidney donation rates. While certain socio-demographic factors have been linked to kidney donation rates, few studies have examined the influence of multiple socio-demographic factors on rates of both living and deceased kidney transplantation (KT) and none have examined their comparative effect in large numbers of culturally and socio-politically diverse countries. In this study, we performed univariate and multivariate analyses of the influence of 15 socio-economic factors on both the living donor (LD) and the deceased donor (DD) kidney transplantation rates (KTR) in 53 countries. Our analyses demonstrated that factors such as UN HDI (United Nations Human Development Index), religion, GDP, education, age, healthcare expenditure, presumed consent legislation and existence of a nationally managed organ donation program were associated with higher deceased KTR. In contrast, the only factors associated with living KTR were a highly significant negative association with presumed consent and variable associations with different religions. We suggest that by identifying factors that affect kidney transplantation rates these can be used to develop programs for enhancing donor rates in individual countries where those rates are below the leading countries. © 2013 The Authors. Nephrology © 2013 Asian Pacific Society of Nephrology.

Field Epidemiology and Laboratory Training Programs in West Africa as a model for sustainable partnerships in animal and human health.

PubMed

Becker, Karen M; Ohuabunwo, Chima; Ndjakani, Yassa; Nguku, Patrick; Nsubuga, Peter; Mukanga, David; Wurapa, Frederick

2012-09-01

The concept of animal and human health experts working together toward a healthier world has been endorsed, but challenges remain in identifying concrete actions to move this one health concept from vision to action. In 2008, as a result of avian influenza outbreaks in West Africa, international donor support led to a unique opportunity to invest in Field Epidemiology and Laboratory Training Programs (FELTPs) in the region that engaged the animal and human health sectors to strengthen the capacity for prevention and control of zoonotic diseases. The FELTPs mixed 25% to 35% classroom and 65% to 75% field-based training and service for cohorts of physicians, veterinarians, and laboratory scientists. They typically consisted of a 2-year course leading to a master's degree in field epidemiology and public health laboratory management for midlevel public health leaders and competency-based short courses for frontline public health surveillance workers. Trainees and graduates work in multidisciplinary teams to conduct surveillance, outbreak investigations, and epidemiological studies for disease control locally and across borders. Critical outcomes of these programs include development of a cadre of public health leaders with core skills in integrated disease surveillance, outbreak investigation, vaccination campaigns, laboratory diagnostic testing, and epidemiological studies that address priority public health problems. A key challenge exists in identifying ways to successfully scale up and transform this innovative donor-driven program into a sustainable multisectoral one health workforce capacity development model.

Financial constraints lead to innovation by IPPF.

PubMed

1998-07-01

In this interview, the International Planned Parenthood Federation's (IPPF) Secretary General, Director of Resource and Program Development, and Special Advisor to the Secretary General commented on IPPF programming innovations being adopted in response to financial constraints. Factors that have led to a reduction in core funding for the IPPF include the fact that other nongovernmental organizations (NGOs) have become more active, that many donor countries have decentralized their funding mechanisms to the country level, and that overall overseas development assistance is being decreased, despite promises made at the 1994 International Conference on Population and Development (ICPD). New funding can be sought from foundations, from the private sector, and by successfully competing with other organizations for funds available from donor countries. Transferring skills to local Family Planning Associations (FPAs) also helps these groups develop their own resource base. The ICPD marked the first time that NGOs were considered a legitimate part of the process of creating a program of action. It will be important for NGOs to demonstrate their ability to translate the goals of the ICPD into action. The IPPF and other NGOs have been successful in helping FPAs expand FP programs to cover reproductive health needs, in dealing with adolescent sexuality, and in enhancing women's empowerment. The IPPF wishes to create stronger alliances between its FPAs and other NGOs dealing with complementary issues and foster a synthesis among the recommendations of the 5 major UN conferences of the 1990s.

Support of Unrelated Stem Cell Donor Searches by Donor Center-Initiated HLA Typing of Potentially Matching Donors

PubMed Central

Schmidt, Alexander H.; Solloch, Ute V.; Baier, Daniel; Grathwohl, Alois; Hofmann, Jan; Pingel, Julia; Stahr, Andrea; Ehninger, Gerhard

2011-01-01

Large registries of potential unrelated stem cell donors have been established in order to enable stem cell transplantation for patients without HLA-identical related donors. Donor search is complicated by the fact that the stored HLA information of many registered donors is incomplete. We carried out a project that was aimed to improve chances of patients with ongoing donor searches to find an HLA-matched unrelated donor. For that purpose, we carried out additional donor center-initiated HLA-DRB1 typing of donors who were only typed for the HLA loci A and B so far and were potential matches for patients in need of a stem cell transplant. In total, 8,861 donors were contacted for donor center-initiated HLA-DRB1 typing within 1,089 donor searches. 12 of these donors have donated stem cells so far, 8 thereof for their respective target patients. We conclude that chances of patients with ongoing donor searches to find an HLA-matched unrelated donor can indeed be improved by donor-center initiated typing that is carried out in addition to the standard donor search process. Our results also raise questions regarding the appropriate use of incompletely typed donors within unrelated donor searches. PMID:21625451

Gamete donation: parents' experiences of searching for their child's donor siblings and donor.

PubMed

Freeman, T; Jadva, V; Kramer, W; Golombok, S

2009-03-01

This study investigates the new phenomenon of parents of donor offspring searching for and contacting their child's 'donor siblings' (i.e. donor offspring conceived by the same donor) and donor. Online questionnaires were completed by 791 parents (39% lone-mother, 35% lesbian-couple, 21% heterosexual-couple, 5% non-specified) recruited via the Donor Sibling Registry; a US-based international registry that facilitates contact between donor conception families who share the same donor. Data were collected on parents' reasons for searching for their child's donor siblings and/or donor, the outcome of these searches and parents' and their child's experiences of any resulting contact. Parents' principal motivation for searching for their child's donor siblings was curiosity and for their donor, enhancing their child's sense of identity. Some parents had discovered large numbers of donor siblings (maximum = 55). Most parents reported positive experiences of contacting and meeting their child's donor siblings and donor. This study highlights that having access to information about a child's donor origins is important for some parents and has potentially positive consequences. These findings have wider implications because the removal of donor anonymity in the UK and elsewhere means that increasing numbers of donor offspring are likely to seek contact with their donor relations in the future.

Voluntary whole-blood donors, and compensated platelet donors and plasma donors: motivation to donate, altruism and aggression.

PubMed

Trimmel, Michael; Lattacher, Helene; Janda, Monika

2005-10-01

To establish if voluntary whole-blood donors and compensated platelet donors and plasma donors may differ in their motivation to donate, altruism, aggression and autoaggression. Whole-blood (n=51), platelet (n=52) and plasma donors (n=48) completed a battery of validated questionnaires while waiting to donate. Bivariate and multivariate analyses of variance and t-tests were performed to detect differences between groups as noted. Altruism (mean=40.2) was slightly higher in whole-blood donors than in platelet (mean=38.3) and plasma donors (mean=39.1) (p=0.07). Blood donors (mean=2.8) scored lower in the spontaneous aggression measure than platelet (mean=4.1) and plasma donors (mean=4.4) (p=0.01). Plasma donors (mean=4.9) had higher auto-aggression than whole-blood donors and platelet donors (mean for both groups=3.4) (p=0.01). Differences between the three groups were mediated by sociodemographic variables (MANCOVA). Whole-blood donors donated to help others, platelet and plasma donors mostly to receive the compensation. However, those platelet and plasma donors, who would continue to donate without compensation were similar in altruism and aggression to whole-blood donors. While most platelet donors and plasma donors were motivated by the compensation, those who stated that they would continue to donate without compensation had altruism and aggression scores similar to voluntary whole-blood donors.

Poor Long-Term Outcomes of Adult Liver Transplantation Involving Elderly Living Donors.

PubMed

Tokodai, K; Kawagishi, N; Miyagi, S; Nakanishi, C; Hara, Y; Fujio, A; Kashiwadate, T; Maida, K; Goto, H; Kamei, T; Ohuchi, N

2016-05-01

Donor hepatectomy requires particular care to ensure the safety of the donor and the success of the liver transplantation. The aim of this study was to evaluate the effect of donor age on the postoperative outcomes of liver transplant donors and the long-term graft survival rates. We retrospectively reviewed 56 consecutive adult patients who underwent living donor liver transplantation at our institution between April 2001 and August 2010. Donors and recipients were divided into 2 groups, based on the age of the donor: the elderly donor group (donor age ≥50 years) and the younger donor group (donor age <50 years). Perioperative variables, postoperative complication rates, and long-term graft survival rates were compared between the 2 groups. The average ages in the elderly donor group and younger donor group were 58 years and 32 years, respectively. Baseline data excluding the age of the donor did not differ between the groups, nor did the overall complication rates of the donors. Hospital stays were longer in the elderly donor group than in the younger donor group (25 vs 18 days, P < .05). The 1-, 3-, and 5-year graft survival rates were 80%, 60%, and 50% in the elderly donor group, and 89%, 87%, and 82% in the younger donor group, respectively (P = .0002). Donor hepatectomy can be performed safely in elderly patients. However, compared with younger donors, their hospital stays were longer and the graft survival rates were shorter. Copyright © 2016 Elsevier Inc. All rights reserved.

Donor selection for adult-to-adult living donor liver transplantation: well begun is half done.

PubMed

Sharma, Amit; Ashworth, April; Behnke, Martha; Cotterell, Adrian; Posner, Marc; Fisher, Robert A

2013-02-15

Donor selection criteria for adult-to-adult living donor liver transplantation vary with the medical center of evaluation. Living donor evaluation uses considerable resources, and the nonmaturation of potential into actual donors may sometimes prove fatal for patients with end-stage liver disease. On the contrary, a thorough donor evaluation process is mandatory to ensure safe outcomes in otherwise healthy donors. We aimed to study the reasons for nonmaturation of potential right lobe liver donors at our transplant center. A retrospective data analysis of all potential living liver donors evaluated at our center from 1998 to 2010 was done. Overall, 324 donors were evaluated for 219 potential recipients, and 171 (52.7%) donors were disqualified. Common reasons for donor nonmaturation included the following: (1) donor reluctance, 21%; (2) greater than 10% macro-vesicular steatosis, 16%; (3) assisted donor withdrawal, 14%; (4) inadequate remnant liver volume, 13%; and (5) psychosocial issues, 7%, and thrombophilia, 7%. Ten donors (6%) were turned down because of anatomic variations (8 biliary and 2 arterial anomalies). Donors older than 50 years and those with body mass index of more than 25 were less likely to be accepted for donation. We conclude that donor reluctance, hepatic steatosis, and assisted donor withdrawal are major reasons for nonmaturation of potential into actual donors. Anatomic variations and underlying medical conditions were not a major cause of donor rejection. A system in practice to recognize these factors early in the course of donor evaluation to improve the efficiency of the selection process and ensure donor safety is proposed.

Donor Selection for Adult- to- Adult Living Donor Liver Transplantation: Well Begun is Half Done

PubMed Central

Sharma, Amit; Ashworth, April; Behnke, Martha; Cotterell, Adrian; Posner, Marc; Fisher, Robert A.

2012-01-01

Background Donor selection criteria for adult-to-adult living donor liver transplantation vary with the medical center of evaluation. Living donor evaluation utilizes considerable resources and the non-maturation of potential into actual donors may sometimes prove fatal for patients with end stage liver disease. On the contrary, a thorough donor evaluation process is mandatory to ensure safe outcomes in otherwise healthy donors. We aimed to study the reasons for non-maturation of potential right lobe liver donors at our transplant center. Methods A retrospective data analysis of all potential living liver donors evaluated at our center from 1998 to 2010 was done. Results Overall 324 donors were evaluated for 219 potential recipients and 171 (52.7%) donors were disqualified. Common reasons for donor non-maturation included: (1) Donor reluctance, 21% (2) >10% macro-vesicular steatosis, 16% (3) assisted donor withdrawal, 14% (4) inadequate remnant liver volume, 13% (5) psychosocial issues, 7% and thrombophilia, 7%. Ten donors (6%) were turned down due to anatomical variations (8 biliary and 2 arterial anomalies). Donors older than 50 years and those with BMI over 25 were less likely to be accepted for donation. Conclusions We conclude that donor reluctance, hepatic steatosis and assisted donor withdrawal are major reasons for non-maturation of potential into actual donors. Anatomical variations and underlying medical conditions were not a major cause of donor rejection. A system in practice to recognize these factors early in the course of donor evaluation to improve the efficiency of the selection process and ensure donor safety is proposed. PMID:23128999

National Marrow Donor Program

DTIC Science & Technology

2008-08-05

Research in HLA Typing, Hematopoietic Stem Cell Transplantation and Clinical Studies to Improve Outcomes 16. SECURITY CLASSIFICATION OF: 19a. NAME...new action item was added to Workflow Management screen for the SCTOD ( Stem Cell Therapeutic Outcomes Data) Data Form. The information will be passed...Improvement Amendment NRP National Response Plan CME Continuing Medical Education NST Non-myeloablative Allogeneic Stem Cell Transplantation COG

An Introduction to Annuity, Life Income, and Bequest Programs.

ERIC Educational Resources Information Center

Dunseth, William B.

Deferred giving in higher education is the practice of making a gift to an institution during one's lifetime while continuing to receive income from that donated asset. The history of the practice and the reasons for its value to donors and institutions are outlined. Options for annuity and life income plans are discussed: gift annuity, deferred…