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Available accessEditorialFirst published June, 2012pp. 116-118
Available accessResearch articleFirst published June, 2012pp. 119-128Although graft and patient survival rates for living kidney donation are improved, some healthcare providers question whether volunteer donors and their informal caregivers are fully informed of the donation process and the risks involved. Donors and their family caregivers have reported that they receive limited information about the predonation and donor recovery process. Offering web-based information and social support is one way to address this gap.
Living kidney donor candidates and their family caregivers participating in the Living Donor Information Network for Caregiving (LINC) have access to a variety of online informational resources and a social support discussion forum throughout their living kidney donation experience. Strategies in the development and implementation of an online information and social-support resource are presented.
Use of the LINC website for information and support may assist health care providers in identifying potential barriers in the current donation process and provide direction for enhancing knowledge and confidence among donors and family caregivers.
Available accessResearch articleFirst published June, 2012pp. 129-132In an effort to expand the deceased donor pool, transplant centers have accepted expanded criteria donors as appropriate for many of the patients in the deceased donor pool. Translating this into the living donor pool is more complex. One must consider not only the quality of the organ procured but the consequences that the nephrectomy might have on the living donors for the rest of their lives. This review examines the available data on higher risk donors and the appropriateness, or lack thereof, of accepting them as kidney donors.
Available accessResearch articleFirst published June, 2012pp. 134-140The purpose of this study was to analyze pregnancy outcomes in female lung transplant recipients. Data were collected from the National Transplantation Pregnancy Registry via questionnaires, interviews, and hospital records. Twenty-one female lung recipients reported 30 pregnancies with 32 outcomes (1 triplet pregnancy). Outcomes included 18 live births, 5 therapeutic abortions, and 9 spontaneous abortions. No stillbirths or ectopic pregnancies were reported. Mean (SD) interval from transplant to conception was 3.6 (3.3) years (range, 0.1–11.3 years). Comorbid conditions during pregnancy included hypertension in 16, infections in 7, diabetes in 7, preeclampsia in 1, and rejection in 5 women. Ten of the 21 recipients received a transplant because of cystic fibrosis and accounted for 12 pregnancy outcomes (7 live births, 3 spontaneous abortions, and 2 therapeutic abortions). At last recipient contact, 13 had adequate function, 2 had reduced function, 5 recipients had died (2 with cystic fibrosis), and 1 recipient had a nonfunctioning transplant. Mean gestational age of the newborn was 33.9 (SD, 5.2) weeks, and 11 were born preterm (<37 weeks). Mean birthweight was 2206 (SD, 936) g and 11 were low birthweight (<2500 g). Two neonatal deaths were associated with a triplet pregnancy; one fetus spontaneously aborted at 14 weeks and 2 died after preterm birth at 22 weeks. At last follow-up, all 16 surviving children were reported healthy and developing well. Successful pregnancy is possible after lung transplant, even among recipients with a diagnosis of cystic fibrosis.
Available accessResearch articleFirst published June, 2012pp. 141-154The aim of this report is to evaluate whether pregnancy is a risk factor for poor outcome of infection with hepatitis C virus or for allograft deterioration among kidney transplant recipients. The first case was in a 41-year-old pregnant kidney transplant recipient with hypercreatinemia and a history of toxic hepatitis. The second case was treated with interferon before transplant. Tacrolimus-based immunosuppressive regimens were used during the pregnancies. Hypertension complicated both pregnancies, and the pregnancies ended with cesarean delivery at preterm and term with healthy but low-weight newborns. The first patient became positive for hepatitis C virus RNA after pregnancy without a flare in transaminase level. Antibodies to hepatitis C virus were negative in the newborns. In conclusion, pregnancy should be promoted for kidney recipients infected with hepatitis C virus who have stable graft and liver function.
Available accessResearch articleFirst published June, 2012pp. 147-154Donating a kidney may provide an opportunity for donors to reevaluate their health maintenance behaviors (eg, regular exercise, smoking cessation, medical checkups). Although the effect of donation on donors' health, quality of life, and financial outcomes has received growing attention, no studies have examined whether donation is related to changes in health maintenance behaviors. The study aims were to (1) describe and compare kidney donors' health maintenance behaviors before and after donation, and (2) determine the correlates of health maintenance behaviors after donation.
We conducted a telephone-interview study with 85 randomly selected laparoscopic kidney donors in a major US transplant center to assess health behaviors before and after donation, postdonation characteristics (eg, quality of life, postsurgical pain), and demographics.
Sample demographics included a median age of 48 years; 55% were female, 82% were white, 71% were married, and 52% were college graduates. Few health behaviors changed significantly from before to after donation. Only the rate of medical checkups increased after donation (
These results may help identify donors who are at greater risk for poor health maintenance behaviors after donation and suggest areas of health behavior that should be the focus of education sessions before donation.
Available accessResearch articleFirst published June, 2012pp. 155-160The frequency and impact of detection of Epstein-Barr virus in the blood of lung and heart-lung transplant recipients in the postoperative period is poorly characterized.
To investigate the frequency of virus detection, associated clinical symptoms and risk factors, and influence of virus detection on outcome.
A cohort of 98 lung transplant recipients were monitored for Epstein-Barr virus in blood before transplant and during their posttransplant hospital stay (median 4 weeks, range 1–21 weeks). Patients were followed up for retransplant or death for a median of 17 months.
Epstein-Barr virus DNA was detected in 15 recipients (18.1%) before and in 39 recipients (41.5%) after transplant. Median viral load after transplant was 2300 copies per milliliter of blood (range, 900–45 000 copies/mL). Detection of Epstein-Barr virus DNA before transplant and mechanical ventilation before transplant were associated with detection of Epstein-Barr virus DNA after transplant. Shortness of breath, fatigue, and hoarseness were associated with detection of viral DNA after transplant. The incidence of retransplant or death was not increased in recipients who had viral DNA detected in their blood.
Epstein-Barr virus DNA in the blood before transplant and mechanical ventilation before transplant were associated with detection of viral DNA after transplant. Detection of viral DNA after transplant was frequent and clinically relevant.
Available accessResearch articleFirst published June, 2012pp. 161-167African Americans are disproportionately represented among those awaiting a transplant, but many are reluctant to donate their organs.
To test the effectiveness of using lay health advisors to increase organ donation among church members.
Churches were pair-matched by average estimated income and size and then randomized to 1 of 2 interventions: one addressing organ donation and the other addressing increasing consumption of fruits and vegetables.
Twenty-two African American churches in Southeast Michigan.
Church members were trained to serve as lay health advisors (called peer leaders).
Peer leaders conducted organ donation discussions with church groups and showed a DVD created for this program that was tailored to African American churches.
The primary outcome was verified registration in the state's donor registry. Participants also completed pre/post questionnaires regarding their attitudes about organ donation.
Once clustering, baseline value, and demographics were adjusted for, the intervention and comparison groups did not differ on any of the 3 attitude scales on the posttest. In logistic regression analysis, with baseline donation status, demographics, and church clustering controlled for, the odds of self-reported enrollment at 1-year posttest did not differ by condition (odds ratio, 1.23; 95% CI, 0.87–1.72). A total of 211 enrollments in the state registry from participating churches were verified. Of these, 163 were from intervention churches and 48 were from comparison churches.
Use of lay health advisors through black churches can increase minority enrollment in a donor registry even absent change in attitudes.
Available accessResearch articleFirst published June, 2012pp. 168-174Efforts to promote organ donation have traditionally relied on mass-mediated or interpersonal communication to promote donor registration. Despite its popularity, the use of online media has yet to be carefully evaluated as a platform to promote organ donation.
To describe results of an intervention to promote donor registration that relies solely on online media to communicate to target audiences.
For 3 years, 6 campaigns were implemented in 3 different online media formats.
Online media formats included (1) traditional online advertising, (2) student seeders' social networking sites campaigns, and (3) challenge campaigns.
Online media campaigns primarily targeted college-aged individuals.
Each campaign directed individuals to the dedicated project website, where they could access educational material about donation and request a donor registration card.
Unique website visitors, webpages viewed per site visit, time spent on site, and organ donor cards requested/received were tracked in relation to each online media format.
Traditional online advertising offered greater message exposure but failed to result in a higher proportion of website visitors who registered their donation intentions. Use of student seeders (ie, motivated students who promote donation by using social networking sites) and challenge campaigns resulted in greater attention to the project website, donor card requests, and subsequent returns. Additional research is recommended to reveal the effect of combining 2 or more varying online media formats within a single campaign.
Available accessCalendarFirst published June, 2012pp. 174-174
Available accessResearch articleFirst published June, 2012pp. 175-182Enhancement of renal allograft function and survival in an era where expanded criteria donors are increasingly used requires validated selection criteria. The goal of this retrospective study was to evaluate the significance of pretransplant donor and allograft parameters to identify risk factors that can be used in a model to predict 1-year allograft outcomes. Donor demographic factors, donor type, and allograft parameters such as biopsy results and machine-measured renal resistance were correlated with 1-year graft outcome. The Kaplan-Meier method was used to estimate graft survival using the categorical predictors of donor type, donor age, and machine-measured renal resistance at 1.5, 3, and 5 hours. The log-rank test was used to test the difference in survival curves between cohorts. The Cox regression analysis was used to estimate hazard ratios for machine-measured renal resistance, donor age, donor terminal creatinine level, donor's estimated glomerular filtration rate, cold ischemia time, and percent glomerulosclerosis. The data show that machine-measured renal resistance at 3 and 5 hours has a statistically significant inverse relationship to 1-year graft survival. All other risk factors had no correlation with 1-year graft survival. The machine-measured renal resistance at 3 hours is the earliest significant predictor of 1-year allograft outcome.
Available accessResearch articleFirst published June, 2012pp. 183-191A 2-year study funded by the United States Department of Health and Human Services, Health Resources and Services Administration was conducted to identify a conceptual model of how college students, particularly those in student organizations, can be the social media catalyst for viral communications designed to motivate others to learn about the need of organ donation and become organ donors. This study reports the qualitative findings.
Methods used included an advisory committee, key informant interviews, and focus groups. A total of 317 individuals participated, including 246 students, 19 student organization advisors, 27 organ transplant experts, 20 university health care professionals, and 5 social media experts.
SPSS Text Smart content analysis software was used to code respondents' verbal comments into various categories. The analysis results in groupings of words that represent the main discussion topics.
College students understand the need for organ donation and they want to make a difference. The donation community needs to overcome several barriers to motivate college students to become organ donors and donor advocates, including (1) lack of a personal connection with donation, (2) lack of (factual) knowledge about organ donation and how to sign up, (3) common myths and misconceptions, and (4) students have a short-term perspective on life.
Our findings suggest that the donation community can motivate college students to register as organ donors and become advocates through outreach efforts that use social media, student organizations, and other college-based media.
Available accessResearch articleFirst published June, 2012pp. 192-198Recent investigations have explored how analyses of genetic DNA from organ donors and recipients may be helpful during organ allocation so as to reduce graft rejection or improve dosing of immunosuppressive medications. This discussion reviews those data and the processes by which genetic coding controls the production of protein that is important in cellular structure and function during donor and recipient care. Changes in gene structure (polymorphisms or mutations) may occur spontaneously or as a result of cell interactions with environmental factors, and may be associated with recognized diseases or, potentially, could reduce or worsen graft rejection.
Available accessResearch articleFirst published June, 2012pp. 200-206Fear inhibits potential donors' willingness to engage in behaviors. Theoretically, fright and anxiety are differentially associated with blood and organ donation, respectively. Fright is the experience of an immediate harm, whereas anxiety is a fear of the unknown.
To compare the fear-related concepts of fright and anxiety in relation to blood donation and signing an organ donor card.
Scales were created to separate the 2 fear types that were consistent in theme and addressed the same dependent variables fright and anxiety.
Participants were 509 college students at a large mid-western university.
Survey responses from 509 participants supported the theoretical explication of the 2 fear types. Multisample analyses and multimeasurement models using confirmatory factor analysis supported that fright and anxiety were differentially associated with the contexts of blood and organ donation.
The results supported the theoretical proposal that fright and anxiety are differentially related. The ability to measure such emotions will help future researchers create models that are more accurate for predicting potential donors and create messages to assuage fears. A greater understanding of fear will lead to more effective messages.
Available accessResearch articleFirst published June, 2012pp. 207-211Since 1998, lung transplants have increased almost 75%, making lung transplant the fastest growing form of organ transplant in the United States. However, the supply of transplantable lungs continues to fall short of the demand. Strategies for expanding the lung donor pool by increasing the number of older donor lungs used has been effective, although these donors do not meet typical clinical selection criteria based on age. In these older donors, effective communication of in-depth donor information is necessary to place and transplant lungs successfully. The following case study illustrates how an “every organ, every time” attitude combined with a technique to communicate clinical information resulted in the successful transplant of 72-year-old donor lungs into a bilateral lung recipient. Since the case outlined in this study, the organ procurement organization has successfully recovered and transplanted an additional 2 lungs from a 74-year-old and 1 lung from a 76-year-old, 2 of the oldest lung donors in the United States. This case demonstrates that although many older donor lungs are deemed unsuitable by clinical selection criteria, an extended criteria population offers an untapped resource for donor organs.
Available accessResearch articleFirst published June, 2012pp. 212-216Little is known about clothing issues among patients with implantable left ventricular assist devices (LVADs). This article describes the experience of a woman who had challenges in adapting to an altered body image imposed by the external components of the LVAD system. The woman discusses her problems about clothes that fit her personal style and shares her strategies and recommendations in overcoming the problem. Her description of how she approached and resolved the problem is situated within the Apparel Body Construct Model. In this context, appropriate selection of apparel is crucial not only to preserving the integrity and function of the LVAD system but also to the recipient's satisfaction with her body image. The information presented is a catalyst for knowledge development and heightening health care providers' awareness of patients' perception of body image, which is vital to adapting to an LVAD as a component of the recipient's body and life.