Progress in Transplantation

Few data-based reports about the role and work environment of advanced practice nurses, specifically nurse practitioners in mechanical circulatory support programs, have been published.

To describe the practice pattern and professional issues confronted by nurse practitioners in the rapidly evolving and expanding mechanical circulatory support programs in the United States.

A descriptive research design was employed using the data from the 2010 mechanical circulatory support nurses survey. Quantitative and qualitative data that pertained to the demographic and practice profiles as well as barriers and overall issues faced by the nurse practitioners in their clinical practice were analyzed.

Nonrandom sample of 48 nurse practitioners from 95 mechanical circulatory support programs nationwide.

The practice pattern of nurse practitioners in mechanical circulatory support programs is similar to the practice pattern reported for nurse practitioners in acute and critical care settings. However, only 44% and 10% of nurse practitioners in mechanical circulatory support programs are authorized to admit and transfer patients into and out of the hospital, respectively. High workload, lack of institutional support, knowledge deficit, role ambiguity, lack of professional recognition, and burnout were the common issues faced by the participants in their clinical practice.

The results provide preliminary evidence on the practice pattern, restrictions, and work environment issues that may threaten the viability of an mechanical circulatory support program in which nurse practitioners play a crucial role. Implications for clinical practice, research, and policy development are discussed.

To compare the effects of calcitonin, etidronate, and alendronate in preventing bone loss during the first 2 years after heart transplant.

A total of 222 heart transplant recipients (mean [SD] age, 52.4 [10] years, 85% male) were evaluated. Patients with normal bone mineral density (reference group, n = 102) received 1000 mg/d calcium plus 800 IU/d vitamin D3. The rest were assigned to 200 IU/d of calcitonin (n = 42), 400 mg/d etidronate orally for 14 days quarterly (n = 33), or 10 mg/d alendronate (n = 45). All patients received calcium and vitamin D. Bone mineral density was assessed by dual-energy x-ray absorptiometry in the lumbar spine, the entire femur, and the femoral neck at baseline and 6, 12, and 24 months after transplant.

At 2 years after transplant, bone mineral density in the lumbar spine had decreased in the reference group (−3.07%), calcitonin group (−0.93%), and etidronate group (−1.87%) but not in the alendronate group (+4.9%; P < .001). After 2 years, bone mineral density in the entire femur decreased in all groups (−3.2% in the reference group, −3.6% in the calcitonin group, −4.6% in the etidronate group, and −0.5% in the alendronate group) but bone loss was significantly lower in the alendronate group (P < .001). Bone mineral density in the femoral neck also decreased in all groups. The incidence of vertebral fractures did not differ among groups. Adverse events were similar between groups.

Alendronate therapy in heart transplant recipients was associated with a significant increase in bone mineral density in the lumbar spine and less bone loss at the hip.

Medical and surgical advancements have resulted in improved long-term survival of pediatric liver transplant recipients. As pediatric patients approach school age and adolescence, transplant centers are challenged to facilitate the process of transitioning from pediatric to adult centers.

To describe pediatric and adult liver transplant coordinators' perspective regarding practice for transitioning patients to adult-oriented transplant centers.

Descriptive

Pediatric and adult liver transplant coordinators associated with Studies of Pediatric Liver Transplantation.

A total of 35 pediatric liver transplant coordinators and 24 adult liver transplant coordinators completed the survey.

Investigator-developed survey to identify current practice for transition process and actual transfer of a patient from pediatric to adult care.

Transplant coordinators play an integral role in the transition process, and study results highlight what experienced coordinators believe are important considerations for a successful transition process. Results also highlight the importance of communication and partnership between the pediatric and adult programs.

Adolescents with chronic illnesses are at increased risk for body image and eating disorders; however, this has not been investigated in solid organ transplant recipients. Adolescent transplant recipients are a vulnerable cohort because of the sustained follow-up and immune-suppressing therapies, which often include steroids and may lead to weight gain and cosmetic changes. Consequences of body dissatisfaction such as disordered behaviors have not been well studied in transplant recipients.

To examine body image, eating attitudes, and behaviors among 28 adolescent thoracic transplant recipients.

Adolescent (11–18 years old) heart and lung transplant recipients a minimum of 3 months after transplant provided informed written consent and completed a standardized questionnaire package about eating attitudes and behaviors; body image and drive for thinness; actual, perceived, and desired weight; and medical and anthropometric information (eg, body mass index) during regular transplant clinics.

Of 25 heart and 3 lung transplant recipients (54% female; median age, 14.5 years; median, 1.6 years after transplant), 37% perceived their current weight as too high or low. Moreover, 81% were dissatisfied with their current weight (38% wanted to lose and 44% wanted to gain weight), yet few engaged in disordered behaviors.

Despite high levels of self-reported body dissatisfaction, low rates of disordered behaviors were observed. Weight dissatisfaction was high (81%) but bidirectional (to lose or to gain weight). Future assessment of disordered eating behaviors should include insidious activities such as medication nonadherence, in addition to traditional weight-control behaviors such as binge eating, strict dieting, or assiduous exercise. Further research will delineate the impact of body dissatisfaction and eating behaviors and outcomes on long-term transplant survivors, older adolescent cohorts, and other recipients of solid organ transplants.

Patient education is crucial to guarantee that transplant recipients are capable of adequate self-management. Until recently, our education program to prepare lung transplant patients for discharge lacked a systematic approach, meaning that it was unclear whether all key information had been provided and whether the patient understood the information. A lack of coordination among the multi-disciplinary team members also was apparent.

(1) To map out a structured education program, outlining the content, process, and evaluation of education for patients before discharge after lung transplant; (2) to integrate this program into the patient's electronic file and pilot test this new form of education tracking.

We used the conceptual framework of Lorig and colleagues, as well as the educational leaflets of the International Transplant Nurses Society, to generate the content of our education program. The interdisciplinary lung transplant team decided when and by whom each educational component should be provided, as well as the evaluation criteria. Next, information technology engineers integrated this educational program into the patient's electronic file. Nurses subsequently tested the program, and their feedback was integrated in the next version of the program.

Health care providers experienced a higher level of uniformity and transparency. After using the education program, most patients indicated that they felt confident to go home.

Our electronic educational platform is promising, yet further testing is necessary to evaluate whether patients indeed have sufficient knowledge and show adequate self-management skills in the long term after transplant.

The immunosuppressants required after transplant cause peripheral neuropathy with an incidence of 10% to 60%. Peripheral neuropathy adversely affects health-related quality of life in other populations.

To describe the lived experience of peripheral neuropathy after solid organ transplant.

A qualitative phenomenological study with semistructured interviews. A purposive sample of 7 solid organ transplant recipients with peripheral neuropathy was recruited from 2 transplant clinics at a large Midwest tertiary care center. Interviews were audio taped and transcribed verbatim. Data were analyzed line-byline and coded by using HyperResearch 2.0.

Although participants' experiences were similar to those reported by others with peripheral neuropathy, there were also unique differences. Unique to this population was unexpected onset, rapid escalation of symptoms, lack of provider monitoring, and poor provider response to reported symptoms. Their experience demonstrated that peripheral neuropathy diminished health-related quality of life. Four themes emerged from the data: (1) nothing is supposed to happen after transplant; (2) neuropathy causes me more problems than my heart; (3) maybe there is something that could help; and (4) I've learned to live with certain limitations.

Development of or worsening of peripheral neuropathy after solid organ transplant may decrease health-related quality of life. Follow-up care should include vigilant monitoring for signs of peripheral neuropathy. Providers need to provide early treatment, education, support, empathy, and understanding.

Although some living donors experience psychological, somatic, and interpersonal difficulties after donation, interventions to prevent such outcomes have not been developed or evaluated.

To (1) summarize empirical evidence on psychosocial outcomes after donation, (2) describe a theoretical framework to guide development of an intervention to prevent poor outcomes, and (3) describe development and initial evaluation of feasibility and acceptability of the intervention.

Based on a narrative literature review suggesting that individuals ambivalent about donation are at risk for poor psychosocial outcomes after donation, the intervention targeted this risk factor. Intervention structure and content drew on motivational interviewing principles in order to assist prospective donors to resolve ambivalence. Data were collected on donors' characteristics at our institution to determine whether they constituted a representative population in which to evaluate the intervention. Study participants were then recruited to assess the feasibility and acceptability of the intervention. They were required to have scores greater than 0 on the Simmons Ambivalence Scale (indicating at least some ambivalence about donation).

Our population was similar to the national living donor population on most demographic and donation-related characteristics. Eight individuals who had been approved to donate either a kidney or liver segment were enrolled for pilot testing of the intervention. All successfully completed the 2-session telephone-based intervention before scheduled donation surgery. Participants' ratings of acceptability and satisfaction were high. Open-ended comments indicated that the intervention addressed participants' thoughts and concerns about the decision to donate.

The intervention is feasible, acceptable, and appears relevant to donor concerns. A clinical trial to evaluate the efficacy of the intervention is warranted.

Hispanics need disproportionately more kidney transplants, yet receive disproportionately fewer kidney transplants and living donor kidney transplants than non-Hispanic whites. Lack of knowledge and cultural beliefs about living kidney donation contribute to these disparities. The Internet is an optimal venue to educate underserved, low-literacy populations.

Websites were evaluated for information on living kidney donation targeted to Hispanics. Hispanic websites addressing living kidney donation were identified through the Google search engine, using the search terms Hispanic, Latino, Spanish, and living kidney donor/donation. Websites were evaluated for accessibility of information, readability, and content required by 9 Centers for Medicare and Medicaid Services regulations representing 12 topics, and cultural competency.

Twenty resources met inclusion criteria. Websites contained 2.3 pages on living kidney donation and required 2.4 links to access all information on living kidney donation. Websites were written at the 9th grade reading level. Sites described alternative treatments for recipients (n = 14), the evaluation process (n = 7), and the surgical procedure (n=6). Few addressed psychosocial risks (n =2). Some contained culturally sensitive colors and pictures (n = 8), but few addressed Hispanic cultural beliefs (n = 4).

A comprehensive website on living kidney donation that provides more robust content and is targeted to Hispanics is needed to increase Hispanics' understanding of treatment options.

Transplant professionals need to gain a better understanding of the factors that facilitate willingness to donate a family member's organs, in order to increase the rate of organ donation.

To conduct an integrated analysis of demographic data relating to key family members, so as to help transplant professionals predict the likelihood that family members would be willing to donate organs.

Demographic variables were collected on 753 brain-dead patients and 995 first-degree relatives in 20 Israeli hospitals from 2004 to 2009. The data were recorded by transplant coordinators who used a uniform format to document meetings with next of kin. The data were analyzed by using the Chaid Statistical Test from the SPSS statistical package.

In this total study population, the most significant factor affecting the decision to donate was religion. With increasing religiousness, the likelihood of consent decreased. A large disparity was apparent among Moslems, Christians, and Jews. Within the religious groups, education (Jews), familial proximity to the deceased (Christians and Moslems), and the quality of relationships with the medical staff (Moslems) were the main predictors of consent.

Most countries have Christian, Moslem, and Jewish residents, so the conclusions of this study and its implications for practice should be relevant for transplant coordinators anywhere. The recommendations, which stem from the results of this study, relate to activities of transplant coordinators before and during their interaction with families, before the request for organ donation.

Resources are currently targeted at increasing organ and tissue donation rates from emergency departments in Australia. Health care professionals' beliefs and personal attitudes regarding organ and tissue donation are known to influence professional attitudes and practice.

To assess emergency department clinicians' general beliefs and personal attitudes toward organ and tissue donation, how general beliefs influence personal attitudes, and which demographic characteristics are related.

A cross-sectional online survey, based on available literature and the validated and widely used Hospital Attitude Survey (DonorAction).

Data were collected from 811 Australian emergency department clinicians, invited to participate through the College of Emergency Nursing Australasia, and the Australasian College for Emergency Medicine.

Most clinicians were very supportive of organ and tissue donation (96.2%), believed that organ and tissue donation can save lives (98.5%), and that organs and tissues will be allocated fairly (82.6%); however, 30.1% did not agree that organ and tissue donation can help the next of kin cope with grief. Holding positive general beliefs increased positive personal attitudes toward organ and tissue donation (P < .001). Most reported willingness to donate their own organs and tissues after death (90%) and give family consent for their children (79.6%) or adult family (86.6%) member to donate. Eighty-six percent had discussed their wishes with next of kin, but only 50.7% had registered on the Australian Organ Donor Register. Older clinicians, male clinicians, and clinicians of certain religious and cultural backgrounds were identified as having less positive general beliefs and personal attitudes.

Although Australian emergency department clinicians are generally positive toward organ and tissue donation, some groups could potentially benefit from education to change their beliefs and attitudes about organ and tissue donation further.

Despite the fact that college students support social causes, this age group has underparticipated in organ donor registration. Little research attention has been given to understanding deeper, higher-order relationships between the antecedent attitudes toward and perceptions of organ donation and registration behavior.

To test a process model useful for understanding the sequential ordering of information necessary for moving college students along a hierarchical decision-making continuum from awareness to support to organ donor registration.

The University of Wisconsin organ procurement organization collaborated with the Collegiate American Marketing Association on a 2-year grant funded by the US Health Resources and Services Administration. A total of 981 association members responded to an online questionnaire.

The 5 antecedent measures were awareness of organ donation, need acknowledgment, benefits of organ donation, social support, and concerns about organ donation. The 2 consequence variables were support for organ donation and organ donation registration.

Structural equation modeling indicated that 5 of 10 direct antecedent pathways led significantly into organ donation support and registration. The impact of the nonsignificant variables was captured via indirect effects through other decision variables. Model fit statistics were good: the goodness of fit index was .998, the adjusted goodness of fit index was .992, and the root mean square error of approximation was .001.

This sequential decision-making model provides insight into the need to enhance the acceptance of organ donation and organ donor registration through a series of communications to move people from awareness to behavior.