Author Interviews, End of Life Care, Transplantation / 09.01.2017
How Spain Became a Leader In Transplant Organ Donation
MedicalResearch.com Interview with:
[caption id="attachment_31094" align="alignleft" width="180"]
Dr. Beatriz Domínguez-Gil[/caption]
Beatriz Domínguez-Gil, MD, PhD
Organización Nacional de Trasplantes
Madrid Spain
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Organ shortage remains the most important barrier to the development of transplantation therapies. It leads to deaths on the waiting list, poor quality of life, increased costs to healthcare systems and emerging unethical practices as organ trafficking, mostly in the form of transplant tourism. Shortage of organs to meet the transplantation needs is a universal problem – also in Spain.
The potential of donation from the deceased is decreasing or expected to decrease in most developed countries, which makes it imperative to conceive new ways of increasing organ availibility.
In 2008, ONT conceived the 40 donors pmp plan, which includes the three strategies that are described in the paper:
- The identification of possible donors outside of the ICU to pose the option of intensive care to facilitate organ donation.
- The promotion of the expanded and non-standard risk donor.
- The development of donation after circulatory death
The three strategies have made the country not only reach, but even surpass the objective of 40 donors pmp (43,4 in 2016).
Dr. Beatriz Domínguez-Gil[/caption]
Beatriz Domínguez-Gil, MD, PhD
Organización Nacional de Trasplantes
Madrid Spain
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Organ shortage remains the most important barrier to the development of transplantation therapies. It leads to deaths on the waiting list, poor quality of life, increased costs to healthcare systems and emerging unethical practices as organ trafficking, mostly in the form of transplant tourism. Shortage of organs to meet the transplantation needs is a universal problem – also in Spain.
The potential of donation from the deceased is decreasing or expected to decrease in most developed countries, which makes it imperative to conceive new ways of increasing organ availibility.
In 2008, ONT conceived the 40 donors pmp plan, which includes the three strategies that are described in the paper:
- The identification of possible donors outside of the ICU to pose the option of intensive care to facilitate organ donation.
- The promotion of the expanded and non-standard risk donor.
- The development of donation after circulatory death
The three strategies have made the country not only reach, but even surpass the objective of 40 donors pmp (43,4 in 2016).
Dr. James Kirkpatrick[/caption]
James N. Kirkpatrick, MD
Director of the Echocardiography Laboratory
Division of Cardiology
Ethics Consultation Service
University of Washington, Seattle
MedicalResearch.com: What is the background for this study?
Dr. Kirkpatrick: With significant advances in technology, implanted cardiac devices like pacemakers and defibrillators, replacement heart valves, and mechanical pumps which assist or replace the pumping function of the heart have become standard therapies for patients with severe cardiac disease. Many patients who would previously have died after living with severe symptoms live longer and with improved quality of life. This is particularly true for elderly patients who receive transcatheter aortic valve replacement (TAVR—valve replacement that doesn’t require open heart surgery) and ventricular assist device (VAD—a durable mechanical heart pump) implantation.
However, like everyone, these patients will die, and some of the patients will experience device complications which will shorten their lives. Elderly patients, in particular, are at risk for device complications, high symptom burden, and loss of the ability to make healthcare decisions, due to illnesses like strokes or dementia. Symptom management and advance care planning are the hallmarks of the medical specialty of Palliative Care and are particularly important in patients with TAVR and VADs, yet patients and clinicians don’t often think of Palliative Care when considering high tech, life-prolonging therapies. The Palliative Care Working Group of the American College of Cardiology’s Geriatrics Section therefore sought to gather data on the attitudes toward Palliative Care among cardiovascular clinicians and the current state of involvement of Palliative Care in the care of patients with TAVR and VAD.
Dr. Jill Cameron[/caption]
Jill Cameron, PhD
Canadian Institutes of Health Research New Investigator
Associate Professor,
Department of Occupational Science and Occupational Therapy
Rehabilitation Sciences Institute
Faculty of Medicine,
University of Toronto
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Cameron: In the world of critical illness, a lot of research has focused on helping people to survive – and now that more people are surviving, we need to ask ourselves, what does quality of life and wellbeing look like afterwards for both patients and caregivers? The aim of our research was to identify factors associated with family caregiver health and wellbeing during the first year after patients were discharged from the Intensive Care Unit. We examined factors related to the patient and their functional wellbeing, the caregiving situation including the impact it has on caregivers everyday lives, and caregiver including their sense of control over their lives and available social support. We used Pearlin’s Caregiving Stress Process model to guide this research.
From 2007-2014, caregivers of patients who received seven or more days of mechanical ventilation in an ICU across 10 Canadian university-affiliated hospitals were given self-administered questionnaires to assess caregiver and patient characteristics, caregiver depression symptoms, psychological wellbeing, and health-related quality of life. Assessments occurred seven days and three, six and 12-months after ICU discharge.
The study found that most caregivers reported high levels of depression symptoms, which commonly persisted up to one year and did not improve in some. Caregiver sense of control, impact on caregivers’ everyday lives, and social support had the largest relationships with the outcomes. Caregivers’ experienced better health outcomes when they were older, caring for a spouse, had higher income, better social support, sense of control, and caregiving had less of a negative impact on their everyday lives. No patient characteristics or indicators of illness severity were associated with caregiver outcomes.
Poor caregiver outcomes may compromise patients’ rehabilitation potential and sustainability of home care. Identifying risk factors for caregiver distress is an important first step to prevent more suffering and allow ICU survivors and caregivers to regain active and fulfilling lives.
Dr. Odejide[/caption]
MedicalResearch.com Interview with:
Oreofe O. Odejide, MD
Instructor in Medicine, Harvard Medical School
Dana-Farber Cancer Institute
Medical Research: What is the background for this study? What are the main findings?
Dr. Odejide: The care that patients with hematologic cancers receive near the end of life is distinct from patients with solid tumors. For instance, previous research has shown that patients with blood cancers are more likely to receive intensive care at the end of life such as chemotherapy within 14 days of death, intensive care unit admission within 30 days of death, and they are less likely to enroll in hospice. My colleagues and I hypothesized that timing of discussions regarding end-of-life preferences with patients may contribute to these findings, and we wanted to examine hematologic oncologists’ perspectives regarding end-of-life discussions with this patient population.
We conducted a survey of a national sample of hematologic oncologists obtained from the publicly available clinical directory of the American Society of Hematology. We received responses from 349 hematologic oncologists, giving us a response rate of 57.3%. In our survey, we asked hematologic oncologists about the typical timing of EOL discussions in general, and also about the timing of the first discussion regarding resuscitation status, hospice care, and preferred site of death for patients. Three main findings emerged:
