Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)最新文献

The number of patients being listed for heart transplantation continues to escalate. Despite a variety of attempts to increase organ donation, the number of available donor hearts remains unchanged. This imbalance of supply and demand creates medical rationing of donor organs. When the success of heart transplantation became apparent, selection criteria was relaxed, further increasing the disparity between the numbers of donor hearts and potential recipients. Decreasing the demand by tightening the selection criteria is the most reasonable solution at this time.

Advances in organ recovery and transplantation have provided us with the skills and opportunity to save, extend, and improve the quality of life for many. But with these opportunities have come challenges to redefine our practice and relationships with donor and recipient families. Although most donor families and transplant recipients receive some information about each other, many still do not. In the past, communication between donor families and recipients has been anonymous and highly controlled, with much inconsistency among and within the transplant community, leaving many involved in the process confused and frustrated. Transplant professionals may wish to consider critically the common ethical values of autonomy, beneficence, salience and benefit of choice in making decisions about information shared with and contact between donor families and recipients.

Although heart transplantation has become recognized as a viable option for the treatment of incorrectable heart disease in infants and children, its application becomes less clear in infants with potentially serious neurologic impairment. The following case study illustrates one transplant team's approach to decision making in the case of an infant born with a chromosomal deletion syndrome.

Pressure to reduce overall transplant costs is one of the factors which has led to earlier hospital discharge and increased patient management challenges in outpatient and home care settings. Earlier discharge often contributes to decreased opportunity to provide and ensure comprehension of critical patient and family education, resulting in challenges for home care clinicians who are committed not only to patient and environmental assessments, but to helping assure patient and family understanding of and compliance with critical posttransplant responsibilities and regimens. This article describes a transplant patient education tool that was developed for use with all types of solid organ transplant recipients discharged from multiple centers yet managed by a single home care organization. The tool provides patient education information that can be realistically reviewed and reinforced during the home visit. The resource focuses on key self-care issues to promote wellness and graft survival and help prevent adverse outcomes.

To improve organ donation performance, the Medical College of Virginia Hospitals implemented a comprehensive family support and communication program, consisting of a standard family communications protocol, a hospital-based team from the Department of Pastoral Care, targeted staff education, and an ongoing quality assurance measuring and monitoring system. The 3 best-demonstrated request practices, private setting, "decoupling," and collaboration in the request between the organ procurement organization and hospital staff, were incorporated into the program. Improvement in the consent and donation rate was evident in the second calendar year of the program; the consent rate was 72% and the donation rate was 50%. During the second year, there was also a positive correlation between "decoupling," appropriate requestor, and the consent rate. Implementation of a hospital-based team and a standard protocol facilitated the clarification of roles and responsibilities toward clearer and more consistent family communication and support. Data suggest that staff experience is a major contributor to a positive donation outcome.

Offering the option of organ and tissue donation to grieving families may seem stressful, but asking the question may provide a positive means to extend care to the bereaved family and help others in return. Many donor families have said donation was an opportunity to make some sense out of a senseless situation and to relieve some of the grief they experienced. This article presents a case that started with such a discussion by ICU nurses in one of our donor hospitals, and ended with successful organ and tissue recovery and transplantation. As "routine" as this may sound, it was anything but routine--it made history.