A new law for allocation of donor organs in Israel Lavee, Jacob, Prof; Ashkenazi, Tamar, MSc; Gurman, Gabriel, Prof ...
The Lancet (British edition),
2010-Mar-27, Letnik:
375, Številka:
9720
Journal Article
Recenzirano
Peters,16 Muyskens,17 Eaton,5 Jarvis,18 Gubernatis and Kliemt,19 Steinberg,20 and Siegal and Bonnie21 have all advocated giving priority in organ allocation to those who have previously consented for ...organ donation on their death. Since all Israeli citizens who are candidates for organ transplantation are fully reimbursed under the National Medical Insurance Law, and are listed by Israel's National Transplant Centre, which also handles the lists of all holders of a donor card and allocates all donated organs, the new policy will be a unique opportunity to gather national data and note the consequences of what has previously been only theoretical speculation.
To present the response of the Israel National Transplantation Center (NTC) to the evolving challenge of COVID-19, the impact on deceased organ donation and living organ kidney donation during 2020, ...and resultant policy and ethical implications.
Data collected included (i) for deceased donors, the total number of potential organ donors, if hospitalized in ICU or general ward, cause of death, number of family authorizations and refusals, number of actual donors, number of organs transplanted/donor and total number of transplants performed; (ii) for living-kidney-donors (related or altruistic), the number of procedures performed; and (iii) the number of patients registered on the national organ waiting-list.
Following the first case (February 2020), deceased organ donation continued uninterrupted. The total number of potential donors was similar to 2019 (181 vs. 189). However, the number of families approached for donation decreased significantly (P = 0.02). This may be attributed to COVID-19-imposed limitations including fewer brain death determinations due to limited possibilities for face-to-face donor coordinator-donor family interactions providing emotional support and visual explanations of the medical situation. Fewer donors were admitted to ICU (P = 0.1) and the number of organs retrieved/donor decreased (3.8/donor to 3.4/donor). The overall result was a decrease of 24.2% in the number of transplant procedures (306 vs. 232). Living kidney donation, initially halted, resumed in May and the total number of procedures increased compared to 2019 due to a significant increase in altruistic donations (P < 0.0001), while the number of related-living donations decreased.
This study of organ donation during a crisis has informed the introduction of policy changes in the NTC including the necessity to mobilize rapidly a "war room", the use of innovative virtual tools for contact-less communication, and the importance of cooperation with hospital authorities in allocating scarce health-care resources. Finally, the pandemic highlighted and intensified ethical considerations, such as under what circumstances living kidney donation be continued in the face of uncertainty, and what information to provide to altruistic donors regarding a prospective recipient, in particular whether all options for related living donation have been exhausted. These should be addressed now.
This article aimed to assess posttraumatic growth among participating and nonparticipating families of organ donors in grief support groups. The program, in the form of both face-to-face and WhatsApp ...groups, is unique in that it extends over many years without limitation for a predefined period, is open to both immediate and extended family members, and is conducted according to predetermined topics. A questionnaire was completed by 84 participants and 115 non-participant family members. Most participants had attended for between 1 and 5 years (57.2%), although 33.3% had participated for >5 years, including 16.7% who participated for >10 years. All measures of posttraumatic growth were significantly higher in group participants (3.40 0.75 vs. 3.15 0.75, p = .010) than non-participants. The often-prolonged participation in the groups suggests there may be an important need for ongoing contact with and support for these families even many years after the loss.
Summary
This study aimed to compare the consent rate for deceased organ donation in Israel over two time periods, namely 2004–2009 (2004/9) and 2016–July 2020 (2016/20). Donor and family data were ...collected from the Israel National Transplantation Center Registry and included donor characteristics, reasons for family consent and refusal, and a subjective assessment of donor coordinator–family interactions. The consent rate increased from 41.6% over the period 2004/9 to 61.8% for the period 2016/20 (P < 0.0001). A significant increase in the proportion of Jewish donors was noted (49.8% in 2004/9 vs. 67.5% in 2016/20, P < 0.0001), while no increase in the consent rate for the Muslim population was noted. Religious objections as a reason for refusal decreased significantly (37.6% vs. 27.3%; P = 0.02), while the proportion of families citing donating as the “right thing to do” increased significantly (7% vs. 26.6%; P < 0.0001). Finally, a significant increase in the proportion of very positive DC–family interactions (59% to 78.3%, P < 0.0001) was noted. In conclusion, the increased consent rate in 2016/20 was associated with changes in expressed decision‐making and donor coordinator–donor family interactions. Additional interventions tailored to all different populations groups need to be developed and further investigated.
Interventions targeted at increasing deceased organ donation in Israel resulted in significant improvements in donor coordinator–family interactions, expressed family donation decision‐making, and less religious objections. These changes were associated with an increase in the consent rate from 41.6% in 2004–2009 to 61.8% in 2016–2020.
Abstract Purpose The purpose of the study is to describe the implementation of measures introduced in Israel in 2009 to promote the safe practice of brain death determination (BDD). Materials and ...methods The measures require (1) physicians to undergo a mandatory training course, (2) the mandatory performance of an ancillary test, and (3) retrospective examination of all BDD forms by an independent committee. Any deviations from practice parameters were noted. Surveys were also undertaken to assess (i) the attitude of local physicians to the measures and (ii) whether similar measures are in place in Europe and whether they were considered necessary. Results After implementation, the measures resulted in the absence of deviations from practice parameters over time. A majority of local physician (n = 64) felt the measures added a sense of security to BDD (73%) and ensured its proper performance (85%). The European survey (n = 20 countries) revealed (1) specialized BDD training is required in 60%, provided in 50%, while felt necessary by 80%; (2) independent supervision of BDD is performed in only one other country; and (3) BDD is performed country-wide using the same criteria in 80% while felt necessary by 95%. Conclusion The measures were successfully implemented, reduced diversity in patient testing, and positively accepted by local physicians. Wider application of the measures may be appropriate as suggested by the results of a European survey and the variability of BDD reported in the literature.
Background
Obstacles encountered during the organ donation process may result in the loss of organs. A centralized medical advisory service (MAS), providing a 24/7/365 service, was established in ...2007 to respond to queries from healthcare professionals regarding organ safety, brain death (BD) determination, and donor management.
Methods
Data collected from 2007 to 2017 included the number and context of the queries and the mean number of organs transplanted/donor. Since 2012, the number of six donor management goals (DMGs) met at the time of consent has been monitored.
Results
The number of queries relative to the number of potential donors increased from 12.4% (n = 78 queries) in 2007 to 48.2% (304 queries) in 2009 and has remained widely utilized, with most queries consistently related to organ safety. The context of the queries informed the formulation of protocols relating to donor infections and malignancy and identified difficulties regarding BD determination and subsequent implementation of solutions. A mean of 5.0 ± 0.7 DMGs was achieved, while the number of organs transplanted/donor increased from 3.4 in 2007 to 4.0 in 2017.
Conclusion
We suggest that this model may provide a valuable resource to improve the safety, standardization, and quality of the donation process.
The Israeli Transplant Law grants priority in organ allocation to patients signing a donor card. Liver transplant candidates get additional 2 points on their Model for End Stage Liver Disease score ...for signing a donor card, 0.1 points for a relative holding a card, and 5 points if a relative donated an organ. We studied the effect of the priority program on waiting list mortality and allocation changes due to priority.
Using Israeli Transplant data of 531 adult liver transplant candidates with chronic liver disease listed between 2012 and 2018 we compared waitlist mortality and transplant rate of candidates with and without priority. Then we analyzed liver allocations resulting from additional priority points and followed outcome of patients who were skipped in line.
Of the 519 candidates, 294 did not sign a donor card, 82 signed, 140 had a relative sign, and for 3, a relative donated an organ. The rates of waitlist mortality in these 4 groups were 22.4%, 0%, 21.4%, and 0%, respectively, and the transplant rates were 50%, 59.8%, 49.3%, and 100%, respectively. Of the 30 patients who were skipped because of priority, 24 subsequently underwent transplant, 2 are on the waiting list, and 4 died within 0.75, 1.75, 7, and 17 mo.
The 2 points added to the Model for End Stage Liver Disease score were associated with lower waitlist mortality and higher transplant rate for candidates signing a donor card without significantly affecting access to transplant during allocation. Further research and consideration of optimal policy when granting priority for candidates signing a donor card should continue.
Altruistic organ donors represent a special population when compared to related living donors, requiring appropriate protection and attention regarding informed consent and psychological aspects ...related to the donation. Following the introduction of the Israeli Transplant Law of 2008, a retrospective study of altruistic donor files revealed that important psycho-diagnostic aspects were not emphasized in the existing guidelines. Thus, a new tool was formulated which incorporated those elements, including assessment of emotional maturity, ego strength, degree of interest in others, reality testing, degree of pressure to donate, anxiety, dysphoric and depressive factors and the ability to function under stress. The study examined 598 cases reviewed by the Central Evaluation Board over the period May 2008 - June 2016. Overall, 23.4% candidates were disqualified of whom 41% were declined on grounds related to mental health. Most of the donors were rejected based on 3-5 elements. Of these, a deficient assessment of reality in ambiguous situations, lack of emotional maturity, and lacking or partial ability to function effectively under stress, were most commonly cited as reasons for rejection. This model allowed the detection of important conditions previously not incorporated into existing guidelines and may serve as a model for other transplantation programs worldwide.
Context—
The effect of loss on those approached for organ and/or tissue donation, particularly in the years thereafter, has received little attention.
Objective—
To assess whether adjustment of a ...parent to loss of a child is influenced by interactions with health care personnel.
Methods—
A self-administered questionnaire was completed by the parents of 216 decedents. Interactions in the hospital were assessed by examining the experience in the hospital, physical separation from the child, and the relationship with health care professionals. Adjustment to loss was defined by 4 components: grief, personal growth after loss, meaning of life after loss, and the meaning of organ donation.
Results—
A positive experience in the hospital was significantly associated with the meaning of donation. Increased satisfaction with the separation process was associated with better adjustment on all components. Finally, a better relationship with health care professionals was associated with less grief and with greater personal growth. These results were characterized after adjustment for time since loss, which was from 6 months to 27 years.
Conclusions—
Interactions in the hospital appear to influence adjustment to loss significantly. Appropriate interventions may aid parents in their adjustment to life.
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