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Access to kidney transplantation: the limitations of our current understanding.

https://arctichealth.org/en/permalink/ahliterature160974
Source
J Nephrol. 2007 Sep-Oct;20(5):501-6
Publication Type
Article
Author
John S Gill
Olwyn Johnston
Author Affiliation
Division of Nephrology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia - Canada. jgill@providencehealth.bc.ca
Source
J Nephrol. 2007 Sep-Oct;20(5):501-6
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Health Services Accessibility - statistics & numerical data
Health Services Research - methods - statistics & numerical data
Humans
Kidney Transplantation - statistics & numerical data
Living Donors
Patient Selection
Registries
Renal Insufficiency - epidemiology - surgery
Residence Characteristics
Time Factors
Tissue and Organ Procurement - organization & administration - statistics & numerical data
United States - epidemiology
Waiting Lists
Abstract
Since kidney transplantation (KTX) is the preferred means of treating kidney failure, ensuring that all patients who may benefit from KTX have equal access to this scarce resource is an important objective. Studies focusing on this issue will become increasingly important as the gap between the demand and supply of organs continues to increase, and changes to the United Network of Organ Sharing organ allocation policy are actively debated. However, it is clear that current methods used to study access to KTX have serious limitations. This review highlights the shortcomings of the methods currently used to assess access to KTX, and the limitations of registry data and national wait-list data as information sources to study patient access to KTX. The review also provides suggestions for research and analytical approaches that might be utilized to improve our future understanding of patient access to KTX. The information provided will aid the reader to critically assess issues related to patient access to KTX.
PubMed ID
17918132 View in PubMed
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The cadaveric organ donor program at Sahlgrenska University Hospital, 1977 to 2005.

https://arctichealth.org/en/permalink/ahliterature79877
Source
Transplant Proc. 2006 Oct;38(8):2631-2
Publication Type
Article
Date
Oct-2006
Author
Lovén C.
Friman S.
Olausson M.
Bäckman L.
Author Affiliation
Department of Transplantation and Liver Surgery, Sahlgrenska University Hospital, Göteborg, Sweden. charlotte.loven@vgregion.se
Source
Transplant Proc. 2006 Oct;38(8):2631-2
Date
Oct-2006
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Cadaver
Cause of Death
Child
Female
Humans
Male
Middle Aged
Retrospective Studies
Sweden
Tissue Donors
Tissue and Organ Procurement - organization & administration - statistics & numerical data
Abstract
The transplantation program with cadaveric organs has been ongoing at our institution for more than 40 years, since 1965. The purpose of this report was to analyze changes in the donor population and causes of death over the years. This retrospective analysis of donor records between 1977 and 2005, included 1331 donors. Since 1977, the number of donors has remained unchanged, but their profile has changed. The median donor age today has almost doubled, from 30 to nearly 60 years. Early on the most common cause of death was head trauma and the majority of donors were men. Since the mid-1980s, the main cause of death was intracerebral hemorrhage or cerebral thrombosis and the gender distribution became equal. The number of procured and transplanted organs from each donor has increased, despite an increased donor age. The multi-organ donor rate exceeded 80% in the beginning of this decade; we retrieved 3.9 organs per donor. These results may be explained by improved organ donor care and organization, and by increased awareness of potential donors among elderly patients.
PubMed ID
17098021 View in PubMed
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The Canadian Organ Replacement Register.

https://arctichealth.org/en/permalink/ahliterature213046
Source
Clin Transpl. 1996;:91-107
Publication Type
Article
Date
1996
Author
S R Walker
D A Parsons
P. Coplestons
S S Fenton
P D Greig
Author Affiliation
Canadian Institute for Health Don Mills, Ontario, Canada.
Source
Clin Transpl. 1996;:91-107
Date
1996
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Cadaver
Canada
Child
Child, Preschool
Family
Female
Geography
Graft Survival
Heart Transplantation - statistics & numerical data
Humans
Infant
Kidney Transplantation - statistics & numerical data
Liver Transplantation - statistics & numerical data
Living Donors
Lung Transplantation - statistics & numerical data
Male
Middle Aged
Pancreas Transplantation - statistics & numerical data
Registries
Renal Replacement Therapy - statistics & numerical data
Survival Rate
Tissue Donors
Tissue and Organ Procurement - organization & administration - statistics & numerical data
Transplantation - mortality - physiology - statistics & numerical data
Waiting Lists
Abstract
The analyses presented in this chapter are a subset of the yearly audit of organ donation and transplantation in Canada published in the CORR Annual Report. They represent the collaborative efforts and the voluntary contributions of many of the transplant physicians, surgeons, nurses and coordinators in Canada. In Canada, organ donation has remained static at approximately 14 per million population. Despite many local and provincial as well as corporate initiatives, this rate is approximately half the current rate in many regions of the U.S.A. and Spain. The modest increases in transplant activity represent an increase in the use of living donors, reassessment of the traditional donor risk factors (including age) and expansion of the potential donors for each organ. Analysis of the renal transplant activity has determined that the likelihood of being transplanted during the first year on the list was less than 40%. A graft loss rate of 4% per year after the first year was observed for a cadaveric kidney, compared with graft loss rates of 3% and 2% per year for living-related and living-unrelated donor kidneys, respectively. Cox regressional analysis identified that the major determinants of patient survival were the transplant year, the region where the transplant was performed, the presence of diabetes, the recipient's age, and whether the kidney was from a living donor. Liver transplantation has increased each year at the transplant centers in Vancouver, Edmonton, London, Toronto, Montreal, and Halifax. Patient and graft survival rates have improved since 1985 and the most significant determinant of patient survival following transplantation was the patient's medical status at the time of transplantation. Living-related liver donor transplant programs have begun in London and Toronto. Pancreas transplantation remains limited across Canada, but with the development of new pancreas programs in Toronto and Halifax, an increase in the availability of this therapy for Type 1 diabetics is anticipated. Heart transplantation has recovered from a decline in 1991-1992 to approximately 6 hearts per million population. There has been a trend towards better one- and 3-year patient survival rates since 1985. With the development of a lung transplantation program in Winnipeg, lung transplantation has increased. This likely reflects increased utilization of the available donor lungs. A particular increase in double-lung transplants was noted.
PubMed ID
9286560 View in PubMed
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Deceased organ donation in Canada: an opportunity to heal a fractured system.

https://arctichealth.org/en/permalink/ahliterature155732
Source
Am J Transplant. 2008 Aug;8(8):1580-7
Publication Type
Article
Date
Aug-2008
Author
J S Gill
S. Klarenbach
E. Cole
S D Shemie
Author Affiliation
Division of Nephrology, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada. jgill@providencehealth.bc.ca
Source
Am J Transplant. 2008 Aug;8(8):1580-7
Date
Aug-2008
Language
English
Publication Type
Article
Keywords
Canada
Heart Transplantation - statistics & numerical data
Humans
Registries
Tissue and Organ Procurement - organization & administration - statistics & numerical data
Waiting Lists
Abstract
There has been no significant increase in the number of deceased organ donors in Canada over the past decade. Canada's donation and transplant system will be restructured with the formation of a new national organization to oversee activity in provincially governed donation and transplantation services. We review the current status of deceased organ donation, highlight issues contributing to the current stagnation in donation and identify changes that will enable success in a new Canadian system. Determining Canada's organ donation performance is difficult because the data required to calculate meaningful metrics of donation performance are not available. Canadians wait longer for transplantation than Americans, and Canada is falling further behind the United States primarily because of fewer donations after cardiac death. The ongoing divide between intergovernmental jurisdictional domains limits national initiatives to improve Canada's donation system. The success of a new national system will be enabled by uniform provincial legislation to ensure that all patients are offered the option to donate, commitment of resources to support organ donation by provincial governments, transparent reporting of comparable metrics of donation performance, establishment of processes to introduce and implement new initiatives and alterations to reimbursement models for organ donation and recovery.
PubMed ID
18694473 View in PubMed
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Fragmented organ donation programs hinder progress.

https://arctichealth.org/en/permalink/ahliterature166910
Source
CMAJ. 2006 Oct 24;175(9):1043
Publication Type
Article
Date
Oct-24-2006
Author
Wayne Kondro
Source
CMAJ. 2006 Oct 24;175(9):1043
Date
Oct-24-2006
Language
English
Publication Type
Article
Keywords
Canada
Developed Countries
Humans
Physician's Role
Registries
State Medicine - organization & administration
Tissue Donors
Tissue and Organ Procurement - organization & administration - statistics & numerical data
Waiting Lists
Notes
Comment In: CMAJ. 2007 Apr 10;176(8):1125-8; author reply 112917420496
Comment In: CMAJ. 2007 Apr 10;176(8):1128-9; author reply 112917420499
Comment In: CMAJ. 2007 Apr 10;176(8):1128; author reply 112917420500
PubMed ID
17060644 View in PubMed
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From hesitation to appreciation: the transformation of a single, local donation-nurse project into an established organ-donation service.

https://arctichealth.org/en/permalink/ahliterature268414
Source
Clin Transplant. 2015 Mar;29(3):185-96
Publication Type
Article
Date
Mar-2015
Author
Linda Gyllström Krekula
Silvia Malenicka
Anders Nydahl
Annika Tibell
Source
Clin Transplant. 2015 Mar;29(3):185-96
Date
Mar-2015
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Humans
Intensive Care Units - organization & administration
Interprofessional Relations
Nursing Staff, Hospital - organization & administration
Program Development
Program Evaluation
Surveys and Questionnaires
Sweden
Tissue and Organ Procurement - organization & administration - statistics & numerical data
Abstract
This study evaluates the transition from a local project to promote organ donation to a permanent county-based donation service inspired by the Spanish model. To address the problem of declining donation rates, a project with one donation-specialized nurse (DOSS) was initiated at a single neuro-intensive care unit. This project was later expanded into a permanent on-call service consisting of seven DOSSes, covering a large urban county. During the different periods (before, during project and during permanent service), the DOSS function's effect on donation rates was significant, and the number of eligible donors that became actual donors increased from 37% to 73% and 74%, respectively. The effect on family vetoes was as prominent with a decrease from 34% to 8% and 14%. The staff appreciation of the DOSS function was also evident during the periods; all areas included in the questionnaire (family care, donor care and staff support) have improved greatly owing to the DOSS. The transition from a single, local donation-nurse project, to an on-call service with several DOSSes covering a large urban county was a success considering the donation rates as well as the staff's appreciation. Hence, organizational models from abroad can be adjusted and successfully adopted.
PubMed ID
25522797 View in PubMed
Less detail
Source
CMAJ. 2007 Apr 10;176(8):1125-8; author reply 1129
Publication Type
Article
Date
Apr-10-2007
Author
David Hollomby
Marc Germain
Sam Shemie
Leah Hollins
Kimberly Young
Source
CMAJ. 2007 Apr 10;176(8):1125-8; author reply 1129
Date
Apr-10-2007
Language
English
Publication Type
Article
Keywords
Benchmarking
Canada
Humans
Registries
State Medicine - organization & administration
Tissue Donors
Tissue and Organ Procurement - organization & administration - statistics & numerical data
United States
Waiting Lists
Notes
Cites: CMAJ. 2006 Mar 14;174(6):S13-3216534070
Cites: CMAJ. 2006 Mar 14;174(6):S1-1316534069
Cites: CMAJ. 2006 Oct 10;175(8):S117124739
Cites: CMAJ. 2006 Oct 24;175(9):104317060644
Comment On: CMAJ. 2006 Oct 24;175(9):104317060644
PubMed ID
17420496 View in PubMed
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The national kidney transplant program in Norway still results in unchanged waiting lists.

https://arctichealth.org/en/permalink/ahliterature33135
Source
Clin Transpl. 1998;:221-8
Publication Type
Article
Date
1998
Author
O H Bentdal
T. Leivestad
P. Fauchald
D. Albrechtsen
P. Pfeffer
B. Lien
A. Foss
O. Oyen
A. Hartmann
K. Nordal
G. Sødal
A. Flatmark
E. Thorsby
I B Brekke
Author Affiliation
Rikshospitalet, University of Oslo, Norway.
Source
Clin Transpl. 1998;:221-8
Date
1998
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Graft Survival
Histocompatibility testing
Humans
Infant
Kidney Failure, Chronic - therapy
Kidney Transplantation - mortality - physiology - statistics & numerical data
Living Donors - statistics & numerical data
Middle Aged
Norway
Registries
Renal Replacement Therapy
Reoperation
Retrospective Studies
Survival Rate
Tissue Donors - supply & distribution
Tissue and Organ Procurement - organization & administration - statistics & numerical data
Waiting Lists
Abstract
1. Of 2,670 patients starting renal replacement therapy for end-stage renal disease in Norway from 1989-1997, 76% were candidates for transplantation. The annual need for transplantations increased from 47 to 64 grafts PMP as the number of elderly patients increased. The national waiting list has remained almost stable during the period from 1989-1997 at levels of 25-30 PMP, but the dialysis population has increased from 57-105 PMP. 2. A total of 1,681 transplants was performed at an annual rate varying between 38 and 46 grafts PMP. The grafts were procured from LDs in 41% and CDs in 59% of cases. Totally 69% of all patients in need were transplanted and 54% of all patients requiring replacement therapy for end-stage renal disease received a transplant. 3. Graft survival rates in recipients of first LD grafts (n = 641) were 91% and 77% at one and 5 years, respectively. One-year graft survival was 97% in HLA-identical grafts (n = 71), 92% in haploidentical grafts (n = 419), 88% in 2 haplotype-mismatched related grafts (n = 43), and 87% in spousal donor grafts (n = 108). 4. Graft survival rates in recipients of first CD grafts (n = 801) were 84% and 65% at one and 5 years, respectively. The rates were 86% and 74% in younger (n = 557) versus 78% and 46% in older (> 65 years) (n = 244) patients. Death with a functioning graft caused approximately 45% and 75% of all graft losses in younger and older patients, respectively. Cardiovascular disease was the major cause of death. 5. A significant beneficial effect of HLA-DR matching was observed in CD grafts performed after 1989, in particular in patients older than age 65.
PubMed ID
10503101 View in PubMed
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[New organization will increase donation frequency].

https://arctichealth.org/en/permalink/ahliterature161872
Source
Lakartidningen. 2007 Jul 11-24;104(28-29):2049-50
Publication Type
Article
Author
Dag Lundberg
Marie Omnell Persson
Torsten Malm
Author Affiliation
Anestesioch intensivvårdsklinilen, Universitetssjukhuset i Lund.
Source
Lakartidningen. 2007 Jul 11-24;104(28-29):2049-50
Language
Swedish
Publication Type
Article
Keywords
Guidelines as Topic
Humans
Sweden
Tissue and Organ Procurement - organization & administration - statistics & numerical data - trends
PubMed ID
17702376 View in PubMed
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13 records – page 1 of 2.