ABSTRACT
In 2016, the Transplantation Society of Australia and New Zealand, with the support of the Australian Government Organ and Tissue authority, commissioned a literature review on the topic of infectious disease transmission from deceased donors to recipients of solid organ transplants. The purpose of this review was to synthesize evidence on transmission risks, diagnostic test characteristics, and recipient management to inform best-practice clinical guidelines. The final review, presented as a special supplement in Transplantation Direct, collates case reports of transmission events and other peer-reviewed literature, and summarizes current (as of June 2017) international guidelines on donor screening and recipient management. Of particular interest at the time of writing was how to maximize utilization of donors at increased risk for transmission of human immunodeficiency virus, hepatitis C virus, and hepatitis B virus, given the recent developments, including the availability of direct-acting antivirals for hepatitis C virus and improvements in donor screening technologies. The review also covers emerging risks associated with recent epidemics (eg, Zika virus) and the risk of transmission of nonendemic pathogens related to donor travel history or country of origin. Lastly, the implications for recipient consent of expanded utilization of donors at increased risk of blood-borne viral disease transmission are considered.
ABSTRACT
OBJECTIVE: To evaluate whether structural elements of a collaborative requesting model were observed in practice, and explore the impact of specialised communications training and elements of the model on consent rates. DESIGN: A national observational study captured staff observations of the organ donation requesting process. SETTING: DonateLife staff in 15 hospitals collected data from medical, nursing and allied health professionals who participated in the donation requesting process over a 12-month period. PARTICIPANTS: Data were collected from 201 family donation conversations (FDCs). MAIN OUTCOME MEASURES: Whether structural elements of the model were observed in practice, and rates of consent to donate. RESULTS: For most cases, there was a team planning meeting (87.0%); a gap in time between the meeting at which family understands brain death or the inevitability of death and the FDC for most cases (72.0%); and at least one trained requester present at the FDC (80.7%). Consent rates were significantly different according to who led the FDC: an untrained treating clinical specialist (45.2%); a trained treating clinical specialist (54.8%); or a trained requester who was not part of the treating clinical team (74.5%) (χ2=11.92, P=0.003). Logistic regression showed that the odds ratio (OR) for consent was significantly greater when the patient was on the Australian Organ Donor Register (OR, 9.3; CI, 3.5-24.5) and when the FDC was led by an FDC-trained requester who was not part of the treating clinical team (OR, 6.8; CI, 2.3-19.9). CONCLUSIONS: Structural elements of the model were observed in most cases, indicating that the model is feasible and acceptable. We showed that the highest consent rates were achieved when FDCs were led by professionals who had completed the specialised communications training and were not part of the treating clinical team for that patient.
