Donation and Equitable Access to Organ, Tissue, and Cell Transplants: A Brazilian Perspective on the Strategy and Plan of Action 2019-2030.

OBJECTIVE: To position the Brazilian Transplant System within the context of the 4 Strategic Lines of Action proposed by the Pan-American Health Organization. METHOD: A specialist analysis was conducted through comparative analyses of the 4 Strategic Lines of Action, objectives, and indicators outlined in the Action Plan, along with the donation and transplantation system in accordance with Brazilian transplantation law. Subsequent to an in-depth review of the document issued by the health authority, a series of meetings involving 8 specialists in organ donation and transplantation were conducted. During these meetings, discussions were carried out with the objective of numerically interpreting each strategy presented in the document, and recommendations constructed. RESULTS: Four strategies were evaluated and only 2 of them the third (81,3%) and the fourth (90%) do not achieve the indicators to complete the objective related to equitable access to organ, tissue, and cell transplants in Brazil. CONCLUSION: The recommendations developed carry importance, as they are innovative and contribute to the establishment of priorities when shaping public policies. The report not only highlights indicators that were not satisfactorily met but also provides insights into the recommendations formulated to improve those indicators that have already been achieved and to work toward achieving those that have not yet been realized. Additionally, these recommendations can justify actions and establish priorities for research efforts in the field.

Patient Undergoing Liver Transplantation: Challenges and Strategies in the Face of the COVID-19 Pandemic.

BACKGROUND: We aimed to identify the challenges and strategies experienced by patients undergoing liver transplantation during the COVID-19 pandemic. METHODS: This was a descriptive study with a qualitative approach conducted in a large liver transplant hospital in southern Brazil. RESULTS: The participants included liver transplant patients between the years 2011 and 2022. Data collection was performed using a semi-structured interview. Data analysis comprised approximation of information and calculation of percentages. RESULTS: A total of 23 patients participated. Challenges identified included an increased dependence on others for daily activities, fear and stress due to the possibility of contamination, and the need for isolation from family and friends. Strategies included adaptation to the daily routine, reorganization of tasks inside and outside the home, formation of a support network, and reduced attendance to consultations and exams. CONCLUSIONS: Evidence of anguish and suffering of patients facing isolation and separation from family members was observed. Still, the study revealed the strength and determination of the patients to create strategies for preventing the SARS-CoV-2 virus and caring for themselves and their families. The study demonstrates the need for support from the health team in the face of such a scenario.

Adverse Events Reporting Systems in Cells, Organs, and Tissues Donation and Transplantation: Scoping Review.

BACKGROUND: This study aimed to map adverse events reporting systems in cells, organs, and tissues donation and transplantation, including the terms applicable in each system and scientific literature. METHODS: This was a scoping review using the Joanna Briggs Institute method. A search strategy in 3 phases was used, and searches were conducted in PubMed, Embase, LILACS, Scholar Google, and government and organ donations and transplantation associations' sites during June and August 2021. Data collection and analysis were independently made by 2 researchers. The scoping review protocol was registered. RESULTS: Twenty-four articles and other materials were selected for data collection. Eleven reporting systems were analyzed, and terms were identified. CONCLUSIONS: Adverse reporting systems in cells, organs, and tissues donation and transplantation were mapped. The main features are presented, which can help develop new and better systems, with an important discussion about the terms used.

Time Elapsed Between Cells, Tissues, and Organs Donation and Transplantation and Adverse Events Detection.

BACKGROUND: This study was designed to discuss the time elapsed between cell, tissue, and organ donation and transplantation and detection of adverse events notified in São Paulo, Brazil. METHODS: This is a descriptive study with a quantitative approach. Data were provided by the Transplant Center of the state of São Paulo from the "Individual notification form of adverse reactions in Biovigilance" between 2016 and 2019. Analysis was performed using descriptive statistics. RESULTS: Fifty-two notifications were analyzed, and 3 categories were formed: (1) adverse events detected on the same day of the transplant, 8; (2) adverse events detected between 1 week and 1.5 years after transplant, 40; and (3) adverse events detected 2 years after transplant, 4. CONCLUSION: The discussion on the topic is beginning; however, it is important. Clinical management of transplant recipients and comprehending what is considered an adverse event and the natural course of a patient's life can impact clinical decision-making, public policies, and patient safety research. This study highlights the need to investigate related factors to adverse events, especially the time between the transplant procedure and adverse event detection, to establish clinical guidelines.

Implantação de time de terapia intravenosa a partir de pesquisa convergente-assistencia / Implementation of an intravenous therapy team based on convergent-assistance research / Implementación de un equipo de terapia intravenosa basado en investigación convergente-asistencial

Objetivo: Implantar um time de terapia intravenosa em um hospital de grande porte. Método: Estudo de abordagem qualitativa realizado a partir de encontros de grupo de convergência, utilizando o referencial metodológico da pesquisa convergente-assistencial. Foram realizadas entrevis-tas semiestruturadas, a apuração dos dados obtidos por meio da análise de conteúdo e a formação de três categorias, que originaram os assuntos para a capacitação dos profissionais. Resultados: Participaram nove enfermeiros e, após a realização de quatro encontros de capacitação, foi implantado um time de terapia intravenosa e desenvolvido documento norteador para a execução do trabalho. Conclusão: O estudo resultou na implantação do time de terapia intravenosa em um hospital de grande porte a partir da pesquisa desenvolvida e da experiência de trabalho dos enfermeiros que atuam na prá-tica assistencial. O referencial metodológico possibilitou aos enfermeiros serem ouvidos enquanto promotores da ação e implementadores da inovação.Palavras-chave: Infecção hospitalar. Cateteres de demora. Infecções relacionadas a cateteres. Segurança do paciente.

Objective: To implement an intravenous therapy team in a large hospital. Method: Qualitative study carried out based on convergence group meetings, using the methodological framework of convergent-assistance research. Semi-structured interviews were carried out, data were collected through content analysis and three categories were formed, which originated the subjects for the training of professionals. Results: Nine nurses par-ticipated in the research and, after four training meetings, an intravenous therapy team was implemented and a guiding document was developed for carrying out the work. Conclusion: The study resulted in the implementation of an intravenous therapy team in a large hospital based on the research developed and the work experience of nurses who work in care practice. The methodological framework allowed nurses to be heard as promoters of action and implementers of innovation.

Objetivo: Implementar un equipo de terapia intravenosa en un gran hospital. Método: Estudio cualitativo realizado a partir de reuniones de grupos de convergencia, utilizando el marco metodológico de investigación convergente-asistencial. Fueron realizadas entrevistas semiestructuradas, reco-gida de datos a través del análisis de contenido y la formación de tres categorías, que originaron los temas para la formación de profesionales. Resultados:Participaron nueve enfermeros y, después de cuatro reuniones de capacitación, se implementó un equipo de terapia intravenosa y se elaboró un docu-mento guía para la realización del trabajo. Conclusión: El estudio resultó en la implementación de un equipo de terapia intravenosa en un hospital de gran porte a partir de la investigación desarrollada y la experiencia laboral de los enfermeros que actúan en la práctica asistencial. El marco metodológico permitió que los enfermeros sean escuchados como promotores de la acción e implementadores de la innovación.

Family Interview Evaluation for Organ Donation: Communication of Death and Information About Organ Donation.

BACKGROUND: The aim of this study was to identify variables related to organ donation that can contribute to the development of best practices in planning and conducting family interviews by health professionals. METHODS: This descriptive and prospective study of quantitative approach was conducted at 2 southern Brazil health institutions referenced in organ donation. Data collection occurred between 2018 and 2019 by health professionals who conduct family interviews using validated instruments that assessed the stages of the interview. Analysis was performed by means of the proportions of the studied variables associated with the donation authorization categories per the χ2 test. The significance level adopted was 0.05. RESULTS: The variables that presented the highest level of significance in the correlation with the prevalence of family authorization for organ donation included the following: communication with the family about the results of each test in the brain death diagnostic protocol; identification of whether the family understood the information about the death; presence of a member of the transplantation commission who had training to communicate information about organ donation; presence of a family member who had power to authorize the donation; and the interval between the communication of death and information about organ donation. CONCLUSIONS: The study presents important gaps that can be filled by health teams and hospitals in order to improve the welcoming and respect for families, as well as the organ donation rates. It is important to understand that each family is unique when facing mourning, and to distance the communication of death from the discussion about organ donation is an act of respect and empathy.

Validating potential organ and tissue donors in the middle of the COVID-19 pandemic: Scoping review and recommendations construction.

OBJECTIVE: To identify the available information to support registered nurses' clinical decisions in assessing and validating potential organ and tissue donors during the COVID-19 pandemic. METHOD: This is a scoping review developed in six stages. The sixth stage was developed with registered nurses who work in the Brazil Organ Donation System. To consolidate the information and prepare all assumptions, the legislation in force in Brazil was followed. RESULTS: Recommendations from 19 articles identified in the literature were analyzed; additionally, 52 professionals who work at Brazil Organ Donation System participated in the research. Four care assumptions were formed: investigation of community transmission, investigation of clinical situations, screening for COVID-19 signs and symptoms, and investigation of alterations presented in the physical examination. Such assumptions are formed by 34 care guidelines. DISCUSSION: Care assumptions were prepared to guide and support registered nurses during assessment and validation of potential organ and tissue donors. From this perspective, assumptions certainly promote safety, effectiveness and quality in the service offered during the organ and tissue donation process in the midst of the COVID-19 pandemic, in addition to empowering registered nurses in this scenario. Quality and bio-surveillance through the donation stages have been discussed extensively in recent times, to improve donation and transplantations by valuing care, safety, and quality of life of recipients. CONCLUSION: The care assumptions presented in this study support and subsidize the daily practice of registered nurses who work in assessing and validating potential organ and tissue donors, enabling these professionals to make decisions based on secure information.

Care bundle for family interview for pediatric organ donation.

PURPOSE: to develop a care bundle for best practices in conducting the family interview for organ and tissue donation with the families of children and adolescents. DESIGN AND METHODS: methodological study, with a qualitative approach, developed in Brazil, in three stages: literature review, qualitative study with professionals and family members, and development of the care bundle. RESULTS: Nine studies were selected and 17 health professionals and nine family members were interviewed. With this data, the care bundle was developed in three categories: communication of death, emotional support and information about organ and tissue donation. The recommendations were evaluated by five external professionals and all of them assessed the bundle as having the highest possible quality. CONCLUSIONS: the care bundle was built following the stages of integrative literature review and interviews with professionals working in this scenario and family members who have already gone through a family interview for organ and tissue donation of children and adolescents. PRACTICE IMPLICATIONS: the use of this material is seen as an important resource to support the professional during the conduction of the family interview in a scenario as sensitive and challenging as the care to family members facing death and the decision of organ and tissue donation of children and adolescents. Furthermore, the care bundle can increase the quality of family interviews and impact the reduction of family refusals. DESCRIPTORS: Practice Guideline as Topic. Tissue and Organ Procurement. Patient Care Team. Nursing. Pediatrics. Communication.

Validating potential organ and tissue donors in the middle of the COVID-19 pandemic: Scoping review and recommendations construction.

OBJECTIVE: To identify the available information to support registered nurses' clinical decisions in assessing and validating potential organ and tissue donors during the COVID-19 pandemic. METHOD: This is a scoping review developed in six stages. The sixth stage was developed with registered nurses who work in the Brazil Organ Donation System. To consolidate the information and prepare all assumptions, the legislation in force in Brazil was followed. RESULTS: Recommendations from 19 articles identified in the literature were analyzed; additionally, 52 professionals who work at Brazil Organ Donation System participated in the research. Four care assumptions were formed: investigation of community transmission, investigation of clinical situations, screening for COVID-19 signs and symptoms, and investigation of alterations presented in the physical examination. Such assumptions are formed by 34 care guidelines. DISCUSSION: Care assumptions were prepared to guide and support registered nurses during assessment and validation of potential organ and tissue donors. From this perspective, assumptions certainly promote safety, effectiveness and quality in the service offered during the organ and tissue donation process in the midst of the COVID-19 pandemic, in addition to empowering registered nurses in this scenario. Quality and bio-surveillance through the donation stages have been discussed extensively in recent times, to improve donation and transplantations by valuing care, safety, and quality of life of recipients. CONCLUSION: The care assumptions presented in this study support and subsidize the daily practice of registered nurses who work in assessing and validating potential organ and tissue donors, enabling these professionals to make decisions based on secure information.

Complications Following Liver Transplant at a Teaching Hospital.

OBJECTIVE: The objective of this study is to analyze the liver transplant complications in a reference transplant hospital in southern Brazil. METHODS: The researchers used a cross-sectional, quantitative, exploratory, and descriptive study, conducted using 103 medical records of patients who underwent liver transplantation from 2011 to 2018. Data were analyzed through median, mean, and standard deviation, and the Kruskal-Wallis test was used. RESULTS: There was a higher proportion of men (70.9%), with a mean age of 53.3 years, who had hepatitis C (43.7%). The indication for the procedure was hepatocellular carcinoma (34%). The most frequent complications included pulmonary (26.7%), graft-related complications such as rejection (21.1%), and viral infections (14.4%). In addition, infectious complications, such as pneumonia (45%) and septicemia (29%), occurred. The main causes of death were septic shock (15.6%) and multiple organ failure (21.9%). There was statistical significance between the recipient's age and the Model for End-Stage Liver Disease value at the time of transplantation for the development of complications. CONCLUSIONS: The data from the present study provide important information about liver transplant. These data may enable the team to propose strategies for practice improvements, which will certainly offer better living conditions and transplant survival.

Communication of Death in the Context of Infant-Child Donation: Best Practices for Creating Family Interview for Organ and Tissue Donation.

OBJECTIVE: To analyze evidence capable of supporting best practices available in the literature to create dialogues about organ and tissue donation with parents of deceased children and adolescents. METHODS: An integrative literature review performed using Scopus, Cochrane, PsycINFO, PubMed/MEDLINE, Web of Science database, and SciELo electronic libraries from November of 2013 to November of 2018, using keyword syntax for each database. The categories were developed using the Alicante model. RESULTS: A total of 745 articles were identified, with 7 selected for analysis. The information obtained was grouped into 3 categories: death communication, which indicates the importance of using simple and clear words; emotional support, which reveals the need to respect family time and the importance of empathy and compassion; and donation information, which punctuates the importance of dissociating communication about the death from that regarding organ donation. CONCLUSIONS: Evidence shows that best practices are the use of simple language, respect for the family during the grieving process, and the importance of establishing different situations in which to communicate about the death and the donation process.