Cultural influences on willingness to donate organs among urban native Americans.

BACKGROUND: The need for organ donation is substantial among Native Americans, driven by the disproportionate burden of ESRD. Due to the dearth of knowledge about willingness to donate (WTD) among urban Native Americans, a group that represents over half of the US Native population, we aimed to examine factors affecting donation. METHODS: We conducted a cross-sectional survey of a convenience sample, using a questionnaire developed specifically for this study using community-based participatory research. The questionnaire was designed to be culturally relevant to the Native community, based on questions from three previously validated instruments and developed through one-on-one interviews. We performed logistic regression to associate survey answers with WTD. RESULTS: Seventy percent of our 183 respondents stated that they would be willing to have their organs donated after death; however, only 41% were already registered as an organ donor on their driver's license. Logistic regression analysis found specific items in domains of trust of the medical community and spirituality most closely associated with WTD. Sixty-two percent of Native Americans surveyed reported they would not donate organs because they distrust the medical community. DISCUSSION: Our findings suggest multiple areas of focus for increasing organ donation within this subset of the diverse Native community. Efforts to promote donation should be aimed at building trust in the medical community.

Multicenter investigation of the reliability and validity of the live donor assessment tool as an enhancement to the psychosocial evaluation of living donors.

The live donor assessment tool (LDAT) is the first psychosocial assessment tool developed to standardize live donor psychosocial evaluations. A multicenter study was conducted to explore reliability and validity of the LDAT and determine its ability to enhance the psychosocial evaluation beyond its center of origin. Four transplant programs participated, each with their own team of evaluators and unique demographics. Liver and kidney living donors (LDs) undergoing both standard psychosocial evaluation and LDAT from June 2015 to September 2016 were studied. LDAT interrater reliability, associations between LDAT scores and psychosocial evaluation outcome, and psychosocial outcomes postdonation were tested. 386 LD evaluations were compared and had a mean LDAT score of 67.34 ± 7.57. In 140 LDs with two LDATs by different observers, the interrater scores correlated (r = 0.63). LDAT scores at each center and overall stratified to the conventional grouping of psychosocial risk level. LDAT scores of 131 subjects who proceeded with donation were expectedly lower in LDs requiring postdonation counseling (t = -2.78, P = .01). The LDAT had good reliability between raters and predicted outcome of the psychosocial evaluation across centers. It can be used to standardize language among clinicians to communicate psychosocial risk of LD candidates and assist teams when anticipating postdonation psychosocial needs.

Asian American adolescents' willingness to donate organs and engage in family discussion about organ donation and transplantation.

CONTEXT: Despite the growing need for organ donation among Asian Americans, studies suggest that they are reluctant to donate. OBJECTIVE: To examine the association of attitudes and knowledge about organ donation and transplantation with willingness to donate and willingness to engage in family discussion about organ donation among Asian American adolescents. DESIGN: A cross-sectional study. SETTING: The Big Island of Hawaii. PARTICIPANTS: Self-identified Asian American adolescents (Japanese, Chinese, Filipino, Korean), ages 16 to 17 years old, and each adolescent's parent or guardian. MAIN OUTCOME MEASURES: Asian American adolescents provided demographic information and completed the Modified Organ Donation Attitude Survey, the Organ Donation and Transplantation Knowledge Survey, and the Suinn-Lew Asian Self-Identity Acculturation Scale. A parent or guardian also provided demographic information. Linear regression analyses were used to examine the associations with willingness to donate and to engage in family discussion about organ discussion. RESULTS: Willingness to donate was associated with positive knowledge related to general aspects about organ donation and cultural limitations in receiving an organ transplant, a high level of acculturation, and a low level of negative attitudes (R2 = 0.402, F = 18.86, P = .005). Asian American adolescents with approving or positive attitudes were likely to engage in family discussion about organ donation (R2 = 0.195, F = 27.93, P = .005). To reinforce and maintain high levels of knowledge and positive attitudes, organ donation education is most likely needed in high schools.

Collaborative use of the peer assist model in large transplant programs in the United States.

CONTEXT: The basic assumption of the peer assist model is that nearly every transplant center is already doing something that other centers could adopt in order to streamline or enhance their own operations. OBJECTIVE: To describe how the Transplant Growth and Management Collaborative used the peer assist model with 2 large transplant centers in the United States and to identify best practices and outcomes. SETTING: The University of California, San Francisco, Medical Center. PARTICIPANTS: Transplant health care providers (surgeons, nurse transplant coordinators) and administrative staff (program directors, financial advisers, quality representatives). INTERVENTION: The peer assist model is a mechanism by which a transplant center receives feedback about a specific topic from another transplant center that encountered similar issues and developed effective action plans for overcoming barriers to success; it is a reciprocal model in which knowledge is shared. RESULTS: The peer assist model benefited the preparation for accelerated growth in 2 of the largest transplant centers in the United States. The collaboration during peer assist visits is an opportune time for transplant centers to learn from one another.

A systematic review of the effectiveness of peer-based interventions on health-related behaviors in adults.

We reviewed 25 randomized clinical trials that assessed the effect of peer-based interventions on health-related behaviors in adults. Effect sizes were calculated as odds ratios or standardized mean differences. We grouped most of the studies by 7 measured outcomes, with effect sizes ranging from -0.50 to 2.86. We found that peer-based interventions facilitated important changes in health-related behaviors, including physical activity, smoking, and condom use, with a small- to medium-sized effect. However, the evidence was mixed, possibly because of the heterogeneity we found in methods, dose, and other variables between the studies. Interventions aimed at increasing breastfeeding, medication adherence, women's health screening, and participation in general activities did not produce significant changes.