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1.
Pediatr Transplant ; 23(3): e13345, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30724003

RESUMO

BACKGROUND: There are no currently agreed upon international standards for reporting of pediatric deceased organ donation activity. This leads to difficulty in comparisons between jurisdictions for both researchers and policy stakeholders. The goal of this project was to develop and test a standardized registry for pediatric deceased donation activity. METHODS: Four countries (Canada, Spain, USA, and the UK) with geographical and practice diversity were approached to participate. Iterative exchanges were used to create data fields and definitions that were acceptable to all participants. Data from 2011 to 2015 (inclusive) were requested from national health databases and analyzed on a secure, web-based survey platform. RESULTS: Data were obtained from three of the four countries (Canada unable to provide). Total pediatric donation rates were stable over the 5-year period, but with variation between countries. pDCD rates were the most variable, representing 32.2% of total pediatric donation in the UK, 14.4% in the United States, and 2.6% in Spain during the studied period. Most organs from pediatric donors were allocated to adult recipients, though the rates of allocation of pediatric kidneys to pediatric recipients ranged from 7% in the United States to 40% in Spain. DISCUSSION: In this limited cohort of three countries, we demonstrated substantial variation in pediatric donation rates and practice. These data highlight opportunities for practice improvement such as the development of rigorous clinical practice guidelines. Future development of this registry will seek to engage more countries, and address barriers that prevented full participation of approached jurisdictions.


Assuntos
Transplante de Órgãos/estatística & dados numéricos , Pediatria/métodos , Sistema de Registros , Doadores de Tecidos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Bases de Dados Factuais , Humanos , Lactente , Recém-Nascido , Cooperação Internacional , Internet , Mortalidade , Estados Unidos
2.
Can J Anaesth ; 66(4): 422-431, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30689134

RESUMO

PURPOSE: Deceased donation data requires standardization to enable accurate interprovincial and international comparisons of deceased donation performance. In Canada, most provincial organ donation organizations (ODOs) have developed different processes and infrastructures for referring potential donors and subsequent data collection. This has led to differing definitions of the performance measures used for each step in the donation process, from potential donor identification to consent to transplantation. The Deceased Donation Data Working Group (DDDWG), comprised of representatives from ODOs across Canada, was therefore convened by Canadian Blood Services to develop a national, comprehensive, standardized deceased donation minimum data set. METHODS: The DDDWG's scope encompassed considering all potential deceased organ donation data elements, including operational and performance data collected along the deceased donor pathway from donation potential to donation and disposition of organs. An environmental scan was conducted of other existing deceased donation registries from the Canadian and the international community. The DDDWG then engaged in regular face-to-face meetings and teleconferences to develop recommendations for the minimum data set that would satisfy key considerations, including the impact on existing ODO data collection processes, financial impact on stakeholders, the clinical and operational needs of multiple healthcare professionals involved in the deceased donation pathway, and availability of other existing national data sets that could be leveraged to reduce data collection burden. RESULTS: The key deceased donation data elements identified by the DDDWG are contained in an inverted pyramid framework that was derived from similar work conducted in other countries. CONCLUSION: The DDDWG developed recommendations for proposed definitions and data sources that should be adopted nationally to guide the collection of deceased donation data. The ultimate purpose of the final minimum data set is to harmonize and standardize donation data definitions in Canada and align with international standards; inform the development of operational and clinical practice standards at the provincial and national levels; develop a framework for deceased donation performance measures; and advance the science of deceased donation.


RéSUMé: OBJECTIF: Les données concernant les dons d'organes de personnes décédées doivent être normalisées pour permettre des comparaisons précises de l'efficacité de ces dons entre provinces et entre pays. Au Canada, la majorité des organismes provinciaux de dons d'organes (ODO) ont élaboré divers processus et infrastructures pour l'orientation des donneurs potentiels et la collecte subséquente des données. Cela a abouti à des définitions différentes des mesures de performances utilisées pour chaque étape du processus de don, de l'identification du donneur potentiel au consentement à la transplantation. Le Groupe de travail sur les données de donneurs décédés (DDDWG), constitué de représentants des ODO de tout le Canada a donc été réuni par la Société canadienne du sang (SCS) pour élaborer un ensemble national et complet de données minimums standardisées de dons d'organes de personnes décédées. MéTHODES: Le DDDWG avait pour mission d'envisager tous les éléments de données de dons d'organes potentiels de personnes décédées, y compris les données opérationnelles et de performance collectées le long du parcours du donneur décédé, depuis le don potentiel jusqu'à l'utilisation des organes. Une analyse environnementale des autres registres existants (canadiens et internationaux) de dons d'organes de personnes décédées a été effectuée. Le DDDWG a alors entrepris des entretiens en face à face et des téléconférences pour élaborer ses recommandations pour un ensemble minimum de données qui répondraient aux problèmes clés, y compris : leur impact sur les processus de collecte de données des ODO existants, l'impact financier pour les différents acteurs, les besoins cliniques et opérationnels des multiples professionnels de santé impliqués tout au long du parcours de don de la personne décédée, et la disponibilité d'autres ensembles de données qui pourraient être utilisés pour réduire le fardeau de la collecte des données. RéSULTATS: Les principales données de don d'organes de donneur décédé, identifiées par le DDDWG, tiennent dans un cadre en pyramide inversée tiré d'un travail semblable mené dans d'autres pays. CONCLUSION: Le DDDWG a élaboré des recommandations pour les définitions proposées et les sources de données qui devraient être adoptées à l'échelon national pour guider la collecte des données de dons d'organes de personnes décédées. Le but ultime de l'ensemble minimum final de données est d'harmoniser et standardiser les définitions des données concernant les dons au Canada et de s'aligner sur les normes internationales; d'informer le développement de normes opérationnelles et de pratique clinique au niveau des provinces et au niveau national; de développer un cadre pour la mesure des performances concernant les dons de donneurs décédés; et de faire progresser les connaissances sur ce type de dons.


Assuntos
Coleta de Dados/métodos , Conjuntos de Dados como Assunto/normas , Doadores de Tecidos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/organização & administração , Canadá , Morte , Humanos , Obtenção de Tecidos e Órgãos/estatística & dados numéricos
3.
Transplantation ; 99(5): 985-90, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25340607

RESUMO

BACKGROUND: Establishment of a national kidney paired donation (KPD) program represents a unique achievement in Canada's provincially organized health care system. METHODS: Key factors enabling program implementation included consultation with international experts, formation of a unique organization with a mandate to facilitate interprovincial collaboration, and the volunteer efforts of members of the Canadian transplant community to overcome a variety of logistical barriers. RESULTS: As of December 2013, the program had facilitated 240 transplantations including 10% with Calculated panel reactive antibody (cPRA) ≥97%. Unique features of the Canadian KPD program include participation of n = 55 nondirected donors, performance of only donor specific antibody negative transplants, the requirement for donor travel, and nonuse of bridge donors. CONCLUSION: The national KPD program has helped maintain the volume of living kidney donor transplants in Canada over the past 5 years and serves as a model of inter-provincial collaboration to improve the delivery of health care to Canadians.


Assuntos
Transplante de Rim , Doadores Vivos , Sistema ABO de Grupos Sanguíneos/imunologia , Incompatibilidade de Grupos Sanguíneos , Canadá , Teste de Histocompatibilidade , Humanos , Programas Nacionais de Saúde
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