Collaborative leadership in transplantation: Blending clinical, business, and regulatory roles.

Transplantation is a high-risk, high-cost treatment for end-stage diseases and is the most strictly regulated area of healthcare in the United States. Thus, achieving success for patients and the program requires skillful and collaborative leadership. Various factors, such as outcomes, volume, and financial health, may measure the success of a transplant program. Strong collaboration between clinical and administrative leaders is key to achieving and maintaining success in those three categories. Clinical leaders of adult programs, such as medical and surgical directors, bear the primary responsibility for a program's volume, outcomes, and patient safety, while administrative directors are focused on business intelligence and regulatory compliance. This paper aims to provide readers with insights into the critical role of collaborative leadership in running a successful program, with a focus on clinical, business, and regulatory perspectives.

Managing the Costs of Routine Follow-up Care After Living Kidney Donation: a Review and Survey of Contemporary Experience, Practices, and Challenges.

Purpose of Review: While living organ donor follow-up is mandated for 2 years in the USA, formal guidance on recovering associated costs of follow-up care is lacking. In this review, we discuss current billing practices of transplant programs for living kidney donor follow-up, and propose future directions for managing follow-up costs and supporting cost neutrality in donor care. Recent Findings: Living donors may incur costs and financial risks in the donation process, including travel, lost time from work, and dependent care. In addition, adherence to the Organ Procurement and Transplantation Network (OPTN) mandate for US transplant programs to submit 6-, 12-, and 24-month postdonation follow-up data to the national registry may incur out-of-pocket medical costs for donors. Notably, the Centers for Medicare and Medicaid Services (CMS) has explicitly disallowed transplant programs to bill routine, mandated follow-up costs to the organ acquisition cost center or to the recipient's Medicare insurance. We conducted a survey of transplant staff in the USA (distributed October 22, 2020-March 15, 2021), which identified that the mechanisms for recovering or covering the costs of mandated routine postdonation follow-up at responding programs commonly include billing recipients' private insurance (40%), while 41% bill recipients' Medicare insurance. Many programs reported utilizing institutional allowancing (up to 50%), and some programs billed the organ acquisition cost center (25%). A small percentage (11%) reported billing donors or donors' insurance. Summary: To maintain a high level of adherence to living donor follow-up without financially burdening donors, up-to-date resources are needed on handling routine donor follow-up costs in ways that are policy-compliant and effective for donors and programs. Development of a government-supported national living donor follow-up registry like the Living Donor Collective may provide solutions for aspects of postdonation follow-up, but requires transplant program commitment to register donors and donor candidates as well as donor engagement with follow-up outreach contacts after donation. Supplementary Information: The online version contains supplementary material available at 10.1007/s40472-022-00379-w.

White paper on antimicrobial stewardship in solid organ transplant recipients.

Antimicrobial stewardship programs (ASPs) have made immense strides in optimizing antibiotic, antifungal, and antiviral use in clinical settings. However, although ASPs are required institutionally by regulatory agencies in the United States and Canada, they are not mandated for transplant centers or programs specifically. Despite the fact that solid organ transplant recipients in particular are at increased risk of infections from multidrug-resistant organisms, due to host and donor factors and immunosuppressive therapy, there currently are little rigorous data regarding stewardship practices in solid organ transplant populations, and thus, no transplant-specific requirements currently exist. Further complicating matters, transplant patients have a wide range of variability regarding their susceptibility to infection, as factors such as surgery of transplant, intensity of immunosuppression, and presence of drains or catheters in situ may modify the risk of infection. As such, it is not feasible to have a "one-size-fits-all" style of stewardship for this patient population. The objective of this white paper is to identify opportunities, risk factors, and ASP strategies that should be assessed with solid organ transplant recipients to optimize antimicrobial use, while producing an overall improvement in patient outcomes. We hope it may serve as a springboard for development of future guidance and identification of research opportunities.

COVID-19: Perspectives From Frontline Critical Care Nurses in New York.

New York City quickly became the epicenter of coronavirus disease-2019 (COVID-19) in early March of 2020. While hospitals were aware of the potential of COVID-19, the volume of critically ill patients that flooded the hospitals in the New York City area was clearly not anticipated. Hospital staff worked quickly to create COVID-19-free areas, but were overcome with the volume of COVID-positive critically ill patients. Many newly admitted patients required respiratory support with mechanical ventilation. As Governor Cuomo issued executive orders to stay at home in mid-March, some patients were afraid to go into hospitals despite symptoms of respiratory distress. Once these patients came to the hospital, they were often critically ill. Emergency departments and intensive care units filled rapidly, overwhelming staff and equipment needs with such things as pumps, dialysis machines, medications, and personal protective equipment. Plans for the day were disrupted with frequent rapid response calls and the need for additional beds. Key issues that confronted the COVID-19 response in critical care units at NYU Langone Health included communication, patient and staff safety.

New York Transplant Teams Versus COVID-19.

New York State, and especially New York City, were hit hard by the coronavirus disease 2019 (COVID-19) virus. While we followed its course in other parts of the world, and began preparations, there was no way we could have been prepared for the volume and severity of illness that began to overflow in our emergency departments and hospital units. We expanded intensive care units into our medical surgical units while turning conference rooms into medical surgical patient care areas. Clinicians at the bedside described war-like situations with numerous patients arresting and requiring ventilator support. Our New York consortia and organ procurement organizations met online 3 times a week and shared creative strategies to address clinical care and work processes. We would like to share strategies from what we hope was a once in a lifetime experience.

Validation of the american quality assessment model and performance improvement to the brazilian transplant.

OBJECTIVE: To validate the quality assessment and performance improvement instrument of US transplant programs to the Brazilian reality. METHOD: Methodological study developed for semantic validation and cultural adaptation of the Quality assessment and Performance Improvement instrument in the following steps: 1) translation; 2) synthesis; 3) back translation; 4) review by expert committee; 5) pretest and 6) content validation. To evaluate the agreement between the five judges, the Kappa coefficient was used and for content validation, the content validation index. RESULTS: Kappa coefficient showed the agreement of the judges for semantic, idiomatic, cultural and conceptual equivalences. Content validation index values for relevance and item sequence of at least 0.80 for all blocks. CONCLUSION: The instrument of Quality Evaluation and Performance Improvement of Transplantation Programs proved to be valid and reliable. This instrument will contribute to the development of quality assurance programs for transplant teams in Brazil.

Validation of the american quality assessment model and performance improvement to the brazilian transplant / Validação do modelo americano de avaliação da qualidade e melhoria do desempenho ao transplante brasileiro / Validación de modelo americano de evaluación de la calidad y mejora del desempeño para el trasplante brasileño

Objective: To validate the quality assessment and performance improvement instrument of US transplant programs to the Brazilian reality. Method: Methodological study developed for semantic validation and cultural adaptation of the Quality assessment and Performance Improvement instrument in the following steps: 1) translation; 2) synthesis; 3) back translation; 4) review by expert committee; 5) pretest and 6) content validation. To evaluate the agreement between the five judges, the Kappa coefficient was used and for content validation, the content validation index. Results: Kappa coefficient showed the agreement of the judges for semantic, idiomatic, cultural and conceptual equivalences. Content validation index values for relevance and item sequence of at least 0.80 for all blocks. Conclusion: The instrument of Quality Evaluation and Performance Improvement of Transplantation Programs proved to be valid and reliable. This instrument will contribute to the development of quality assurance programs for transplant teams in Brazil.

Objetivo: validar o instrumento de avaliação da qualidade e melhoria do desempenho dos programas de transplantes dos Estados Unidos à realidade brasileira. Método: estudo metodológico desenvolvido para a validação semântica e adaptação cultural do instrumento Quality assessment and Performance Improvement nas seguintes etapas: 1) tradução; 2) síntese; 3) retrotradução; 4) revisão por comitê de especialistas; 5) pré-teste e 6) validação de conteúdo. Para avaliar as concordâncias entre os cinco juízes, utilizou-se o coeficiente Kappa e para validação de conteúdo, o índice de validação de conteúdo. Resultado: o coeficiente Kappa mostrou a concordância dos juízes para as equivalências semântica, idiomática, cultural e conceitual. Valores de índice de validação de conteúdo para relevância e sequência de itens de, pelo menos, 0,80 para todos os blocos. Conclusão: o instrumento de Avaliação da Qualidade e Melhoria do Desempenho dos Programas de Transplantes mostrou-se válido e confiável. Este instrumento irá contribuir para o desenvolvimento de programas de garantia de qualidade para equipes de transplante no Brasil.

Objetivo: validar el instrumento de evaluación de la calidad y mejora del desempeño de los programas de trasplantes de los Estados Unidos a la realidad brasileña. Método: estudio metodológico desarrollado para validación semántica y adaptación cultural del instrumento Quality assessment and Performance Improvement en las siguientes etapas: 1) traducción; 2) síntesis; 3) retrotraducción; 4) revisión por comité de especialistas; 5) pretest y 6) validación de contenido. Para evaluar las concordancias entre los cinco jueces, se utilizó el coeficiente Kappa y para la validación de contenido, el índice de validación de contenido. Resultado: el coeficiente Kappa mostró la concordancia de los jueces para las equivalencias semántica, idiomática, cultural y conceptual. Los valores de índice de validación de contenido para relevancia y secuencia de ítems, de por lo menos, 0,80 - para todos los bloques. Conclusión: el instrumento de Evaluación de la Calidad y Mejora del Desempeño de los Programas de Trasplantes se mostró válido y confiable. Este instrumento podrá contribuir para el desarrollo de programas de garantía de calidad para los equipos de trasplante en Brasil.

Validation of the american quality assessment model and performance improvement to the brazilian transplant / Validação do modelo americano de avaliação da qualidade e melhoria do desempenho ao transplante brasileiro / Validación de modelo americano de evaluación de la calidad y mejora del desempeño para el trasplante brasileño

Objective: To validate the quality assessment and performance improvement instrument of US transplant programs to the Brazilian reality. Method: Methodological study developed for semantic validation and cultural adaptation of the Quality assessment and Performance Improvement instrument in the following steps: 1) translation; 2) synthesis; 3) back translation; 4) review by expert committee; 5) pretest and 6) content validation. To evaluate the agreement between the five judges, the Kappa coefficient was used and for content validation, the content validation index. Results: Kappa coefficient showed the agreement of the judges for semantic, idiomatic, cultural and conceptual equivalences. Content validation index values for relevance and item sequence of at least 0.80 for all blocks. Conclusion: The instrument of Quality Evaluation and Performance Improvement of Transplantation Programs proved to be valid and reliable. This instrument will contribute to the development of quality assurance programs for transplant teams in Brazil.

Objetivo: validar o instrumento de avaliação da qualidade e melhoria do desempenho dos programas de transplantes dos Estados Unidos à realidade brasileira. Método: estudo metodológico desenvolvido para a validação semântica e adaptação cultural do instrumento Quality assessment and Performance Improvement nas seguintes etapas: 1) tradução; 2) síntese; 3) retrotradução; 4) revisão por comitê de especialistas; 5) pré-teste e 6) validação de conteúdo. Para avaliar as concordâncias entre os cinco juízes, utilizou-se o coeficiente Kappa e para validação de conteúdo, o índice de validação de conteúdo. Resultado: o coeficiente Kappa mostrou a concordância dos juízes para as equivalências semântica, idiomática, cultural e conceitual. Valores de índice de validação de conteúdo para relevância e sequência de itens de, pelo menos, 0,80 para todos os blocos. Conclusão: o instrumento de Avaliação da Qualidade e Melhoria do Desempenho dos Programas de Transplantes mostrou-se válido e confiável. Este instrumento irá contribuir para o desenvolvimento de programas de garantia de qualidade para equipes de transplante no Brasil.

Objetivo: validar el instrumento de evaluación de la calidad y mejora del desempeño de los programas de trasplantes de los Estados Unidos a la realidad brasileña. Método: estudio metodológico desarrollado para validación semántica y adaptación cultural del instrumento Quality assessment and Performance Improvement en las siguientes etapas: 1) traducción; 2) síntesis; 3) retrotraducción; 4) revisión por comité de especialistas; 5) pretest y 6) validación de contenido. Para evaluar las concordancias entre los cinco jueces, se utilizó el coeficiente Kappa y para la validación de contenido, el índice de validación de contenido. Resultado: el coeficiente Kappa mostró la concordancia de los jueces para las equivalencias semántica, idiomática, cultural y conceptual. Los valores de índice de validación de contenido para relevancia y secuencia de ítems, de por lo menos, 0,80 - para todos los bloques. Conclusión: el instrumento de Evaluación de la Calidad y Mejora del Desempeño de los Programas de Trasplantes se mostró válido y confiable. Este instrumento podrá contribuir para el desarrollo de programas de garantía de calidad para los equipos de trasplante en Brasil.

The 2018 ISHLT/APM/AST/ICCAC/STSW Recommendations for the Psychosocial Evaluation of Adult Cardiothoracic Transplant Candidates and Candidates for Long-term Mechanical Circulatory Support.

The psychosocial evaluation is well-recognized as an important component of the multifaceted assessment process to determine candidacy for heart transplantation, lung transplantation, and long-term mechanical circulatory support (MCS). However, there is no consensus-based set of recommendations for either the full range of psychosocial domains to be assessed during the evaluation, or the set of processes and procedures to be used to conduct the evaluation, report its findings, and monitor patients' receipt of and response to interventions for any problems identified. This document provides recommendations on both evaluation content and process. It represents a collaborative effort of the International Society for Heart and Lung Transplantation (ISHLT) and the Academy of Psychosomatic Medicine, American Society of Transplantation, International Consortium of Circulatory Assist Clinicians, and Society for Transplant Social Workers. The Nursing, Health Science and Allied Health Council of the ISHLT organized a Writing Committee composed of international experts representing the ISHLT and the collaborating societies. This Committee synthesized expert opinion and conducted a comprehensive literature review to support the psychosocial evaluation content and process recommendations that were developed. The recommendations are intended to dovetail with current ISHLT guidelines and consensus statements for the selection of candidates for cardiothoracic transplantation and MCS implantation. Moreover, the recommendations are designed to promote consistency across programs in the performance of the psychosocial evaluation by proposing a core set of content domains and processes that can be expanded as needed to meet programs' unique needs and goals.

The 2018 ISHLT/APM/AST/ICCAC/STSW recommendations for the psychosocial evaluation of adult cardiothoracic transplant candidates and candidates for long-term mechanical circulatory support.

The psychosocial evaluation is well-recognized as an important component of the multifaceted assessment process to determine candidacy for heart transplantation, lung transplantation, and long-term mechanical circulatory support (MCS). However, there is no consensus-based set of recommendations for either the full range of psychosocial domains to be assessed during the evaluation, or the set of processes and procedures to be used to conduct the evaluation, report its findings, and monitor patients' receipt of and response to interventions for any problems identified. This document provides recommendations on both evaluation content and process. It represents a collaborative effort of the International Society for Heart and Lung Transplantation (ISHLT) and the Academy of Psychosomatic Medicine, American Society of Transplantation, International Consortium of Circulatory Assist Clinicians, and Society for Transplant Social Workers. The Nursing, Health Science and Allied Health Council of the ISHLT organized a Writing Committee composed of international experts representing the ISHLT and the collaborating societies. This Committee synthesized expert opinion and conducted a comprehensive literature review to support the psychosocial evaluation content and process recommendations that were developed. The recommendations are intended to dovetail with current ISHLT guidelines and consensus statements for the selection of candidates for cardiothoracic transplantation and MCS implantation. Moreover, the recommendations are designed to promote consistency across programs in the performance of the psychosocial evaluation by proposing a core set of content domains and processes that can be expanded as needed to meet programs' unique needs and goals.