Progress in Transplantation

Kidneys from deceased donors with acute renal failure are not widely used.

To compare outcomes for recipients of kidneys from donors with acute renal failure at organ recovery with outcomes for recipients of kidneys from donors with normal serum levels of creatinine.

Records of deceased donors and recipients of their organs at the Saudi Center for Organ Transplantation from 2003 to 2005 were reviewed. A total of 33 donors (donating 65 kidneys to 65 recipients) with elevated serum levels of creatinine (>1.7 mg/dL) and 94 donors (donating 188 kidneys to 188 recipients) with normal (<1.1 mg/dL) serum levels of creatinine at organ recovery and their respective recipients were compared. Both groups had normal creatinine levels at admission.

Recipients in both groups had similar renal function at discharge and follow-up. Delayed graft function occurred more often (P= .009) in the recipients of kidneys from donors with acute renal failure (47.7%) than in recipients of kidneys from donors with normal creatinine levels (29.8%). Elevation of serum level of creatinine at organ recovery did not correlate significantly with kidney function at discharge or last follow-up or with graft survival.

Survival of patients or grafts at 1, 2, and 3 years did not differ significantly between the recipients in the 2 groups. Only the frequency of delayed graft function differed between the 2 groups.

As part of an organ sharing network's outreach, African American adults were interviewed to assess their awareness of the network's efforts and willingness to donate their organs after death.

To describe (1) the proportion who expressed their intentions to be an organ donor, (2) the means they had used, and (3) sociodemographic characteristics of the participants who used a particular means.

A repeated, cross-sectional, random-digit dialing telephone interview was conducted from July 2005 (start of wave 1) to April 2006 (end of wave 3). Each interview averaged 7 minutes and consisted of 60 items.

Trained interviewers placed telephone calls to the residences of African Americans who resided in 1 of 4 New Jersey locales: East Orange/Orange, Irvington, Jersey City/Newark, and Trenton.

One thousand five hundred sixty-seven African Americans, aged 18 to 95 years.

Five Yes/No items were used to determine if participants had declared their intention to be an organ donor via driver's license application, donor card, donor registry, will/healthcare directive, or discussion with a family member.

Twenty-seven percent of the participants had expressed their intentions to be an organ donor with an organ donor card, driver's license, donor registry, or will/healthcare directive. The participants who had used one or more of these formal means were 14.4 times more likely to have discussed their intention to be an organ donor with a family member than were the participants who had not.

Growing waiting lists for organ transplantation require attention to populations with a high demand for organs but a low donation rate. American Indians experience a high demand for kidney transplantation because of an epidemic of type 2 diabetes, yet donation consent rates are low in this group.

To design and evaluate an educational intervention to increase the intention to serve as an organ or tissue donor among American Indians.

Sharing the Gift of Life was designed for reservation-dwelling American Indians living in the Northern Plains area of the United States. The intervention addressed important cultural traditions and was derived from the Transtheoretical Model of behavior change.

A 2-stage descriptive evaluation design was used.

Two evaluation groups were included. American Indian members of a project advisory council served as cultural expert evaluators (stage 1). Northern Plains reservation–dwelling American Indian adults were community member evaluators (stage 2).

Stage 1 used an Educational Materials Review Form. Stage 2 used an adapted community member evaluation tool.

The cultural expert evaluation was strong. All items met the <3.0 mean acceptability criterion (range 1.93–2.89). Content validity indices met criterion of 0.80 for the overall evaluation and for all items. Cultural specific changes to the materials were suggested. After revision, community member evaluation was favorable. Mean evaluation scores met criterion and content validity indices were acceptable. Pronunciation of traditional language was corrected in the video. Sharing the Gift of Life is a promising intervention that should undergo efficacy testing.

To implement and evaluate a change in practice regarding the timing of introducing donation for inpatient hospice staff and families whereby scripted information about tissue/organ donation was given by the nurse upon admission as part of the normal admission process and then repeated at the time of death per usual protocol.

Data were collected from staff for 6 months (January to June 2006). The hospice staff agreed to complete a donor services comment log at the admission and at the death of each patient to relay any concerns with the change in practice rather than just writing down complaints as was the previous practice. Data were supplemented with staff input during regular meetings. Donation rates were compiled as usual for 6 months and compared with the preceding 6 months.

Data were analyzed from the written interactions. Trends identified were limited by the small sample size. The results confirmed that both nursing staff and potential donor families supported the change in practice. No families or staff called the organ procurement organization with complaints during the 6-month period. Corneal donations increased from 2 to 7, a 250% increment for the 6-month period.

The assumption that discussing donation when hospice patients are admitted will lead to a decrease in donation is not supported by the results of this study. The findings suggest the need for a methodologically rigorous, theoretically driven examination of hospice donor families' reactions to the introduction of donation at admission and the subsequent decrease in stress and increase in donation rates.

To analyze hospital charges for all liver transplant admissions to determine major cost drivers of the total charge.

Retrospective review of hospital billing records.

Hospital charges were collected for all liver transplant admissions between July 1995 and December 2005 and 276 billing records were included in the analysis. Charges were itemized into pharmacy, inpatient room, laboratory, organ acquisition, and other.

Despite maintaining a median length of stay of about 10 days, hospital charges increased from 1995 to 2005. Mean total pharmacy charges (± SEM) before a 1998 cost-containment initiative were $17 405 ±$4080 and constituted a 12% fraction of total charges, but had reduced to $11238 ±$2828 (7.8% of total charges) immediately thereafter, decreasing to $9891 ±$2351 (3.7% of total charges) for the most current period (2005). The increase in the total charge was largely driven by an increase in the organ acquisition charge and daily laboratory and room charges.

Pharmacy charges no longer are a major contributor to the total liver transplant charges at our institution. A major reduction in total liver transplant charge can now only be achieved by targeting other cost centers such as laboratory, room, and organ acquisition. The transplant team has limited control over these cost centers.

Heart transplant recipients often suffer from obesity, dyslipidemia, and hypertension thought to be related to triple-drug immunosuppression and poor adherence to diet and exercise. A lifestyle intervention that allows recipients to attend a community-based weight management program may improve health outcomes.

To determine (1) the effects of attending a community-based weight management program on weight, systolic and diastolic blood pressure, and the lipid profile; and (2) the feasibility of a community-based program for weight management.

Twenty-one patients (81% male; age 57 years, 99.7 months since transplantation) participated in a randomized clinical trial and received either weight management counseling (control) or a 6-month scholarship to a structured commercial program (treatment). Using simple analysis of covariance models, group differences were assessed and reported as marginal means.

At baseline, there were no demographic differences between groups. There were no differences in outcome variables except weight (control, 102.1 kg vs treatment, 98.3 kg; P = .05). After 6 months, significant differences were found in weight (control, 100.5 kg vs treatment, 95.6 kg; P = .047) and high-density lipoprotein cholesterol (control, 40.6 mg/dL vs treatment, 49.1 mg/dL; P = .044). A marginally significant difference was found in systolic blood pressure (control, 138 mm Hg vs treatment, 121 mm Hg; P=.07). A decrease in diastolic blood pressure (6 mm Hg) was attributed to treatment effect (P = .16). No differences were noted in total cholesterol, triglycerides, or low-density lipoprotein cholesterol.

The structured commercial program appears to be an effective, feasible alternative to usual care. Findings need to be confirmed in future research with a larger sample.

Relatively few transplant recipients participate in regular physical activity. There is a paucity of information regarding barriers and facilitators to physical activity in kidney transplant recipients.

To investigate factors that transplant recipients perceive as barriers and facilitators to physical activity and whether these barriers and facilitators differ on the basis of transplant patients' reported level of physical activity. Method—Using a descriptive, cross-sectional design, a convenience sample of 100 kidney transplant recipients provided survey data on a physical activity questionnaire on their current levels of physical activity and determinants that influence participation in physical activity.

The “rarely/never” (32%) physical activity group reported more frequent barriers and the “often” (20%) group reported the least. Overall, perceived facilitators were reported most frequently by the “often” (80%) physical activity group and least by the “rarely/never” (67%) group.

Motivational interventions should focus on diminishing perceived barriers in the less physically active transplant recipients and enhancing perception of health-related facilitators. Nurses should be innovative in customizing interventions, recommending structured physical activity programs, and encouraging less structured, enjoyable ways to increase activities that expend energy. Interventions with achievable outcomes and realistic expectations are more acceptable to patients.