scholarly journals Allocating Scarce Organs: How a Change in Supply Affects Transplant Waiting Lists and Transplant Recipients

2019 ◽  
Vol 11 (4) ◽  
pp. 210-239 ◽  
Author(s):  
Stacy Dickert-Conlin ◽  
Todd Elder ◽  
Keith Teltser
Keyword(s):  
Survival Rates ◽  
State Level ◽  
Deceased Donor ◽  
Crowding Out ◽  
Transplant Recipients ◽  
Supply Shocks ◽  
Motorcycle Helmet ◽  
Transplant Candidates ◽  
Helmet Laws ◽  
The Universe

Vast organ shortages motivated recent efforts to increase the supply of transplantable organs, but we know little about the demand side of the market. We test the implications of a model of organ demand using the universe of US transplant data from 1987 to 2013. Exploiting variation in supply induced by state-level motorcycle helmet laws, we demonstrate that each organ that becomes available from a deceased donor in a particular region induces five transplant candidates to join that region's transplant wait list, while crowding out living-donor transplants. Even with the corresponding demand increase, positive supply shocks increase post-transplant survival rates. (JEL D47, I11, I18)

Novelty Helmet Use by Motorcycle Riders in Florida

2000 ◽  
Vol 1734 (1) ◽  
pp. 69-76 ◽  
Author(s):  
Patricia A. Turner ◽  
Christopher A. Hagelin
Keyword(s):  
Lower Cost ◽  
State Level ◽  
Safety Equipment ◽  
Helmet Use ◽  
Usage Rate ◽  
Motorcycle Helmet ◽  
Period Data ◽  
Almost All ◽  
Helmet Laws ◽  
Motorcycle Crashes

Although Florida law requires all motorcyclists to wear helmets, 16 percent of all motorcycle drivers and 30 percent of all their passengers killed in motorcycle crashes in 1996 were not wearing protective helmets. In addition, the use of novelty helmets may be on the rise in states with universal helmet laws. The objectives of this research were to determine motorcycle helmet use rates on Florida roadways and to estimate the level of novelty helmet use by motorcycle occupants. A total of 2,498 motorcyclists in 13 Florida counties were observed over a 2-month period. Data were collected on helmet use and type, motorcycle type, gender, and use of other safety equipment. Almost all motorcycle occupants wore some type of helmet; the observed state-level usage rate was 99.5 percent. However, a significant number of these helmets were novelty helmets. The type of helmet motorcyclists choose to wear may be related to the type of motorcycle driven and the gender of the driver and passenger. Overall, novelty helmet use was higher for passengers than for drivers, and the majority of observed novelty helmets were on motorcycle occupants riding cruiser-type motorcycles. Moreover, females exhibited lower rates of compliance than males, especially when associated with cruiser-type motorcycles. Although the survey did not collect information about the reasons for the increase in novelty helmet use, possible explanations may be that novelty helmets are more readily available at lower cost, and that there is an overall perceived lack of enforcement of the motorcycle helmet use law.

scholarly journals Changes in quality of life (QoL) and other patient-reported outcome measures (PROMs) in living-donor and deceased-donor kidney transplant recipients and those awaiting transplantation in the UK ATTOM programme: a longitudinal cohort questionnaire survey with additional qualitative interviews

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e047263
Author(s):  
Andrea Gibbons ◽  
Janet Bayfield ◽  
Marco Cinnirella ◽  
Heather Draper ◽  
Rachel J Johnson ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Outcome Measures ◽  
Deceased Donor ◽  
Patient Reported Outcome Measures ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Post Transplant ◽  
Patient Reported

ObjectiveTo examine quality of life (QoL) and other patient-reported outcome measures (PROMs) in kidney transplant recipients and those awaiting transplantation.DesignLongitudinal cohort questionnaire surveys and qualitative semi-structured interviews using thematic analysis with a pragmatic approach.SettingCompletion of generic and disease-specific PROMs at two time points, and telephone interviews with participants UK-wide.Participants101 incident deceased-donor (DD) and 94 incident living-donor (LD) kidney transplant recipients, together with 165 patients on the waiting list (WL) from 18 UK centres recruited to the Access to Transplantation and Transplant Outcome Measures (ATTOM) programme completed PROMs at recruitment (November 2011 to March 2013) and 1 year follow-up. Forty-one of the 165 patients on the WL received a DD transplant and 26 received a LD transplant during the study period, completing PROMs initially as patients on the WL, and again 1 year post-transplant. A subsample of 10 LD and 10 DD recipients participated in qualitative semi-structured interviews.ResultsLD recipients were younger, had more educational qualifications and more often received a transplant before dialysis. Controlling for these and other factors, cross-sectional analyses at 12 months post-transplant suggested better QoL, renal-dependent QoL and treatment satisfaction for LD than DD recipients. Patients on the WL reported worse outcomes compared with both transplant groups. However, longitudinal analyses (controlling for pre-transplant differences) showed that LD and DD recipients reported similarly improved health status and renal-dependent QoL (p<0.01) pre-transplant to post-transplant. Patients on the WL had worsened health status but no change in QoL. Qualitative analyses revealed transplant recipients’ expectations influenced their recovery and satisfaction with transplant.ConclusionsWhile cross-sectional analyses suggested LD kidney transplantation leads to better QoL and treatment satisfaction, longitudinal assessment showed similar QoL improvements in PROMs for both transplant groups, with better outcomes than for those still wait-listed. Regardless of transplant type, clinicians need to be aware that managing expectations is important for facilitating patients’ adjustment post-transplant.

scholarly journals Hepatitis C disease severity in living versus deceased donor liver transplant recipients: An extended observation study

Hepatology ◽  
2014 ◽  
Vol 59 (4) ◽  
pp. 1311-1319 ◽  
Author(s):  
Norah A. Terrault ◽  
R. Todd Stravitz ◽  
Anna S.F. Lok ◽  
Greg T. Everson ◽  
Robert S. Brown ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Liver Transplant ◽  
Disease Severity ◽  
Deceased Donor ◽  
Transplant Recipients ◽  
Donor Liver ◽  
Observation Study ◽  
Donor Liver Transplant ◽  
Liver Transplant Recipients

scholarly journals Effects of Rituximab on the Development of Viral and Fungal Infections in Renal Transplant Recipients

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Samir J. Patel ◽  
Jennifer M. Devos ◽  
Richard J. Knight ◽  
Kyle L. Dawson ◽  
Wadi N. Suki ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Odds Ratio ◽  
Viral Infections ◽  
Fungal Infections ◽  
Graft Function ◽  
Deceased Donor ◽  
Infectious Complications ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

Background. Rituximab is becoming increasingly utilized in renal transplant recipients; however, its association with infections remains unclear. Methods. We reviewed the incidence of viral and fungal infections in kidney transplant recipients treated with () or without () rituximab (RTX) in addition to standard immunosuppression. Results. Infections occurred in 134 (30%) patients, with a greater proportion in RTX versus no RTX patients (47% versus 28%; ). Viral infections occurred in 44% and 27% of RTX and no RTX patients, respectively (). This was largely driven by the frequency of BK viremia and noncytomegalovirus/non-BK viruses in RTX patients (27% versus 13% () and 15% versus 2% (), resp.). Fungal infections also occurred more often in RTX patients (11% versus 3 %; ). Multivariate analysis revealed deceased donor recipient (odds ratio = 2.5; ) and rituximab exposure (odds ratio = 2.2; ) as independent risk factors for infection. Older patients, deceased donor recipients, those on dialysis longer, and those with delayed graft function tended to be at a greater risk for infections following rituximab. Conclusions. Rituximab is associated with an increased incidence of viral and fungal infections in kidney transplantation. Additional preventative measures and/or monitoring infectious complications may be warranted in those receiving rituximab.

scholarly journals Tacrolimus Pharmacokinetics in Living-Donor and Deceased-Donor Liver Transplant in Saudi Patients

2019 ◽  
pp. 288-294
Author(s):  
Hisham S. Abou-Auda ◽  
Eqbal Qaddour ◽  
Hussein Alsisi ◽  
Azizah Ajlan ◽  
Mohammad Alsebayel
Keyword(s):  
Liver Transplant ◽  
Deceased Donor ◽  
Apparent Volume ◽  
Volume Of Distribution ◽  
Transplant Recipients ◽  
Donor Liver ◽  
Apparent Clearance ◽  
Donor Liver Transplant ◽  
Liver Transplant Recipients ◽  
Apparent Volume Of Distribution

Introduction: Tacrolimus is a macrolide immunosuppressant. It has a narrow therapeutic index and serious side effects which necessitate monitoring of tacrolimus blood concentration. The trough concentration of the drug may also differ based on the type of liver transplant. This study was conducted to investigate differences in pharmacokinetics between transplant types and to determine tacrolimus population pharmacokinetic in liver transplant recipients in Saudi Arabia. Method: Patients on tacrolimus, as the main immunosuppressant, who underwent liver transplant throughout2012-2014 were retrospectively studied. Demographic characteristic, tacrolimus blood trough concentrations, liver, renal, biochemistry, and hematology lab results were all collected. The pharmacokinetic parameters were estimated assuming one compartment model. Results: Tacrolimus pharmacokinetic parameters were found to be as following; elimination rate constant () 0.094 ±  0.0123, apparent volume of distribution () 112.48±63.033 L/hr, elimination half-life () 7.46± 1.01 hr and apparent total body clearance () 10.27± 5.69 L/hr (mean ± SD). Statistically significant difference was found between living-donor and deceased-donor liver transplant with respect to apparent clearance and apparent volume of distribution. Living-donor liver transplant recipients have apparent volume of distribution of 97.39±47.00 L (mean ± SD) and an apparent clearance of 8.89±4.24L/hr (mean± SD). On the other hand, deceased-donor liver transplant has an apparent clearance of 12.97±7.09L/hr (mean ± SD) and an apparent volume of distribution of 142.17± 78.65 L (mean ± SD). Conclusions: Tacrolimus pharmacokinetics parameters were accurately determined in liver transplant recipients in Saudi Arabia. The results of the present study can be clinically used in the therapeutic drug monitoring of tacrolimus in the individualization of drug dosage and taking the appropriate clinical decisions to prevent allograft rejection.

Neurocognitive Effects of Solid Organ Transplantation

2010 ◽  
Author(s):  
Nataliya Zelikovsky ◽  
Debra S. Lefkowitz
Keyword(s):  
Organ Transplantation ◽  
Survival Rates ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Chronic Illnesses ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Transplant Patients ◽  
Neurocognitive Outcomes ◽  
Medical Advances

The first successful organ transplant was a kidney transplant performed between identical twins in 1954. Since that time, major medical advances have been made to help improve survival rates for transplant recipients. In 2008, there were 1,964 solid organ transplants performed for children under age 18 (2007 Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients [OPTN/SRTR] Annual Report 1997–2006). Currently, approximately 1,830 pediatric patients are awaiting some type of solid organ transplant (2007 OPTN/SRTR Annual Report 1997–2006). Organ transplantation in children is relatively recent compared to other treatments for children with chronic illnesses. The focus over the first few decades has been on medical advances and improving survival rates for transplant patients. In the recent years, increasing attention has been given to the developmental, neurocognitive, and psychosocial outcomes prior to transplant and in the short-term period post transplant. Most chronic illnesses and acute traumatic medical events have implications for neurocognitive outcomes. End-stage disease of the liver, kidney, heart, and lung are all believed to affect intellectual, academic, and neurocognitive functions. Gross neurodevelopmental deficits have become less common due to early medical intervention (e.g., improved nutrition, surgical intervention, reduced exposure to aluminum (Warady 2002). Organ transplantation is believed to ameliorate the deleterious long-term developmental and neurocognitive effects, but this topic has received little attention in the literature, and the available results with regard to intellectual, academic, and neurodevelopmental results have been mixed. In a combined sample of solid organ transplant patients, 40% had clinically significant cognitive delays (Brosig et al. 2006). Examining the impact of different underlying disease processes and transplantation of each solid organ separately is critical. Thus, we discuss the neurocognitive outcomes of each organ group separately in this chapter. Neurocognitive outcomes can be assessed in a variety of ways depending upon the age of the child. Among infants and toddlers, neurocognitive functioning is measured by an assessment of motor function, social and environmental interaction, and language development. Assessment of older children may involve the evaluation of intelligence, academic achievement, emotional and behavioral functioning, and adaptive skills.

scholarly journals Educational Animations to Inform Transplant Candidates About Deceased Donor Kidney Options

2020 ◽  
Vol 6 (7) ◽  
pp. e575
Author(s):  
Liise K. Kayler ◽  
Beth A. Dolph ◽  
Chelsea N. Cleveland ◽  
Maria M. Keller ◽  
Thomas H. Feeley
Keyword(s):  
Deceased Donor ◽  
Donor Kidney ◽  
Deceased Donor Kidney ◽  
Transplant Candidates

scholarly journals 4101 Creating a Culturally Sensitive Report Card for African American (AA) Kidney Transplant Candidates

2020 ◽  
Vol 4 (s1) ◽  
pp. 54-54
Author(s):  
Warren McKinney ◽  
Marilyn J. Bruin ◽  
Sauman Chu ◽  
Bertram L. Kasiske ◽  
Ajay K. Israni
Keyword(s):  
Decision Making ◽  
Focus Groups ◽  
Kidney Transplant ◽  
Culturally Sensitive ◽  
Report Card ◽  
Medical Decision ◽  
Transplant Recipients ◽  
Transplant Program ◽  
Study Population ◽  
Transplant Candidates

OBJECTIVES/GOALS: AA are over-represented on the waitlist for kidney transplant and are often unaware of how waitlist acceptance practices differ across transplant programs and influence access to transplant. We will develop a culturally sensitive transplant program report card to communicate these variations. METHODS/STUDY POPULATION: Scientific Registry of Transplant Recipients (SRTR) data will be used to identity clinical factors strongly associated with AA access to transplant. Interviews and focus groups with AA kidney transplant candidates and their families will collect feedback on the SRTR report card and inform the development of the culturally sensitive report card. Additional focus groups will evaluate its effect on knowledge and medical decision making. We will collaborate with the stakeholders, including AA transplant candidates and their families, transplant programs, SRTR, and providers, to identify strategies to disseminate the report card in the AA community RESULTS/ANTICIPATED RESULTS: To date, no investigation has systematically collected feedback on the SRTR transplant program report card from AA candidates to ensure that the tool is accessible and effective in the AA community. We hypothesize that a culturally sensitive report card will improve AA candidates’ knowledge of program factors that impact access to transplant and enable informed decisions about where they pursue a transplant evaluation. The results of this study have the potential to change how AA patients are counselled while seeking transplantation. DISCUSSION/SIGNIFICANCE OF IMPACT: A culturally sensitive report card can reach more AA patients and enable more informed decision making by providing education about differences in transplant programs that may impact their access to transplant. In the future, we will design a trial to evaluate the prototype.

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