The independent living donor advocate: a guidance document from the American Society of Transplantation's Living Donor Community of Practice (AST LDCOP).

The independent living donor advocate (ILDA) serves a mandated and supportive role in the care of the living organ donor, yet qualifications and role requirements are not clearly defined. Guidance comes from Centers for Medicare and Medicaid Services (CMS) Conditions for Transplant Center Participation and interpretive guidelines, Organ Procurement and Transplantation Network (OPTN) Policy and CMS and OPTN site surveys, yet interpretation of regulations varies. Herein, the AST Living Donor Community of Practice (LDCOP) offers seven recommendations to clarify and optimize the ILDA role: (a) the ILDA must have a certain skill set rather than a specific profession, (b) the ILDA must be educated and demonstrate competence in core knowledge components, (c) the ILDA's primary role is to assess components of informed consent, (d) centers must develop a transparent system to define ILDA independence, (e) the ILDA should have a reporting structure outside the transplant center, (f) the ILDA's role should be integrated throughout the donor care continuum, (g) the ILDA role should include a narrow "veto power." We address controversies in ILDA implementation, and offer pathways to maximize benefits and minimize limitations of approaches that may each meet regulatory requirements but confer different practice benefits. We propose a research agenda to explore the impact of the ILDA.

Alberta dairy farm survey response.

All dairy producers in the Canadian province of Alberta were mailed a questionnaire to determine current management practices and production. This survey was undertaken to develop and to plan extension programs based on current dairy producer needs. Of the producers contacted, 802 (57%) responded to the survey questionnaire. The results indicated that the mean herd size was 67 cows, and mean daily milk production was 21.9 kg/d per cow. More than 60% of the producers reported that the majority of their calf losses occurred at birth, and another 15.6% stated that losses occurred within the 1st wk. Less than one-third of the cooperators individually penned calves to prevent contact among calves prior to weaning. Approximately 31% of the cows in the herds surveyed required two or more breedings, partially because of inadequate estrus detection; only 50.3% of the respondents had daily scheduled detection times. The most frequent health concerns perceived by the producers were mastitis, foot problems, and silent estrus. Educational and extension programs should focus on specific areas, such as newborn calf management and reproductive management, to improve the efficiency and profitability of dairy production in Alberta.