Design and implementation of the European-Mediterranean Postgraduate Programme on Organ Donation and Transplantation (EMPODaT) for Middle East/North Africa countries.

This prospective study reports the design and results obtained after the EMPODaT project implementation. This project was funded by the Tempus programme of the European Commission with the objective to implement a common postgraduate programme on organ donation and transplantation (ODT) in six selected universities from Middle East/North Africa (MENA) countries (Egypt, Lebanon and Morocco). The consortium, coordinated by the University of Barcelona, included universities from Spain, Germany, Sweden and France. The first phase of the project was to perform an analysis of the current situation in the beneficiary countries, including existing training programmes on ODT, Internet connection, digital facilities and competences, training needs, and ODT activity and accreditation requirements. A total of 90 healthcare postgraduate students participated in the 1-year training programme (30 ECTS academic credits). The methodology was based on e-learning modules and face-to-face courses in English and French. Training activities were evaluated through pre- and post-tests, self-assessment activities and evaluation charts. Quality was assessed through questionnaires and semi-structured interviews. The project results on a reproducible and innovative international postgraduate programme, improvement of knowledge, satisfaction of the participants and confirms the need on professionalizing the activity as the cornerstone to ensure organ transplantation self-sufficiency in MENA countries.

Do kidney transplantations save money? A study using a before-after design and multiple register-based data from Sweden.

BACKGROUND: The health care costs of kidney transplantation and dialysis are generally unknown. This study estimates the Swedish health care costs of kidney transplantation and dialysis over 10 years from a health care perspective. METHOD: A before-after design was used, in which the patients served as their own controls. Health care costs the year before transplantation were assumed to continue in the absence of a transplant and the cost savings was therefore calculated as the difference between the expected costs and the actual costs during the 10-year follow-up period. Factors associated with the size of the cost savings were studied using ordinary least-squares regression. RESULTS: Altogether 66-79% of the expected health care costs over 10 years were avoided through kidney transplantation, resulting in a cost savings of €380 000 (2012 price-year) per patient. Savings were the highest for successful transplantations, but on average the treatment was cost-saving also for patients who returned to dialysis. No gender or age differences could be found, with the exception of a higher cost of transplantation for children and a generally higher cost for younger compared with older patients on dialysis. A negative association was also found between age at the time of transplantation and the size of the cost savings for the younger part of the sample. CONCLUSION: Kidney transplantations have led to substantial cost savings for the Swedish health care system. An increase in donated kidneys has the potential to further reduce the cost of renal replacement therapy.

Effects of Kidney Transplantation on Labor Market Outcomes in Sweden.

BACKGROUND: Kidney transplantation is considered a superior treatment for end-stage renal disease compared with dialysis although little is known about the wider effects, especially on labor market outcomes. The objective is to estimate the treatment effect of kidney transplantation compared with dialysis on labor market outcomes, controlling for the nonrandom selection into treatment. METHODS: The average treatment effect is estimated using an inverse-probability weighting regression adjustment approach on all patients in renal replacement therapy 1995 to 2012. RESULTS: Kidney transplantation is associated with a treatment advantage over dialysis on employment, labor force participation, early retirement, and labor income. The probability of being employed 1 year after treatment is 21 (95% confidence interval, 16-25) percentage points higher for transplantation. The positive effect increases to 38 (95% confidence interval, 30-46) percentage points after 5 years, mainly due to worsening outcomes on dialysis. The effect on labor income is mainly mediated through employment probability. The productivity gains of transplantation compared to dialysis amounts to &OV0556;33 000 over 5 years. CONCLUSIONS: Transplantation is superior to dialysis in terms of potential to return to work as well as in terms of labor income and risk of early retirement, after controlling for treatment selection. This positive effect increases over time after transplantation.

Obstacles to organ donation in Swedish intensive care units.

OBJECTIVE: To identify obstacles to organ donation in Swedish intensive care units. DESIGN: A survey exploring attitudes and experiences of organ donation activities was sent to half of all anaesthetists and all neurosurgeons in Sweden (n=644). Total response rate was 67%; 69% from the anaesthetists and 54% from the neurosurgeons. RESULTS: Neurosurgeons had more experiences of caring for potential donors and requesting donation than anaesthetists. Twenty-seven percent of the anaesthetists were not confident with clinical neurological criteria for brain incarceration. Nine per cent found donation activities solely burdensome, and 14% wanted an external team to take over the donation request. A quarter regarded the request definitely as an extra load on the family, and more than half of the respondents had refrained from asking in emotionally strained situations. Forty-nine per cent had a neutral approach to relatives when requesting donation while 38% had a pro-donation approach. Thirty-six per cent terminated ventilator treatment for a potential donor without waiting for total brain infarction. Lack of resources in the ICUs resulted in not identifying a possible donor according to 29% of respondents. Knowing the prior wish of the deceased was regarded as the single most important factor that facilitated the work with organ donation for the intensivists. CONCLUSIONS: The identified obstacles (neutral approach of donation request, ethical problems concerning the potential donor and the relatives, varying competence in diagnosing total brain infarction, and lack of intensive care bed resources) require tailored efforts in order to increase organ donation. Checking these factors can be used as a quality control when analysing donation activities at hospitals.

[Obstacles for recruiting organ donors in intensive care units can be overcomed. Identified obstacles are attitudes, ethics, resources and competence, as shown by an inquiry]. / Hindren för organdonation i intensivvården kan överbryggas.

The aim of this study was to identify obstacles for recruiting organ donors in the ICU. All specialists in neurosurgery and half of the specialists in anaesthesiology in Sweden were surveyed. Response rate was 67%. The following obstacles were identified: A neutral approach of the physicians when requesting organ donation of the families instead of a pro-donation approach; ethical problems concerning non-therapeutic ventilation and requesting donation of grieving families; varying competence in diagnosing brain infarction; lack of resources at the ICU. Suggestions for organizational and educational improvements are given.