Disparities in kidney transplantation accessibility among immigrant populations in Europe: A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: Disparities in access to healthcare for patients with an immigration background are well-known. The aim of this study was to determine whether disparities among immigrant populations translate into a relative difference in the number of kidney transplants (KT) performed in documented immigrant patients (first and second generation) relative to native-born patients in Europe. METHODS: A literature search was performed in PubMed from inception to 11-10-2022. Studies were eligible if: (1) written in English, (2) included immigrant and native-born KT patients, (3) performed in countries registered as Council of Europe members, (4) focused on documented first- and second-generation immigrant populations [1]. Systematic reviews, literature reviews, and case reports or articles about emigration, non-KT, and undocumented immigrants were excluded. The outcome measurement was a relative percentage of KTs to the total population per 100.000 residents. By dividing the immigrant percentages by the native-born resident percentages, the odds ratio (OR) was calculated in a meta-analysis. The risk of bias was assessed; articles with high risk of bias were excluded in a second meta-analysis. RESULTS: Out of 109 articles, 5 were included (n = 24,614). One Italian study (n = 24,174) had a ratio below 1, being 0.910 (95%CI 0.877-0.945). The other four articles (n = 196, n = 283, n = 77, n = 119) had ratios above 1: 1.36 (95%CI 0.980-1.87), 2.04 (95%CI 1.56-2.68), 2.23 (95%CI 1.53-3.25) and 2.64 (95%CI 1.68-4.15). After performing a meta-analysis, the OR did not show a significant difference: 1.68 (95%CI 1.03-2.75). After bias correction, this remained unchanged: 1.78 (95%CI 0.961-3.31). CONCLUSIONS: In our meta-analysis we did not find a significant difference in the relative number of KTs performed in immigrant versus native-born populations in Europe. However, a lesser likelihood for immigrants to receive a pre-emptive kidney transplantation was found. Large heterogeneity between studies (e.g. different sample size, patient origins, study duration, adult vs children patients) was a shortcoming to our analysis. Nevertheless, our article is the first review in this understudied topic. As important questions (e.g. on ethnicity, living donor rate) remain, future studies are needed to address them.

Taking a "Care Pathway/Whole Systems" Approach to Equality Diversity Inclusion (EDI) in Organ Donation and Transplantation in Relation to the Needs of "Ethnic/Racial/Migrant" Minority Communities: A Statement and a Call for Action.

International evidence shows variation in organ donation and transplantation (ODT) based upon a range of patient characteristics. What is less well understood is the impact of patient "ethnicity/race/immigration background," as these terms are defined and intended differently across countries. We also know that these characteristics do not operate in isolation but intersect with a range of factors. In this paper, we propose a framework that seeks to clarify the definition of the key terms "ethnicity/race/migrant" and to review how these communities are operationalized across European studies about inequities in ODT. Further, patients and the public wish to see Equality Diversity Inclusion (EDI) approaches in their everyday lives, not just in relation to ODT. We propose a 'care pathway/whole-systems' approach to ODT encompassing culturally competent public health interventions for a) the prevention and management of chronic diseases, b) improvements in public engagement for the promotion of the culture of ODT and enhancements in end-of-life care, through to c) enhanced likelihood of successful transplant among migrant/ethnic minority communities. Our framework recognizes that if we truly wish to take an EDI approach to ODT, we need to adopt a more social, human and holistic approach to examining questions around patient ethnicity.

Mobile Extracorporeal Membrane Oxygenation Teams for Organ Donation After Circulatory Death.

The shortage of available organ donors is a significant problem worldwide, and various efforts have been carried out to avoid the loss of potential organ donors. Among them, organ donation from cardiocirculatory deceased donors (DCD), in which withdrawal of life-sustaining therapies is ongoing (Maastricht type III donors), is one emerging strategy. Thanks to the latest advances in transplantation and organ preservation, such as normothermic regional perfusion (NRP), ex vivo perfusion techniques, and good organization and communication among prehospital care providers, emergency departments, intensive care units, and transplantation units, DCD is rapidly increasing; it's estimated that it will increase the number of donations of lungs and splanchnic organs by more than 40%. Although Maastricht type II DCD requires a 24/7 available experienced extra corporeal membrane oxygenation (ECMO) team in the institution, Maastricht DCD type III could be organized in secondary care and spoke hospitals without in loco ECMO facilities for NRP. This article analyses a potential mobile team organization based on the hub-and-spoke model, which already exists and functions in Italy, by estimating the dimension of the controlled DCD phenomenon in Italy, coordination requirements, costs, personnel training, and education, and reporting a single center experience in Milan, Italy.

Formación en habilidades de comunicación en estudiantes de medicina de la Facultad de Medicina y Ciencias de la Salud de la Universitat de Barcelona / No disponible

No disponible

Effect of Active and Early Possible Organ and Tissue Donor Detection in the Emergency Room in a University Hospital.

PURPOSE: The emergency room of the hospital is the gateway for patients with severe brain damage due to neurologic or cardiac conditions such as stroke or cardiac arrest. The main purpose is to design an active registry of patients, in the emergency room, to facilitate the detection and follow-up of potential donors according to their clinical evolution. MATERIAL AND METHODS: This is a 1-year prospective study from May 2017 to May 2018 with a register for detection of patients admitted to the emergency room with severe brain damage (Glasgow Coma Scale score ≤ 8), with active follow-up until hospital discharge, who might have died or otherwise become possible organ and tissue donors. RESULTS: One hundred sixty-six (107 men and 59 women) patients met the inclusion criteria: (1) 30.7% recovered from cardiac arrest; (2) 31.3% from stroke; (3) 16.9% from traumatic brain injury and multiple trauma; (4) 10.2% had decreased level of consciousness; (5) 4.8% had other cardiac conditions; and (6) 6.0% had other diagnoses. Seventy-seven out of 166 patients (46.4%) were evaluated as possible organ and tissue donors, with 37 out of 77 (48.0%) of the possible donors becoming real donors. This means that 37 out of 166 (22.3%) of the possible donors admitted to the emergency room became real donors. Twenty-two out of 77 of the patients (28.6%) evaluated had clinical contraindications for donation and in 18 out of 77 (23.4%), there was family refusal for any kind of organ or tissue donation. This record allowed the generation of the following organs and tissues: 4 hearts, 19 livers, 14 lungs, 52 kidneys, 2 pancreata, 29 corneas, 19 donations of bone allografts, 15 donations of skin tissue, 14 donations of valvular allografts, and 11 vascular allografts. CONCLUSIONS: The early and active possible donors registry at the emergency room has facilitated early detection and allow adequate follow-up and evaluation of possible organ and tissue donors.

Situación actual de la formación en comunicación en la Facultad de Medicina y Ciencias de la Salud de la Universitat de Barcelona / Current situation of education in communication abilities in the Faculty of Medicine and Health Sciences of the Barcelona University

Introducción: La comunicación es una competencia fundamental en la formación de los futuros médicos. Objetivos: Conocer la percepción de la comunidad universitaria e identificar la situación actual de la formación en habilidades de comunicación en el Grado de Medicina de la Facultad de Medicina y Ciencias de la Salud de la Universitat de Barcelona. Sujetos y métodos: Análisis descriptivo de las respuestas a tres encuestas diseñadas por método Delphi, dirigidas a profesorado y estudiantes de cuarto y sexto curso durante el período académico 2017-2018. Resultados: La encuesta de profesorado fue respondida por 43 docentes; la de cuarto curso, por 87 alumnos, y la de sexto curso, por 79 alumnos. Los alumnos que respondieron suponían un tercio de los matriculados en esos cursos. Había acuerdo entre los encuestados respecto a la alta importancia de la comunicación y del feedback clínico. Los profesores daban más valor formativo a las clases teóricas que los alumnos, quienes otorgaban más valor a las herramientas con participación activa. Los mini-CEX y el feedback clínico fueron las herramientas consideradas más útiles. La falta de feedback en las evaluaciones clínicas objetivas estructuradas limitaba su utilidad. Los alumnos de cuarto curso utilizaban más herramientas de formación activa que los de sexto. Conclusión: Se detecta una mejora progresiva en la formación en habilidades de comunicación y en la utilización de herramientas docentes activas, pero se identifican áreas y medidas de mejora en la formación de competencias de comunicación de fácil implementación en el grado

Introduction: Communication is a fundamental competence for the university education of the future doctors. Aims: To know the university community perception and to identify the current situation of education regarding communication abilities in the Medicine Bachelor of the Faculty of Medicine and Health Sciences of Barcelona University. Subjects and methods: Descriptive analysis of the obtained answers to three surveys designed by Delphi method, addressed to three subgroups of the university population: professors and students in their fourth and sixth years of the academic year 2017-2018. Results: The survey was answered by 43 professors, 87 fourth-year students and 79 sixth-year students. Around a third of the enrolled students participated. The three populations commonly scored high the importance of communication and feedback of the clinical performance. The professors gave more value to theoretical classes than students did, who scored higher the active teaching tools. Mini-CEX and feedback were the more useful considered tools. The lack of feedback after the objective structured clinical examination limits its use. Fourth-grade students used more active training tools than the sixth-grade students. Conclusion: Evidence shows a progressive improvement in the education in communication abilities and suggests areas of improvement of easy implementation in the education of these skills

Real-Time Polymerase Chain Reaction in Stool Detects Transmission of Strongyloides stercoralis from an Infected Donor to Solid Organ Transplant Recipients.

Solid organ transplant recipients can acquire Strongyloides stercoralis from an infected donor. The diagnosis of S. stercoralis in immunocompromised individuals may be challenging due to a lower sensitivity of available parasitological and serological methods, compared with immunocompetent individuals. Recently, a real-time polymerase chain reaction (RT-PCR) in stool has been developed for S. stercoralis diagnosis. We report two cases of S. stercoralis infection transmitted by a donor to two solid organ transplant recipients, who were diagnosed with RT-PCR in stool. This test could play an important role inS. stercoralis diagnosis in immunosuppressed patients, facilitating rapid treatment initiation and reducing the risk of severe strongyloidiasis. Adherence to current recommendations of screening among donors and recipients from endemic areas is also urgently needed.

Proceso de Bolonia (VI): aprendiendo comunicación para la salud en el Grado de Medicina / Bologna Process (VI): learning health communication in medical undergraduate

La comunicación forma parte de la actividad clínica y en ocasiones determina el éxito o fracaso del proceso asistencial. Sin embargo, no ha sido reconocida en los planes de estudio del Estado español hasta muy recientemente, sobre todo con el impulso del llamado 'Plan Bolonia'. En el año 2009 se aprobó en la Facultad de Medicina de la Universitat de Barcelona un nuevo plan docente que proponía incorporar la enseñanza de la comunicación en las materias clínicas y preclínicas, contabilizando entre 3 y 6 créditos europeos (ECTS), como competencia transversal. El presente artículo aborda el diseño de esta competencia, los pros y contras, cómo se inserta en diferentes asignaturas y cómo puede evaluarse (AU)

Communication is part of the clinical activity and sometimes determines the healthcare success or failure. However it has not been recognized in the Spanish curricula until recently, in the context of the so called Plan Bologna. In 2009 a new teaching plan was approved at Medical School of Barcelona University which intended to incorporate communication in clinical and preclinical areas (3-6 ECTS). In this article we explain pros and cons to introduce communication not as a subject, but as a competency, how can be integrated in different subjects and how can be evaluated (AU)

Presente y futuro de la donación y trasplante de órganos: ¿nos enfrentamos a la crisis del «Modelo Español»? / Present and future of organ donation and transplantation: are we confronting a crisis in the “Spanish Model”?

La donación y trasplante de órganos se enfrenta a nuevos escenarios que pueden inducir la crisis del llamado «Modelo Español». El descenso de los accidentes de tráfico; las campañas de prevención de los factores de riesgo cardiovascular; la mejoría en el tratamiento médico y quirúrgico del paciente neurocrítico; la aplicación de protocolos de «limitación del tratamiento de soporte vital» al final de la vida; el control del ingreso de pacientes sin pronóstico vital en Urgencias; la actuación precoz desde los Servicios de Emergencia extrahospitalarias en el manejo de los pacientes isquémicos con la implementación de protocolos desde la creación de los «códigos infarto agudo de miocardio» o las Unidades de Ictus; son factores que pueden causar descenso de la potencialidad de donación con la consiguiente pérdida del liderazgo mundial si no se produce un proceso de reinvención por parte de las instituciones y del personal involucrado a pesar de las circunstancias médicas y socioeconómicas actuales(AU)

New challenges confronting the process of organ donation and transplantation could lead to a crisis situation in the so called “Spanish Model”. The reduction in traffic accidents; better campaigns to prevent cardiovascular risk factors; improvement in the medical and surgical approach of neurocritical patients; application of protocols for withdrawal of therapeutic efforts together with a restricted hospitalization of patients without vital prognosis performed in Emergency Departments; better acute management of ischaemic patients in extra-hospital emergencies, together with the development of Acute Myocardial Infarction and Stroke Units, are all factors that could have a negative impact in potential organ donors and threaten Spain‘s leadership if the institutions and personnel involved do not work to reinvent the process by confronting the medical and socioeconomic circumstances(AU)