Reasons for refusing a donor heart for transplantation in Brazil.

BACKGROUND: Major advances have been made in heart transplantation, but there is a discrepancy between the number of patients potentially treatable by transplantation and the limited number of viable grafts. The aim of this study was to evaluate the reasons for refusal of donor hearts. METHODS: This was a retrospective analysis of donor data from an organ procurement organization in the state of São Paulo (Brazil) between 2010 and 2012. Fisher's exact test, Student's t-test, and the Mann-Whitney U-test were used in the statistical analysis. RESULTS: Only 26 (7.9%) of 328 potential heart donors actually became donors. Most donors were men (18/26, 69.2%), Caucasians (14/26, 53.8%), and had a mean age of 23.5 yr. There were significant associations of use of donor hearts with the variables: brain death after trauma (p = 0.002), history of hypertension (p = 0.001), electrocardiographic changes (p = 0.007), and age (p = 0.001). Older age (n = 101, 33.4%) was the main reason for refusal of donor hearts, followed by poor medical history (n = 44, 14.6%), cardiac arrest of the donor during donor care (n = 25, 8.3%), use of vasopressor drugs (n = 23, 7.6%), and hemodynamic instability (n = 20, 6.6%). CONCLUSIONS: Age, poor medical history, cardiac arrest, use of vasopressors, and hemodynamic instability were the most prevalent reasons for refusal of donor hearts. Echocardiogram evaluation is a potential intervention to improve heart transplantation conversion in Brazil.

Reasons for refusing a donor heart for transplantation in Brazil

BACKGROUND:Major advances have been made in heart transplantation, but there is a discrepancy between the number of patients potentially treatable by transplantation and the limited number of viable grafts. The aim of this study was to evaluate the reasons for refusal of donor hearts. METHODS: This was a retrospective analysis of donor data from an organ procurement organization in the state of São Paulo (Brazil) between 2010 and 2012. Fisher's exact test, Student's t-test, and the Mann-Whitney U-test were used in the statistical analysis. RESULTS: Only 26 (7.9%) of 328 potential heart donors actually became donors. Most donors were men (18/26, 69.2%), Caucasians (14/26, 53.8%), and had a mean age of 23.5 yr. There were significant associations of use of donor hearts with the variables: brain death after trauma (p = 0.002), history of hypertension (p = 0.001), electrocardiographic changes (p = 0.007), and age (p = 0.001). Older age (n = 101, 33.4%) was the main reason for refusal of donor hearts, followed by poor medical history (n = 44, 14.6%), cardiac arrest of the donor during donor care (n = 25, 8.3%), use of vasopressor drugs (n = 23, 7.6%), and hemodynamic instability (n = 20, 6.6%)...

The effectiveness of interventions in managing treatment adherence in adult heart transplant patients: a systematic review.

BACKGROUND: Over the past 20 years, solid organ transplantation has evolved from experimental treatments to an effective alternative for the treatment of various diseases, including heart failure. Treatment non-adherence is a limiting factor for the success of heart transplants. A systematic review of the evidence is needed to examine the effectiveness of interventions for managing adherence to treatment in heart transplant patients. OBJECTIVE: The primary objective of this systematic review was to synthesize the best available evidence regarding interventions for managing adherence to pharmacological and non-pharmacological treatments in heart/heart-lung transplant patients. INCLUSION CRITERIA: This review considered primary studies that included patients 18 years old or older, who had undergone heart or heart-lung transplantation (regardless of gender, ethnicity, comorbidities or whether they had received other treatments or not) who were receiving pharmacological and non-pharmacological treatments.This review considered studies that evaluated the effectiveness of interventions in managing adherence to pharmacological or non-pharmacological treatments among adult heart/heart-lung transplant patients. Primary studies comparing standard care with any type of intervention to maintain treatment adherence were considered.This review considered any experimental study design including randomized controlled trials; other research designs, such as non-randomized controlled trials and before and after studies, were also considered for inclusion.The primary outcome considered was patient adherence to pharmacological or non-pharmacological treatments by means of objective or self-report assessment. SEARCH STRATEGY: Published and unpublished studies in English, Portuguese and Spanish were searched in electronic databases. Searches were completed in January 2014. METHODOLOGICAL QUALITY: Two independent reviewers, using the standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument, assessed methodological quality. DATA EXTRACTION: Data were extracted using the standardized data extraction tool from Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. DATA SYNTHESIS: Statistical pooling was not possible due to substantial heterogeneity of the studies; therefore data were presented as a narrative summary. RESULTS: Three quasi-experimental studies were included in this review. One study found that a dose reduction of immunosuppressive medications from a twice-daily to a once-daily regimen had a positive impact on treatment adherence; one found no significant difference in treatment adherence between patients who received educational intervention conducted in a teaching laboratory and those who received standard care; the third one also reported no significant difference in outcomes between a multifaceted intervention consisting of internet-based interactive workshops and standard care. CONCLUSIONS: The current best evidence to guide decisions regarding interventions to manage treatment adherence in heart transplant patients is limited. There is weak evidence that psycho-educational interventions (other than the standard care) has a positive impact on adherence and that decreasing the complexity of the treatment regimen by reducing the daily dose of the immunosuppressant drug improves adherence in heart transplant patients.

Comparative analysis of family consent to tissue donation according to two different donation form structures.

OBJECTIVE: To define donors' profile of an Organ and Tissue Procurement Center and compare the family consent for tissue donation before and after modification of the Donation Term. METHODS: A descriptive, documentary and quantitative study performed in an Organ and Tissue Procurement Center, analyzed 111 feasible donors' charts in the period from March 13 to September 13, 2010 (1st period), and from September 14, 2010 to March 14, 2011 (2nd period), based on the modification date. RESULTS: The mean age of donors was 45.2 years, being 52.3% female. The causes of death included cerebral vascular accident (stroke) (64%), head trauma (27%), anoxic encephalopathy (2.7%), firearm injuries (2.7%) and others (3.6%). The notifications were predominantly of spontaneous origin (91%). Comparing the periods before and after the modification of the Donation Term, the donation consent for cornea increased by 17.2% and the consent for skin, bones, tendons and muscles had a discreet increase by 3.1%, 9.9% and 0.4%, respectively. On the other hand, there was decrease in consent for blood vessel (0.8%) and heart valves (4.1%) between the two periods. CONCLUSION: There was increase in family consent for donation of most tissues, but it was statistically significant only for cornea donation.

Comparative analysis of family consent to tissue donation according to two different donation form structures / Análise comparativa do consentimento familiar para doação de tecidos em função da mudança estrutural do termo de doação

Objective To define donors’ profile of an Organ and Tissue Procurement Center and compare the family consent for tissue donation before and after modification of the Donation Term. Methods A descriptive, documentary and quantitative study performed in an Organ and Tissue Procurement Center, analyzed 111 feasible donors’ charts in the period from March 13 to September 13, 2010 (1st period), and from September 14, 2010 to March 14, 2011 (2nd period), based on the modification date. Results The mean age of donors was 45.2 years, being 52.3% female. The causes of death included cerebral vascular accident (stroke) (64%), head trauma (27%), anoxic encephalopathy (2.7%), firearm injuries (2.7%) and others (3.6%). The notifications were predominantly of spontaneous origin (91%). Comparing the periods before and after the modification of the Donation Term, the donation consent for cornea increased by 17.2% and the consent for skin, bones, tendons and muscles had a discreet increase by 3.1%, 9.9% and 0.4%, respectively. On the other hand, there was decrease in consent for blood vessel (0.8%) and heart valves (4.1%) between the two periods. Conclusion There was increase in family consent for donation of most tissues, but it was statistically significant only for cornea donation. .

Objetivo Traçar o perfil dos doadores viabilizados por um Serviço de Procura de Órgãos e Tecidos e comparar o consentimento familiar para doação de tecidos antes e após esta modificação do Termo de Doação. Método Estudo descritivo, documental, quantitativo, realizado em um Serviço de Procura de Órgãos e Tecidos, analisou 111 prontuários de doadores viabilizados nos períodos de 13 de março a 13 de setembro de 2010 (1o Período) e de 14 de Setembro de 2010 a 14 de Março de 2011 (2o período), selecionados com base na data desta modificação. Resultado Foi encontrada média de idade de 45,2 anos entre os doadores, sendo 52,3% do sexo feminino. As causas de morte incluem acidente vascular encefálico (64%), traumatismos cranioencefálicos (27%), encefalopatias anóxicas (2,7%), ferimentos por arma de fogo (2,7%) e outras (3,6%). As notificações foram predominantemente de origem espontânea (91%). Comparando os períodos antes e após a modificação do Termo de Doação, o consentimento para doação de córneas apresentou aumento de 17,2% e para doação de pele, ossos, tendões e músculos, discreto aumento de 3,1%, 9,9% e 0,4% respectivamente. Por sua vez, apresentou discreta diminuição o consentimento de vasos sanguíneos, de 0,8%, e valvas cardíacas de 4,1%, entre os períodos. Conclusão Obteve-se um aumento do consentimento familiar para a doação da maioria dos tecidos, porém com significância estatística apenas para doação de córneas. .

Efetividade de intervenções para o manejo da adesão ao tratamento para pacientes adultos submetidos ao transplante cardíaco: uma revisão sistemática / The effectiveness of interventions to manage treatment adherence of adult patients undergoing heart transplant: a systematic review

Introdução: A falta de adesão ao tratamento é fator limitante para o sucesso dos transplantes de coração, pois contribui para o aumento da morbidade e mortalidade, reduz a qualidade de vida e aumenta os custos referentes ao uso de serviços de saúde. Objetivo: Sintetizar as melhores evidências sobre as intervenções para o manejo da adesão ao tratamento farmacológico e não farmacológico no transplante cardíaco. Método: Revisão sistemática de literatura por meio de busca de estudos publicados e não publicados nas seguintes bases: CINAHL, EMBASE, ProQuest dissertations and theses, PsycINFO, MEDLINE/Pubmed, SCOPUS, Web of Science e banco de Teses da Capes. Foram critérios de inclusão: estudos clínicos com pacientes adultos depois de transplante cardíaco, que tivessem testado o impacto de qualquer intervenção na adesão ao tratamento, avaliada objetivamente ou por auto-relato, usando instrumentos válidos e confiáveis, comparada ao cuidado usual. A qualidade metodológica dos estudos elegíveis foi realizada por dois revisores independentes e as discordâncias foram resolvidas por consenso. Os resultados foram integrados de forma narrativa. Resultados: Foram identificadas 2.519 citações potencialmente relevantes. Excluídos 1.336 por repetição, restaram 1.183 citações que tiveram seus resumos lidos e, após a aplicação de critérios de inclusão, restaram sete publicações para análise da qualidade metodológica.Quatro estudos foram excluídos e os principais motivos foram a falta de avaliação de intervenção (dois estudos), estudo teórico (um estudo) e a adesão ao tratamento não ter sido o foco da intervenção estudada (um estudo). Um dos estudos mantidos não detectou diferença entre intervenção educativa realizada em laboratório de ensino comparada a cuidado usual; outro estudo também não detectou diferença entre uma intervenção multifacetada, composta por oficinas interativas, oferecida pela internet comparada a cuidado usual; e o terceiro detectou impacto positivo da diminuição na dose diária do imunossupressor, de duas vezes ao dia para uma vez. Com relação ao método, dois estudos utilizaram ensaio clínico controlado não randomizado e um foi descritivo / observacional. Conclusões: As evidências disponíveis para orientar decisões sobre intervenções para controlar a adesão do paciente submetido ao transplante de coração ainda são escassas. A realização de ensaios clínicos randomizados, com alta qualidade metodológica, é fundamental para fornecer evidencias mais robustas sobre o manejo da adesão no transplante cardíaco.

Introduction: Treatment adherence failure is a limiting factor for effective heart transplants, as it contributes with increased morbidity and mortality and a reduced quality of life in addition to increasing health service costs. Objective: To synthesize the best available evidence regarding interventions for managing adherence to pharmacological and non-pharmacological treatments in heart transplant patients. Method: Systematic literature review by searching published and unpublished studies on the following databases: CINAHL, EMBASE, ProQuest dissertations and theses, PsycINFO, MEDLINE/Pubmed, SCOPUS, Web of Science and the Capes Thesis database. The inclusion criteria were: clinical studies with adult heart transplant patients, which tested the impact of any intervention over treatment adherence, evaluated objectively or through self-reports, using validated and reliable instruments, compared to common care. Two independent raters assessed the methodological quality of the eligible studies and any disagreements were solved by consensus. The results were integrated in a narrative form. Results: A total of 2.519 potentially relevant statements were identified. Of the total, 1.336 were repeated, and, therefore, excluded. The abstracts of the remaining 1.183 statements were read and, after considering the inclusion criteria, seven publications were analyzed in terms of their methodological quality. Four studies were excluded mainly because they did not present an evaluation of the intervention (two studies), one was a theoretical study, and one study was not center the investigation on treatment adherence.On of the selected studies did not find any difference between the educational intervention performed in a teaching laboratory compared to common care; another study also did not find any difference between one multiple intervention, comprised of online interactive workshops, compared to common care; and the third study found a positive impact from reducing the immunosuppressant dose from twice to once a day. Regarding the method, there were two non-randomized clinical trials and one descriptive/observational study. Conclusions: The current best evidence to guide decisions regarding interventions to manage treatment adherence of heart transplant patients remain scant. Randomized clinical trials with high methodological rigor are key to obtain more robust evidence regarding treatment adherence management in heart transplants.

Doador dominó de coração: possibilidade de aproveitamento das valvas cardíacas / Domino donor heart: possibility of using cardiac valves

Introdução: As valvopatias destacam-se dentre as cardiopatias cirúrgicas, principalmente em nosso meio, sendo que muitas vezes aconservação da valva é difícil pelo extenso acometimento e a sua substituição torna-se imperativa. Entre os substitutos valvares, as prótesese biopróteses, os substitutos homólogos apresentam vantagens especiais; porém, seu maior fator limitante é a dificuldade de obtenção. Diantedessa situação, os corações nativos explantados nos transplantes podem representar importante fonte de oferta dos substitutos valvares.Objetivo: Verificar a real possibilidade de aproveitamento das valvas cardíacas oriundas de corações nativos explantados de transplantecardíaco. Método: Estudo do tipo exploratório, descritivo e documental, realizado em hospital da rede estadual de São Paulo, referenteao atendimento a doenças cardiovasculares. Resultados: A amostra foi composta por 202 corações de pacientes submetidos a transplante,sendo 155 (76,7%) homens e 47 deles com idade entre 56-70 anos (31,1%). Em relação à etiologia da cardiomiopatia, encontravam-seassim distribuídas: 51 (25,2%) possuíam tal informação, e destes, a mais frequente foi cardiomiopatia dilatada em 16 casos (31,4%). Dos202 corações analisados, 114 (56,4%) a avaliação foi possível, sendo que destes, 69 (59,6%) laudos relataram que as valvas não possuíamalteração, enquanto 46 (40,4%) informavam presença de alteração valvar. As valvas cardíacas com menos frequência de alterações foramas pulmonares, em 82 (71,9%) casos e aórtica em 81 (71,1%). Conclusão: O estudo anatomopatológico de corações retirados de receptorescardíacos mostrou a existência de valvas cardíacas que poderiam ser utilizadas em transplante valvar, em especial da valva aórtica.

Perfil dos doadores efetivos de múltiplos órgãos e tecidos viabilizados pela organização de procura de órgãos de uma instituição pública de cardiologia / Profile of effective donors of multiple organs and tissues by the Organ Procurement Organization in a public institution of cardiology

Estudo realizado na Organização de Procura de Órgãos (OPO) do Instituto Dante Pazzanese de CArdiologia, com objetivo de descrever o perfil dos doadores de órgãos e tecidos viabilizados. Objetivo: Caracterizar os doadores entre 1998 e 2005 quanto ao sexo, idade, estado civil, cor, escolaridade, causa da morte encefálica (ME), tipo de notificação , setor notificante , setor notificante , reponsável legal pela doação, órgãos/estado civil, cor, escolaidade, causa da morte encefálica (ME), tipo de notificação, setor notificante, repo, reponsável legal pela doação, órgãos/tecidos disponibilizados, e, posteriormente, relacionar as causas da ME com sexo e idade. Método: Exploratório, descritivo , documental. Resultado: A amostra totalizou 241 doadores, prevalecendo o sexo masculino em 151 (62,7%) casos, com faixa etária entre 7 a 74 anos , 116 (48,1%) solteiros, 174 (72,2%) de raça branca e 103 (42,7%) com ensino fundamental incompleto. Do total das notificações ,205 (81%) foram notificados pelo hospital de origem do potencial doador, prevalencendo a Unidade de Terapia Intensiva com 123 (51%) casos. Como causas da ME, destacam-se Traumatismo Crânio-Encefálico (TCE) com 94 (39%) casos e Acidente Vascular Envefálico Hemorrágico (AVEH)com 63 (26,1%) dos casos. Em relação aos responsáveis pela doação, 118(49%) dos casos possuíam parentesco de 1.º grau. Os órgãos/tecidos mais captados foram: coração 132 (54,8%), fígado 210 (87,1%), rim 428 (88,8%) e córneas 191 (79,3%). Comparando as causas de ME com sexo e idade , observou-se maior incidência de AVEH em mulheres, com 38 (42,2%) casos e idade média de 43.6 ano; nos homens houve predomínio de TCE, 76 (50,7%)casos, e ferimento por arma de fogo com 2 (16%) casos. Conclusão: Houve predomínio de doadores do sexo masculino, solteiros , tendo como causa de morte encefálica traumas e doenças vasculares, além de menor número de captação de pulmões, intestinos e pâncreas, bem como valvas, ossos, vasos, pele, músculos e tendões.