Online Curriculum in Transplant Psychiatry.

BACKGROUND: Transplant psychiatry is a subspecialty of consultation-liaison psychiatry that focused on evaluation, treatment, and research of mental health problems in organ transplant recipients and organ donors. To date, there is no literature about training programs that would ensure psychiatrists acquire the necessary knowledge and skills required to meet the clinical needs of these patients. OBJECTIVES: The author describes the implementation of an online curriculum in transplant psychiatry created at the request of physicians located outside the United States. METHOD: A 3-session online interactive course focused on knowledge relevant to transplant psychiatry was held in the fall of 2018. While the instructor was based in the United States, all attendees were located in Pakistan. The impact of the course was evaluated via precourse and postcourse surveys assessing knowledge level, interest in transplant psychiatry, and level of comfort with transplant psychiatry evaluations in the pretransplantation and posttransplantation settings. RESULTS: Nine participants attended at least one of the 3 sessions, and 6 attended all 3 sessions. There were no significant events regarding the implementation of the curriculum. The response rate to the questionnaire was 100% before the course and 88.8% after the course. Precourse and postcourse tests indicated the curriculum had a positive impact on the level of knowledge and level of confidence in addressing problems relevant to transplant psychiatry. CONCLUSIONS: Online curriculum for highly specialized areas of psychiatry is feasible and can have a positive impact on knowledge levels and confidence in addressing clinical challenges.

The Influence of Age, Gender and Religion on Willingness to be an Organ Donor: Experience of Religious Muslims Living in Sweden.

The transplantation of organs is one of the most successful medical advances in recent decades, and transplantation is the treatment of choice for severe organ failure worldwide. Despite this situation and the general acknowledgment of organ donation (OD) as a global priority, the demand for organs outstrips the supply in virtually every country in the world. The study aims to elucidate whether age, gender and religion influence decision-making about organ donation in religious Muslims living in Sweden Data were collected through three group interviews using open-ended questions and qualitative content analysis. Twenty-seven participants, 15 males and 12 females from four countries, participated in the focus group interviews. The analysis of the collected data resulted in three main categories: "Information and knowledge about organ donation," "The priorities when deciding about organ donation" and "The religious aspects of organ donation," including a number of subcategories. Good information about and knowledge of OD, priorities in OD, importance of the fact that religion must be studied and taught daily and religious education were only a few of the factors informants emphasized as predictors of the total and successful donation of organs. Age, gender or religion did not have an impact on organ donation. High levels of education through religious education and good information via various media, as well as a good knowledge of the Swedish language, are predictors of improved OD. In order to overcome religious ideology as a source of misinformation relating to OD and to promote increased OD in the future, specific intervention studies and the improved involvement of religious communities and education in schools and the healthcare system are vital and must be a starting point for improved OD.

Transplant Surgeon Burnout and Marital Distress in the Sandwich Generation: The Call for Organizational Support in Family Life.

Burnout (emotional exhaustion, depersonalization, and low personal accomplishment) is the enervation an individual experiences from a chronically taxing work environment. Little research has examined the demands of the sandwich generation (both children and older adults in the home) on burnout and marital satisfaction. METHODS: This is a cross-sectional survey of American and European transplant surgeons on the effects of sandwich generation-related demands on burnout and marital satisfaction, covarying for transplant surgeon age. RESULTS: A total of 286 married or partnered transplant surgeons were included. Presence (vs absence) of children in the home did not impact burnout, but those with children who reported difficulties with flexible childcare reported greater emotional exhaustion (P = .03) and depersonalization (P = .02) than those without difficulties. A total of 38.5% of married transplant surgeons reported marital distress. European transplant surgeons reported lower marital satisfaction than those from the United States (P < .01). Having an older adult in the home may also negatively impact transplant surgeons' marital satisfaction (P = .048). DISCUSSION: As health care organizations move forward with programs aimed at creating a sustainable workforce, providing professional environments supportive of important family-related demands is imperative.

Attitudes and Knowledge of Healthcare Professionals Regarding Organ Donation. A Survey of the Saolta University Health Care Group.

Organ donation saves lives and healthcare professionals (HCPs) play a vital role in that process. Therefore, the purpose of this study was to assess the attitudes and level of knowledge of HCPs regarding organ donation. An online anonymous self-administered questionnaire containing 40 questions on organ donation using google forms was created. The survey was distributed to HCPs working in the Saolta University Health Care Group. A hundred and thirty-nine responses were received giving a response rate of 11.8%. HCPs willingness to donate their organs was at 93% compared to 97% willing to receive a transplant. More HCPs understood or had knowledge of the term donation after brain death (64%) than donation after circulatory death (49%). HCPs working in intensive care knew more about the management of brain dead donors than other specialties (p<0.0001). Over 60% of HCPs when asked either disagreed or strongly disagreed with the adequacy of training in organ donation and transplant. Overall, HCPs surveyed had positive attitudes towards organ donation but there was a lack of knowledge particularly among non-intensive care professionals. This study highlights the need to increase awareness along with implementation of educational programmes among HCPs regarding organ donation and transplant.

Facial Disfigurement and Identity: A Review of the Literature and Implications for Facial Transplantation.

Facial disfigurement can significantly affect personal identity and access to social roles. Although conventional reconstruction can have positive effects with respect to identity, these procedures are often inadequate for more severe facial defects. In these cases, facial transplantation (FT) offers patients a viable reconstructive option. However, FT's effect on personal identity has been less well examined, and ethical questions remain regarding the psychosocial ramifications of the procedure. This article reviews the literature on the different roles of the face as well as psychological and social effects of facial disfigurement. The effects of facial reconstruction on personal identity are also reviewed with an emphasis on orthognathic, cleft, and head and neck surgery. Finally, FT is considered in this context, and future directions for research are explored.

Development of a Reliable and Valid Organ Tissue Donation and Transplantation Knowledge Scale.

INTRODUCTION: Knowledge has an important role in an individual's willingness to donate organs upon death. Knowledge enables clarification of false beliefs, which can increase willingness to consent to organ donation. The purpose of the study was to describe and examine the validity and reliability of the Organ-Tissue Donation and Transplantation Knowledge Scale (ODTKS). METHODS: We performed a comprehensive literature review and chose 23 items for the scale according to specialists' recommendations. A total of 6 items were excluded from the scale. Finally, the scale consisted of 17 items and 2 subdimensions. RESULTS: The study group consisted of 540 (267 [49.4%] male and 273 [50.6%] female) nonmedical staff members; 23.5% were primary school graduates, 47.6% were high school graduates, and 28.9% had university degrees or higher. The difficulty index and discrimination index of the overall scale were 22.41% to 54.07% and 0.23 to 0.46, respectively. Cronbach α coefficient was 0.88 overall. Retest reliability scores were significant (r = 0.87, P < .001). CONCLUSIONS: The total score of the ODTKS was significantly higher among university graduates compared with primary school graduates and among people willing to donate. The ODTKS therefore has adequate reliability and validity for evaluating Turkish adults' knowledge about organ tissue donation and transplantation.

Assessing Transplant Attitudes: Understanding Minority Men's Perspectives on the Multifarious Barriers to Organ Donation.

African Americans comprise 11 % of living organ donors, yet constitute 34 % of the kidney transplant waiting list. There are many barriers to organ donation among minorities that include decreased awareness of transplantation, cultural mistrust of the medical community, financial concerns, and fear of the transplant operation. This study investigates the societal misconceptions and demographic health factors that correlate with minority participation in organ and tissue donation. A 57 question Health and Wellness survey was designed to assess participants' demographic information, medical history, professional background, and opinions regarding organ transplantation. Participants were also asked to complete Quality Metric's Short Form-8 (SF-8) survey to assess physical health, mental health, and quality-of-life. Three hundred twenty-six surveys were administered to minority men. The majority of men were identified as African American, and 55 % were below the age of 40. Though 44 % of participants were willing to donate, only 27 % were registered as organ and tissue donors. Minorities who held misconceptions about organ donation-including the belief that they were too old or unhealthy to donate, for example-had lower general, physical, and mental health scores than those who did not (p = <0.0001). Minorities aware of the shortage for organs or who know a registered donor, an organ recipient, a dialysis patient, or someone on the waiting list were more willing to donate organs. Improving the general, physical, and mental health of minorities, coupled with an active educational outreach program, could result in a greater percentage of minorities registering and willing to be organ and tissue donors.

Head Transplants and Personal Identity: A Philosophical and Literary Survey.

The criterion of personal identity is clearly called into question by the project to perform a human head transplant. Is identity provided by psychological continuity alone, or does it depend on bodily continuity as well? And how do these different perspectives interface with our notion of mind and mind-body relationship? The reader will be provided with a discussion concerning these problems, together with a philosophical and literary survey about the conception of body-mind relationship from the Greek thought to contemporary philosophy. The analysis will conclude with a discussion concerning the possibility to consider the issue of personal identity from a statistic point of view, which privileges the general perception of identity, so as it has been shaped by the cultural trends of the last four centuries. It could hence be argued that personal identity is not something which can be defined once and for all. On the contrary, the general perception of identity is subject to significant alterations resulting from one's cultural environment. However, the cultural environment itself can be changed by particularly notable events, such as, hypothetically, the successful outcome of a human head transplant.

Entrevista familiar para doação de órgãos: conhecimentos necessários segundo coordenadores emtransplantes / Entrevista familiar para la donación de órganos: conocimientos requeridos por coordinadores en trasplantes / Family interview for organ donation: necessary knowledge according to coordinators in organ transplants

Objective: this study aimed to understand the importance attached to family interview within steps of organ donation by the multidisciplinary team in transplantation; and identify which skills are required for the interview. Method: a qualitative approach, a hermeneutic study; approved by the Ethics Committee nº 321/11. Data were obtained with twenty-four subjects in the period January/May 2012 by semi-structured interview with eight open questions. Results: family interview is regarded as crucial for the process of donation; it also represents a means of education and emotional support. It is necessary to have technical knowledge, know and believe in the donation process, have personal and professional characteristics specific to accomplish it, as well as know how to deal with family members. Conclusion: interview is recognized as an extremely important moment in this process, representing a crucial point, in which not only the technical knowledge is relevant but also the emotional preparation of the interviewer.

Objetivo: compreender a importância atribuída a entrevista familiar dentro dos passos da doação de órgãos pela equipe multidisciplinar de coordenadores avançados em transplantes; e, identificar quais conhecimentos são necessários para realização da entrevista na visão dos coordenadores. Método: abordagem qualitativa, estudo hermenêutico; aprovado pelo Comitê de Ética nº 321/11. Dados foram obtidos com vinte e quatro sujeitos, no período de jan/mai 2012, por entrevista semiestruturada contendo oito questões abertas. Resultados: a entrevista familiar é considerada como decisiva/determinante para o processo da doação, também representa meio educativo e de apoio emocional. É preciso ter conhecimentos técnicos, saber e acreditar no processo da doação, possuir características pessoais e profissionais específicas para realizá-la, assim como saber lidar com os familiares. Conclusão: a entrevista é reconhecida como um momento de extrema importância no processo, representando um ponto crucial no qual não somente o conhecimento técnico é relevante, mas também o preparo emocional do entrevistador.

Objetivo: este estudio tubo como objetivo entender la importancia que se concede a la entrevista familiar en los pasos de la donación de órganos por el equipo de coordinadores en trasplante; e indique qué habilidades son necesarias para la misma en el concepto de los cordinadores. Método: enfoque cualitativo, estudio hermenéutico; aprobado por el Comité de Ética nº 321/11. Datos se obtuvieron de 24 sujetos en enero/mayo 2012, mediante entrevistas semi–estructuradas. Resultados: la entrevista familiar es considerada como fundamental para el proceso de donación, representa un medio educativo y apoyo emocional. Se necesita experiencia, saber y creer en el proceso de donación, tener características personales y profesionales específicas para lograrla, así como la forma de tratar con los miembros de la familia. Conclusión: la entrevista es reconocida como un momento muy importante en el proceso, representa punto crucial que no sólo el conocimiento técnico es importante, pero también la preparación emocional del entrevistador.

Knowledge of, beliefs about, and perceived barriers to organ and tissue donation in Serbian, Macedonian, and Greek Orthodox communities in Australia.

CONTEXT: Despite the lifesaving benefits of organ and tissue donation, a worldwide shortage of suitable and registered donors exists. Although the reasons for this shortage are multifactorial, it has been recognized that distinct barriers to registration, family discussion, and consent that require targeted intervention and action are present among minority cultural, religious, and immigrant communities. OBJECTIVE: To explore the knowledge, attitudes, and beliefs of 3 orthodox religious communities in Australia (Macedonian, Greek, and Serbian Orthodox) and determine the implications for engaging with these communities to improve knowledge, attitudes, family discussion, and the ability to make an informed decision about donation. DESIGN: Qualitative approach using focus groups moderated by researchers and bicultural health workers with the assistance of accredited interpreters. PARTICIPANTS: 98 adult members of the Greek, Macedonian, and Serbian Orthodox communities in the Illawarra region of New South Wales, Australia. RESULTS: Clear barriers to discussing and making an informed decision about organ and tissue donation were identified. Knowledge of processes and procedures was low and discussion about death (and organ and tissue donation) with family members and loved ones was considered taboo. Despite these barriers, all 3 communities expressed a desire for more information and engagement. Of particular interest were the perspectives of 3 types of "experts": medical, religious, and other community members (who had experience with the organ and tissue donation system). Future programs designed for orthodox religious communities should consider the need for active strategies that facilitate information sharing and engagement between community members and these 3 types of experts.

Health-related quality of life in pediatric intestinal transplantation.

To determine HRQOL after pediatric intestinal transplantation. Thirty-four IT survivors from 1999 to 2012 were asked to complete age-specific HRQOL non-disease-specific questionnaires: TAPQOL (0-4 yr), KINDL-R (5-7 yr; 8-12 yr; 13-17 yr), and SF-36v2 (>18 yr), all validated with Spanish population. Primary caregiver completed a SF-36 questionnaire and CBI. Thirty-one participants were included. Median age was 10.2 yr (1-29) and time after transplant 4.4 yr (0-13). Overall patient scores were 78.2 ± 10.6 (n = 8), 83.3 ± 9.7 (n = 6), 72.2 ± 9.21 (n = 6), 80.5 ± 12.4 (n = 7), and 82.2 ± 12.4 (n = 4) for each age group. Highest scores were obtained for vitality (group I), self-esteem (group IV), and physical and social functioning and emotions (group V). Lowest scores were obtained in appetite and behavior (I), family and school (III), and chronic disease perception (III, IV). No significant differences were found between caregivers and their children. CBI showed stress in 52%. SF-36 for caregivers was lower than general population. No significant differences were found depending on relevant clinical and sociodemographic data. HRQOL was acceptable and improved with age and time since transplantation. Parents had a slighter own QOL and worse perception of health than their children. When successful, intestinal transplantation allows a normal life in most patients and can be offered as an attractive option.

Post-transplant adjustment--the later years.

As survival rates for pediatric solid organ transplantation have continued to improve, researchers and healthcare providers have increasingly focused on understanding and enhancing the HRQOL and psychosocial functioning of their patients. This manuscript reviews the psychosocial functioning of pediatric transplant recipients during the "later years," defined as more than three yr post-transplant, and focuses on the day-to-day impact of living with a transplant after the immediate period of adjustment and early years after surgery. Key topics reviewed include HRQOL, cognitive functioning, impact on the family, regimen adherence, and transition of responsibility for self-management tasks. Overall, pediatric transplant recipients evidence impairment in HRQOL, neuropsychological outcomes, and family functioning as compared to non-transplant recipients. However, the degree of impairment is influenced by a variety of factors including, disease severity, age, solid organ type, and study methodologies. Studies are limited by small samples, cross-sectional design, and the lack of universal assessment battery to allow for comparisons across solid organ populations. Areas for future research are discussed.

For the sake of others: reciprocal webs of obligation and the pursuit of transplantation as a caring act.

This article highlights reciprocal webs of care and moral obligations toward kin during transplantation, using an expansive notion of "care" to include both its obvious and more hidden forms. Evidence from 24 months of ethnographic fieldwork among transplant patients, their loved ones, and clinical personnel in the U.S. Midwest suggests that patients are simultaneously caregivers to others and are considered vital members of reciprocal webs of care without whom their kin networks could not effectively operate. Transplantation can become a person's main, perhaps only hope of fulfilling ongoing obligations to others, so pursuing a transplant becomes not a matter of choice, but rather a moral orientation. A potential implication of these findings is that rather quotidian and conventional (even if contested) notions of what kin ought to do and be for each other may be among the underpinnings of high-tech biomedical practices like transplantation.

Los trasplantes de órganos y tejidos y sus impacto pscosocial / Organ and tissue transplantations and their psychosocial impact

La enorme difusión alcanzada en las últimas décadas por los trasplantes de órganos y tejidos en la población infantil, ha puesto de manifiesto la complejidad e importancia de los factores psicosociales asociados a los mismos. Las indicaciones de la técnica, su preparación, los periodos de hospitalización, la fase postrasplante y su seguimiento posterior precisan de un cuidadoso y constante apoyo psicosocial por personal cualificado. Se estudian las sucesivas fases del trasplante, los trastornos psiquiátricos más comúnmente asociados a estas terapias, la calidad de vida de los pacientes y el ajuste psicosocial a su etapa vital posterior (AU)

The enormous diffusion reached in recent decades by organ and tissue transplantations in the child population has manifested the complexity and importance of the psychosocial factors associated to them. The indications of the technique, its preparation, hospitalization periods, post-transplantation phase and its subsequent follow-up require careful and continuous psychosocial support by qualified personnel. The successive phases of the transplantation, psychiatric disorders most commonly associated to these therapies, quality of life of the patients and psychosocial adjustment to their subsequent life stage are studied (AU)

[Preoperative evaluation of the body concept of donors and recipients of living kidney donations]. / Präoperative Evaluation des Körperkonzepts von Nierenlebendspendern und -empfängern.

OBJECTIVES: The psychosocial evaluation of the body concept of living kidney donors and recipients is part of a general psychosocial assessment as well as the early detection of organ integration disorders. METHODS: From 2010 to 2011 we investigated the eligibility for living kidney donation in 36 living kidney donors and 36 recipients using a semistructured clinical interview and the German version of the Transplant Evaluation Rating Scale (TERS). In addition, we used the Fragebogen zum Körperbild (FKB-20) to evaluate body concept. RESULTS: Living kidney donors and recipients differed in their body concept. Living kidney recipients described a body-centered disturbance stemming from a reduction of body-intensive activities including destabilization of body concept. CONCLUSION: The psychological coping process involved in living kidney donation demands a reconstitution of the body self. The coping/health behavior and the affective state of living kidney recipients are protective factors that influence successful organ integration.