Qualitative Research Process Applied to Organ Donation.

The family interview for organ donation continues to be one of the main concerns of transplant coordinators. We approach the family because we need to know the opinion of the person who has just died about the donation of his or her organs. The objective of this article is to describe how the application of the qualitative methodology has been followed to perceive what the relatives live in the moment in which they are informed of the death of their relative and they are offered the option of organ donation. Phenomenology is a philosophy that deals with the granting of meanings. It can simply describe or try to interpret them. Our informants were selected from among donor families until the 11 families were obtained. We use the Giorgi method because it allows us to identify the essence of a phenomenon and transform the lived experience into a textual expression of its essence. The unit of analysis was, each of the statements of the discourse that describes and interprets a reality, what we call "essence" or "meaning units." It must be the minimum expression of an episode and the experience in relation to it. We have detected 24 themes of the meaning units are most important for families in our area. Families agree on talking about donation, mourning, death, consolation from the donation, and the importance of the support received. Phenomenology is adequate to deepen into the feelings and interests of families in the process of donation.

Does multiorgan donation influence survival in heart transplantation?

UNLABELLED: Current heart transplant survival in Spain at 1, 5, and 10 years is 80%, 70%, and 60%, respectively. Our objective was to establish how donor type affects survival in heart transplantation. MATERIALS AND METHODS: This was a retrospective study of heart transplant recipients from 102 donors, divided into three types: (a) heart-liver-kidney donors (group I); (b) heart-liver-kidney-lung donors (group II); and (c) heart-liver-kidney-lung-pancreas donors (group III). We excluded retransplantations, pediatric transplantations, and cardiopulmonary transplantations. The outcome variable was the actuarial survival by type of donation. Statistical analysis was performed for event-free survival based on the Kaplan-Meier method (log-rank test). RESULTS: Groups I, II, and III included 63, 26, and 13 donors, respectively. The survival curves showed similar values for all three groups (P > .05). CONCLUSIONS: The different combinations of multiorgan donation do not entail a poorer prognosis in terms of cardiac transplant patient survival.

Study of the evolution of the clinical profile of heart donors.

UNLABELLED: Certain characteristics of the donor have implications for the early and late survival of transplants. The trends show a progressive worsening in the clinical profile of heart donors. Our objective was to analyze changes in the clinical characteristics of donors. MATERIALS AND METHODS: This retrospective study of 396 donors was divided into three periods: 1990 to 1994, 1995 to 1999, and 2000 to 2004. We excluded combination transplantations, retransplantations, and pediatric transplantations. The donor variables included age, cause of death, cardiorespiratory arrest, ICU stay, and ischemia time. Statistical analysis used ANOVA, Kruskall-Wallis, and Chi square test, with significance set at P < .05. RESULTS: Differences were found in age (1990-1994: 27 +/- 1, 1995-1999: 29 +/- 1, 2000- 2004: 34 +/- 1 years; P = .0001), ischemia time (1990-1994: 119 +/- 6, 1995-1999: 145 +/- 4, 2000-2004: 156 +/- 4 minutes; P = .0001), and death from brain hemorrhage (1990-1994: 28%, 1995-1999: 31%, 2000-2004: 43%; P = .031). CONCLUSIONS: There were differences in the clinical characteristics of the donors in the study periods. The age of the donor, stroke-related deaths, and ischemia time have increased significantly in recent years.

Study on health-related quality of life in patients with advanced heart failure before and after transplantation.

UNLABELLED: Our objective was to evaluate health-related quality of life in patients with advanced heart failure on the waiting list for a heart transplant. MATERIALS AND METHODS: The study was performed using the EUROQOL-5D questionnaire (EQ-5D) on 38 patients (age: 53 +/- 2 years, 82% men) who were analyzed consecutively during the pretransplant period, as well as at 3, 6, and 12 months after transplantation. We excluded pediatric transplants, retransplantations, heart and lung transplantation, and patients scoring below 17 points on the Folstein's Cognitive Mini-Examination. The studied variables included the five dimensions of the EQ-5D test: mobility, self-care, daily activities, pain-discomfort, anxiety and depression; a visual analog scale from 0 to 100; and perception of health status. Statistics included analysis of variance and chi-square tests. Significance was set at P < .05. RESULTS: There were significant differences in all tested parameters. The worst values were observed prior to transplantation, with a significant improvement at 3 months. CONCLUSIONS: Patients with heart failure showed a significant impairment in health-related quality of life before transplantation. The improvement in health-related quality of life was significant and rapidly evident in the posttransplantation period. The most affected dimensions were activities of daily living and pain-discomfort. All dimensions became stable at 3 months, except for anxiety and depression. At 6 to 12 months, a plateau was reached in the feelings of well-being.

Impact of organ donation in Spanish families: phenomenological approach through relatives' lived experiences.

INTRODUCTION AND PURPOSE: This study explores the family experience when they are told that their recently deceased relative is in a potential position for organ donation, as well as the connotations that develop from that situation and how those nuances have lasted since then for family members. In Spain, and especially in Valencian region (where this study took place), one of the most productive counties for organ donation nationwide, the family interview is considered to be one of the most important tools that transplant coordinators can use to improve and succeed through the process of a potential organ donation. METHODOLOGY AND DATA ANALYSIS: This is a qualitative study based on a phenomenological approach using Giorgi's method for data analysis. Members of 11 families who donated their deceased relatives' organs in La Fe Hospital, Valencia, Spain, from 2009 to 2011, participated through in-depth interviews after signing informed consent agreements. DISCUSSION: Experiences described have shown how the relatives' overview has been affected by the situation in a way that is very different from the professional staff's view of reality. The difference in perspectives creates a barrier which can make the professional team less effective in understanding family interests to create a helpful and successful relationship for organ donation. Understanding the experiences of the families involved can help healthcare providers to conduct a more supportive family interview when the topic is organ donation.

[Frozen section biopsy in the assessment of organs for transplantation]. / Biopsia extemporánea en la valoración de órganos para trasplante.

BACKGROUND: The success of transplantation and the increase in its indications has caused organ donations to be unable to meet the global demand. By broadening the donor selection criteria and accepting so-called suboptimal donors in an attempt to solve this problem, a careful individualized assessment is required of the validity of each donor. This often implies the need for a pretransplantation biopsy study. MATERIAL AND METHODS: Evaluation of frozen-section biopsy studies in the assessment of graft and donor validness in the the transplantation program of the La Fe University Hospital (Valencia, Spain) during 1998, when a total of 301 solid organ transplantations were performed. RESULTS: Sixty pretransplantation frozen-section biopsies were performed (29 of the liver, 21 renal, 3 lymph nodes, 3 brain, 2 prostatic, 1 myometrial and 1 pericardial). As a result of the bioptic study, 18 transplantations were invalidated (30% of all biopsies). The most frequent causes of invalidation were liver macroesteatosis (7 cases), malignancies (5 cases) and renal parenchymal lesions (5 cases). Among the tumor diagnosis there were one false-positive and one false-negative results of malignancy. CONCLUSION: Frozen-section biopsies evaluation in suboptimal organ donors or donors suspected of suffering disease integrates morphological analysis in the transplantation team decision process, and affords a quality factor in the selection of donors.