The lived experience of sacrificing something important

The purposes of this research, using the Parse method, were to discover the structure of sacrificing something important and to expand the theory of human becoming. The core concepts of relinquishing the cherished, shifting preferred options, and fortifying affiliations were discovered during the process of extraction-synthesis using synopses of dialogues from 10 church parishioners. The structure, sacrificing something important is relinquishing the cherished while shifting preferred options amid fortifying affiliations is the central finding of this study, adding to the theory of human becoming, stimulating further research, and informing nurses about this universal lived experience of health.     

Human becoming criticism--a critique of Florczak's study on the lived experience of sacrificing something important

This article presents a critical appraisal of Kristine Florczak's Parse research method study on the phenomenon of sacrificing something important. The processes of Mitchell's framework for human becoming criticism-sketching the horizon of understanding, illuminating artistic disclosure, and enhancing the original with artform-are utilized.     

Blood donor satisfaction and intention of future donation

BACKGROUND: New regulatory requirements for donor eligibility challenge blood centers to recruit and retain enough donors. This study evaluated correlations between overall satisfaction with the donation process and donor demographics and the effect of both on a donor's intent to return. STUDY DESIGN AND METHODS: An anonymous, self-administered questionnaire was given to donors at multiple sites of one blood center over a 3-week period. First-time and repeat donors were asked questions on demographic characteristics, satisfaction with the current donation process, motivation for current and future donations, and intent to return. RESULTS: More than 75 percent of donors rated the overall donation process at 9 or 10 on a scale of 10 (mean, 9.19; standard deviation, 1.09), with female, high school-educated, and first-time donors giving higher satisfaction ratings than male, college-educated, and repeat donors, respectively (all p < 0.001). Donor satisfaction was correlated with intent to return for another donation (p = 0.002). For the current donation, donors rated altruistic motivations most highly. Medical testing was the most highly rated incentive for future donations, followed by frequent donor programs and convenient donation times and locations; preferences varied by demographic subgroup. CONCLUSIONS: Blood donor satisfaction varies among demographic and donation history subgroups and is positively correlated with the intent to return for future donation. Although the primary motivation among all donors was altruism, incentives to future donation may need to be tailored according to demographic subgroups.     

Death anxiety and psychological distress post-donation in non-directed living kidney donors

Abstract

The current study sought to assess death anxiety and psychological distress among kidney donors, in comparison to a control population. Seventy-eight non-directed living kidney donors were recruited through the Israeli voluntary kidney donation association. This sample was compared to 396 participants from a control population. The results revealed that non-directed living kidney donors had higher levels of death anxiety in comparison to the control population while their psychological distress was lower in comparison to the control population. The results of this study highlight the importance of relating to non-directed living kidney donors’ death anxiety.     

An exploration of the concept of sacrifice

This column seeks to contribute to the understanding of the concept of sacrifice and its significance to nursing through an extensive account of relevant literature from the disciplines of theology, sociology, anthropology, and psychology. The review uncovered that in sacrificing something of value, individuals anticipate connecting with families, groups, society, and deities. Knowledge of the phenomenon of sacrifice has importance for nurses who use the human becoming theory as a guide for practice as they participate with individuals who are struggling with relinquishing something of value, while hoping to strengthen connections with others.     

Clinical evaluation of potential living-related kidney donors☆

BACKGROUND:With the extensive development of the renal transplants from living-related donors, how to protect the donors’ long-term survival get more and more attention. OBJECTIVE:To summarize our clinical experience of 79 potential living-related kidney donors, and to evaluate the effects and reliability of the procedure. METHODS:We analyzed clinical data from 79 potential living-related kidney donors assessed at the Department of Transplantation and Urology, Affiliated Ruikang Hospital of Guangxi University of Chinese Medicine from June 2007 to August 2010. And the clinical effect was analyzed. RESULTS AND CONCLUSION:A total of 38 patients were assessed for qualified. The operating time for al donors ranged from 1 to 2 hours. The warm ischemia time of the donated kidney was about 15 seconds, and the cold ischemia time was 1-2 hours. No surgical or medical complications occurred during the perioperative period. Al donors have survived to date, with kidney function in the normal range. Rigorous assessment is important for ensuring the long-term survival of living kidney donors.     

亲属活体肾移植供者的临床评估

背景：随着活体肾移植的广泛开展,如何保证活体肾移植供者的长期存活愈发引人关注。目的：总结79名亲属活体供肾移植的临床评估情况,评价其效果及安全性。方法：广西中医学院附属瑞康医院移植泌尿外科在2007-06/2010-08共完成亲属活体供肾移植评估79名,回顾分析供者相关的临床资料及移植的效果。结果与结论：经评估共有38名供者合格,所有供者手术时间1.0-2.0h,供肾热缺血时间15s左右,冷缺血时间1.0-2.0h,围手术期间无外科及内科并发症发生。随访至2011年8月,所有供、受者均正常生存,移植肾功能均保持在正常范围。采用比较严格的供者评估方式是保证供者长期存活的必要手段。     

Understanding the sex disparity in living kidney donation

Living donors are the preferred source of organs for kidney transplantation, which is the treatment modality of choice for end‐stage kidney disease. Health care systems widely promote living kidney donation. However, women are consistently overrepresented among living donors. The reasons behind the sex‐based disparity in living kidney donation remain poorly understood. Compared to women, men possess a greater amount of kidney function, and the higher deceased donation rate among men reflects their higher overall kidney quality. A plausible medical explanation for the sex‐based disparity in living kidney donation includes an uncompromising emphasis on preserving donor health, with less emphasis placed on organ quality, which is the main criterion in deceased donor selection. On the other hand, consent to deceased donation is also greater in women, indicating their greater desire to donate even though fewer women actually become deceased donors. Therefore, nonmedical reasons for the sex disparity in living donation must be sought. Increased empathic distress or emotional memory; a greater sense of responsibility, urgency, and impulsiveness with increased reaction to empathy; a different body image; and a different social status may all contribute to greater living kidney donation in women. Economic inequity may be the singular explanation when personal worth links to economic worth. To better understand the sex disparity in living kidney donation, we need better data on the reasons behind both nondonation and donor rejection after evaluation in clinical practice. Nondirected living kidney donation provides unique opportunities to minimize factors such as emotional distress, empathy, and impulsiveness. More liberal acceptance criteria for donors with isolated medical abnormalities and testing legitimate donor reimbursement strategies based on actual income levels rather than a fixed amount can assist in both ascertaining the reasons behind the sex disparity in living kidney donation and increasing overall living kidney donation rates.     

Plasma homocysteine levels in living kidney donors before and after uninephrectomy

An increased prevalence of hyperhomocysteinemia has been observed among patients with end-stage renal disease, and numerous studies have demonstrated that kidney function is one of the most important determinants of plasma total homocysteine (tHcy) concentration. In an effort to understand the mechanism of hyperhomocysteinemia in renal disease, we chose, as our model, living kidney donors who had undergone uninephrectomy. We studied 10 living kidney donors and measured fasting plasma tHcy, plasma creatinine, folate, vitamins B(12) and B(6), and high-sensitivity C-reactive protein (hsCRP) 24 hours before nephrectomy and 2 days, 6 weeks, and 6 months after nephrectomy compared to the values 24 hours before nephrectomy. Mean fasting tHcy and creatinine concentrations were significantly higher in donors 2 days, 6 weeks and 6 months after nephrectomy they were 24 hours before nephrectomy. Both the increases in tHcy levels 2 days after nephrectomy and subsequent decreases 6 weeks and 6 months after are paralleled by the changes in plasma creatinine values, although neither returned to its presurgery value. Decreases in tHcy are significantly correlated with decreases in creatinine values. The B vitamins were unchanged, and the hsCRP level was increased 2 days after surgery but had returned to the baseline level after 6 weeks. We conclude that tHcy and creatinine levels parallel each other after uninephrectomy and that the gradual decrease in tHcy is accounted for by hypertrophy of the remaining kidney. Our results, the first to be obtained from living kidney donors, support the hypothesis that renal metabolism of tHcy is the mechanism responsible for the correlation between renal function and plasma tHcy level.     

The nurse's role in promoting the rights of donor families

The critical care nurse is a vital link in the referral of organ donors and, thus, is the determining factor in the number of patients that will receive organ transplants. The process of referring a potential donor to OPOs should be as convenient as possible. It was the goal of this article to explain the referral process of organ donors and, more important, to communicate the dedication and availability of all OPO staff to the critical care nurse. Donor families have repeatedly stated that having the option of organ donation offered to them at one of their most difficult times helped them take something positive away from their loved one's death. This option can occur only when the critical care nurse is an active participant in the organ procurement process.     

Comparison of the effectiveness of potential marrow donors recruited from apheresis donors or whole blood donors and through appeals to the general public

Marrow transplants with phenotypically HLA-matched, unrelated donors have been used effectively to treat a number of diseases. Many blood centers have recruited HLA-typed apheresis blood donors into marrow donor registries. However, to build larger registries so that more patients may be treated with unrelated donor marrow transplants, whole blood donors and people who do not donate blood have been added to the registries. The marrow donor program at our blood center had 2844 potential donors, of whom 1725 were also apheresis donors, 608 were whole blood donors, and 511 were recruited from the general public as a result of community appeals for marrow donors for a specific patient. Over a 9-month period, 297 potential donors were asked to donate blood samples for HLA-DR typing or mixed lymphocyte culture (MLC) testing or to participate in an informational session, undergo a medical evaluation, and sign a statement indicating an intention to donate marrow for a specific patient. Overall, these requests were successfully completed by 75.5 percent of apheresis donors, 87.2 percent of whole blood donors, and 78.1 percent of the potential donors recruited through community appeals. Furthermore, there was no difference among the three groups in the portion of people who donated blood samples for HLA-DR typing or MLC testing. Fifteen of 18 apheresis donors who were found to match a specific donor signed a statement of intent to donate marrow, 2 apheresis donors were deferred for medical reasons, and 1 decided not to donate.(ABSTRACT TRUNCATED AT 250 WORDS)     

亲属活体肾移植供者移植前行肺部CT检查的必要性(英文)

背景:亲属肾移植供者年龄较大会有一定肺部疾病发病率。目的:了解亲属活体供者肺部疾病的发生率进而探讨亲属活体供者移植前行肺部CT 检查的必要性。方法:纳入郑州大学第一附属医院自2009-07/2011-04 拟行亲属供肾切取的127 例亲属肾移植供者,排除捐献禁忌证如高血压、糖尿病及供受者血型不符后,常规行胸部 CT 及 X 射线检查。由 2 位放射科医师结合临床表现讨论后对胸部 CT及 X 射线结果作出诊断,评价肺部检查结果对供肾移植的影响。结果与结论:127 例供者常见肺部疾病依次为肺炎(15.0%)、肺气肿(7.9%)、肺实质钙化(6.3%)、胸膜增厚(3.1%)、胸膜粘连(3.1%)。除钙化外肺部 CT 检查比 X 射线可以更敏感的监测出各种肺部疾病(P <0.05)。此外,供者肺炎冬季发生率比夏季高(P < 0.05),有吸烟史供者肺气肿发生率高于无吸烟史供者(P < 0.01)。绝大多数肺部疾病并不影响活体供肾手术的进行,仅有 1 例治疗无效的间质性肺炎供者放弃手术。结果证实,肺部疾病在亲属肾移植供者中有较高发生率,有吸烟史或手术安排在冬季进行的供者移植前有必要行 CT 检查。     

Kidney organ donation knowledge and attitudes among health care professionals: Findings from a Greek general hospital

Identified barriers of organ donation advancement include lack of knowledge, personal beliefs, and a negative attitude from health professionals. This article reports on current knowledge and attitudes toward kidney donation among nurses and physicians in a Greek general hospital. A previously used questionnaire was applied. More physicians than nurses were donor card holders, with registration rates being lower than expected. Over half of the participants did not consider themselves well informed about registering as a kidney donor. Older nurses differed significantly from younger ones in their willingness to become live donors if an adult required a kidney. Nurses who were blood donors had higher odds ratio of feeling well informed when compared with nurses who were not blood donors. Integrating organ donation issues into undergraduate health science curricula and continuous education interdisciplinary programs is essential in increasing awareness, eradicating negativism, and reversing inertia.     

高龄亲属活体供肾移植7例中长期效果：同一机构2年资料回顾分析

背景：随着肾移植中肾供体的短缺,＂边缘＂供肾提供了一条缓解途径。目的：观察高龄亲属活体供肾移植的安全性和中长期临床效果。方法：回顾性分析随访36~64个月的7例≥65岁亲属活体供肾移植的供者和受者的临床资料。结果与结论：供、受者移植后均恢复顺利,无严重并发症。受者1周内移植肾功能正常、供者肾功能较术前略有增高、但均在正常范围内。无排斥反应发生。5例人/肾正常存活36~64个月;2例移植后≥1年死亡。供者均正常存活,无蛋白尿、高血压,肾功能正常。提示≥65岁高龄亲属活体供肾应经过严格筛选,部分可为临床扩大供肾来源。     

Safety and donor acceptance of an abbreviated donor history questionnaire

BACKGROUND: Surveys have shown donor dissatisfaction with the duration of the donation process and repetitive questioning. An abbreviated donor history questionnaire (AQ) may improve satisfaction, but must be safe. STUDY DESIGN AND METHODS: An FDA-approved 34-question AQ was implemented in 2003. Travel, medication, and health history questions were decreased by 18. Donors were eligible for AQ if they had successfully completed three donor suitability assessments on the full-length questionnaire (FQ), including one in the prior 6 months. Data were analyzed from more than 50,000 donations during each of three 20-day periods over the first year of progressive implementation of the AQ. We evaluated the performance of the AQ by comparing donor deferrals for medical history (MHD), physical examination findings (PED), and reactive screening and/or confirmatory tests (RSCT) for viral markers among AQ-ineligible and AQ-eligible donors and separately among AQ-eligible donors who received AQ or FQ. RESULTS: Approximately one-third of presenting donors were AQ-eligible. Use of AQ progressed from 48 percent in October 2003 to 76 percent in November 2004. AQ-eligible donors had lower rates of MHD, PED, and RSCT than donors ineligible for AQ (p < 0.05). Among donors eligible for the AQ, those who received the FQ had slightly more MHD and PED than those who received the AQ (p < 0.05), but there was no difference in RSCT. A postdonation survey indicated significantly increased satisfaction and intent to donate among donors who received the AQ. CONCLUSIONS: In frequent repeat donors, use of an AQ led to increased donor satisfaction and no significant medical concerns about donor or recipient safety.     

Kidney Microstructural Features at the Time of Donation Predict Long-term Risk of Chronic Kidney Disease in Living Kidney Donors

ObjectiveTo determine whether microstructural features on a kidney biopsy specimen obtained during kidney transplant surgery predict long-term risk of chronic kidney disease in the donor.Patients and MethodsWe studied kidney donors from May 1, 1999, through December 31, 2018, with a follow-up survey for the results of recent blood pressure and kidney function tests (estimated glomerular filtration rate [eGFR] and proteinuria). If not recently available, blood pressure and eGFRs were requested from a local clinic. Microstructural features on kidney biopsy at the time of donation were assessed as predictors of hypertension and kidney function after adjusting for years of follow-up, baseline age, sex, and clinical predictors.ResultsThere were 807 donors surveyed a mean 10.5 years after donation. An eGFR less than 45 mL/min/1.73 m² in 6.4% (43/673) of donors was predicted by larger glomerular volume per standard deviation (odds ratio [OR], 1.48; 95% CI, 1.08 to 2.04) and nephron number below the age-specific 5th percentile (OR, 3.38; 95% CI, 1.31 to 8.72). An eGFR less than 60 mL/min/1.73 m² in 42.5% (286/673) of donors was not predicted by any microstructural feature. Residual eGFR (postdonation/predonation eGFR) was predicted by nephron number below the age-specific 5th percentile (difference, ?6.07%; 95% CI, ?10.24% to ?1.89%). Self-reported proteinuria in 5.1% (40/786) of donors was predicted by larger glomerular volume (OR, 1.42; 95% CI, 1.08 to 1.86). Incident hypertension in 18.8% (119/633) of donors was not predicted by any microstructural features.ConclusionLow nephron number for age and larger glomeruli are important microstructural predictors for long-term risk of chronic kidney disease after living kidney donation.     

Kidney donors and kidney transplants have abnormal aminothiol redox status,and are at increased risk of oxidative stress and reduced redox buffer capacity

Objective

Living kidney donors have been part of a successful kidney transplant programme in Norway for almost 50 years. Glomerular filtration rates (GFRs) have tended to remain stable at about 70% of pre-donation levels. Plasma total homocysteine (Hcy) has an inverse relationship to kidney function, and previous reports indicate elevated levels of Hcy in kidney donors. We wanted to examine the most important plasma aminothiols in kidney donors, i.e. Hcy, cysteine (Cys) and cysteinylglycine (CG) with their redox species. The aminothiol redox-system appears to be an integral part of the extracellular antioxidant defence system in the body.

Design and methods

Plasma concentrations of total Hcy were obtained in 82 previous kidney donors, 82 healthy controls and 26 kidney transplants with stable and good kidney function. In a subset of 30 kidney donors, 30 matched controls and 12 kidney transplants plasma samples were analysed for Hcy, Cys, CG and their redox species. There were no differences between groups for B-vitamin status.

Results

Kidney donors and kidney transplants had elevated plasma concentrations of total Hcy, Cys and CG. The plasma levels of reduced Hcy species were high — with a high reduced/oxidized ratio. The plasma levels of reduced Cys species were low — with a low reduced/oxidized ratio.

Conclusions

Previous kidney donors have abnormal plasma aminothiol redox status. The present findings indicate that donors may have increased risk of oxidative stress with low redox buffer capacity and disturbed cellular redox-dependent signalling pathways. Similar observations were made in the kidney transplants.     

Urinary excretion of epidermal growth factor in living human kidney donors and their recipients

Abstract. Epidermal growth factor (EGF) is a growth-promoting peptide that is synthesized in the distal tubules of the kidney and excreted in urine. EGF has been suggested to play a role in the repair after renal tissue damage, as well as in compensatory growth of the remaining kidney after uninephrectomy. The present study examined the urinary EGF excretion after uninephrectomy and transplantation among relatives. The urinary EGF excretion rate and the glomerular filtration rate (GFR) were followed for 26–54 days in 16 healthy kidney donors and nine recipients. After uninephrectomy the median urinary EGF excretion rate in the donors was not 50% of the pre-operative value, but around 65% (95% confidence limits of the median on the fifth post-operative day: 59–72%). This suggests that there is a compensatory increase in the EGF excretion rate from the remaining kidney of around 30% after uninephrectomy. A similar compensatory increase was demonstrated for GFR, indicating that the compensatory changes in EGF excretion rate and GFR might be correlated. In the transplanted kidneys, GFR was consistently around 15% lower and EGF excretion rate around 40% lower than in the corresponding kidneys remaining in the donors. This might reflect ischaemic and drug-induced damage of the transplanted kidneys. The present study demonstrated a compensatory increase of around 30% in urinary EGF excretion from the remaining kidney after uninephrectomy in healthy humans. Whether EGF plays a role in the adaptive processes in the remaining kidney or whether changes in EGF excretion are merely of a secondary nature is still uncertain.     

亲属活体肾移植供者术后长期生活质量随访调查（附41例报告）

目的调查亲属活体肾移植供者术后长期生活质量变化。方法按照国际通用SF-36健康调查问卷对其术后长期生活质量进行评价,并使用为肾移植供者特制的再移植意愿度问卷,了解供者对供。肾的态度及进一步探讨可能影响供者抉择的因素。结果术前与术后生活质量比较差异有统计学意义（P〈0．05）,术后1个月与术前比较,除躯体疼痛、情感角色、精神健康得分有所上升外,余5项均下降,差异有统计学意义（P〈0．05）;术后1年躯体疼痛得分与术前比较差异有统计学意义（P〈0．05）,余各项比较差异无统计学意义（P〉0．05）;术后5年各测评项得分与术前比较差异均无统计学意义（P〉0．05）。后悔供肾组的生活质量得分低于愿再供肾组,大部分指标差异有统计学意义（P〈0．05）。结论活体亲属肾移植手术安全可行,供者完善的术前评估与选择以及术后严密长期随访、供肾后健康知识的普及十分重要。