Should cardiac disease prevent autologous blood donation?

AIDS has created considerable concern among the public regarding being transfused with potentially infectious blood. However, autologous blood donations are still not maximally provided nor utilized. Significant heart disease disqualifies all allogeneic and most autologous blood donors (American Association of Blood Banks (AABB) Standards 1994). Disqualification is based on the widespread belief that donating blood could possibly be detrimental to their health. However, this belief has not been sufficiently documented. Sixty-eight donors (ages 14-84 years), all with histories of significant cardiac diseases, donated 111 units of whole blood (1-3 units). Twenty-eight patients donated 1 unit, 37 donated 2 units, and three patients donated 3 units. Fifty-nine patients had ischemic heart disease, and nine had valvular heart disease (five with mitral stenosis and four with mitral valve prolapse). No patient received erythropoietin, and only one received equal volume replacement with normal saline during donation. All these patients eagerly wished to donate in spite of being informed of the possible complications. No patient wishing to donate has been refused, and none has experienced any adverse consequences from donating. Forty-four patients underwent total hip/knee replacements. Only 56 units (50%) were transfused to 37 patients (54%). Although our experience is limited, it appears that many patients with histories of well established cardiac diseases can easily tolerate donating blood without compromising their health.     

Postmortem tissue donation for research: a positive opportunity?

Previous research using human brain tissue has increased the understanding of many brain disorders, such as Alzheimer's disease and Creutzfeldt Jakob disease. However, there are other conditions, such as multiple sclerosis, which remain poorly understood and which require further investigation. The ongoing decline in the consented postmortem rate poses a threat to tissue collections and, consequently, future research. In the setting of the new Human Tissue legislation the authors set out to ascertain whether families recently and suddenly bereaved were willing to grant authorization for tissue samples and/or organs to be retained for research purposes at the time of medico-legal postmortem examination in adequate numbers to support the establishment of a brain and tissue bank. During the 2-year pilot phase of the project, 96% of families authorized retention of tissue samples for research and 17% agreed to whole brain donation. Respondents to a short questionnaire indicated that they were not further distressed by the approach and the majority were of the opinion that research donation should be offered to all bereaved families. This research concludes that the overwhelming majority of families who are recently and suddenly bereaved are willing to authorize research use of tissue taken at the time of postmortem examination.     

Organ donation after circulatory death: the forgotten donor?

Donation after circulatory death (DCD) can be performed on neurologically intact donors who do not fulfill neurologic or brain death criteria before circulatory arrest. This commentary focuses on the most controversial donor-related issues anticipated from mandatory implementation of DCD for imminent or cardiac death in hospitals across the USA. We conducted a nonstructured review of selected publications and websites for data extraction and synthesis. The recommended 5 min of circulatory arrest does not universally fulfill the dead donor rule when applied to otherwise neurologically intact donors. Scientific evidence from extracorporeal perfusion in circulatory arrest suggests that the procurement process itself can be the event causing irreversibility in DCD. Legislative abandonment of the dead donor rule to permit the recovery of transplantable organs is necessary in the absence of an adequate scientific foundation for DCD practice. The designation of organ procurement organizations or affiliates to obtain organ donation consent introduces self-serving bias and conflicts of interest that interfere with true informed consent. It is important that donors and their families are not denied a 'good death', and the impact of DCD on quality of end-of-life care has not been satisfactorily addressed to achieve this.     

Exploring the dynamics of the theory of planned behavior in the context of blood donation: does donation experience make a difference?

BACKGROUND: This study investigates the influence of different variables from the theory of planned behavior (TPB) on intention within multiple donation categories, covering the entire range of lifetime number of donations (LND). Does the same set of variables predict intention equally strong throughout the donor career? STUDY DESIGN AND METHODS: Measures of intention, self‐efficacy, cognitive and affective attitude, and subjective and moral norms were assessed within a sample of 11,480 whole blood donors. Donors were categorized into 65 donation classes using their LND; for example, all donors with one donation (n = 483) in the first donation class, all donors with two donations (n = 447) in the second donation class, and so on. For each donation class, separately for men and women, linear multiple regression models for intention were fitted using self‐efficacy, cognitive attitude, affective attitude, subjective norm, and moral norm as predictor variables. RESULTS: During all stages of the donor career, self‐efficacy is the main predictor of intention, with a relatively constant beta (β = 0.64, p < 0.001). Cognitive attitude (β = 0.11, p < 0.001) and moral norm (β = 0.10, p < 0.001) contributed marginally to the prediction. Several sex effects were observed; self‐efficacy is a stronger predictor of intention in women, whereas subjective norm predicts intention in men only. CONCLUSION: Regardless of the number of lifetime donations, the same set of TPB variables, both in composition and in relative strength, predicts intention. A feeling of self‐efficacy remains equally important for all donors. It is worthwhile to study whether directed intervention strategies are necessary to target self‐efficacy within donor groups with different levels of donation experience.     

Human milk donation: what do you know about it?

The American Academy of Pediatrics (AAP) strongly endorses that human milk is species specific and the optimal nutrition for infants, and that banked human milk is a suitable alternative. After the death of an infant, breast milk often is disposed of without consideration of donation because the public and healthcare providers are unaware of human milk banks. In the United States, 10 human milk banks operate under strict guidelines established by the Human Milk Banking Association of North America. Donors are screened, and milk is pasteurized while preserving many of the beneficial components of breast milk. It is imperative that healthcare providers become educated regarding human milk banking because of the increase in informal sharing of breast milk via the Internet. Breast milk that has not been screened and treated has the risk of transmitting infections such as hepatitis and HIV. Healthcare providers should be familiar with the selection criteria for suitable donors and how to approach families when the death of an infant is imminent. Human milk banks are able to provide human milk to adopted, preterm, or ill infants whose mothers are unable to provide their own milk.     

Organ donation: what can we learn from North America?

The aim of this qualitative case study was to investigate how organ donation is promoted and managed in North America aimed specifically at patients and relatives. A 4-week study to Boston and Baltimore in America was undertaken to observe and learn how organ donation is promoted and managed within a critical care environment. The study tour was undertaken specifically to examine the policy and procedures that enhance the procurement of organ donation in specific centres in the USA. The study tour wanted to examine and gain a better understanding of the issues, policies and procedures used by these centres when seeking permission for organ donation. Data were collected by a variety of methods involving observation, unstructured informal interviews, examinations of policies and procedures and a daily diary was maintained. A thematic analysis method was used to analyse the qualitative data collected. Four areas were identified as potential areas for learning. Approaching relatives of potential donors for consent, at a time of intense emotional crisis, is a challenge that involves all nurses working in critical areas. Nurses are identified as a key component in the process of organ donation; research highlights that approaching relatives can be problematic and stressful for nursing staff. The British government should consider required request legislation that ensures all hospitals refer potential donors to the Regional Transplant Center. In-house coordinators could be appointed and protocols developed for referrals of potential donors. It is also suggested that the approach for consent is decoupled and designated requesters approach relatives.     

Organ donation: is there a need for new legislation?

Organ donation rates are insufficient to meet the demand. Current legislation may be considered out of date but proposals for a new system raise difficult ethical problems. Nurses need to develop their knowledge and skills to come to terms with the complex ethical issues surrounding organ donation.