Patterns of Volunteerism,Testing, and Exclusion Among Potential Living Kidney Donors

We found that in kidney transplantation, more females donate. We analyzed transplant recipients for patterns of potential donor exclusion and found that equal proportions of male and female po tential donors existed among first-degree biological relatives. More male recipients were married and therefore had more spousal potential donors. Among friends and non-first-degree relatives, significantly fewer males offered to donate to females. Equal proportions of female and male potential donors were excluded from donating for medical comorbidities, blood type incompatibility, recipient refusal, and potential donor reluctance. We concluded that female transplant candidates had fewer potential donors among spouses and opposite sex volunteers from friends and non-first-degree relatives.     

Transplantation-transmitted tuberculosis--Oklahoma and Texas, 2007

Approximately 28,000 organ transplants were performed in the United States in 2007. When infections are transmitted from donors, the implications can be serious for multiple recipients. Tuberculosis (TB), a known infectious disease complication associated with organ transplantation, occurs in an estimated 0.35%-6.5% of organ recipients in the United States and Europe posttransplantation. In 2007, the Oklahoma State Department of Health identified Mycobacterium tuberculosis in an organ donor 3 weeks after the donor's death. This report summarizes results of the subsequent investigation, which determined that disseminated TB occurred in two of three transplant recipients from this donor, and one recipient died. Genotypes of the donor and recipient TB isolates were identical, consistent with transmission of TB by organ transplantation. To reduce the risk for TB transmission associated with organ transplantation, organ recovery personnel should consider risk factors for TB when assessing all potential donors. In addition, clinicians should recognize that transplant recipients with TB might have unusual signs or symptoms. When transmission is suspected, investigation of potential donor-transmitted TB requires rapid communication among physicians, transplant centers, organ procurement organizations (OPOs), and public health authorities.     

Characteristics of Rural and Urban Cadaveric Organ Transplant Donors and Recipients

CONTEXT: Health disparities have been found when comparing rural and urban populations. Purpose: To compare characteristics of rural and urban cadaveric transplant donors and recipients. METHODS: We used deidentified individual-level data on 55,929 cadaveric transplant donor-recipient exchanges between 2000 and 2003 and examined the relative rates of donating and receiving cadaveric transplants for rural compared to urban residents, as defined by ZIP Codes. FINDINGS: When compared to their urban counterparts, rural organ donors were more likely to have died from head trauma, drowning, motor vehicle accidents, or suicide and less likely to have died from cerebrovascular events, cardiac events, or homicide (P < .001 for all). Rural transplant recipients had lower levels of educational attainment and were less likely to have had the transplant financed by private insurance (P < .001 for all). While we found no statistical difference in days wait to organ transplantation, rural residents were more likely to donate than to receive cadaveric organs (P < .001). CONCLUSIONS: The differences in organ donation that we found warrant further exploration.     

The role of message frame, perceived risk, and ambivalence in individuals' decisions to become organ donors

The decision to become an organ donor involves considering both self-relevant risks and the needs of others. This study applied prospect theory to examine how news exemplar message frames that focus on the possible survival or death of a potential organ transplant recipient affect participants' willingness to become organ donors. Perceived personal risk and ambivalence were examined as moderating variables. Results indicate that risk, rather than ambivalence, played an instrumental role in participants' decisions to donate. Although no main effects or interactions related to message frame emerged in initial analyses, a supplemental analysis revealed an interaction such that there was a modest persuasive advantage for the loss-framed message among low-risk participants. Findings suggest that vivid exemplar message frames, compared to other types of more explicit organ donor appeals, may be associated with unique decisions about organ donation.     

The Role of Message Frame,Perceived Risk,and Ambivalence in Individuals' Decisions to Become Organ Donors

The decision to become an organ donor involves considering both self-relevant risks and the needs of others. This study applied prospect theory to examine how news exemplar message frames that focus on the possible survival or death of a potential organ transplant recipient affect participants' willingness to become organ donors. Perceived personal risk and ambivalence were examined as moderating variables. Results indicate that risk, rather than ambivalence, played an instrumental role in participants' decisions to donate. Although no main effects or interactions related to message frame emerged in initial analyses, a supplemental analysis revealed an interaction such that there was a modest persuasive advantage for the loss-framed message among low-risk participants. Findings suggest that vivid exemplar message frames, compared to other types of more explicit organ donor appeals, may be associated with unique decisions about organ donation.     

Adolescent contraceptive use: comparisons of male and female attitudes and information.

Information and attitudes about contraception and pregnancy were assessed with a self-administered questionnaire in a sample of urban Black teenagers. Data were obtained from 607 male and female students in high school health classes and a demographically similar group of 123 never-pregnant teenage women in a family planning clinic who had not attended these classes. Males were less likely to recognize the risk of pregnancy, had less information about contraceptives, and fewer attitudes that supported contraceptive use than females who participated in the same shool health classes. More males than females indicated that school classes had been the main source of contraceptive information. Teenage women in the family planning clinic did not differ from the high school females in attitudes about contraceptives, but the school group had somewhat more contraceptive information. The female school group was more likely to have discussed contraception with parents, obtained more contraception information from their mothers, and discussed contraception more with male friends than the teenagers who requested contraceptives at the family planning clinic.     

Suicide and friendships among American adolescents

OBJECTIVES: We investigated the relationship between friendships and suicidality among male and female adolescents. METHODS: We analyzed friendship data on 13,465 adolescents from the National Longitudinal Survey of Adolescent Health to explore the relationship between friendship and suicidal ideation and suicide attempts. We controlled for known factors associated with suicidality. RESULTS: Having had a friend who committed suicide increased the likelihood of suicidal ideation and attempts for both boys and girls. Socially isolated females were more likely to have suicidal thoughts, as were females whose friends were not friends with each other. Among adolescents thinking about suicide, suicide attempts appear largely stochastic, with few consistent risk factors between boys and girls. CONCLUSIONS: The friendship environment affects suicidality for both boys and girls. Female adolescents' suicidal thoughts are significantly increased by social isolation and friendship patterns in which friends were not friends with each other.     

Knowledge, attitudes and behavior regarding organ transplantation: the impact of the first transplantation from a brain-dead donor under the organ transplantation act

OBJECTIVE: To investigate knowledge, attitudes and behavior regarding organ transplantation, and to estimate the impact of the first organ transplantation from a brain-dead donor under the Organ Transplantation Act. SUBJECTS AND METHODS: A telephone survey was made using the Random Digit Dialing method in May 1999. People living in the Tokyo Metropolitan area ages 20 years or over were asked about their knowledge, attitudes and behavior regarding organ transplantation, and their opinions on the first organ transplantation conduced in February 1999. The results were compared with an opinion poll made 7 months previously to estimate the impact of this first case. RESULTS: The number of respondents was 489 (response rate: 46.0%). 1) Knowledge of organ transplantation: most people knew that organ donation from brain-dead donors was possible under the act, and that written consent on a form and family member's agreement were necessary before donating. More people knew about donor cards. 2) Organ transplantation: more people were willing to donate their organs when they die, and to agree to donation when a family member died who had wanted to donate his/her organs on their death. In the poll 7 months before, fewer people were willing to donate their organs or to agree to donate their family member's organs after brain death compared with after heart arrest. However, no such difference between brain death and heart arrest was found in this later study, suggesting that the distinction between the two was no longer considered to be so important. 3) Respondents themselves having donor cards constituted 15.2%, showing a marked increase from 7 months earlier. Another 39.7% wished to carry a donor card; the most common reason for not carrying one was they did not know how to acquire it. 4) The first transplantation was considered to have contributed to the increase in knowledge, and a favorable change in attitudes and behavior toward organ transplantation. 5) Respondents who agreed to that organ donation from children aged under 15 should be possible constituted 46.4%, of the to be this not being allowed at the present time. 6) The majority of respondents considered that the brain death was diagnosed properly in the first case and that the donation was made voluntarily, concluding that the transplantation was made fairly. 7) Respondents who considered that the privacy of the donor and the recipients was violated were 46.2% and 36.1%, respectively. The attitude of the mass media toward the first transplantation was criticized by 56.9% of the respondents. 8) Respondents who had a favorable impression of the organ transplantation were 61.9%. Such people are likely to donate their organs, to agree to a family member's donation, and to have a donor card than people who had not gained a favorable impression. The two groups exhibited no difference in their knowledge concerning organ transplantation. CONCLUSIONS: An increase in knowledge and a favorable change in attitudes and behavior regarding organ transplantation was confirmed in this survey, as compared with results 7 months earlier, probably because the first transplantation took place. The majority of the respondents considered that the first transplantation was made fairly, although they criticized the attitude of the mass media invading the privacy of the donor and the recipients. Further studies should be made to facilitate effective delivery of donor cards to people who want to carry them, and to change the rules on organ donation from children.     

Living kidney donor decision making and communication

There is high demand for kidney donors in the United States, and it is widely accepted that living donation is optimal for individuals who need a kidney. Much research has focused on the potential recipient, but little has been studied about the communication and decision making of living kidney donors. Interviews assessed the communication and decision-making processes of 43 kidney donor volunteers. Almost all of the participants were not asked, but instead volunteered, to donate. The majority of donors reported having conversations with the recipient and speaking about their decisions with other individuals in their social networks besides the recipient. Some participants said that they stopped talking to others because of negative feedback. Future research should further examine the communication of donors with non-recipient others and potential methods of training recipients and donors to communicate effectively about the donation process.     

Couples’ employment after spousal kidney donation

ABSTRACT

We used data from the United Network for Organ Sharing registry of living kidney donors and recipients to identify correlates of paid employment among couples following spousal living donation. Among such couples, post-transplant employment of both spouses (41%) was as common as employment of the donor only (41%). However, when the recipient was female, donor-only employment after transplant was more than twice as likely as compared to employment of both spouses (relative risk ratio = 2.57; p < .001). We conclude that traditional gender roles regarding paid workforce participation may be associated with the likelihood of employment after spousal kidney donation.     

Sex ratio of human T-lymphotropic virus type I infection and blood transfusion

The prevalence of human T-lymphotropic virus type I (HTLV-I) infection is higher for females than for males. Blood transfusion is a potential confounding factor which might contribute to this high female:male ratio. Two studies were performed in Martinique (French West Indies) to clarify this issue: a case-control survey comparing the experience of previous blood transfusion among 62 HTLV-I-seropositive and 88 HTLV-I-seronegative blood donors, and a retrospective study of the sex of recipients of blood. Blood transfusion was strongly associated with HTLV-I infection (odds ratio = 6.4, p less than 0.001). Females were more often given blood transfusions (57.9 percent, p less than 0.001) and received a higher percentage of blood units (53.5 percent, p less than 0.05) than could be expected from their proportion in the general population (51.6 percent). Thus, the high female:male sex ratio of HTLV-I-infected subjects might be due partially to a sex difference for blood transfusion.     

Seroprevalence of Kaposi's sarcoma-associated herpesvirus in various populations in Cuba.

OBJECTIVE: Little is known about the prevalence and distribution of Kaposi's sarcoma-associated herpesvirus (KSHV) infection in the Caribbean. The aim of this study was to determine rates of KSHV seropositivity in various populations in Cuba. METHODS: During the years 1998 to 2002 we screened serum samples from 410 subjects in Cuba. Serologic screening for KSHV antibodies was a two-step process using (1) indirect immunofluorescence assay (IFA) specifically reactive to the KSHV latency-associated nuclear antigen (LANA) encoded by open reading frame 73 (ORF73), and (2) confirmatory immunoblot using recombinant KSHV ORF65.2, a lytically expressed, 20-kilodalton protein as the target antigen. Five different populations were studied: (1) 45 AIDS patients with Kaposi's sarcoma (AIDS-KS), (2) 154 HIV-1-infected patients without clinical evidence of KS, (3) 171 HIV-negative blood donors, (4) 27 consecutive kidney transplant recipients, who were HIV-negative, and (5) 13 contacts (sexual contacts or relatives) of the AIDS-KS-affected patients. RESULTS: Among the 45 AIDS-KS subjects, 35 of them (77.8%) were KSHV-seropositive. Thirty-two of the 154 HIV-positive patients without KS (20.8% of them) were KSHV-seropositive, and 6 of the 13 contacts of KS-affected patients (46.2% of them) were infected with KSHV. In contrast to other researchers, we did not find in the populations that we studied in Cuba that KSHV seropositivity was associated with male homosexual or bisexual activity. We found high KSHV seropositivity rates among women reporting sexual contact with bisexual men and among men who had acquired an HIV infection in Africa. There were low rates of KSHV infection among the blood donors (1.2%) and the renal transplant recipients (0.0%). The low rates of KSHV infection that we found among the non-HIV-infected populations in Cuba are similar to patterns found in populations in Europe and in the United States. CONCLUSIONS: Together with similar results from Brazil, Jamaica, and the United States of America, our results suggest that KSHV infection is uncommon in some populations in the Western Hemisphere and that KSHV is largely confined to patients with AIDS-associated KS.     

Communication about sexual issues: mothers, fathers, and friends.

PURPOSE: To identify the content, characteristics, and comfort level of discussions about sexuality held between mothers and their early adolescent children and to determine the extent to which the conversations predicted sexual values and initiation of sexual intercourse of the adolescent. METHODS: This was part of a larger study to evaluate the impact of personal family characteristics on human immunodeficiency virus risk-reduction behavior among low-income predominately African-American adolescents, ages 13-15 years. Adolescents attending a metropolitan community-based afterschool program and their mothers were invited to participate in a 1-hour interview. Mothers and adolescents were interviewed separately. The interview included questions about the type of information related to sexuality that adolescents discussed with mothers, fathers, and friends; in addition, mothers were asked what topics they discussed with their adolescents. Four hundred five adolescents and 382 mothers participated. Some mothers had more than one adolescent in the study. RESULTS: The results showed that both male and female adolescents were more likely to discuss sexual topics with their mothers than their fathers. Male adolescents were more likely than female adolescents to discuss sex-based topics with their fathers. Both male and female adolescents were less likely to discuss sex-based topics with their friends than with their mothers, but more likely to discuss these topics with their friends than their fathers. Content of conversations of male adolescents was fairly consistent among mothers, fathers, and friends, and sexually transmitted disease/acquired immune deficiency syndrome and condom use were popular topics of discussion. Female adolescents tended to talk about the menstrual cycle with their mothers, sexual abstinence with their fathers, and sexual intercourse with their friends. Adolescents who reported a greater number of topics discussed with their mothers were more likely not to have initiated sexual intercourse and to have conservative values, whereas adolescents who reported a greater number of topics discussed with their friends were more likely to report the initiation of intercourse and more "liberal" sexual values. Both male and female adolescents were most comfortable discussing sexual issues with their friends. Male adolescents were less comfortable talking to mothers, but more comfortable talking to their fathers than were females. Mothers were likely to report feeling very comfortable talking about almost all discussion areas. Fathers' comfort level was not measured, as they were not directly questioned. CONCLUSION: Early adolescence (13-15 years old) is characterized by more sex-based discussions with mothers than friends or fathers. Daughters and sons discuss different topics with their fathers, although discussion by both genders with fathers is limited. If an adolescent talks more with the mother about sexual issues than with friends, he/she is less likely to initiate sexual intercourse and more likely to have conservative values. This points to the importance of fostering good communication and comfort between parents and adolescents about sexual issues.     

Living Kidney Donor Decision Making and Communication

There is high demand for kidney donors in the United States, and it is widely accepted that living donation is optimal for individuals who need a kidney. Much research has focused on the potential recipient, but little has been studied about the communication and decision making of living kidney donors. Interviews assessed the communication and decision-making processes of 43 kidney donor volunteers. Almost all of the participants were not asked, but instead volunteered, to donate. The majority of donors reported having conversations with the recipient and speaking about their decisions with other individuals in their social networks besides the recipient. Some participants said that they stopped talking to others because of negative feedback. Future research should further examine the communication of donors with non-recipient others and potential methods of training recipients and donors to communicate effectively about the donation process.     

Transplantation as an abstract good: practising deliberate ignorance in deceased organ donation in Denmark

This article investigates valuations of organ transfers that are currently seen as legitimising increasingly aggressive procurement methods in Denmark. Based on interviews with registered donors and the intensive care unit staff responsible for managing organ donor patients we identify three types of valuation: the needs of recipients, respect for donors' autonomy and support of donors' relatives in their grieving process. Sometimes these modes of valuation conflict with each other, and we show how our informants then respond with a form of deliberate ignorance. We suggest that deliberate ignorance has a more general salience in the organ transplant field by way of facilitating a perception of organ transplantation as an abstract moral good rather than a specific good for specific people. Furthermore, we suggest that multiple forms of ignorance sustain each other: a desire for ignorance with respect to the prioritisation of recipients sustains pressure for more organs; this pressure necessitates more aggressive measures in organ procurement and these measures increase the need for ignorance in relation to the actual procedures as well as the actual recipients. These attempts to avoid knowledge are in remarkable contrast to the otherwise widespread policy emphasis on education and information in this medical domain.     

Parental Support,Psychological Control,and Early Adolescents' Relationships with Friends and Dating Partners

Interdependence and social exchange theories were used to explore parent–adolescent relationship quality and early adolescents' relationships with close friends and dating partners. Associations among adolescents' perceptions of parental support and psychological control, peer relationship experiences (communication, emotional support, and possessiveness), and peer relationship satisfaction were examined using a test‐replication design. Our largely African American and female samples ranged from age 11 to 15. Results indicated the parenting variables were directly related to peer relationship experiences, which, in turn, predicted relationship satisfaction. The association between parental support and relationship satisfaction was mediated by peer communication and emotional support. Limited moderation by gender and relationship type was found. Parental psychological control mattered more for female and parental support more for male adolescents' close peer relationships. Dating partner possessiveness was most detrimental for females' relationship satisfaction, whereas communication influenced relationship satisfaction most for females reporting on friends and males reporting on dating partners.     

Hepatitis E virus infection without reactivation in solid-organ transplant recipients, France

Infections with hepatitis E virus (HEV) in solid-organ transplant recipients can lead to chronic hepatitis. However, the incidence of de novo HEV infections after transplantation and risk for reactivation in patients with antibodies against HEV before transplantation are unknown. Pretransplant prevalence of these antibodies in 700 solid-organ transplant recipients at Toulouse University Hospital in France was 14.1%. We found no HEV reactivation among patients with antibodies against HEV at the first annual checkup or by measuring liver enzyme activities and HEV RNA. In contrast, we found 34 locally acquired HEV infections among patients with no antibodies against HEV, 47% of whom had a chronic infection, resulting in an incidence of 3.2/100 person-years. Independent risk factors for HEV infection were an age <52 years at transplantation and receiving a liver transplant. Effective prophylactic measures that include those for potential zoonotic infections should reduce the risk for HEV transmission in this population.     

The effect of the National Kidney Registry on the kidney-exchange market

We assess the causal effect of the National Kidney Registry (NKR), the largest national kidney-exchange network in the U.S., on kidney-exchange outcomes. Analyzing a unique database hosted by the Scientific Registry of Transplant Recipients (SRTR) that contains information on all kidney donors, wait-listed candidates, and transplant recipients in the U.S., we find that patients in an NKR hospital are 2.5–3 times more likely than their counterparts in a non-NKR hospital to receive a transplant from a living donor, conditional on wait-time. At the same time, NKR participation does not have a significant effect on the desirability of donors and the health status of recipients. We employ various approaches to ensure our finding is robust in addressing the non-random sorting of patients and donors. As far as the outcomes we study, the expansion of the NKR brings about an overall positive impact on the kidney exchange market.