Outcomes and satisfaction of two optional cadaveric dissection courses: a 3-year prospective study

Teaching time dedicated to anatomy education has been reduced at many medical schools around the world, including Nova Medical School in Lisbon, Portugal. In order to minimize the effects of this reduction, the authors introduced two optional, semester-long cadaveric dissection courses for the first two years of the medical school curriculum. These courses were named Regional Anatomy I (RAI) and Regional Anatomy II (RAII). In RAI, students focus on dissecting the thorax, abdomen, pelvis, and perineum. In RAII, the focus shifts to the head, neck, back, and upper and lower limbs. This study prospectively analyzes students' academic achievement and perceptions within the context of these two, newly-introduced, cadaveric dissection courses. Students' satisfaction was assessed anonymously through a questionnaire that included items regarding students' perception of the usefulness of the courses for undergraduate teaching, as well as with regards to future professional activity. For each of the three academic years studied, the final score (1 to 20) in General Anatomy (GA), RAI, and RAII was on average 14.26 ± 1.89; 16.94 ± 1.02; 17.49 ± 1.01, respectively. The mean results were lower in GA than RAI or RAII (P < 0.001). Furthermore, students who undertook these courses ranked them highly with regards to consolidating their knowledge of anatomy, preparing for other undergraduate courses, and training for future clinical practice. These survey data, combined with data on participating students' academic achievement, lend strong support to the adoption of similar courses as complementary and compulsory disciplines in a modern medical curriculum

Donating a kidney to a stranger: Are healthcare professionals facilitating the journey? Results from the BOUnD Study

Unspecified kidney donors (UKDs) are approached cautiously by some transplant professionals. The aim of this study was to interrogate the views of UK transplant professionals towards UKDs and identify potential barriers. A purposely designed questionnaire was validated, piloted and distributed amongst transplant professionals at each of the 23 UK transplant centres. Data captured included personal experiences, attitudes towards organ donation, and specific concerns about UKD. 153 responses were obtained, with representation from all UK centres and professional groups. The majority reported a positive experience with UKDs (81.7%; p &lt; 0.001) and were comfortable with UKDs undergoing major surgery (85.7%; p &lt; 0.001). 43.8% reported UKDs to be more time consuming and 52% felt that a mental health assessment should take place before any medical tests. 77% indicated the need for a lower age limit. The suggested age range was broad (16–50 years). Adjusted mean acceptance scores did not differ by profession (p = 0.68) but higher volume centres were more accepting (46.2 vs. 52.9; p &lt; 0.001). This is the first quantitative study of acceptance by transplant professionals to a large national UKD programme. Support is broad, however potential barriers to donation have been identified, including lack of training. Unified national guidance is needed to address these.</p

Outcomes and motivations in unspecified (nondirected altruistic) kidney donation:Results from a United Kingdom prospective cohort study

Unspecified kidney donors (UKDs) increase the number of high-quality kidneys available for transplantation. This study aimed to determine whether the practice was acceptable, based on the noninferiority of donor physical and psychosocial outcomes when compared to specified kidney donors (SKDs). This longitudinal, prospective cohort study investigated potential living kidney donors from across all 23 UK adult kidney transplant centers. Participants completed validated questionnaires at 4 time points (recruitment, 2-4 weeks predonation, 3- and 12-months postdonation). Clinical outcome data were collected from National Health Service Blood and Transplant. Three hundred seventy-three (of 837 recruited; 45.7%) went on to donate (November 2016 to January 2021). There were no differences in donation rates (204 SKDs [54.7%] vs 169 UKDs [45.3%]; P = .944). Both groups reported being motivated by the desire to help someone (P = .157). Tests for noninferiority indicated that UKDs do no worse than SKDs on psychosocial or clinical outcomes over 12 months, and costs are similar (P &gt; .05). This is the world's largest prospective observational study comparing SKDs and UKDs. It demonstrates no differences in primary motivation, donation rates, regret, cost, or psychosocial and physical outcomes. These data should reassure transplant professionals and potential donors and can bolster confidence in the practice around the world.</p

Barriers to and outcomes of unspecified kidney donation in the UK::BOUnD, a mixed-methods study

BackgroundUnspecified living kidney donation, where an individual donates a kidney to a stranger, is practised in very few countries. Since the Human Tissue Act 2006, the practice has been increasingly prevalent in the United Kingdom. However, evidence exists of uncertainty from healthcare professionals as to whether this is appropriate or manageable.ObjectivesThe Barriers and Outcomes in Unspecified Donation study is a mixed-methods study designed to determine the answers to three research questions:Is there variation in transplant professionals’ practice and attitudes, which is preventing some unspecified donations?Are psychosocial and physical outcomes after unspecified donation equivalent to those after specified donation?What is the economic benefit from unspecified donation?DesignFor RQ1, a qualitative study of healthcare professionals using focus groups and interviews was performed. Additionally, a quantitative, questionnaire-based study, including healthcare professionals from all United Kingdom transplant centres, was carried out.For RQ2, a qualitative study of unspecified kidney donors, including those who did not donate, was performed. A prospective, questionnaire study of both specified kidney donors and unspecified kidney donors across the United Kingdom was completed, and linked to data recorded by National Health Service Blood and Transplant.For RQ3, data on utilisation and quality of life were collected pre- and postoperatively using health economic and quality-of-life questionnaires to allow calculation of costs and comparisons between unspecified kidney donors and specified kidney donors.ResultsRQ1Fifty-nine interviews were conducted with healthcare professionals at six United Kingdom centres. There was broad support for unspecified donation, but key themes included the need for further training and information, consistency in approach across the United Kingdom, and uncertainty about age limits and psychological assessments. Managing donor expectations was a major concern.One hundred and fifty-three healthcare professionals, from all 23 United Kingdom transplant units, were recruited into the questionnaire study. The themes above were confirmed, and the need for more resource, particularly training and staffing, were emphasised.RQ2Eight hundred and thirty-seven participants including (59.3%) specified kidney donors and (40.7%) unspecified kidney donors were recruited to the prospective questionnaire study, of whom 373 went on to donate. We found no difference in psychosocial or physical outcomes, withdrawal rates [hazard ratio: unspecified kidney donors vs. specified kidney donors 1.12 (95% confidence interval 0.75 to 1.67)] or regret, although unspecified kidney donors experienced fewer positive perceptions [specified kidney donors 319 (86.2%) vs. unspecified kidney donors 247 (79.9%); p = 0.034].In the qualitative study of 35 unspecified kidney donors (15 donated, 20 withdrawn), we found evidence of psychological distress in those not proceeding to donation, with a need for consistency and management of expectations.Data from the RQ2 prospective study showed a wide variation in withdrawal rates of donors across the United Kingdom, with withdrawal less likely in high volume, well-staffed centres. Fifty-eight per cent of unspecified kidney donors came from just five centres.RQ3We found no difference in costs between the two groups (£937 vs. £778; ns). We calculated that a 10% increase in unspecified kidney donors nationally would save at least £5 million.ConclusionsThis study suggests that unspecified donation is a safe and acceptable practice. Training and information should be disseminated across United Kingdom centres, with increased resource for unspecified donation where necessary. Consistency in approach and support for donors who do not proceed is important

Donating a kidney to a stranger : a review of the benefits and controversies of unspecified kidney donation

Summary of Background Data: Unspecified kidney donation (UKD) describes living donation of a kidney to a stranger. The practice is playing an increasingly important role within the transplant programme in the United Kingdom, where these donors are commonly used to trigger a chain of transplants; thereby amplifying the benefit derived from their donation. The initial reluctance to accept UKD was in part due to uncertainty about donor motivations and whether the practice was morally and ethically acceptable. Objectives: This article provides an overview of UKD and answers common questions regarding the ethical considerations, clinical assessment, and how UKD kidneys are used to maximize utility. Existing literature on outcomes after UKD is also discussed, along with current controversies. Conclusions: We believe UKD is an ethically acceptable practice which should continue to grow, despite its controversies. In our experience, these donors are primarily motivated by a desire to help others and utilization of their kidney as part of a sharing scheme means that many more people seek to benefit from their very generous donation

Experiences of completed and withdrawn unspecified kidney donor candidates in the UK : an inductive thematic analysis from the BOUnD study

Objectives: This study sheds light on some controversial aspects of unspecified kidney donation (UKD) as well as the ways in which potential donors are screened and prepared for the donation experience and its aftermath. The aim of this study was to qualitatively investigate the experiences of individuals involved in the United Kingdom (UK) UKD scheme, including those who complete the donation, are eventually medically withdrawn, or self-withdraw. Better insight into the different experiences of these groups will provide useful guidance to clinical teams on how to better address the differing psychological needs of completed donors as well as those who do not proceed to donation. Methods: A purposive sample was recruited through the Barriers and Outcomes in Unspecified Donation (BOUnD) study covering twenty-three transplant centres in the UK. Semi-structured interviews were audio-recorded and transcribed verbatim and subjected to inductive thematic analysis. Results: Participants consisted of 15 individuals who had donated, 11 who had been withdrawn by the transplant team and 9 who had self-withdrawn. The analysis resulted in 6 themes and 14 subthemes. The major themes were maximising and sharing benefits; risk-to-motivation analysis; support; self-actualisation / finding meaning; the donor as patient; and relationship with the transplant team. Conclusions: The data demonstrates that, although all donors enter the process with a similar level of commitment, those who did not proceed to donation expressed dissatisfaction and lingering emotional consequences linked to lack of follow-up from transplant teams. The implication for the UKD programme is that from the beginning there needs to be a strategic and consistent approach to managing expectations in order to prepare those who embark on the donation process for all possible outcomes and their associated emotional consequences

Understanding barriers and outcomes of unspecified (non-directed altruistic) kidney donation from both professional’s and patient’s perspectives: research protocol for a national multicentre mixed-methods prospective cohort study

IntroductionLiving donation accounts for over one-third of all kidney transplants taking place in the UK.1The concept of anonymously donating a kidney to a stranger (non-directed altruistic or unspecified kidney donation (UKD)) remains uncomfortable for some clinicians, principally due to concerns about the motivations and long-term physical and psychological outcomes in this donor group.AimsThe research programme aims to provide a comprehensive assessment of the unspecified donor programme in the UK. It aims to identify reasons for variations in practice across centres, explore outcomes for donors and ascertain barriers and facilitators to UKD, as well as assess the economic implications of unspecified donation.MethodsThe research programme will adopt a mixed-methods approach to assessing UKD nationally using focus groups, interviews and questionnaires. Two study populations will be investigated. The first will include transplant professionals involved in unspecified kidney donation. The second will include a 5-year prospective cohort of individuals who present to any of the 23 UK transplant centres as a potential unspecified living kidney donor. Physical and psychological outcomes will be followed up to 1 year following donation or withdrawal from the donation process. A matched sample of specified donors (those donating to someone they know) will be recruited as a control group. Further qualitative work consisting of interviews will be performed on a purposive sample of unspecified donors from both groups (those who do and do not donate).DisseminationThe findings will be reported to NHS Blood and Transplant and the British Transplant Society with a view to developing national guidelines and a protocol for the management of those presenting for unspecified donation.Trial registration numberISRCTN23895878, Pre-results