S 07 Workshop

Omega 2

Programme of the session:

GS: Peter Carstedt
Transplantation – Presenting results and experiences from work to improve transplant programme situation in Sweden

O 09
Tandem haemodialysis–immunoadsorption: nursing experience at Toulouse University Hospital, the French leader in immunoadsorption
Sébastien Maggioni (France)

O 10
Responding to the growth of renal transplantation in Saudi Arabia
John Sedgewick (Saudi Arabia)

O 11
Living donors in renal transplantation. Considerations and Dilemmas
Xanthi Dimitriou-Sarantzi (Greece)

O 12
Becoming a living kidney donor; considerations and decision-making
Hanne Agerskov (Denmark)

Abstracts

GUEST SPEAKER

Abstract is not available

Biography of the guest speaker

O 09
Tandem haemodialysis–immunoadsorption: nursing experience at Toulouse University Hospital, the French leader in immunoadsorption
S. Maggioni¹, M. Hermelin¹, E. Faubel¹, A. Allal¹, L. Rostaing^1
1Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France

Background: The University Hospital of Toulouse (France) chose to concentrate expertise into a single location, creating high-quality collaboration between medical and paramedical personnel.

Objectives: Because of the lack of deceased-kidney donors we have developed a living-kidney transplant program, which permits pre-emptive kidney transplantation which i) is cost-effective as compared to haemodialysis, and ii) improves patient quality of life. In the setting of living-kidney transplantation we often face ABO incompatibility or HLA incompatibility. To overcome these barriers we have implemented specific as well as non-specific immunoadsorption (IA) in our unit from scratch. Our aim is to enable transplants from living-kidney donors to be given to renal candidates who either have an ABO-incompatible donor or HLA-incompatible donor. Historically, IA sessions have been performed either just before an haemodialysis session or on the previous day. This was very tedious for haemodialysis patients. Moreover, the net body-weight gain during a non-specific IA session is ~1 kg, which can have adverse effects on patient’s health.

Methods: We decided in October 2012 to couple haemodialysis (HD) sessions with IA sessions, i.e., tandem IA–HD. From that decision, the nursing team has committed to achieving this goal. Today, tandem IA/HD has become the method of choice at the Toulouse Hospital.

Results: The tandem method not only saves time, thereby reducing costs, but also improves the quality-of-life of patients. We have performed more than 100 tandem IA–HD sessions. This method allows us to treat up to two patients per day.

Conclusion/Application to practice: The tandem method has now become the routine method in the University's Hospital of Toulouse.

Disclosure: No conflict of interest declared

O 10
Responding to the growth of renal transplantation in Saudi Arabia
S. Alkhomry¹, M. Abrahams¹, S. McAllister¹, J. Sedgewick¹, W. Habhab^1
1Nursing Affairs, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia

Background: Renal transplantation in Saudi Arabia has been available since 1979. As the CKD patient population expands, renal transplantation becomes a viable treatment option. Currently, the hospital has the second largest transplant programme in Saudi Arabia. Optimum renal transplantation requires integrated services that ensure quality patient care from admission through to discharge.

Objectives: A pilot service improvement project was initiated with the development of a post-renal transplant coordinator position to enhance the care of patients, whilst simultaneously responding to the strategic goal of increasing renal transplantation.

Methods: Evaluating patient flow patterns through the outpatient clinic was undertaken. A re-engineering of the ‘whole management’ of the patient experience post-transplant was implemented. Providing a native Saudi post-transplant coordinator to improve the patient experience was central to the project.

Results: The post-renal transplant coordinator has enhanced the patient experience and coordination of post-transplant care. Improved efficiency of service and freeing up physician clinic appointments for new patients has allowed renal transplant capacity to increase. In 2011, 53 patients were transplanted increasing to 112 in 2013; graft survival remains at 100%. The post-renal transplant coordinator has significantly enhanced patient education, where cultural beliefs influence how patients manage post-transplant recovery & rehabilitation.

Conclusion/Application to practice: As the renal transplant programme expands, there remains an important need to ensure that patients and families receive optimum care. Providing a native Saudi post-renal transplant coordinator enhances culturally congruent care. The post-transplant coordinator is a vital part of this service.

Disclosure: No conflict of interest declared

 

O 11
Living donors in renal transplantation: Considerations and Dilemmas
X. Dimitriou-Sarantzi^1
1Renal Transplantation, General Hospital of Athens "Laiko", Athens, Greece

Background: When Joseph Murray performed the first successful living donor renal transplant in 1954, it would be difficult to imagine the percentage of living donors reaching approximately 50% and 20.6%  in the USA and Europe respectively.

Objectives: Hence there have been a number of moral questions posed: Is inflicting considerable physical harm to a healthy person in the benefit of a sick person acceptable and moral? However, donors believe that the decision is theirs to make and research confirms that decision making is clearly personal.

Results: Strict rules for choosing suitable future donors exist, but over time these are replaced depending on current needs.  Research findings support that 90-95% of donors would undergo donorship if placed in the same situation, and 72% feel well within themselves by donating. On the other hand, a number of studies report negative results: 24% of donors report significant psychological burden, 12% report a worse health status, and 23% report financial difficulties.  In a very interesting study titled “Assessing elements of informed consent among living donors” that took place in Minnesota (USA), 40% of donors reported feeling some pressure to donate and only 69% understood the psychological risks of donation, 52% the long-term medical and 32% the financial risks.

Conclusion/Application to practice: Despite the fact that donorship decision making is governed by strict criteria and donors receive all the necessary information, it is obvious that the decision making presents with significant gaps. Further study is necessary to determine the extent donors understand consent, so information giving techniques can be evaluated and improved.

Disclosure: No conflict of interest declared

 

O 12
Becoming a living kidney donor; considerations and decision-making
H. Agerskov^1,2, C. Bistrup¹, M.S. Ludvigsen³, B.D. Pedersen^2
1Department of Nephrology, Odense University Hospital, Odense, Denmark; ²Research Unit of Nursing, University of Southern Denmark, Odense, Denmark; ³Department of Nephrology , Aarhus University Hospital, Aarhus, Denmark

Background
When possible, renal transplantation is the treatment of choice for patients with end-stage renal disease. Technological developments in immunology have made it possible to perform kidney transplants between donors and recipients despite antibodies against the donor organ. This allows for a wider range of relationships between recipient and donor.

Objectives
The aim was to investigate the early experiences of, and reflections on, kidney donation among genetic and non-genetic living donors before first consultation at the transplant centre.

Methods
The study was conducted within a phenomenological-hermeneutic theoretical framework. Data were generated through semi-structured interviews with 18 potential donors and participant with observation of consultation between potential donors, recipients, doctors and nurses. Data was interpreted and discussed in accordance with Ricoeur´s interpretation theory on the three levels of: naïve reading, structural analysis, and critical interpretation and discussion.

Results
The decision to donate a kidney involved considerations and reflections in relation to personal and family situation, dilemmas regarding the donation process and concern for and identification with, the recipient’s illness situation and everyday life. The desire to help was prominent, and the potential benefits to both donor and recipient were significant in the decision-making process.

Conclusion/Application to practice
Involving donors narrative in reflections about and modifications to clinical nursing practice can help in planning and providing individual nursing care and support to donors. This support might have an impact on the entire donation process

Disclosure: No conflict of interest declared

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