Donor Network West

Patient-centered outcomes are increasingly recognized by the transplant community as a key component to improving knowledge and patient counseling, and long-term outcomes after living kidney or liver donation are not well understood. With efforts underway to follow living donors and donor candidates long term, it is critical that living donors and candidates drive the process of patient-centered data collection. Living donors on the Scientific Registry of Transplant Recipients' Living Donor Steering Committee were engaged to brainstorm and prioritize which data elements should be captured. Committee members identified long-term lab values, difficulty with normal activities, and diagnosis of chronic kidney or liver disease as critical long-term outcomes. Additional high-priority elements included short-term lab values, deaths related to donation, mortality among donors compared to nondonors, hospital readmissions, costs and physical limitations related to donation, and whether a donor would donate again. Finally, living donors wanted to know the risk of organ failure among donors compared to nondonors. This prioritization exercise provided valuable insights from living donors to help determine key themes and discrete data elements that should be prioritized for long-term collection and reporting to living donors and living donor candidates.

Ruch, Brianna; Kumm, Kayla; Kirk, Wendy Van; Geraghty, PJ; Harbell, Jack W; Aqel, Bashar A; Reddy, Kunam S; Katariya, Nitin N; Mathur, Amit K Author Information

The present work revisits how artificial intelligence, as technology and ideology, is based on the rational choice theory and the techno-liberal discourse, supported by large corporations and investment funds. Those that promote using different algorithmic processes (such as filter bubbles or echo chambers) create homogeneous and polarized spaces that reinforces people’s ethical, ideological, and political narratives. These mechanisms validate bubbles of choices as statements of fact and contravene the prerequisites for exercising deliberation in pluralistic societies, such as the distinction between data and values, the affirmation of reasonable dissent, and the relevance of diversity as a condition indispensable for democratic deliberation.

Despite the institution of a new Kidney Allocation System in 2014, A2/A2B to B transplantation has not increased as expected. The current Organ Procurement and Transplantation Network policy requires subtyping on two separate occasions, and in the setting of discrepant results, defaulting to the A1 subtype. However, there is significant inherent variability in the serologic assays used for blood group subtyping and genotyping is rarely done. The National Kidney Registry, a kidney paired donation (KPD) program, performs serological typing on all A/AB donors, and in cases of non-A1/non-A1B donors, confirmatory genotyping is performed. Between 2/18/2018 and 9/15/2020, 13.0% (145) of 1,111 type A donors registered with the NKR were ultimately subtyped as A2 via genotyping. Notably, 49.6% (72) of these were subtyped as A1 at their donor center, and in accordance with OPTN policy, ineligible for allocation as A2. Inaccurate A2 subtyping represents a significant lost opportunity in transplantation, especially in KPD where A2 donors can not only facilitate living donor transplantation for O and highly sensitized candidates, but can also facilitate additional living donor transplants. This study highlights the need for improved accuracy of subtyping technique, and the need for policy changes encouraging optimal utilization of A2 donor kidneys.

As Western blood transfusion practices are changing, there is interest and need in anticipating the future demand of blood products and how a blood establishment can actively prepare for various long-term developments. This article provides an overview of how a scenario approach was used to prioritize key categories of drivers for the future demand of red blood cells and the organizational implications thereof for Sanquin, the Dutch national blood establishment. Based on previously identified drivers from interviews and a literature review (Step 1), we conducted scenario sessions and a survey to rank a list of drivers ("themes") with its related opportunities and threats (Step 2), to identify mitigating measures per theme through focus groups (Step 3). In Step 2, 10 themes were found that were classified in terms of importance and uncertainty. These were plotted on a two-dimensional graph with an ellipse to indicate the interquartile ranges per theme. Experts rated the top three most important themes to be the blood supply organization, precision medicine, and red blood cell replacements. In Step 3, focus groups identified specific mitigating measures per theme. These measures had parallel ideas, such as the need for an innovative mentality, internal and external communication and collaboration, and building Sanquin's reputation and trust with the public. Having identified the most important themes with suggestions for mitigating measures, Sanquin can take steps to become adaptive and proactive. Other blood establishments may also use a scenario approach to create contextualized long-term strategies.

Learning Health Networks (LHN) improve the well-being of populations by aligning clinical care specialists, technology experts, patients and patient advocates, and other thought leaders for continuous improvement and seamless care delivery. A novel LHN focused on pediatric transplantation, the Starzl Network for Excellence in Pediatric Transplantation (SNEPT), convened its inaugural meeting in September 2018. Clinical care team representatives, patients, and patient families/advocates partnered to take part in educational sessions, pain point exercises, and project identification workshops. Participants discussed the global impact of transplant from both a population and individual perspective, identifying challenges and opportunities where the Starzl Network could work to improve outcomes at scale across a variety of transplant-related conditions.