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Accept or refuse? Factors influencing the decision-making of transplant surgeons who are offered a pancreas: results of a qualitative study.

Loss J, Drewitz KP, Schlitt HJ, Loss M - BMC Surg (2013)

Bottom Line: The interviewees agreed upon certain main selection criteria, e.g. donor age, lab results, ICU stay.However, there was no consistency in judging these parameters, and clear cut-offs did not exist.Finally, better training for donor surgeons seems advisable, in order to increase trust and thus pancreas utilization.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medical Sociology, University of Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg D-93053, Germany. julika.loss@ukr.de.

ABSTRACT

Background: Most offered pancreases are not transplanted. This study investigates the factors that inform and influence the transplant surgeon's decision to select an offered pancreas.

Methods: Semi-standardized interviews were conducted with 14 highly qualified transplant surgeons from all 14 German transplant centers performing > 5 pancreas transplantations per year. The interviews focused on medical and non-medical criteria on which the individual accept/refuse decision depends. Interviews were recorded, transcribed and underwent content analysis.

Results: The interviewees agreed upon certain main selection criteria, e.g. donor age, lab results, ICU stay. However, there was no consistency in judging these parameters, and clear cut-offs did not exist. The pancreas macroscopy is a pivotal factor, as well as knowing (and trusting) the donor surgeon. 3/14 surgeons reported that they had occasionally refused a pancreas because of staff shortage. Some interviewees followed a restrictive acceptance policy, whereas others preferred to accept almost any pancreas and inspect it personally before deciding.

Conclusion: The assessment of medical donor characteristics is highly inconsistent. Both very cautious as well as very permissive acceptance policies may render the allocation process less efficient. A more standardized policy should be discussed. Finally, better training for donor surgeons seems advisable, in order to increase trust and thus pancreas utilization.

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Categories of criteria that play a role when deciding to accept/reject a pancreas.
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Figure 1: Categories of criteria that play a role when deciding to accept/reject a pancreas.

Mentions: As illustrated schematically in Figure 1, we identified seven main factors influencing the decision-making process (the numbers in brackets refer to Figure 1 and to the subheadings of the following text): The decision to accept or refuse an offered donor pancreas is mainly based on medical criteria. The key factors of medical criteria are the donor’s medical history (1), and, significantly more important, the donor organ macroscopy (2). The decision-making process is also influenced by confidence in the recovery team’s expertise (3). Non-medical aspects play a role in certain circumstances, mainly in terms of staff shortage (4) or prior decisions of other centers (5). The decision is also influenced by the comparatively benign prognosis of patients waiting for a pancreas transplant (6). Finally, the decision-making process can also be guided by strategic considerations, e.g. regarding competition with other centers, or risk management (7).


Accept or refuse? Factors influencing the decision-making of transplant surgeons who are offered a pancreas: results of a qualitative study.

Loss J, Drewitz KP, Schlitt HJ, Loss M - BMC Surg (2013)

Categories of criteria that play a role when deciding to accept/reject a pancreas.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4016525&req=5

Figure 1: Categories of criteria that play a role when deciding to accept/reject a pancreas.
Mentions: As illustrated schematically in Figure 1, we identified seven main factors influencing the decision-making process (the numbers in brackets refer to Figure 1 and to the subheadings of the following text): The decision to accept or refuse an offered donor pancreas is mainly based on medical criteria. The key factors of medical criteria are the donor’s medical history (1), and, significantly more important, the donor organ macroscopy (2). The decision-making process is also influenced by confidence in the recovery team’s expertise (3). Non-medical aspects play a role in certain circumstances, mainly in terms of staff shortage (4) or prior decisions of other centers (5). The decision is also influenced by the comparatively benign prognosis of patients waiting for a pancreas transplant (6). Finally, the decision-making process can also be guided by strategic considerations, e.g. regarding competition with other centers, or risk management (7).

Bottom Line: The interviewees agreed upon certain main selection criteria, e.g. donor age, lab results, ICU stay.However, there was no consistency in judging these parameters, and clear cut-offs did not exist.Finally, better training for donor surgeons seems advisable, in order to increase trust and thus pancreas utilization.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medical Sociology, University of Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg D-93053, Germany. julika.loss@ukr.de.

ABSTRACT

Background: Most offered pancreases are not transplanted. This study investigates the factors that inform and influence the transplant surgeon's decision to select an offered pancreas.

Methods: Semi-standardized interviews were conducted with 14 highly qualified transplant surgeons from all 14 German transplant centers performing > 5 pancreas transplantations per year. The interviews focused on medical and non-medical criteria on which the individual accept/refuse decision depends. Interviews were recorded, transcribed and underwent content analysis.

Results: The interviewees agreed upon certain main selection criteria, e.g. donor age, lab results, ICU stay. However, there was no consistency in judging these parameters, and clear cut-offs did not exist. The pancreas macroscopy is a pivotal factor, as well as knowing (and trusting) the donor surgeon. 3/14 surgeons reported that they had occasionally refused a pancreas because of staff shortage. Some interviewees followed a restrictive acceptance policy, whereas others preferred to accept almost any pancreas and inspect it personally before deciding.

Conclusion: The assessment of medical donor characteristics is highly inconsistent. Both very cautious as well as very permissive acceptance policies may render the allocation process less efficient. A more standardized policy should be discussed. Finally, better training for donor surgeons seems advisable, in order to increase trust and thus pancreas utilization.

Show MeSH