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  1. Article ; Online: Factors influencing deceased organ donation rates in OECD countries: a panel data analysis.

    Qu, Zhi / Oedingen, Carina / Bartling, Tim / Schrem, Harald / Krauth, Christian

    BMJ open

    2024  Volume 14, Issue 2, Page(s) e077765

    Abstract: Objectives: This study aims to investigate factors with a significant influence on deceased organ donation rates in Organisation for Economic Co-operation and Development (OECD) countries and determine their relative importance. It seeks to provide the ... ...

    Abstract Objectives: This study aims to investigate factors with a significant influence on deceased organ donation rates in Organisation for Economic Co-operation and Development (OECD) countries and determine their relative importance. It seeks to provide the necessary data to facilitate the development of more efficient strategies for improving deceased organ donation rates.
    Design: Retrospective study.
    Setting: Publicly available secondary annual data.
    Participants: The study includes 36 OECD countries as panel members for data analysis.
    Outcome measures: Multivariable panel data regression analysis was employed, encompassing data from 2010 to 2018 for all investigated variables in the included countries.
    Results: The following variables had a significant influence on deceased organ donation rates: 'opt-in' system (β=-4.734, p<0.001, ref: 'opt-out' system), only donation after brain death (DBD) donors allowed (β=-4.049, p=0.002, ref: both DBD and donation after circulatory death (DCD) donors allowed), number of hospital beds per million population (pmp) (β=0.002, p<0.001), total healthcare employment pmp (β=-0.00012, p=0.012), World Giving Index (β=0.124, p=0.008), total tax revenue as a percentage of gross domestic product (β=0.312, p=0.009) and percentage of population aged ≥65 years (β=0.801, p<0.001) as well as high education population in percentage (β=0.118, p=0.017).
    Conclusions: Compared with the promotion of socioeconomic factors with a positive significant impact on deceased organ donation rates, the following policies have been shown to significantly increase rates of deceased organ donation, which could be further actively promoted: the adoption of an 'opt-out' system with presumed consent for deceased organ donation and the legal authorisation of both DBD and DCD for transplantation.
    MeSH term(s) Humans ; Organisation for Economic Co-Operation and Development ; Retrospective Studies ; Tissue and Organ Procurement ; Organ Transplantation ; Tissue Donors
    Language English
    Publishing date 2024-02-21
    Publishing country England
    Document type Journal Article
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2023-077765
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Systematic review on the involvement and engagement of patients as advisers for the organisation of organ transplantation services.

    Qu, Zhi / Oedingen, Carina / Bartling, Tim / Krauth, Christian / Schrem, Harald

    BMJ open

    2023  Volume 13, Issue 5, Page(s) e072091

    Abstract: Objectives: This systematic review aims to derive practical lessons from publications on patient involvement and engagement in the organisation of organ transplantation services.: Design: This systematic review was conducted according to the ... ...

    Abstract Objectives: This systematic review aims to derive practical lessons from publications on patient involvement and engagement in the organisation of organ transplantation services.
    Design: This systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Inclusion criteria for the analysis of publications in English cited in the databases PubMed and Web of Science until 6 December 2022 required that patients participated as advisers in the organisation of organ transplantation services. Quality assessment was performed using the Guidance for Reporting Involvement of Patients and the Public (GRIPP) 2 small form and the Critical Appraisal Skills Programme (CASP) tool for the assessment of the risks of bias.
    Results: Deployed search strings identified 2263 records resulting in a total of 11 articles. The aims and strategies, deployed methods, observed effects, observed barriers and proposed improvements for the future varied vastly. All reported that well-developed programmes involving and engaging patients at an organisational level provide additional benefits for patients and foster patient-centred care. Lessons learnt include: (1) to empower patients, the information provided to them should be individualised to prioritise their needs; (2) financial as well as organisational resources are important to successfully implement patient involvement and engagement; (3) systematic feedback from patients in organisational structures to health providers is required to improve clinical workflows and (4) the consideration of ethical issues and the relationship between investigators and participating patients should be clarified and reported.
    Conclusions: Actionable management recommendations could be derived. The quantitative impact on clinical outcome and economic clinical process improvements remains to be investigated. Study quality can be improved using the GRIPP 2 guidance and the CASP tool.
    Prospero registration number: CRD42022186467.
    MeSH term(s) Humans ; Patient Participation/methods ; Patients ; Patient-Centered Care ; Organ Transplantation
    Language English
    Publishing date 2023-05-10
    Publishing country England
    Document type Systematic Review ; Journal Article
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2023-072091
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Setting Organ Allocation Priorities: A Discrete Choice Experiment with German Patients and Their Relatives.

    Bartling, Tim / Oedingen, Carina / Schrem, Harald / Kohlmann, Thomas / Krauth, Christian

    Patient preference and adherence

    2023  Volume 17, Page(s) 827–838

    Abstract: Purpose: Organ transplantation systems benefit from guidelines that are harmonious with the preferences of the people involved. Discrete choice experiments are useful tools for eliciting preferences.: Patients and methods: This study evaluated the ... ...

    Abstract Purpose: Organ transplantation systems benefit from guidelines that are harmonious with the preferences of the people involved. Discrete choice experiments are useful tools for eliciting preferences.
    Patients and methods: This study evaluated the preferences of patients and their relatives (n=285) to identify their priorities in organ allocation using a discrete choice experiment. In eight hypothetical allocation decisions, the participants were asked to select the candidate they considered the most suitable The candidates differed in years of life gained after transplantation, quality of life after transplantation, waiting time until transplantation, age, compliance and social support.
    Results: The most important aspects for setting priority in organ allocation were lack of compliance (β= -2.5, p<0.001) and good quality of life after transplantation (β = +1.4, p<0.001). The lack of social support (ß = -0.8, p<0.05) and the more years of life gained after transplantation (β = +0.5, p<0.001) had less but still a significant amount of influence on this decision, while the waiting list was not considered significantly important (β = 0.1, p>0.05). The comparison of the different relations to transplantation showed that life years gained after transplantation was of high relevance to posttransplant patients (+10 years: β = +0.709, p<0.001 / +15 years: β = +0.700, p<0.001) and of no importance to waitlisted patients (+10 years: β = +0.345, p>0.05 / + 15 years: β = +0.173, p>0.05) and relatives (+ 10 years: β = +0.063, p>0.05 / +15 years: β = +0.304, p>0.05).
    Conclusion: This study provides useful insights into the unique perspective of patients and their relatives on priority-setting in the allocation of donor organs that should be reflected in improved donor organ allocation rules.
    Language English
    Publishing date 2023-03-24
    Publishing country New Zealand
    Document type Journal Article
    ZDB-ID 2455848-5
    ISSN 1177-889X
    ISSN 1177-889X
    DOI 10.2147/PPA.S402203
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: How Should Deceased Donor Organs Be Allocated? The Patient's Perspective Derived from Semi-Structured Interviews.

    Bartling, Tim / Oedingen, Carina / Kohlmann, Thomas / Schrem, Harald / Krauth, Christian

    Patient preference and adherence

    2022  Volume 16, Page(s) 2375–2385

    Abstract: Purpose: The gap between the supply and demand for deceased donor organs is increasing worldwide, while patients on waiting lists for organ transplantation die. This situation requires ethical donor organ allocation rules. The patients' perspective on ... ...

    Abstract Purpose: The gap between the supply and demand for deceased donor organs is increasing worldwide, while patients on waiting lists for organ transplantation die. This situation requires ethical donor organ allocation rules. The patients' perspective on donor organ allocation rules offers a highly relevant and unique perspective that may differ from the perspectives of physicians and the general public.
    Patients and methods: Semi-structured telephone interviews were conducted with the regional group coordinators of the federal self-help organization for organ transplanted patients and their relatives in Germany in early 2021. Twelve interviews were conducted with patients and relatives of transplantation patients who received transplants for the affected organs including the lungs, heart, kidney, and liver. Transcripts were analyzed using the deductive framework method which was based on an earlier study. All criteria were reported following the COREQ statement.
    Results: Participants emphasized aspects of "medical urgency" and "effectiveness/benefit" of transplantation and associated trade-offs as well as the recipient's responsibility for organ failure ("own fault"), the appreciation for the gifted graft and the patient's capability of taking care of it ("appreciation/responsibility"). Patients acknowledged that urgent patients should be prioritized and they showed a clear preference toward allocation rules that strive to maximize both the life years and quality of life gained by transplantation.
    Conclusion: The patients' perspective is unique in that patients agree on certain rules for allocation and share many preferences, but also have a hard time finding clear cutoff points when considering selecting a participant for allocation. Patient representatives should therefore be consulted in the debate on donor organ allocation rules.
    Language English
    Publishing date 2022-08-30
    Publishing country New Zealand
    Document type Journal Article
    ZDB-ID 2455848-5
    ISSN 1177-889X
    ISSN 1177-889X
    DOI 10.2147/PPA.S372603
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: 'As a surgeon, I am obliged to every single patient': evaluation of focus group discussions with transplantation physicians on the allocation of donor organs.

    Bartling, Tim / Oedingen, Carina / Schrem, Harald / Kohlmann, Thomas / Krauth, Christian

    Current opinion in organ transplantation

    2021  Volume 26, Issue 5, Page(s) 459–467

    Abstract: Introduction: Organ transplantation is the last resort for many patients. The ubiquitous shortage of suitable donor organs raises the question of best-justifiable allocation worldwide. This study investigates how physicians would allocate donor organs.!# ...

    Abstract Introduction: Organ transplantation is the last resort for many patients. The ubiquitous shortage of suitable donor organs raises the question of best-justifiable allocation worldwide. This study investigates how physicians would allocate donor organs.
    Methods: Focus group discussions with a total of 12 transplant surgeons and 2 other transplant-related physicians were held at the annual conference of the German Transplantation Society (Oct 2019). Three groups discussed aspects of 'egalitarianism', 'effectiveness/benefit', 'medical urgency', 'own fault', 'medical background' and 'socio-demographic status'.
    Results and discussion: It was observed that physicians often find themselves confronted with conflicts between (a) trying to advocate for their individual patients versus (b) seeing the systemic perspective and understanding the global impact of their decisions at the same time. The groups agreed that due to the current shortage of donor organs in the German allocation system, transplanted patients are often too sick at the point of transplantation and that a better balance between urgency and effectiveness is needed. The aspects of 'effectiveness' and 'urgency' were identified as the most challenging issues and thus were the main focus of debate. The dilemmas physicians find themselves in become increasingly severe, the larger the shortage of suitable donor organs is.
    MeSH term(s) Focus Groups ; Humans ; Organ Transplantation ; Surgeons ; Tissue Donors ; Tissue and Organ Procurement
    Language English
    Publishing date 2021-07-27
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1390429-2
    ISSN 1531-7013 ; 1087-2418
    ISSN (online) 1531-7013
    ISSN 1087-2418
    DOI 10.1097/MOT.0000000000000908
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Lohnt sich Rehabilitation? : Überblick über gesundheitsökonomische Analysen der Rehabilitation in Deutschland.

    Krauth, Christian / Bartling, Tim

    Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz

    2017  Volume 60, Issue 4, Page(s) 394–401

    Abstract: Because of demographic change, the rehabilitation sector in Germany is going to face increasing demands in the future. Limited budgets make the optimal allocation of resources a top priority. To support decisions about the optimal scope and design of ... ...

    Title translation Is rehabilitation worth it? : Review of economic evaluations of rehabilitation in Germany.
    Abstract Because of demographic change, the rehabilitation sector in Germany is going to face increasing demands in the future. Limited budgets make the optimal allocation of resources a top priority. To support decisions about the optimal scope and design of rehabilitation, studies on health economics are of utmost importance. The aim of this article is to provide an overview of the evaluation of rehabilitation with regard to health economics in Germany.Based on a comprehensive literature research, 17 studies on the cost-effectiveness of rehabilitation in Germany were identified. The health economics evaluation focuses on four main topics: patient education (5 studies), the comparison of outpatient and inpatient rehabilitation (7 studies), medico-occupational rehabilitation programs (2 studies) and aftercare programs (3 studies). All four topics show that innovative rehabilitation technologies can be cost-effective. Significant potential savings in program costs of 25-35% are demonstrated in outpatient rehabilitation (with comparable effectiveness with inpatient care). Designated patient education programs often lead to significant savings with indirect costs, by reducing periods of unfitness to work and extending the long-term ability to work. This review article also points out that some relevant areas of rehabilitation, such as the flexibilization of rehabilitation programs or the efficient organization of access to rehabilitation, have not been evaluated sufficiently on the basis of health economics. This article ends with the requirement to carry out more economics-based rehabilitation studies.
    MeSH term(s) Ambulatory Care/statistics & numerical data ; Cost-Benefit Analysis/economics ; Disabled Persons/rehabilitation ; Disabled Persons/statistics & numerical data ; Germany/epidemiology ; Health Care Costs/statistics & numerical data ; Hospitalization/economics ; Humans ; Models, Economic ; Patient Education as Topic/economics ; Patient Education as Topic/statistics & numerical data ; Rehabilitation/economics ; Rehabilitation/statistics & numerical data ; Treatment Outcome
    Language German
    Publishing date 2017-04
    Publishing country Germany
    Document type Journal Article ; Meta-Analysis ; Review
    ZDB-ID 1461973-8
    ISSN 1437-1588 ; 1436-9990
    ISSN (online) 1437-1588
    ISSN 1436-9990
    DOI 10.1007/s00103-017-2514-0
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  7. Article ; Online: Organ procurement and transplantation in Germany during the COVID-19 pandemic.

    Qu, Zhi / Oedingen, Carina / Bartling, Tim / Schrem, Harald / Krauth, Christian

    Lancet (London, England)

    2020  Volume 396, Issue 10260, Page(s) 1395

    MeSH term(s) Betacoronavirus ; COVID-19 ; Coronavirus Infections ; Germany/epidemiology ; Humans ; Pandemics/prevention & control ; Pneumonia, Viral ; SARS-CoV-2 ; Tissue and Organ Procurement
    Keywords covid19
    Language English
    Publishing date 2020-10-14
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 3306-6
    ISSN 1474-547X ; 0023-7507 ; 0140-6736
    ISSN (online) 1474-547X
    ISSN 0023-7507 ; 0140-6736
    DOI 10.1016/S0140-6736(20)32213-3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Systematic review on potential brain dead donor estimations and conversion rates to actually realized organ donations.

    Qu, Zhi / Oedingen, Carina / Bartling, Tim / Beneke, Jan / Zink, Michael / Krauth, Christian / Schrem, Harald

    Transplantation reviews (Orlando, Fla.)

    2021  Volume 35, Issue 4, Page(s) 100638

    Abstract: Introduction: Accurate estimations of potential organ donors (POTDs) are required to improve transplant systems. This systematic review analyses current studies on national estimations of potential donors for transplantation as well as the practical and ...

    Abstract Introduction: Accurate estimations of potential organ donors (POTDs) are required to improve transplant systems. This systematic review analyses current studies on national estimations of potential donors for transplantation as well as the practical and policy implications of detected differences.
    Method: A systematic review of literature published between 01.01.2010 and 01.04.2020 in PubMed was conducted. Data was extracted into a self-developed matrix, and further data retrieved on national population sizes, waiting lists and transplant activities.
    Results: Six studies were included. Investigated populations, underlying data collections and eligibility criteria for POTDs varied widely. Estimated POTDs per million population (p.m.p.) ranged from 25.8 to 333.6, conversion rates from 3.2% to 47.5% leading to 41.2 to 86.4 transplanted organs p.m.p.. Patients on the waiting lists varied from 66.7 to 338.9 p.m.p., defining gaps between organ supply and demand in countries. Not all studies adhered to the definitions and processes of the critical pathway for deceased donation which is the latest international consensus statement on deceased organ donation.
    Conclusion: Differences in estimated POTDs and differences in supply and demand of donor organs between countries cannot be satisfactorily explained yet due to an obvious lack of evidence, consistent methodology, international consensus and robust underlying datasets. Future studies should be based on robust underlying data sets and aim for potential donor estimations that allow national comparisons due to the adherence to the international consensus on definitions, processes and methodology.
    MeSH term(s) Brain Death ; Humans ; Organ Transplantation ; Tissue Donors ; Tissue and Organ Procurement ; Waiting Lists
    Language English
    Publishing date 2021-07-03
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review ; Systematic Review
    ZDB-ID 639400-0
    ISSN 1557-9816 ; 0955-470X
    ISSN (online) 1557-9816
    ISSN 0955-470X
    DOI 10.1016/j.trre.2021.100638
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  9. Article ; Online: Public preferences for the allocation of donor organs for transplantation: A discrete choice experiment.

    Oedingen, Carina / Bartling, Tim / Schrem, Harald / Mühlbacher, Axel C / Krauth, Christian

    Social science & medicine (1982)

    2021  Volume 287, Page(s) 114360

    Abstract: This study aimed to assess public preferences for the allocation of donor organs in Germany with the focus on ethical principles of distributive justice. We performed a discrete choice experiment (DCE) using a self-completed online questionnaire. Based ... ...

    Abstract This study aimed to assess public preferences for the allocation of donor organs in Germany with the focus on ethical principles of distributive justice. We performed a discrete choice experiment (DCE) using a self-completed online questionnaire. Based on a systematic review and focus group discussions, six attributes, each with two-four levels, were selected (corresponding principle of distributive justice in brackets), including (1) life years gained after transplantation (principle of distributive justice: effectiveness/benefit - utilitarianism), (2) quality of life after transplantation (effectiveness/benefit - utilitarianism), (3) chance for a further donor organ offer (principle of distributive justice: medical urgency - favouring the worst-off), (4) age (medical and social risk factors: sociodemographic status), (5) registered donor (principle of distributive justice: value for society), and (6) individual role in causing organ failure (principle of distributive justice: own fault). Each respondent was presented with eight choice sets and asked to choose between two hypothetical patients without an opt-out. Data were analysed using conditional logit, mixed logit and latent class models. The final sample comprised 1028 respondents. Choice decisions were significantly influenced by all attributes except chance for a further donor organ offer. The attributes of good quality of life after transplantation, younger age, and no individual role in causing organ failure had the greatest impact on choice decisions. Life years gained after transplantation and being a registered donor were less important for the public. The latent class model identified four classes with preference heterogeneities. Respondents preferred to allocate deceased donor organs by criteria related to effectiveness/benefit, whereas medical urgency was of minor importance. Therefore, a public propensity for a rational, utilitarian, ethical model of allocation could be identified. Public preferences can help to inform policy to warrant socially responsible allocation systems and thus improve organ donation rates.
    MeSH term(s) Choice Behavior ; Focus Groups ; Humans ; Organ Transplantation ; Patient Preference ; Quality of Life ; Tissue Donors ; Tissue and Organ Procurement
    Language English
    Publishing date 2021-09-03
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Systematic Review
    ZDB-ID 4766-1
    ISSN 1873-5347 ; 0037-7856 ; 0277-9536
    ISSN (online) 1873-5347
    ISSN 0037-7856 ; 0277-9536
    DOI 10.1016/j.socscimed.2021.114360
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  10. Article ; Online: Public, medical professionals' and patients' preferences for the allocation of donor organs for transplantation: study protocol for discrete choice experiments.

    Oedingen, Carina / Bartling, Tim / Krauth, Christian

    BMJ open

    2018  Volume 8, Issue 10, Page(s) e026040

    Abstract: Introduction: Organ transplantation is the treatment of choice for patients with severe organ failure. Nevertheless, donor organs are a scarce resource resulting in a large mismatch between supply and demand. Therefore, priority-setting leads to the ... ...

    Abstract Introduction: Organ transplantation is the treatment of choice for patients with severe organ failure. Nevertheless, donor organs are a scarce resource resulting in a large mismatch between supply and demand. Therefore, priority-setting leads to the dilemma of how these scarce organs should be allocated and who should be considered eligible to receive a suitable organ. In order to improve the supply-demand mismatch in transplantation medicine, this study explores preferences of different stakeholders (general public, medical professionals and patients) for the allocation of donor organs for transplantation in Germany. The aims are (1) to determine criteria and preferences, which are relevant for the allocation of scarce donor organs and (2) to compare the results between the three target groups to derive strategies for health policy.
    Methods and analysis: We outline the study protocol for discrete choice experiments, where respondents are presented with different choices including attributes with varied attribute levels. They were asked to choose between these choice sets. First, systematic reviews will be conducted to identify the state of art. Subsequently, focus group discussions with the public and patients as well as expert interviews with medical professionals will follow to establish the attributes that are going to be included in the experiments and to verify the results of the systematic reviews. Using this qualitative exploratory work, discrete choice studies will be designed to quantitatively assess preferences. We will use a D-efficient fractional factorial design to survey a total sample of 600 respondents according to the public, medical professionals and patients each. Multinomial conditional logit model and latent class model will be analysed to estimate the final results.
    Ethics and dissemination: This study has received Ethics Approval from the Hannover Medical School Human Ethics Committee (Vote number: 7921_BO_K_2018). Findings will be disseminated through conference presentations, workshops with stakeholders and peer-reviewed journal articles.
    MeSH term(s) Choice Behavior ; Focus Groups ; Germany ; Humans ; Patient Preference ; Qualitative Research ; Research Design ; Stakeholder Participation ; Systematic Reviews as Topic ; Tissue and Organ Procurement/organization & administration
    Language English
    Publishing date 2018-10-17
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2747269-3
    ISSN 2044-6055 ; 2044-6055 ; 2053-3624
    ISSN (online) 2044-6055
    ISSN 2044-6055 ; 2053-3624
    DOI 10.1136/bmjopen-2018-026040
    Database MEDical Literature Analysis and Retrieval System OnLINE

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