I takt med att behovet av organ ökar utförs det fler organtransplantationer varje år. För att kunna få ett nytt organ innebär det för många att någon annan avlider under de omständigheterna så att organen kan doneras, och framförallt att viljan att donera sina organ finns från den avlidne eller dess anhöriga. Ett beslut som kan ge flera andra livet tillbaka. Transplantationsprocessen är lång och slutar inte när det nya organet är transplanterat, förutom livslång medicinering kan många tankar och frågor uppstå. Syftet med studien var att beskriva patienters upplevelser att leva med ett organ från en avliden donator. Studien genomfördes som en allmän litteraturstudie där tio resultatartiklar som svarade till studiens syfte granskades och sammanställdes, vilket resulterade i fem teman; Upplevelser av tacksamhet, Upplevelser av ansvar inför donator, Upplevelser av ett förändrat själv, Upplevelser av skuld samt Upplevelser av sorg. Huvudfynden i resultatet var att mottagarna upplevde en förändring av sig själva efter transplantationen samt upplevelser av tacksamhet över att ha fått en andra chans i livet. För att hantera förändringen krävs det hjälp och förståelse från sjukvården. Större förståelse kring mottagares upplevelser efter transplantationen med organ från en avliden donator behövs för att bättre kunna bemöta deras behov. / The need for organ transplants has risen considerably, that is why there are more organ transplants carried out each year. To acquire a new organ means for many that somebody has to die during circumstances that an organ can be donated and the donor or their relatives must have a will to donate their organ. The transplant process is long and doesn't end when the new organ is transplanted, in addition to lifelong medication there can be many thoughts and questions that can arise. The purpose of this study was to describe the patients experience to live with an organ from a deceased donor. The study was carried out like a general literature study. The ten resulting articles were assessed, compiled and resulted in the following five themes: Experience of gratefulness, Experience of responsibility to the donator, Experience of a changed self, Experience of guilt and Experience of grief. The main findings from the study is that the recipient experiences a change in their self and experience of gratefulness. A wider understanding around the recipient experiences after a transplant with an organ from a deceased donor, where personal treatment is needed to support the requirements.

This thesis is the first known study to relocate Acropora cervicornis across multiple regions of the Florida Reef Tract. Since 2006, A. cervicornis has been listed as a threatened coral species under the U.S. Endangered Species Act. In response, restoration efforts utilizing coral nursery methods have been implemented throughout the Caribbean. The primary objective of this research was to determine the response of A. cervicornis colonies to being relocated between two coral nurseries separated by approximately 150km along the Florida Reef Tract. To accomplish this, a reciprocal transport was conducted between coral fragments with known genotypes from Broward County and Monroe County, Florida. A subset of coral ramets (fragments of a single genotype) was removed from the nursery of origin and relocated to the opposing coral nursery, while the remaining ramets stayed in their original nursery to serve as controls. Following transplant, both relocated and non-relocated corals were monitored for 14 months and survivorship, growth rates, branching frequency, and coral condition data were collected. In addition, tissue samples were collected twice during the monitoring period to determine zooxanthellae densities. Reaction norms were used to predict the responses of each measured variable for each genotype in response to being relocated. Relocated coral colonies from both nurseries exhibited equal or greater survivorship than the non-relocated corals from their original nursery. Growth rates, branching frequency, and zooxanthellae densities were highest in the corals that were previously in or relocated to Broward County. Within each nursery, relocated and non-relocated corals were not significantly different in any of the measured parameters. Throughout the study period, there were no signs of disease, bleaching, or predation on any of the corals. These findings demonstrate that A. cervicornis colonies can be successfully relocated across regions of the Florida Reef Tract suggesting that colonies throughout the FRT may be used for collaborative restoration efforts. Reaction norm analysis indicated phenotypically plastic responses in each growth parameter with some instances of genotype-by-environment interactions. Finally, these results suggest the need for additional research to investigate regional differences in A. cervicornis populations for proper management and restoration approaches.

Class of 2015 Abstract / Objectives: To determine if using three-factor prothrombin complex concentrate (PCC) immediately prior to heart transplantation reduces blood product transfusions in patients bridged to heart transplantation by mechanical circulatory support (MCS) devices who are treated with warfarin. Methods: This study retrospectively reviewed patients that either received PCC or received usual care (i.e. fresh frozen plasma – FFP) prior to heart transplantation. Outcomes that were evaluated included packed red blood cell (RBC), FFP, platelet and cryoprecipitate transfusions intra and five days post-operatively, Cell Saver autologous blood volume administered intra-operatively, chest tube output for the five days post-operatively, and thromboembolic events post-operatively. Results: There were 24 patients included in the study, 12 from each group. The PCC group showed significantly less intra-operative RBC transfusion (2.60 ± 1.49 units vs. 5.09 ± 2.42 units, p=0.018), Cell Saver autologous blood usage (2.60 ± 1.49 units vs. 4.02 ± 1.55 units, p=0.032), and FFP transfusion (2.14 ± 2.30 units vs. 10.94 ± 5.96 units, p=0.0005) than the usual care group. There was no difference in amount of vitamin K given, change in INR, platelets administered, cryoprecipitate administered, chest tube output, or thromboembolic events between the groups. The average dose of PCC was 31 units/kg IV; repeat doses were given to 2 patients. Conclusions: We propose that the use of PCC prior to heart transplant surgery for patients on MCS devices anticoagulated with warfarin may result in the reduction for the need of RBC’s, autologous blood use and FFP during surgery.

Class of 2011 Abstract / OBJECTIVES: The purpose of this study was to analyze the impact of patient and hospital characteristics as well as selected comorbidities on inpatient mortality and charges in pediatric HSCT. We have determined the top 25 comorbidities reported during all inpatient stays for HSCT as well as for those stays ending in mortality. METHODS: All data was extracted from the AHRQ KID databases for the years 1997, 2000, 2003, and 2006. Two regression analyses were performed to determine the contribution of various independent variables on mortality and charges. Subjects of this study included all cases of HSCT reported in the Healthcare Cost and Utilization Project (HCUP) KID as ICD-9 41.XX. RESULTS: Factors accounting for larger increases in cost included death during hospital stay, the development of disseminated intravascular coagulation (DIC), pneumonia, and length of stay (LOS). The largest decreases in charges were seen for patients coming from a small or “micropolitan” location, patients cared for in teaching hospitals, and in hospitals with large bedsizes. Variables associated with increased risk of mortality on linear regression included development of DIC, sepsis, or pneumonia. CONCLUSION: Further study relating to HSCT is necessary to determine the contribution of specific comorbidities to mortality and charges. Importantly, DIC is associated with both greater risk of mortality and greater charges. It would be prudent to recommend increased monitoring and early treatment for DIC based on these results.

Vascularized composite allotransplantation has developed as a specialty at the interface of reconstructive and transplant surgery, offering restoration of function and form in scenarios where options for autologous reconstruction are limited, and for which the burden of donor-site morbidity may be high. Over the past 15 years some 28 patients have received face, and 85 patients upper extremity transplants. Results have been encouraging, with good functional outcomes, and the majority of patients reporting return to independence, employment and improved quality of life. However, the immunological management of these patients remains a significant challenge. While conventional immunosuppressive regimens have proven effective in preventing graft loss to rejection, they have failed to protect patients from acute rejection episodes, which have been reported in 85% during the first year post-transplant. When considered alongside the burden of comorbidity associated with life-long immunosuppression, the impetus for development of novel approaches to the prevention of rejection is clear. Induction of hematopoietic mixed chimerism has successfully achieved transplant tolerance, defined as specific unresponsiveness to donor antigens permitting life-long acceptance of transplanted tissues without maintenance immunosuppression, in numerous animal models and recently, of renal allografts in clinical trials. The work presented in this thesis investigates mixed chimerism for induction of tolerance of vascularized composite allografts (VCAs) across class I and II major histocompatibility (MHC) barriers in the Massachusetts General Hospital miniature swine model; a large animal model with defined MHC immunogenetics, and skin closely analogous to that of humans. The data presented demonstrate development of a reproducible model of VCA tolerance and stable hematopoietic mixed chimerism in a preclinical model. Importantly, tolerance extended to all components of VCAs including the epidermis and dermis, a previously un-reproducible finding. In vitro analysis demonstrated no evidence for either IL-2 reversible anergy or cellular regulation as mechanisms of donor-specific unresponsiveness, suggesting that at a systemic level, tolerance in this model may be primarily mediated by clonal deletion. In contrast, characterization of the cutaneous immune system demonstrated rapid infiltration of VCAs with recipient T cells and Langerhans’ cells, which in chimeric recipients did not cause rejection but rather established stable chimerism in all tissue-resident populations including dermal T cells with the phenotype of Tregs (CD25+FoxP3+); findings which suggest tissue-specific, and regulatory, mechanisms may play important roles. These data support the hypothesis that mixed chimerism is sufficient for whole-skin tolerance of VCAs, but further work is required to demonstrate the necessity of stable, rather than transient, chimerism and to confirm the necessity of other systemic or tissue-specific factors for prevention of epidermal rejection.

Objective: To explore quality of life in patients with multiple sclerosis. Concept Analysis: A concept analysis of quality of life in multiple sclerosis was conducted using Rodgers’ evolutionary concept analysis method. Eighty-three studies were reviewed. Study Proposal for Secondary Analysis: The proposal was for a secondary analysis using a quantitative, longitudinal, repeated measures design to determine if stem cell transplant has an impact on the quality of life of multiple sclerosis patients with aggressive disease. Summary of Findings: A concept analysis provided valuable insight into the use and understanding of the concept of quality of life in the multiple sclerosis literature. The subjective and multidimensional attributes of quality of life in multiple sclerosis were similar to findings in previous concept analyses of quality of life in general and in other diseases. The other attributes of the concept being measureable, modifiable and predictable revealed the uniqueness of quality of life in multiple sclerosis and provided a foundation for the development of future research. The results of the secondary analysis will provide new knowledge of a novel treatment for multiple sclerosis and its impact on quality of life. This advancement of knowledge in nursing and across health care disciplines will aid in the delivery of collaborative and comprehensive patient-centred care to ultimately improve the lives of multiple sclerosis patients.

This diploma thesis deals with the possible solution of the kidney shortage problem. Especially analyses effect of legislation system of registration to organ donation on count of kidney transplants and waiting time. The effect of the legislation system is analyzed with panel data of OECD countries. Using random effects method, the estimated result suggest that the countries using informed consent produce on average 7,49 kidney transplants per million population fewer and on average 1,95 years longer waiting time, than countries using presumed consent. Although model predicted positive impact of presumed consent system, empirical data from Chile didn't confirm this assumption. Based on the analysis, I suggest better solution of kidney shortage problem, than change of the registration system. Introduce of compensatory payments to living kidney donors.

Falls are a contributing factor to increased morbidity in the elderly and chronically ill populations and can affect overall quality of life. The literature indicates that oncology patients are a particularly vulnerable population who are further at risk for falls due to increased age, treatment related fatigue, side effects of medications, co-morbidities, decreased muscle tone, altered mental status, and anemia. Although patients with cancer are at a high risk for falls, this is not a well-documented patient problem in the nursing literature. This study examined the validity of the use of the Morse Fall Assessment Tool for use with Bone Marrow Transplant patients and explored other variables that might influence fall outcomes. This study was a retrospective chart review. The sample consisted of a total of 59 patients, which included 29 fallers and 30 non-fallers on a bone marrow transplant unit. There were 22 males and 37 females, ranging in age from 20 to 70 with a mean age of 53.9 (SD= 12.2).The results of this study indicate that there is a significant difference between fallers' (M= 43.8) and non-fallers' (M= 26.8) scores on the Morse Fall Scale (p= 0.000). Significant differences between groups were found with history of falls (p= 0.042), secondary diagnosis (p= 0.015), and muscle weakness (p= 0.025). Laboratory results from fallers and non-fallers revealed significant differences in platelet count (p= 0.003), BUN (p= 0.032), glucose (p= 0.009), and phosphorous (p= 0.001). This is the first study to document falls in the bone marrow transplant population. This study should be a stimulus for future studies conducted in the oncology and/or bone marrow transplant population. Studying falls in these patients is essential to understanding the physiological risk factors that may contribute to patient falls. Findings lay the foundation for studying falls in the bone marrow transplant population. It is crucial to study falls in this population in order to make appropriate assessments and interventions to keep this population free from injury.

Perceived availability or receipt of tangible or instrumental social support has generally been associated with favorable outcomes in kidney transplant recipients, yet there has been insufficient attention in the literature to other social relationship processes beyond support that may contribute to mental and physical health. The overall objective of the current study was to examine whether specific dimensions of relationship quality, such as emotional closeness, sexual relations, support transactions, respect/acceptance, and conflict/negative communication, within the context of a close interpersonal relationship, were associated with psychosocial and medical outcomes in kidney transplant recipients when accounting for the effects of global social support. Participants had received a living or deceased donor kidney transplant and were 6 months - 5 years post-surgery at the time of enrollment in the study. A total of 93 participants completed self-report measures and a semi-structured clinical interview via telephone that assessed each of the aforementioned dimensions with regard to a specified relationship. A subsample of 67 participants were married or involved in a committed dating relationship and responded to interview questions with their partner in mind; the remaining participants selected the person to whom they felt closest over the preceding 6 months (e.g., friend, sibling, parent). Structural equation modeling and linear regression were used to analyze the data. Results suggested that the distinct yet highly correlated dimensions reflected an underlying 'relationship quality' construct. Poorer relationship quality was associated with increased symptoms of depression, decreased feelings of well-being, and worse mental health-related quality of life for both the full sample and the subsample of participants in a romantic relationship. The path between relationship quality and depression remained significant for romantic relationship participants when global social support was included in the model, but global social support was more strongly associated with depression, well-being, and health-related quality of life for all participants. Relationship quality was not associated with adherence or graft function in this sample. However, interesting interaction effects were found, such that high conflict and lack of emotional intimacy were more strongly associated with poorer self-reported adherence in women. In addition, women who reported higher conflict in their relationship also endorsed increased depression, decreased well-being, and worse mental health-related functioning compared to men. These findings are consistent with previous research that has cited the importance of global social support for patients who have received a kidney transplant. The present study also provides novel evidence that other dimensions of relationship quality contribute to outcomes in this population. A comprehensive assessment of recipients' close relationships throughout the transplant process, particularly of conflict and emotional intimacy in women, would allow clinicians to recommend psychosocial interventions that could improve patient outcomes.

PATIENTERS UPPLEVELSER I VÄNTAN PÅ ORGANTRANSPLANTATIONEN LITTERATURSTUDIEPETRA NILSSONKRISTINA NINICNilsson, P & Ninic, K. Patienters upplevelser i väntan på organtransplantation. Enlitteraturstudie. Examensarbete i omvårdnad 15 högskolepoäng. Malmöuniversitet: Fakulteten för hälsa och samhälle, institutionen för vårdvetenskap,2020.AbstraktSyfte: Syftet med studien är att belysa patienters upplevelser av att vänta påorgantransplantation.Bakgrund: Behovet av transplantationer ökar och väntetiden blir längre. Enöversikt av utförda transplantationer presenteras både i Sverige och globalt.Lungor, hjärta, njurar och lever är väsentliga organ som behövs för överlevnad,när ett av dessa organ drabbas av sviktande funktion kan den enda behandlingenvara transplantation. Organ kan doneras både från levande och avliden donator.Metod: En litteraturstudie med kvalitativ innehållsanalys med induktiv ansats somär baserad på 14 kvalitativa artiklar som relevans och kvalitetsgranskades.Artiklarna hittades i databaser CINAHL och PubMed.Resultat: Flera upplevelser identifieras under väntan på transplantation ochkategoriseras som: väntan skapar en pendling mellan hopp och hopplöshet,väntan skapar oro, väntan leder till social isolering samt att få hjälp i hanteringav situationen under väntetiden. Dessa huvudkategorier leder till sammanlagt 14subkategorier.Konklusion: Denna studie belyser patienternas upplevelser och lyfter fram möjligaomvårdnadsåtgärder som sjuksköterskor kan vidta för att tillfredsställapatienternas behov samt ge en god omvårdnad.Nyckelord: omvårdnad, patient, sjuksköterska, transplantation, upplevelser, väntan / PATIENT´S EXPERIENCES AWAITING AN ORGAN TRANSPLANTATIONA LITERATURE REVIEWPETRA NILSSONKRISTINA NINICNilsson, P & Ninic, K. Patient´s experiences awaiting an organ transplantation. Aliterature review. Degree project in nursing 15 credit points. Malmö university:Faculty of health and society, department of health care sciences, 2020.AbstractAim: The aim of the study is to describe patient´s experiences of waiting for organtransplantation.Background: The need for transplants is increasing and the waiting time becomeslonger. An overview of transplant presented performed both in Sweden andglobally. Lungs, heart, kidneys and liver are essential organs that are required forsurvival, when one of these organs is affected by malfunctioning, the onlytreatment may be transplantation. Organs can be donated both from a living ordeceased donor.Method: A literature review using qualitative content analysis with inductiveapproach, which is based on 14 qualitative articles that were relevant andqualitative reviewed. The articles were found in CIHNAL and PubMed.Resultat: Several experiences are identified while waiting for a transplant and arecategorized as: the wait creates feelings that goes back and forth between hopeand hopelessness, the wait creates worry, the wait leads to social isolation and toget help in handling the situation during the wait. These main categories lead to atotal of 14 subcategories.Conclusion: This study highlights patient´s experiences and shows possiblenursing measures that nurses can take to satisfy patient´s needs and provide goodnursing care.Keywords: experiences, nurse, nursing, patient, transplant, waiting.