Faculty Bibliography

Introduction: Veno-venous extracorporeal membrane oxygenation (VV ECMO) may improve survival in trauma patients with respiratory failure. However, many consider traumatic brain injury (TBI) an absolute contraindication for VV ECMO as systemic anticoagulation could worsen intracranial injury. We evaluated outcomes and complications in patients with TBI treated with VV ECMO. Methods: We retrospectively reviewed TBI patients >= 18 years of age admitted between January 1st 2007 and December 31st 2017 treated with VV ECMO. Demographics, injury specific data, pre-ECMO and ECMO data were collected. The primary outcome was survival to discharge. Secondary outcomes included progression of intracranial hemorrhage, bleeding complications, and episodes of oxygenator thrombosis requiring exchange. Medians and interquartile range were reported where appropriate. Results: 13 patients with TBI received VV ECMO support during the study period. The median age was 28 years old [IQR 25-37.5] and 85% were male. Median admission GCS was 5 [IQR 3-13.5]. Median injury severity score (ISS) was 48 [IQR 33.5-66]. Median head AIS was 4 [IQR 3.5-4.5] with median head AIS 3 [IQR 3-4] in survivors. Median pre-ECMO PaO2:FiO2 ratio was 58 [IQR 47-74.5]. Median time from injury to VV ECMO cannulation was 5 days [IQR 0.75-13]. Median time on ECMO was 192 hours [IQR 48-384]. Five (38.4%) patients survived to hospital discharge. Cause of death included: multisystem organ failure in 4, removal of life sustaining therapy in 3 and death by neurologic criteria in 1. 6 patients (46%) received systemic anticoagulation (A/C). No patient had worsening of intracranial hemorrhage on CT. 1 patient was diagnosed with TBI after initiation of VV ECMO. There were two minor bleeding complications in patients on A/C, neither was related to TBI. 4 patients required oxygenator change; 2 in patients on A/C. Conclusion: VV ECMO is safe in patients with TBI and can be used without A/C in high risk TBI patients without increased oxygenator thrombosis. TBI is not a contraindication to the use of VV ECMO in severe respiratory failure

IMPORTANCE/OBJECTIVE:The growing demand for organs continues to outpace supply. This gap is most pronounced in minority populations, who constitute more than 40% of the organ waiting list. Hispanic Americans are particularly less likely to donate compared with other minorities for reasons that remain poorly understood and difficult to change. OBJECTIVE:To determine whether outreach interventions that target Hispanic Americans improve organ donation outcomes. DESIGN, SETTING, AND PARTICIPANTS/METHODS:Prospective before-after study of 4 southern California neighborhoods with a high percentage of Hispanic American residents. We conducted cross-sectional telephone surveys before and 2 years after outreach interventions. Respondents 18 years or older were drawn randomly from lists of Hispanic surnames. Awareness, perceptions, and beliefs regarding organ donation and intent to donate were measured and compared before and after interventions. INTERVENTION/METHODS:Television and radio commercials about organ donation and educational programs at 5 high schools and 4 Catholic churches. MAIN OUTCOMES AND MEASURES/METHODS:Number of survey participants who specify intent to donate. RESULTS:A total of 402 preintervention and 654 postintervention individuals participated in the surveys. We observed a significant increase in awareness of and knowledge about organ donation and a significant increase in the intent to donate (17.7% vs 12.1%; adjusted odds ratio, 1.55 [95% CI, 1.06-2.26; P = .02]). CONCLUSIONS AND RELEVANCE/CONCLUSIONS:Focused donor outreach programs sustain awareness and knowledge and can significantly improve intent to donate organs in the Hispanic American population. These programs should continue to be evaluated and implemented to influence donor registration.

IMPORTANCE/OBJECTIVE:The need for suitable organs for transplantation is especially pronounced in minority populations such as Hispanic Americans owing to disproportionately high rates of diabetes mellitus and kidney disease. Considerable barriers exist for Hispanic Americans consent to donation, resulting in significantly lower donation rates compared with white individuals. OBJECTIVE:To investigate the effect of an aggressive outreach intervention during a 5-year period aimed at improving organ donation rates among Hispanic Americans. DESIGN, SETTING, AND PARTICIPANTS/METHODS:Prospective longitudinal observation study of organ donors treated at a major metropolitan level I trauma center. The center provides most of the medical care to the 4 Southern California neighborhoods with a high percentage of Hispanic Americans that were included in the study. INTERVENTIONS/METHODS:Television and radio media campaigns and culturally sensitive educational programs implemented at high schools, churches, and medical clinics in the target neighborhoods. MAIN OUTCOME AND MEASURE/METHODS:Consent rate for organ donation recorded during the study. RESULTS:Outreach interventions started in 2007 and were completed by 2012. Of 268 potential donors, 155 total donors (106 Hispanic Americans) provided consent during this time. A significant increase in consent rate was noted among Hispanic Americans, from 56% in 2005 to 83%in 2011 (P = .004); this increase was not evident in the population that was not Hispanic (67%in 2005 and 79% in 2011; P = .21). CONCLUSIONS AND RELEVANCE/CONCLUSIONS:Aggressive outreach programs can reduce the disparity between organ supply and demand by improving the consent rate among the target group.

BACKGROUND:High school students are an important target audience for organ donation education. A novel educational intervention focused on Hispanic American (HA) high school students might improve organ donation rates. METHODS:A prospective observational study was conducted in five Los Angeles High Schools with a high percentage of HA students. A "culturally sensitive" educational program was administered to students in grades 9 to 12. Preintervention surveys that assessed awareness, knowledge, perception, and beliefs regarding donation as well as the intent to become an organ donor were compared to postintervention surveys. RESULTS:A total of 10,146 high school students participated in the study. After exclusions, 4876 preintervention and 3182 postintervention surveys were analyzed. A significant increase in the overall knowledge, awareness, and beliefs regarding donation was observed after the intervention, as evidenced by a significant increase in the percentage of correct answers on the survey (41% pre- versus 44% postintervention, P < .0001). When specifically examining HA students, there was a significant increase in the intent to donate organs (adjusted odds ratio 1.21, 95% confidence interval: 1.09, 1.34, P = .0003). CONCLUSION/CONCLUSIONS:This is the first study to demonstrate a significant increase in the intent to donate among HA high school students following an educational intervention.

Religion is an important determinant in Hispanic Americans (HA) becoming organ donors as HA often believe religion forbids donation. We investigated the effect of an educational program targeting HA organ donation in places of worship. A prospective observational study was conducted at four Catholic churches with a high percentage of HA. A 45-min "culturally sensitive" educational program, conducted in Spanish, was implemented. Organ donation awareness, knowledge, perception, and beliefs, as well as the intent to become an organ donor, were measured before and after the intervention. Differences between before and after the intervention were analyzed. A total of 182 surveys were conducted before and 159 surveys were conducted after the educational program. A significant increase was observed in organ donation knowledge (54% vs. 70%, p<0.0001), perception (43% vs. 58%, p<0.0001), and beliefs (50% vs. 60%, p=0.0001). However, no significant difference was found in the willingness to discuss donation with family, intent-to-donate, or registering to donate after the intervention. This study demonstrates that a focused educational program in places of worship can significantly improve HA knowledge, perceptions, and beliefs regarding organ donation. Further work is needed to understand why intent-to-donate does not increase despite the increase in organ donation awareness.

The growing need for transplantable organs continues to outpace supply. This discrepancy is most pronounced in minority populations. Hispanic Americans, however, are significantly less likely to donate their organs for reasons that remain poorly understood. We sought to identify factors that influence Hispanic American high school students' intent to donate organs. A prospective observational study was conducted in five Los Angeles high schools within four separate zip codes known for a high percentage of Hispanic Americans. High school students, ages 15 to 20 years, were surveyed to assess demographic factors, cultural factors, awareness and knowledge, perception, and belief regarding organ donation and the intent to donate. A total of 5444 surveys were collected over a 4-month period. After logistic regression analysis, independent risk factors for predicting the intent to donate were: family support, 11th and 12th grade high school students, being female, religion, and the belief that Hispanics are more likely to need an organ transplant. This study represents the largest study to date examining factors associated with the intent to donate in Hispanic American high school students. To address the organ shortage crisis in Hispanic Americans, these risk factors should be considered using specific, effective educational programs.