Expanding Organ Donation in Different Cultural Groups in BC: A Feasibility Study
South Asian (SA) and Chinese Canadians make up nearly 20% of all British Columbians, but account for less than 10% of organ donors. Increasing donation in these communities will increase access to transplantation for all British Columbians.
We are studying ways to improve the process by which South Asian and Chinese families of deceased persons are approached to consent for donation in hospitals. To do this, we will examine all deaths that occur in 5 hospitals in the Lower Mainland of BC over a 1-year period to identify how many South Asian and Chinese Canadians could have been organ donors, how many were asked, and how many consented. This will help us understand if the problem is that we are not asking or that families are not consenting.
We will interview doctors, nurses, and donation specialists to better understand what they see as the barriers to donation in these communities. Additionally, we will interview South Asian and Chinese families that were asked to donate the organs of their deceased loved ones (both when they agreed and didn’t agree to donate) to understand what supported and prevented consent for donation in their cases. Finally, we will ask all of these individuals what they feel could help improve how families are currently asked to donate the organs of their loved ones.
This study will, for the first time, offer solutions from the people directly involved in donation – the medical staff, organ donation specialists, and the families being approached. The results from this study will be used to develop a study in BC hospitals where a culturally tailored intervention will be tested when approaching South Asian and Chinese families for organ donation.
Dr. James Lan
Immunosuppression Reduction and the Risk of De Novo Donor-Specific Antibody Formation After Kidney Transplantation
Kidney transplantation improves the quality of life and longevity of patients with end-stage kidney disease. Despite major improvements in the science of transplantation, a particular form of kidney rejection known as antibody-mediated rejection (AMR) accounts for more than 50% of organ loss. AMR is caused by recipient production of antibodies against unique molecules expressed on the surface of donor cells (donor-specific antibodies, DSA). Under normal circumstances, the recipient does not produce DSA as their immune system is adequately suppressed by the prescribed dosage of anti-rejection medications. However, some patients may experience drug-related side effects such as upset stomach, diarrhea, infection and cancer, which would often trigger a reduction or interruption of certain anti-rejection medications. Although this is routinely practiced in the clinic, it is unknown whether temporary or prolonged reduction of immunosuppression increases the risk of forming DSA, which sets the stage for organ injury and failure down the road.
The goal of this study is to describe the current pattern of prescribed immunosuppression reduction in the clinic and to understand the impact of this practice on DSA development, which portends poor outcomes. This study will help physicians understand the circumstances when it is safe and not safe to reduce immunosuppression. This moves healthcare providers away from the traditional model of “one-size-fits-all”, and allows sophisticated practice guidelines to be implemented at the provincial level to improve patient care.