Medicalsocial History

The U.S. Public Health Service (USPHS) set the standard for current clinical practice in Draft Guidelines for Prevention of Transmission of HIV Through Transplantation of Human Tissue and Organs, March 1993.5 In 1994, the Center for Disease Control (CDC), a division of USPHS, announced regulations regarding behaviors that constitute a high-risk donor.8 OPOs then determined how best to screen potential donors for high-risk behaviors and prepared detailed questionnaires for use in obtaining the donor's medical and social history. The RSC would conduct the interview, which would be the vital link to assuring the highest level of quality control for the intended recipients. Formalized training for the interviewer is arranged by OPOs.5

The medical/social history interview is conducted with the next-of-kin and significant life partners in a confidential, sensitive and professional manner. All questions are asked exactly as written to provide objectivity and all answers must be recorded. In addition to the interview, medical records must be reviewed and discussions conducted with physicians, friends and other healthcare agencies that may be able to provide pertinent information. In pediatric patients under the age of 18 months, the mother and, if possible, the father are interviewed about their behaviors that might place the patient at high-risk.

If the potential donor is determined to be high-risk, each OPO has policies regarding which organs will be offered for transplantation and whether to proceed with the donation at all. Beside its use as a screen for high-risk behaviors, the medical/social history provides extensive information that allows the physician to make a better decision for organ acceptance or refusal.

When high-risk behavior is identified, transplant surgeon(s) are called regarding interest. The number of calls may be determined by the behavior identified, by time constraints, and by current urgent needs. A potential recipient identified as an urgent need may nullify the high-risk behavior due to the patient's shortened life span without a transplant. If an OPO does not have any urgent needs when the high-risk potential donor is identified, the RSC may be advised by the administrator or medical director to continue making calls on a regional and national level. However, it must be remembered that in light of the current donor crisis, when lifesaving organs are involved, the CDC's recommendation is to use any potential donor who tests negative for HIV (see chapter 5, Testa).

Identified high-risk behaviors can produce confusion for hospital staff members because criteria for the exclusion of high-risk behaviors change daily as recipient conditions change.

0 0

Post a comment