Reliable information on COVID19 2023

If you have been looking at social media on the - #coronavirus, #COVID19, #COVID-19, #coronavirusoutbreak you may be finding it hard to keep up with what is happening. Particularly if you have a chronic medical condition, now that this pandemic remains ongoing around the world.

Amongst the facts being pushed out by the various public health and government organizations involved in the ongoing response to this virus, there are a steady stream of variable quality posts continuing to be posted from individuals, news organizations and companies. At times there are multiple perspectives on the same topic which continue to be confusing for many people. However, what is apparent is that the situation is continuing to evolve in many countries -ie how many people are being affected by what strain of the virus along with what measures authorities continue to have in place.

So, what are the most important things that you as an individual can continue to do right now? There are 4 things, and they are (as contained in this useful video)-

https://youtu.be/1APwq1df6Mw


a) wash your hands regularly, especially after going to the bathroom or being in contact with other people. Good old fashioned soap and water will do if you are not able to access hand sanitiser (see image below). 

b) cover your mouth when coughing or sneezing and avoid shaking hands with other people. Plus wear a mask if you are out and about around other people whilst there is ongoing community transmission of the COVID19 virus (or any of its variants). Of note the type of mask is important-a respirator type mask is better than either a surgical or cloth mask (see link below on masks).

c) understand what social distancing means should there be further outbreaks of coronavirus near where you live and/or work. This means avoiding people who are sick.

d) understand what you need to do if asked to self isolate for a period of time and put plans into place in case you need to

e) keep an eye on reliable web sites for information. This may vary depending in which country you reside

f) keep up to date with your vaccinations against COVID19. The type of vaccine you will receive along with the timing of the first, second and now subsequent booster doses will depend on which country you live in. There is some indication that for people who live in some countries that a fifth or even sixth dose of the vaccine will be required, particularly if they have underlying health conditions. If in doubt speak to your doctors and or specialist (if you are a solid organ transplant recipient). The latest info on vaccinating solid organ transplant recipients can be found here-

https://www.myast.org/statement-covid-19-vaccination-solid-organ-transplant-recipients

Some useful web sites are-

WHO information on coronavirus

WHO COVID 19 measures

US CDC Coronavirus travel information

Interim Guidance US CDC on the coronavirus for householders

Advice for Transplant Recipients (tailored to recipients within the United States)

Information on COVID19 vaccination United States Transplant recipients

Kidney Care UK COVID advice

Information about masks

How to Contribute to the Organisations Caring for Injured and Displaced Wildlife due to the BushFires in Australia

Over an 8 month period from the second half of 2019 until February 2020 there were a number of devastating bush fires which occurred, particularly along the east coast of Australia. In addition, parts of South Australia (including the iconic Kangaroo Island) were also involved. Along with vast areas of bushland being burnt there was some loss of buildings but fortunately to relatively few lives were lost of the local human inhabitants. The farm animal losses numbered in the tens of thousands. There was also a colossal loss of wildlife habitat which will have medium to long term implications. This has translated into millions of wildlife being killed including most recently on Kangaroo Island where it is estimated that 25,000 koalas have perished.

Due to the ferocity and extent of these fires a lot of the wildlife were not able to escape in time. This includes reptiles and the marsupials including possums as well as the koalas. There have been some dramatic rescues of the koalas one of which attracted a lot of media attention when it involved a woman saving a koala. This particular koala went on to die despite being intensively nursed in a wildlife hospital.

A video of this same rescue effort can be seen here https://youtu.be/YzRix8ktta4


The list of organisations some of which you may wish to contribute include-

1) The Rescue Collective (rescuing and feeding injured & displaced wildlife on the east coast of Australia) -https://therescuecollective.com/

2) Wildlife rescue and rehabilitation Kangaroo Island (includes koalas)- https://www.gofundme.com/f/help-save-kangaroo-islands-koalas-and-wildlife?utm_source=facebook&utm_medium=social&utm_campaign=p_cf+share-flow-1&fbclid=IwAR0nhRxUpEZlzegf7ZBOCRaJT6aJlUP8fe3hQNGxbg8ekOrtUZdGGqujt1E

3) South Australian Veterinary Emergency Management (helping with treating wildlife injured on both Kangaroo Island as well as in the Adelaide Hills) https://www.savem.org.au/

4) Adelaide and Hills Koala Rescue (South Australia Fires Dec 2019) - https://www.gofundme.com/f/sa-koala-burn-victims?utm_source=customer&utm_medium=copy_link&utm_campaign=p_cf+share-flow-1&fbclid=IwAR1yhfuolxBQ8n5li7300q0QaC3XDM4fj4YuEY47lo7mpWQgsNTVG2ZIzJo

5) Adelaide Koala Rescue - https://www.akr.org.au/

6) Cobargo Wildlife Centre, Cobargo New South Wales -NB severely impacted by the bushfires https://www.gofundme.com/f/wildlife-fire-ground-carers

7) The Nature Foundation of SA Kangaroo Island Conservation programs         https://www.naturefoundation.org.au/support-us/kangaroo-island-conservation-programs

8) Fauna Rescue South Australia (NB Kangaroo Island fires) https://www.faunarescue.org.au/

9) Wildlife Victoria - *** really need help (for wildlife impacted upon by bushfires in Victoria) https://www.wildlifevictoria.org.au/

10) East Gippsland Wildlife rescue (Victoria bushfires) - https://mkc.org.au/donations/koalaisland?fbclid=IwAR2KRGo1f9_d9FT5qNjFxaN7atKtyR8KXY_RcXlM6r-dPr29tfOqkm_E3bU

11) Wildlife Rescue Habitat Boxes (because so many trees have been destroyed) https://wildlifeboxes.raisely.com/

12) Science for Wildlife (based in Sydney, New South Wales - medium to long term assistance programs including for koalas) -http://scienceforwildlife.org/

13) Native Animal Rescue Group, Braidwood, New South Wales- http://narg.asn.au/

14) Koalas in Care (New South Wales) - http://www.koalasincare.org.au/

15) Bangalow Koalas - http://www.bangalowkoalas.com.au/support-bangalow-koalas/

16) Port Stephens Koalas (New South Wales) https://portstephenskoalas.com.au/

17) FAWNA (care for all other injured wildlife except koalas) https://www.fawna.org.au/donating-to-fawna/

18) Shoalhaven Bat Clinic https://www.facebook.com/pg/Shoalhaven.Bat.Clinic/posts/

19) Rural and Hive Aid (Support Farmers & Honey Bees) https://www.ruralaid.org.au/donate/

20) Wombat hospital http://www.cedarcreekwombatrescue.com/

21) Sleepy Burrows Wombat Sanctuary https://sleepyburrows.com.au/

22) Dingo Sanctuary Bargo (impacted upon by the bushfires but the animals have been saved) https://dingosanctuarybargo.com.au/

23) Wildlife Rescue South Coast -***Really need help (Rescue all types of wildlife South Coast New South Wales) https://www.wildlife-rescue.org.au/

24) Wildcare Australia (build nest boxes- medium to long term efforts) https://wildcare-australia-inc.giveeasy.org/urgent-help-for-our-wildlife

25) Blue Mountains Koala Project https://www.givenow.com.au/koalaconservation

26) Trillion Trees Australia (ongoing recovery strategy to plant trees restore habitat) https://trilliontrees.org.au/

27) Birdlife Australia Bushfire appeal http://www.birdlife.org.au/current-appeal

28) Port Macquarie Koala Hospital https://www.koalahospital.org.au/ (As of 23rd November 2019 the team at the hospital are requesting that donations of supplies be made to the other organisations)

29) Currumbin Wildlife Sanctuary koala appeal https://www.gofundme.com/f/save-our-koala-bushfire-victims

30) Australian Wildlife Conservancy (medium to long term conservation efforts) https://www.australianwildlife.org/

31) Aussie Ark (conservation efforts in the medium to long term) https://www.aussieark.org.au/

32) WIRES New South Wales (*** are reasonably well off due to donations currently) https://www.wires.org.au

33) Friends of the Koala https://friends-of-the-koala.giveeasy.org/urgent-help-required?fbclid=IwAR2BZucQgc6U7zKUX83j-gcTGW2ieVWZvaCYmwC2b27VFM7fRH_xDGFtDr4
(Update-they are replete with funds as from the 24th November)

33) WIRES Northern Rivers (Caring for burnt possums)- https://www.facebook.com/Wires-Northern-Rivers-129514553790887/4

Published articles being retracted from scientific journals including Transplantation

There is now confirmation that 15 scientific articles have been retracted from journals from around the world due to concerns that organs from executed prisoners were used for the purposes of transplantation. These articles are all from China.

As outlined in this online post from Retraction Watch the majority of the studies were published in PLOS One and the Transplantation journal.

This has been confirmed in an open access Editorial published in Transplantation where it is confirmed that some of the relevant scientific publications will now be retracted. It is understood that  a decision has been made at PLOS One to also retract a number of publications following a review having been undertaken. This intention of PLOS One to review previously published articles, was signalled earlier in 2019 Statement PLOS One In addition the scientific journal Kidney International has published online an expression of concern over 2 manuscripts that were previously published.

For all healthcare professionals involved in organ donation and or solid organ transplantation this is an important development as all possible measures are brought to bear on countries around the world where there are issues with how organs from organ donors are actually obtained.

Update : What is involved in the end to end process of assessing a potential deceased organ donor?

Following on from an earlier post in this blog on this particular topic, the time has come to provide an update as to what is involved in the end to end processes around the world  of undertaking a full medical/surgical assessment of a potential organ donor. This process extends from the initial identification of a potential organ donor in hospital through to the surgical recovery of the organs that are then deemed suitable for transplantation. In particular this information applies to deceased donors whether it be that they proceed via the donation after circulatory death (DCD) pathway or whether it be following the neurologic determination of death (otherwise known as brain death - DBD).

A number of professional organizations and statutory organ donation organizations also have relevant up to date information which can be accessed via the relevant web sites. This includes NHS Organ Donor , the United Network of Organ Donation in the United States ( UNOS ), and the Australian Organ and Tissue Authority via it's DonateLife website

However the best practice principles of assessing each and every organ donor are the same regardless of either the location or the circumstances. This involves putting together the relevant data and information for every point of interest as summarized in each of the pieces of the jigsaw in the following graphic-

One particular point of note and that is that along the way, from the beginning of the assessment process through to the end of the organ retrieval/recovery surgery being performed on an actual donor, as new information comes to hand this may rule out some or all of the organs for transplantation purposes. For example testing for infectious disease involves a battery of tests being performed the results of which are not available for a number of hours. As each year goes by the tests either become more sophisticated for eg the nucleic acid testing (NAT) for viruses. In addition as new blood tests are developed these are added to the battery of tests being undertaken, depending on the circumstances.

At times additional tests such as echo cardiograms, ultrasound scans and even computerized tomographic imaging may be performed if there are concerns that the donor may have additional medical problems which may need to be investigated further. On occasion more sophisticated tests are also performed on tissue obtained from undertaking a biopsy of one or more of the donor organs. These biopsies may also be undertaken during the organ retrieval/recovery surgery if the surgeons are concerned that there are specific abnormalities which need to be investigated further.

Acknowledgements: Lesley Logan NHS Scotland for providing feedback on this updated graphic prior to this blog post going live.

Everest - What it takes to climb to the summit - it is the end result of determination and planning (& some luck)

How hard is it to reach the summit of Mount Everest? As you can see and hear in the above link to this video footage, it is very hard. This condensed, YouTube footage consists of climbers who are initially on the approach to and then subsequently reach the summit of Mount Everest. It was put together by adventurer Elia Saikaly who recently made it available online.

For more on Elia you can check out the information that is available at the end of the video.

Many people climb Everest as a way of raising attention to and/or advocating on other human interest type issues that are of a significant interest to them. On occasion organ donation has been flagged as being an issue of particular importance to an Everest climber. This was the case in 2017, when a physiotherapist from HongKong successfully summitted the mountain. As outlined in this following online post (via the link), Elton Ng Chun-ting mentions how difficult it was to actually undertake the climb and how he also developed some temporary visual disturbance whilst on the mountain. The article also contains a video which is worth watching.

What both of these posts reveal is that is takes determination, along with physical conditioning and experience in high altitude mountain climbing to reach the summit of Everest. In addition a reasonable amount of forward planning and sound decision making are both required to achieve such a goal. The element of chance (or luck) is always a factor with this type of activity, as sudden illness of any of the team members, an unforeseen equipment failure or adverse weather conditions can either alone or in combination rule out reaching the end goal of a summit attempt.

Public disagreement via social media over the first lung transplant in Romania

Even if the information in the following online post about the first ever lung transplant having been performed in Romania is only half correct, it is still of concern First-lung-transplant-Romania

It appears that an argument has been waged via social media by officials over whether or not the Sfanta Maria hospital in Bucharest had received the appropriate authorisation.

Regardless of who may or may not be correct here, this is no way to deal with this, for multiple reasons, not least maintaining public confidence in the hospital system. Hopefully the issues that are alluded to in the article will be addressed and most importantly the war of words via social media will cease.

Meanwhile it does seem that the first transplant in Romania has actually been performed. Of note up until recently lung transplants for Romanian citizens were performed in Vienna, Austria (as mentioned in the article).

For information on the actual lung transplant procedure as it was reported in Romania, click on the following link -Lung transplant at Sfanta Maria hospital

Cessation of content curation via the Scoop.it platform

As alluded to in a previous post, one of my advocacy roles in the online space had involved content curation via the Scoop.it platform - www.scoop.it mainly pertaining to the topics of organ donation and organ transplantation.

However nothing in the online space remains static from year to year (think Facebook and the Cambridge Analytica story in 2018). Hence it can be expected that the developers and/or business owners of the various social media platforms will introduce changes on a regular basis. In addition individual users of social media platforms have to balance the rewards of using any particular online platform versus the risks and costs.

Hence from April 2018 how I go about my various advocacy roles in the online space will evolve.

The following changes will now occur-

A) Cessation of use of the Scoop.it platform predominantly due to the increasing charges being levelled by the owners for the same degree of functionality. This no doubt partly reflects the success of pitching this particular tool to users in the online space who are heavy users of content curation for specific purposes.

This means there will be no more new posts onto either of the following two sites-

            1) Organ Donation Transplant Matters www.scoop.it/t/organ-donation-transplant-matters

            2) Organ Donation Transplant Matters Resources www.scoop.it/t/organ-donation-transplant-matters-resources

B) Greater emphasis on the use of the second Twitter Handle @ODT_M https://twitter.com/ODT_M for pushing out content specifically on organ donation and transplantation

C) Ongoing use of Google+ and Linked In for advocacy purposes

D) An ongoing search for another content curation tool which is fit for purpose for this blogger

Enabling healthcare transformation and the power of data

Insights Gained from the Implementation of a Content Curation Strategy

Towards the end of 2011 the then new Scoop.it  content curation platform became available online. This precipitated the formulation of a strategy for content curation from the world wide web in close to real time for a niche area within healthcare. The strategy implementation would need to be iterative and undertaken in a stepwise manner in order to meet sustainability goals.

The first topic chosen for a domain on the Scoop.it platform was solid organ donation and transplantation. The focus would predominantly be on curating relevant news, patient stories and other related social media advocacy that would all be of interest to a general audience. The web sub site was named Organ Donation Transplant Matters (ODTM) and a logo generated. For the first 3 months highly selective filters were placed on the RSS feeds via the back end of the Scoop.it platform in order to not overwhelm the resources allocated towards curation activities. When it became apparent after the first month that only 1% of the visible RSS feeds were being posted, the filters were then significantly loosened such that as many information sources as possible could then be tapped into.

Consideration was subsequently given to establishing a second related domain on the Scoop.it platform and this was implemented 4 months after the first. The second sub site would have more of a professional focus and  hence would contain curated reports, guidelines and professional opinion on organ donation and transplantation. This second sub site was named Organ Donation Transplant Matters Resources (ODTMR). Only good quality material would be selected for posting which meant that more highly selective filters were able to be placed right from the start on the RSS feeds for the ODTMR sub site.

So after three years what are the lessons learned? Metrics available via the back end of the Scoop.it platform now provide data on the most reliable sources for posts. In addition the Scoop.it platform has been progressively re-engineered such that there is now far more interaction between the curator and the platform. The low rate of postings onto the ODTM sub site means that the filters for these particular RSS feeds will now be significantly altered (and tightened). 

Whereas for the ODTMR sub site, the RSS feed filters can and will be progressively altered in an ongoing iterative manner to include some of the suggestions which are now beginning to be made available from the Scoop.it end. In addition feedback can be provided to Scoop.it on which types of links are not useful.

This ongoing steady optimization of the RSS feeds for curation purposes, contributes to efficiency and efficacy goals both continuing to be met. With the ongoing increase in online activity year upon year it is apparent that effective content curation requires the use of an online tool that is also changing in parallel to meet the increasing demands of dealing with the burgeoning flow of online information.  

This is part of the humarithm philosophy (the interaction between humans and technology), underpinning the ongoing evolution of the Scoop.it platform from which this curator is one of the many continuing to benefit.

Why Innovation is a hot topic in the health care sector

It is relatively easy for anyone who works in the healthcare sector to concentrate only on the day to day, week to week activities which are the major focus of ones working life. So what do you think of when you hear the term 'Innovation' being used? Do you think of innovation as being like the light bulb switching on (i.e. a new idea), or perhaps even a new process?

In fact innovation is a little more complicated than just being a light bulb moment. You can have the best idea in the world but if it does not translate into an outcome that results in some fundamental change, then it remains ..... just an idea.

One of the best definitions of Innovation can be found via Wikipedia and involves the notion of doing something differently versus just doing something better.

Due to the ongoing challenges faced across the world in the healthcare sector  'Innovation' is beginning to feature in the parlance of a number of major healthcare organizations. Examples include the Center for Innovation Mayo Clinic , the Cleveland Clinic Innovations Centre as well as the web portal for the Innovation Dashboard NHS in the United Kingdom.

What all of these organizations have in common, is an understanding at the leadership level of the importance of harnessing the untapped talents of all of the employees. This is in order to bring about the types of ongoing fundamental change that will enable increasing value to be derived from the allocation of resources within the organization. This involves building both a community and culture for innovation within the organization. This process requires that a number of  elements be in place as summarized in the following graphic-

So why is it important for healthcare organizations to embrace innovation? As outlined in this online post via the Harvard Business Review there remain a number of unmet challenges facing healthcare organizations and hence embracing innovation is one strategy for addressing these challenges,                                                  

Decided about organ and tissue donation? - DonateLife Australia Video

This well put together video has been produced in order to inform Australians of the importance of organ and tissue donation and what is required to ensure that as many people as possible can then benefit

Why a cirrhotic liver needs to be replaced with a transplanted liver.

Often during conversations that transplant surgeons have with potential candidates for liver transplantation procedure, it can take a while to reach an understanding of exactly why the whole liver needs to be replaced. Particularly as this will involve major surgery along with waiting for a suitable liver from an organ donor. Also there are currently no other types of medical treatment which can reverse end stage liver disease once it is diagnosed.

With the liver being hidden from view under the right lower rib cage at the top of the abdomen as described in this British Liver Trust post, it can be hard for any individual with liver disease to know exactly what is going on. Plus many types of liver disease in the early stages do not usually lead to specific symptoms such as abdominal pain or the development of yellow jaundice.

So by the time the symptoms of chronic liver disease do occur there is often already a significant amount of liver scarring present, i.e. there is cirrhosis.  This means that the underlying disease process in the liver can already be well advanced. Cirrhosis affects the whole liver and the scarring process turns the liver from being a slightly soft triangular shaped organ into being a far harder, scarred organ with lots of nodules. This can be seen in the image below or via watching this video What is cirrhosis of the liver?  

 

Cirrhosis can also lead to other significant changes occurring within the abdomen which also tend not to be visible until this type of liver damage is well advanced. Changes like the accumulation of fluid lead to abdominal swelling and this is otherwise known as ascites. Increased pressure within certain veins in the abdomen cause a condition known as portal hypertension which can lead to major bleeding from the junction of the oesophagus with the stomach.  In advanced cirrhosis yellow jaundice and problems with kidney function may also occur. Further information on liver disease and cirrhosis can be obtained via the MedLine Plus WebMD or the American Liver Foundation sites.

Hence this is why in the advanced stages of many of the chronic liver diseases which lead to cirrhosis, liver transplantation is currently the only long lasting effective treatment, because the whole diseased liver must be replaced. As yet other therapies such as stem cells and bio engineered organs are nowhere close enough to being considered effective therapies for this condition.

If you are a patient receiving treatment for liver disease or a relative you should always check with your doctor that any information you source online is appropriate for your circumstances.

 

Why ‘every tablet every time’ is so important for transplant recipients

No conversation about an organ transplant surgical procedure is complete without mention being made of one other important topic. That is the absolute necessity for additional medicines to be given post transplant, otherwise known as the ‘immunosuppressive medications’. So why are these types of medicines needed? Why do transplant recipients need to understand the importance of the saying “every tablet every time”?

Well it is all about the fact that our ‘immune system’ is designed to protect us by repelling anything from entering our bodies that is not made up of our own tissue. This includes bacteria, viruses and yes vital transplanted organs. A very general overview of how our immune system works can be obtained via this YouTube video.

Hence these white blood cells (lymphocytes), and other related factors need to be kept suppressed by medications as summarised in this article via  News Medical This prevents the newly transplanted organ from being ‘rejected’.

These extra medications will commence in most cases around the time that the organ transplant surgical procedure occurs. Initially quite high dosages are usually required and as a result side effects may occur, as summarised via this article from the National Kidney Foundation 

 

In order to limit the long term consequences of all of the possible side effects from these medications, many transplant recipients will ultimately be managed on the lowest dose that is possible. Hence why taking “every tablet every time” is essential. Skipping medications can allow the immune system to be triggered, which then contributes to premature loss of the vital transplanted organ. No one wants this outcome.

General information on ‘immunosuppressive medications’ can also be obtained via web sites maintained by legitimate professional organisations for e.g. eMedicine Medscape or Up to Date

NB: Immunosuppressive medication regimens do vary markedly, as there are many factors which go into the decision making as to which medications are suitable for each recipient. Hence this is why all transplant recipients if they have any concerns over their medications, need to also seek advice from their treating doctor.

 

 

Using Social Media for information streaming in healthcare

Are you in health care and accessing social media for work purposes? Are you also comfortable with using some of the current social media platforms as tools for the streaming of information that meets your needs? If so, the following information is probably not new. However, if you do not fit in either of these two categories, then feel free to read on.

The amount of information related to health care is burgeoning whether it be in the form of facts, published scientific reports, or related to other day to day work processes. Much of this information is now sourced electronically including via the Internet. This situation has not gone unnoticed in some areas with there being an increasing realisation that somehow all of this needs to be managed. At times individuals can feel like they are "trying to drink from a fire hydrant" (Mitchell Kapoor) as pictured.

This same analogy was featured in a blog written by a medical student in Scientific American Blog-Unofficial Prognosis where the impact of this information deluge on medical students was explored.

So how can you use social media to help with your information needs regardless of where you are in the health sector? Plus why might this now be an increasingly important topic? First you need to gain familiarity with use of the most common social media platforms which include Facebook, Twitter, YouTube and Linked In (see below image). Then you need to ascertain which organizations, groups and individuals are relaying information via these platforms which can help meet your learning needs. As it turns out an increasing number of organizations are relaying important information via social media.

 

For example if you have recently joined Twitter but still feel a little unsure of how to go about finding the organizations or individuals of interest, the good news is that help is at hand. This is in the form of the Symplur hashtags project- @healthhashtags Via this Symplur web site you can find hashtags including for organizations, communities of practice(eg nursing, medicine, audiology), diseases, treatments, management and informatics. As a result of exploring the hashtags you will also be able to find relevant organizations, plus individuals on Twitter as well as their related web sites and other social media channels. As everyone has slightly different learning needs in health care, this is why it is now important that you know how to source useful information for yourself.

Finally feel free to explore, find like minded individuals and most important of all continue to learn! Also take some time to check out advice that is available on the safe use of social media platforms eg for Facebook via reputable channels including Mashable Social Media.

Organ Donation: Three essential 'A's.

You may notice that the postings on to this site mainly provide information on 3 topics - organ donation, organ transplantation and use of social media. So what would you say it you were told that there are important common messages contained within these topics? What does this represent? Well it comes down to three important words all beginning with ‘A’.

A is for Awareness, a term used frequently over the last 10-20 years for various campaigns promoting organ donation around the world. So do you think that having lots of ‘Awareness’ leads to higher organ donor rates? What would you say if you were told that the country with the highest organ donor rate in the world-Spain- does not run ‘awareness’ campaigns? Can you say that you or your family are truly aware of the importance of organ donation or what is involved? How about your friends or work colleagues? What steps have you taken to find out more about organ donation even though you may be ‘aware’ of its importance? This is where one other word beginning with ‘A’ becomes important.

A is for Action, a term used when individuals or organisations take steps to convert their ‘Awareness’ of a problem or issue into steps that lead to real change and hence results. Without taking action ‘Awareness’ on its own will not achieve any lasting impact. Probably the greatest example of awareness not leading to appropriate action for health is the world-wide obesity epidemic. Despite clear documentation of an increasing problem for e.g. CDC statistics, numerous campaigns via both media and professional organisations including, reports from the Institute of Medicine, the problem continues. You can view an Obesity info graphic from the Australian Science Media Centre which outlines the projected rates of obesity in that country if action is or is not taken.

So what do you need to do to take action on organ donation? Well first you need to find out the facts and there are a number of good web sites which include Organdonor.gov, United Kingdom NHS Then you need to talk to your family. You can also note your decision via your Facebook timeline if you wish. If you belong to an organisation with an interest in organ donation, then you will be combining Awareness with Action which are two essential components as depicted in order to help form a platform for leading and driving change

A is for Advocacy, a term used to signal the action being taken by individuals, groups or organisations who want change [or reform] to occur, including within the health care system and at policy level, for the barriers to organ donation to be overcome.



Three essential A's required for change

So there you have it, the 3 A’s as they relate to organ donation as depicted above, which is of enormous importance for organ transplantation. You cannot have one without the other two. As for social media, well this is now a conduit via which relevant information [for both Awareness and Action] is being relayed both by individuals and organisations with an Advocacy role. This is in order to facilitate the changes that are required in many countries to ensure that the maximum benefits of organ donation are realised.

The Most Important Transplant Surgeon Conversation- Providing an Outline of the Transplant Surgical Procedure

The  most important conversation that a transplant surgeon needs to have with any potential recipient relates to the planned transplant surgical procedure. This involves describing what the actual procedure involves, as well as any potential problems that can occur with the surgery followed then by the expected post-operative course.

All transplant surgical procedures are considered major operative procedures and there are common elements which they all share-

a)     Making an appropriate incision either on the chest or the abdomen to gain the required access

b)    The surgical removal of the recipients own diseased organ in the case of the lungs, liver and heart in order to make space for the new organ to be transplanted. This also requires that some blood vessels and other structures need to be preserved to assist with the next phase of the surgery.

c)    Implanting the new donor organ which involves suturing a number of vessels and other pipes/structures that are specific to each type of donor organ

d)    Ensuring that any other problems such as bleeding are then dealt with

e)    Inserting drainage tubes and closing the incision

 Once the surgery is completed one of two things then happens-

1)    In the case of kidney recipients, most of the time the patient can be woken up from the anaesthetic and transferred to a ward or step-down unit for close post-operative monitoring to occur

2)    For the heart, lung and liver recipients most patients are kept asleep at the end of the surgery and transferred straight from the operating room to the intensive care unit for ongoing close monitoring. This is required until it is apparent that the patient is stabilising following the surgery and that the newly transplanted organ is functioning.

The nature of the surgery and the expected post-operative course can generate many other questions. There are some general guides available including via the Internet. In particular via the MedlinePus site in the United States-  Liver transplantation heart transplantation kidney transplantation  lung transplantation

The pieces of information that need to be put together for every transplant recipient including the last piece of information that can be obtained only during the actual transplant procedure.

However both the magnitude of the surgery as well as the range of possible complications do vary depending on both the organ being transplanted and how unwell each potential recipient is at the time of the transplant procedure -

       a) How each transplant recipient fares during the surgery and early on post operatively is   
           related to the many specific bits of information that need to be put together at the time-as 
           outlined in the above image.  


      b)  It is important to remember that the last 2 pieces of the recipient information jigsaw 
           puzzle are only able to be put together in the operating room during the actual transplant   
           surgery. For example there is no test for how much scarring may be present in the 
           abdomen in a liver recipient who has undergone previous surgery, hence this can only be 
           determined during the actual transplant surgical procedure. 


      c) Also if the combination of all of the non-surgical pieces of information were to predict an 
          unfavourable outcome in advance for a recipient, then the transplant surgery would not be 
          able to go ahead.

Hence specific advice should be sought by potential transplant patients and their relatives from the transplant programme that they are currently in contact with. There are both pluses and minuses from currently seeking health care advice only via the Internet as outlined via the following link- Mashable- what-doctors-think-about-your-online-health-searches


Image designed by Deb Verran 2012: acknowledgement Presentation magazine

Another Transplant Surgeon conversation: Waiting for an organ transplant

When a transplant surgeon is holding a conversation with a patient who requires an organ transplant, there is one topic that usually attracts more questions. It is the timing of that all important phone call that will be made to the patient with the offer of the donor organ. Can you imagine what it must be like to be listed for a transplant and waiting for that call day after day, week after week?

The conversation often goes like this-
Q: So doctor, when will I get the phone call [about the donor organ being available]?
A: You can get the call any time of the day or night, week day or weekend. So even in the middle of the night it is important to answer the phone.
Q: Why is that?
A: Well, first because the deceased organ donors can be identified at any time in the hospitals. Second, there is a need to track down all of the potential recipients of the organs from each donor, as there are time limits once the organ donation process is underway.
Q: So when I receive the call, do I need to hurry to hospital?
A: Yes, you do need to make your way to hospital reasonably quickly, but also safely. This is so you can be prepared for the surgery. If you live a long distance from hospital, special arrangements may need to be made to get you there in time.
Q: After I get to hospital, when do I know the transplant is definitely going ahead?
A: Once the organ you require has been surgically retrieved from the donor and is cleared to be suitable for transplant, you will be told. The organ often also has to be transported to the hospital as well.

Explaining what is actually involved in the process for obtaining the organ from the organ donor through to commencing the actual transplant surgical procedure is important. The journey to a transplant can be tough on potential recipients and their loved ones. Some descriptions of this journey can be obtained via the Organtransplants web site.

It takes good co-ordination for the available organs from every deceased donor to be successfully transplanted. Time is often of the essence once the organs have been surgically removed from the donor, due to limits on storage times of the organs. In many countries this co-ordination is achieved by agencies and or networks of professionals. Further information on this part of the process can be obtained via professional sources including from the United States and the United Kingdom

Some other general web sites which provide information are-
Transplant Living , OrganTransplants Understanding , United Kingdom
If you or a loved one are waiting for an organ transplant, it is best to seek advice from the professionals in the Transplant Programme that you are in contact with.

An important task for Transplant surgeons. Helping piece together the picture for every donor organ.

Transplantation involves the surgical removal of the organ(s) from a donor-who is either living or deceased- and then surgically implanting each precious organ into the designated recipient.

Do you know that there are many steps in the organ donation process that are all critical for deciding on whether or not a donor's organ(s) can go on to be transplanted? Transplant surgeons are very much involved in this process of assessing the suitability of the donor organs for transplantation.

Are you aware of instances where individuals were unable to be live kidney donors? Do you know of occasions where organ donation was not able to go ahead from a potential deceased donor (i.e.after death) in hospital, due to there being medical concerns?

Being able to assess each organ donor for their 'medical suitability' to donate one or more organs is one of the essential parts of the downstream transplant process. Although general information on organ donation is available via the Internet for eg, this website from the United States of America more specific information on the In's and out's of organ donation, may not be  easily located unless you know where to find it, eg from the United Kingdom

There are many pieces of information (see below image), that have to be obtained for each and every organ donor as to whether they are suitable to donate an organ (as a live donor) or multiple organs(after death). This whole process is like putting together a jigsaw puzzle, with the final two pieces (bottom right hand of the image), made up of what the surgeons discover at the time of the actual organ retrieval surgery. As most of the pieces of the jigsaw are put together prior to the retrieval surgery, this helps explain why not all donors proceed to the operating room. However, information obtained by surgeons during the retrieval surgery is often critical to the final decision as to whether or not a particular organ can be actually used for transplantation.

Legend- DCD: Donation after Cardio-Circulatory Death; DBD: Donation after Brain Death; NAT: Nucleic Acid Testing

Of note as rates of organ donation do vary between countries as outlined in this report from the WHO Transplant observatory particularly for deceased donors, it is important to place this information into the context of where you live. However, as you can see transplant surgeons are very much involved in the assessing of the donor organs for transplantation!

Image designed by Deb Verran 2012: acknowledgement Presentation magazine 

Ellen Meets a Survivor-Young advocate for Organ Donation

If you want to be inspired by a young advocate for organ donation then watch this video-a conversation between Helene Campbell and Ellen DeGeneres which recently occurred- live on The Ellen Show.

This came about as the result of a twitter campaign via @alungstory with the hashtag #beanorgan donor tweeting up to @TheEllenShow By the way Ellen supports organ donation!

Why should I use Twitter, as a healthcare worker?

How often do I hear comments being made about Twitter including the 'it is for socialising with celebrities' statement. If this was truly the case this blog would not need to be written nor posted! If you know all about Twitter you do nor need to read on, for everyone else here are some facts plus tips.

The use of social media in health care is now very much on the increase as outlined in a recent posting on the popular medical blog KevinMD . So hoping that you can continue to ignore this major trend, is probably no longer useful.

Twitter has become a conduit for relaying information rapidly around the world and is increasingly being used not only by individuals but a number of organisations. Here are some of examples of organisations who all use Twitter- governmental Food and Drug Administration , VicHealth , United Kingdom National Health Service , international organisations World Health Organisation , OECD , professional entities Kings Fund , American College of Surgeon, universities Harvard University , Imperial College , hospitals Mayo Clinic , Kings College Hospital , and medical journals New England Journal of Medicine , Lancet. Also in the public health arena Twitter has been used for 'tweeting' out information on policy Centres for Disease Control , APHA , new developments Johns Hopkins Public Health and evolving health issues CDC Social Media

So what use is this information for you? Well by joining onto Twitter you can elect to follow some of the organisations or entities that relay practical, useful information that you already know about. Look out for the Twitter symbol which is usually a small blue bird icon or a small blue 't' on their web sites and by clicking on that logo, you can then become a follower. Then by checking on your own home page on Twitter you can view all of the tweets of everyone you follow. The information contained in these tweets plus their accompanying links onto web pages may be useful for ongoing learning activities and adding to your knowledge base.

By trial and error you can also find other organisations you may wish to follow by entering relevant words into the Twitter search tool bar. If you find yourself following someone or something that is not particularly useful you can always unfollow! Guides on how to use Twitter are available on the Internet and the Mashable  guide is one of the more popular currently.

How about actually 'tweeting'? Remember what you tweet is immediately in the public global Internet sphere, so anyone can potentially see it. Think before you write and even more importantly before you click on send! One unfortunate tweet can have major, major implications. There are guides available for the use of social media in the health sector. Examples include from the Australian Medical Association , and the British Medical Association . Your employer may also have a social media policy which you need to be fully aware of.

So what now? You can try joining up onto Twitter and start following what interests you. Whether you wish to tweet is up to you and please remember there are rules. Information contained in this recent Cool Info graphic , and the Jeffbullas Blog very much confirm that the use of social media is on the increase. So even if you are currently not accessing Twitter, there is a very good chance that people you know are. Good luck!