Understanding organ donation in the collaborative era: a qualitative study of staff and family experiences

BACKGROUND: Despite the success of the Breakthrough Collaborative Methodology (BCM) in increasing organ donation rates there has been little published evidence on the effect of the BCM on the wider attitudes and experiences of those involved in organ donation. This study sought to identify whether the National Organ Donation Collaborative in Australia had any additional influence on improving the experiences of staff and family members in the organ donation process. METHODS: IN-depth qualitative interviews with 17 family members from 13 families who had agreed to the organ donation of a deceased relative and 25 nurses and intensive care specialists at the Alfred Hospital, Melbourne, Victoria were carried out. RESULTS: The key factor in family members' decision to donate was prior knowledge of the deceased's donation wish. Although most family members did not regret their decision to donate, many were deeply dissatistified and, at times, confused by the technical and administrative nature of the donation process. Most staff members commented that the key community message about donation should be to encourage people to discuss donation rather than urging people to sign donor registers. CONCLUSION: This study identified valuable insights into the processes by which family members and intensive care unit staff deal with the actual processes of donation. Findings suggest that the process for families is far more complex than a simple agreement or refusal to donate. This study suggests that we should not assume that 'rates' of donation in Australia would increase merely through administrative programmes or marketing campaigns.

The expression profiles of the galectin gene family in primary and metastatic papillary thyroid carcinoma with particular emphasis on galectin-1 and galectin-3 expression

INTRODUCTION: Galectin family members have been demonstrated to be abnormally expressed in cancer at the protein and mRNA level. This study investigated the levels of galectin proteins and mRNA expression in a large cohort of patients with papillary thyroid carcinoma and matched lymph node metastases with particular emphasis on galectin-1 and galectin-3. METHODS: mRNA expression of galectin family members (1, 2, 3, 4, 7, 8, 9, 10 and 12) were analysed by real-time polymerase chain reaction in 65 papillary thyroid carcinomas, 30 matched lymph nodes with metastatic papillary thyroid carcinoma and 5 non-cancer thyroid tissues. Galectin-1 and 3 protein expression was determined by immunohistochemistry in these samples. RESULTS: Significant expression differences in all tested galectin family members (1, 2, 3, 4, 7, 8, 9, 10 and 12) were noted for mRNA in papillary thyroid carcinomas, with and without lymph node metastasis. Galectin-1 protein was more strongly expressed than galectin-3 protein in papillary thyroid carcinoma. Galectin-1 protein was found to be overexpressed in 32% of primary papillary thyroid carcinomas. A majority of lymph nodes with metastatic papillary thyroid carcinoma (53%) had significantly increased expression of galectin-1 protein, as did 47% of primaries with metastases. Galectin-1 mRNA levels were decreased in the vast majority (94%) of primary thyroid carcinomas that did not have metastases present. Galectin-3 protein levels were noted to be overexpressed in 15% of primary papillary thyroid carcinomas. In primary papillary thyroid carcinoma with lymph node metastases, 32% had over expression of galectin-3 protein. Overexpression of galectin-3 mRNA was noted in 58% of papillary thyroid carcinomas and 64% of lymph nodes bearing metastatic papillary thyroid carcinoma. Also, primary papillary thyroid carcinoma with lymph node metastases had significantly higher expression of galectin-3 mRNA compared to those without lymph node metastases. CONCLUSION: Galectin family members show altered expression at the mRNA level in papillary thyroid cancers. Overexpression of galectin-1 and 3 proteins were noted in papillary thyroid carcinoma with lymph node metastases. The results presented here demonstrated that galectin-1 and galectin-3 expression have important roles in clinical progression of papillary thyroid carcinoma.

John and Ursula Schlosstein nee Gottschalk with their infant son Ralph. portraits family

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Lotte Stern and Dr. Alfred Stern with Otto Wallerstein, a relative of Lotte's father; Berkeley, California.

From left to right: Lotte Stern, Otto Wallerstein, Alfred Stern; Photograph taken shortly after arrival in Berkeley, California

Gottschalk family in the park; Hannover, Germany. Portraits Family

Left to right: Therese Godshaw (Gottschalk) nee Molling, Walter, Freddy, Grandmother Henriette Gottschalk nee Rothschild, Ursula, Hal and Kurt

Shimon Gottschalk with his wife Jo and family on his 70th birthday; Florida Portraits Family

Front row left to right: Tikkun, Back row: the twins, age 8, Shimon's wife Jo,, right: Ariela, age 28, the eldest

The Gottschalk family seated around the dining table; Seelhorst Strasse 26, Hannover Portraits Family

From left to right: Kurt, Therese nee Molling, Ursula, the maid, Elizabeth and Hal,

Gottschalk family on vacation; Norderney, Germany.

Left to right: two unidentified women, Kurt Gottschalk, Therese Gottschalk nee Molling, Fritz Gottschalk, unidentified woman (the maid?), and Elizabeth Gottschalk

Gathering in the home of Dr. Alfred Stern and his wife Lotte nee Wallerstein; Paula Wallerstein nee Molling; Rheydt, Germany. Portraits Groups

Dr. Alfred Stern probably standing far left; Paula Wallerstein nee Molling seated in center

Lotte Stern and Dr. Alfred Stern with Otto Wallerstein, a relative of Lotte's father; Berkeley, California.

From left to right: Lotte Stern, Otto Wallerstein, Alfred Stern; Photograph taken shortly after arrival in Berkeley, California

Schoenewald family portrait; Bad Nauheim, Germany.

Includes Rosi Schoenewald (sister of Dora), Dora Schoenewald (wife of Alfred Apfel and mother of Hannah Busoni), Henni Apfel, Tilly Schoenewald, Luise Schoenewald, Max Schoenewald (brother of Dora), Felix Schoenewald (brother of Dora), Samuel Schoenewald (brother of Dora), and Gerhardt Schoenewald

Studio portrait of seven of David Gruenspecht and Rebecca Gruenspecht nee Hoffman's ten children Portraits Family

Includes Louis Gruenspecht, Max Gruenspecht, Abraham (Adolf) Gruenspecht, Babette Gruenspecht, Isaac Gruenspecht, Moses (Moritz) Gruenspecht and Michael Gruenspecht; Missing are Rosalie Gruenspecht, Sarah Gruenspecht and Hirsch Gruenspecht

Studio portrait of David Gruenspecht and Rebecca Gruenspecht nee Hoffman with one of their young sons Portraits Family

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John and Ursula Schlosstein nee Gottschalk with their infant son Ralph. portraits family

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