BACKGROUND: Analyzing the attitudes toward organ donation and the factors that influence such attitudes is fundamental to improving the quality of management for the process of brain dead organ donation. METHODS: We interviewed 23 primary carers of donors after a minimum period of one year post organ donation from a single hospital, from 2008 to 2011. This telephone survey analyzed factors including relationship with the donor and the impact of such factors on making the decision for donation and attitude towards organ donation. RESULTS: With respect to the carers' relationship with the donor, seven carers who participated in the interview were spouses (30.4%), six were parents (26.0%), three were offspring (13.0%), and seven were siblings (30.4%). Ten of the decision makers (43.4%) were not legal priority holders. Twenty-two interviewees (95.6%) experienced no regret for their decision to go through with the donation. Fifteen participants (65.1%) were willing to donate their own organs in case of brain death, and the favorability towards organ donation was significantly related to the satisfaction with their experience of medical services during the process of organ donation. CONCLUSIONS: Organ donation after brain death is still viewed favorably by carers even after the bereavement period. Positive attitude and favorability toward organ donation were significantly related to the satisfaction with the medical service. We suggest interventions to improve the quality of medical services in order to promote organ donation.
Bereavement ; Brain Death* ; Caregivers ; Humans ; Parents ; Siblings ; Spouses ; Telephone ; Tissue and Organ Procurement* ; Tissue Donors*

BACKGROUND: Analyzing the medical expenses of the family members of brain dead organ donors would be helpful in ascertaining better ways of applying national assistance, which is important for promotion of brain dead organ donation. METHODS: We collected data regarding the medical expenses of 119 brain dead organ donors from January 2009 to December 2013 at a single institution that specializes in organ donation. Donation year, cause of brain death, age, and admission days were deemed factors affecting medical expenses, and these were analyzed. Medical expenses were compared with national assistance (maximum of 1.8 million Korean won [KRW]). RESULTS: Average age of donors was 42.7 years, and, in the older age group, there was a lower average for medical expenses (P=0.025). Brain dead organ donations that were consented to within 2 days after the brain death comprised 41.2%, and medical expenses increased as the consent days were delayed (P<0.001). Average medical expense for donor families was 2,161,297 KRW, and the average national assistance to the families was 577,056 KRW. The medical expenses of 73 donors (61.3%) were below the national assistance maximum; 19 (16.0%) had no charges of their own with other insurance coverage. CONCLUSIONS: National assistance for medical expenses to family members of brain dead organ donors is necessary in Korea, where the rate of brain dead organ donation is very low. As 61% of donors were covered below the maximum assistance amount, there could be additional ways to utilize the remaining budget.
Brain Death* ; Budgets ; Health Expenditures ; Humans ; Insurance Coverage ; Korea ; Tissue and Organ Procurement ; Tissue Donors*

PURPOSE: This study aimed to determine the mortality rate in patients with severe trauma and the risk factors for trauma mortality based on 3 years' data in a regional trauma center in Korea. METHODS: We reviewed the medical records of severe trauma patients admitted to Ajou University Hospital with an Injury Severity Score (ISS) > 15 between January 2010 and December 2012. Pearson chi-square tests and Student t-tests were conducted to examine the differences between the survived and deceased groups. To identify factors associated with mortality after severe trauma, multivariate logistic regression was performed. RESULTS: There were 915 (743 survived and 172 deceased) enrolled patients with overall mortality of 18.8%. Age, blunt trauma, systolic blood pressure (SBP) at admission, Glasgow Coma Scale (GCS) at admission, head or neck Abbreviated Injury Scale (AIS) score, and ISS were significantly different between the groups. Age by point increase (odds ratio [OR], 1.016; P = 0.001), SBP < or = 90 mmHg (OR, 2.570; P < 0.001), GCS score < or = 8 (OR, 6.229; P < 0.001), head or neck AIS score > or = 4 (OR, 1.912; P = 0.003), and ISS by point increase (OR, 1.042; P < 0.001) were significant risk factors. CONCLUSION: In severe trauma patients, age, initial SBP, GCS score, head or neck AIS score, and ISS were associated with mortality.
Abbreviated Injury Scale ; Blood Pressure ; Glasgow Coma Scale ; Head ; Humans ; Injury Severity Score ; Korea ; Logistic Models ; Medical Records ; Mortality* ; Neck ; Risk Factors* ; Trauma Centers ; Wounds and Injuries

Lung cancer, breast cancer and lymphoma are the common oncologic causes of malignant pleural effusion, comprising more than the half of the causes. However, an endocrinologic carcinoma associated malignant effusion is very rare. Recently, we encountered a case of papillary thyroid carcinoma causing malignant effusion. An 83-year-old female patient presented with dyspnea due to massive pleural effusion in her left side. The pleural biopsy, pleural fluid cytology and breast needle aspiration biopsy results were consistent with a metastatic papillary thyroid carcinoma. Thyroid ultrasonography showed two thyroid masses, but the patient refused a thyroid biopsy. This case highlights the need for considering the possibility of papillary thyroid carcinoma when the cause of malignant pleural effusion cannot be found because one of the rare clinical manifestations of a papillary thyroid carcinoma can be dyspnea due to malignant effusion.
Aged, 80 and over ; Biopsy ; Biopsy, Needle ; Breast ; Breast Neoplasms ; Dyspnea ; Female ; Humans ; Lung Neoplasms ; Lymphoma ; Needles ; Neoplasm Metastasis* ; Pleural Effusion ; Pleural Effusion, Malignant ; Thyroid Gland ; Thyroid Neoplasms ; Ultrasonography

Lung cancer, breast cancer and lymphoma are the common oncologic causes of malignant pleural effusion, comprising more than the half of the causes. However, an endocrinologic carcinoma associated malignant effusion is very rare. Recently, we encountered a case of papillary thyroid carcinoma causing malignant effusion. An 83-year-old female patient presented with dyspnea due to massive pleural effusion in her left side. The pleural biopsy, pleural fluid cytology and breast needle aspiration biopsy results were consistent with a metastatic papillary thyroid carcinoma. Thyroid ultrasonography showed two thyroid masses, but the patient refused a thyroid biopsy. This case highlights the need for considering the possibility of papillary thyroid carcinoma when the cause of malignant pleural effusion cannot be found because one of the rare clinical manifestations of a papillary thyroid carcinoma can be dyspnea due to malignant effusion.
Aged, 80 and over ; Biopsy ; Biopsy, Needle ; Breast ; Breast Neoplasms ; Dyspnea ; Female ; Humans ; Lung Neoplasms ; Lymphoma ; Needles ; Neoplasm Metastasis* ; Pleural Effusion ; Pleural Effusion, Malignant ; Thyroid Gland ; Thyroid Neoplasms ; Ultrasonography

PURPOSE: The optimal cytotoxic regimens have not been established for patients with non-small cell lung cancer (NSCLC) who develop disease progression on first-line epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI). MATERIALS AND METHODS: We conducted a multi-center randomized phase II trial to compare the clinical outcomes between pemetrexed plus cisplatin combination therapy followed by maintenance pemetrexed (PC) and pemetrexed monotherapy (P) after failure of first-line EGFR-TKI. The primary objective was progression-free survival (PFS), and secondary objectives included overall response rate (ORR), overall survival (OS), health-related quality of life (HRQOL), and safety and toxicity profiles. RESULTS: A total of 96 patientswere randomized, and 91 patientswere treated at 14 centers in Korea. The ORR was 34.8% (16/46) for the PC arm and 17.8% (8/45) for the P arm (p=0.066). With 23.4 months of follow-up, the median PFS was 5.4 months in the PC arm and 6.4 months in the P arm (p=0.114). The median OS was 17.9 months and 15.7 months in PC and P arms, respectively (p=0.787). Adverse events ≥ grade 3 were reported in 12 patients (26.1%) in the PC arm and nine patients (20.0%) in the P arm (p=0.491). The overall time trends of HRQOL were not significantly different between the two arms. CONCLUSION: The outcomes of pemetrexed therapy in NSCLC patients with disease progression after firstline EGFR-TKI might not be improved by adding cisplatin.
Arm ; Carcinoma, Non-Small-Cell Lung ; Cisplatin ; Disease Progression ; Disease-Free Survival ; Epidermal Growth Factor ; Follow-Up Studies ; Humans ; Korea ; Lung Neoplasms ; Lung ; Pemetrexed ; Protein-Tyrosine Kinases ; Quality of Life ; Receptor, Epidermal Growth Factor ; Tyrosine