| Section I – Demographic factors |
| 1. In which region of Brazil is your transplant center located? |
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a) North |
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b) Northeast |
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c) South |
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d) Southwest |
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e) Midwest |
| 2. How many years have you been working specifically with liver transplantation? |
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a) <5 years |
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b) 5-10 years |
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c) 10-15 years |
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d) >15 years |
| 3. How many liver transplants are performed at your center annually? |
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a) <30 |
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b) 30-60 |
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c) >60 |
| Section II – Perception of the use of livers from deceased donors |
| 4. How do you consider the utilization rate of livers from deceased donors (ratio between the number of organs offered and the number of organs transplanted) today in Brazil? |
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a) High. |
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b) Appropriate (all organs possible are utilized). |
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c) Low (it would be possible to optimize the utilization of donor organs). |
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d) Very low (many organs that could be utilized are discarded). |
| 5. Do you think it is possible to increase the utilization rate of livers from deceased donors currently practiced in Brazil? |
|
a) Yes |
|
b) No |
| 6. Do you believe that over the past few years there has been a higher prevalence of marginality criteria among organ donors offered for transplantation? |
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a) Yes |
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b) No |
| 7. Do you believe the expansion of the extended criteria donor population has directly affected the utilization rate of donor livers? |
|
a) Yes |
|
b) No |
| Section III – Reasons for discarding donor livers for transplantation |
| 8. Into which of the following categories do your reasons for not accepting a donor organ for transplantation most commonly fall? |
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a) Donor related conditions (e.g., doubts regarding function, age, and obesity). |
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b) Conditions related to the transplant center (for example, logistics, and lack of blood components). |
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c) Recipient-related conditions (e.g., severity of the recipient's liver disease). |
| 9. Among the reasons below for not accepting an organ (liver) from a deceased donor, which do you consider the major factor, in your clinical practice? |
|
a) Prolonged estimated cold ischemia time (due to the long distance from the organ procurement hospital to the transplant center). |
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b) Difficulty in making a good match between donor and recipient (balance between the recipients’ liver disease severity and donor/organ characteristics). |
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c) Donor past medical history data (including laboratory tests) - doubts regarding organ function. |
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d) Findings during harvesting (steatosis, anatomical abnormalities, injuries during the surgery, unsatisfactory organ perfusion, and organ size - donor/recipient disproportion). |
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e) Donor organ biopsy findings. |
| 10. Among the reasons below for not accepting an organ (liver) from a deceased donor, which do you consider the second major factor in your clinical practice? |
|
a) Prolonged estimated cold ischemia time (due to the long distance from the organ procurement hospital to the transplant center). |
|
b) Difficulty in making a good match between donor and recipient (balance between the liver disease severity of recipients and donor/organ characteristics). |
|
c) Donor past medical history data (including laboratory tests) - doubts regarding organ function. |
|
d) Findings during the extraction (steatosis, anatomical abnormalities, injuries during extraction, unsatisfactory organ perfusion, and organ size - donor/recipient disproportion). |
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e) Donor organ biopsy findings. |
| 11. Among the reasons below for not accepting an organ (liver) from a deceased donor, which do you consider the third major motive in your clinical practice? |
|
a) Prolonged estimated cold ischemia time (due to the long distance from the organ procurement hospital to the transplant center). |
|
b) Difficulty in making a good match between donor and recipient (balance between the recipients’ liver disease severity and donor/organ characteristics). |
|
c) Donor past medical history data (including laboratory tests) - doubts regarding organ function. |
|
d) Findings during the harvesting (steatosis, anatomical abnormalities, injuries during the surgery, unsatisfactory organ perfusion, and organ size - donor/recipient disproportion). |
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e) Donor organ biopsy findings. |
| 12. In your opinion, are there any other reasons for not accepting an organ (liver) from a deceased donor that are not listed in the options above? If yes, please specify. |
| Answer:_________________________________________________ |
| Section IV – Measures to favor the use of livers from deceased donors |
| 13. Among the measures below, which do you think would be the primary action to optimize the use of livers from deceased donors? (Select two alternatives) |
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a) Offers only from donors within more restrictive criteria (for example, maximum age limit, serum sodium level at or near normal limits, and body mass index limits). |
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b) Development of an organ allocation system that already considers donor and recipient characteristics prior to donation. |
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c) Development/investment in new technologies to improve preservation and perform function evaluation of donor organs before transplantation (machine perfusion of the liver). |
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d) Better training of intensive care unit teams in organ donor care. |
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e) Allocation of organs only regionally (allocation zones), imposing distance limits for organ supply. |
| 14. Among the measures below, which do you think would be the second major action to optimize the use of livers from deceased donors? (Select two alternatives) |
|
a) Offers only from donors within more restrictive criteria (e.g., maximum age limit, serum sodium level at or near normal limits, and body mass index limits). |
|
b) Development of an organ allocation system that already considers donor and recipient characteristics prior to donation. |
|
c) Development/investment in new technologies to improve preservation and perform function evaluation of donor organs before transplantation (liver perfusion machine). |
|
d) Better training of intensive care unit teams in organ donor care. |
|
e) Procurement of organs only regionally (procurement zones), imposing distance limits for organ supply. |
| 15. Do you believe that the implementation of the ex situ machine perfusion of the liver will positively affect liver transplantation, favoring a greater use of donor livers? |
|
a) Yes |
|
b) No |
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c) I do not have an opinion. |
| 16. Are there other strategies that you think could further improve the donor utilization rate? |
|
a) Yes |
|
b) No |
| 17. If you answered yes to the previous question, please specify which strategy you think would also contribute: |
| Answer:____________________________________________________ |
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