Second Opinion in the Italian Organ Procurement Transplantation: The Pathologist Is In
2. History, Role, and Advantages
3. Critical Issues and Rooms for Improvement
- The service’s operating methods: Second opinion experts are now available 24 h a day by telephone, which is still a reliable medium in a country such as Italy with geographical and logistic difficulties and differences among regions, providing real-time availability for every center in every region, despite logistical problems. However, transplant pathology aims to become digital  by establishing national networks of subspecialist pathologists to support nationwide out-of-hours histopathology for emergency frozen sections and critical decisions . This transition would lead to greater efforts by the entire healthcare system to overcome differences between regions and to create a uniform practice background among centers, with obvious positive consequences for safety throughout the entire process. Furthermore, the introduction of digital pathology has catalyzed the application of artificial intelligence (AI) with the development of novel machine-learning models for tissue interrogation and discovery. Such technological advances offer the potential to improve the ability to classify disease, more accurately quantify morphological alterations, discover correlations with pathogenesis and clinical data, and predict disease outcomes with new prediction models . Regarding the question of when machine-learning algorithms will be ready for use in this setting, we know that the application of AI tools depends on two main factors. The first is the implementation of digital pathology networks. The second is the development of robust and validated AI tools, which should not only replicate experts, but also be directly trained to predict the desired transplant outcome endpoints.
- Standardization: There is often variation in how diagnostic second opinions are conducted, potentially leading to inconsistencies and errors. Social interactions and unrelated conversations often interfere with the process and reduce second opinion quality . Standardizing the process and establishing clear guidelines can help ensure that the second opinion is thorough and accurate. Ensuring that both parties perform their checks of the available data independently can prevent them from potentially following the same reasoning, minimizing the chance of errors .
- Data integration: Records may be fragmented or difficult to access, and auto-processing can be an issue. This issue might involve the two people managing a second opinion, where one simply reads the available medical data and the other simply nods in assent. Improving data integration and interoperability can make it easier for specialists to review relevant information and provide an accurate second opinion .
- Communication: Effective communication among players is essential for a successful second opinion, with several themes that can contribute to the failure of a second opinion. One theme was deference to authority, which occurs when the individual asked to perform the second opinion is perceived to be below them in the “hierarchy,” sometimes related to their formal title or status. It should be noted that double checks are a form of social redundancy and basically involve one fallible person monitoring the work of another fallible person. When people hear and see what they expect to see, their effectiveness is reduced . Improving communication channels and ensuring that all parties are committed and on the same wavelength can ensure tracking and safety.
- Checklist: Checklists add a cognitive element to oversee tasks or projects and ensure nothing important is forgotten during execution . This way, nothing that might compromise the results is omitted. Additionally, they ensure activities are completed in an orderly, organized manner.
- Transplant outcome tracking: It is vital to track the outcomes of diagnostic second opinions to ensure they effectively improve network management and transplant procedure safety. This tracking can help identify areas for improvement and ensure that the process continues to evolve and improve over time.
4. Future Directions
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
- Hillen, M.A.; Medendorp, N.M.; Daams, J.G.; Smets, E.M.A. Patient-Driven Second Opinions in Oncology: A Systematic Review. Oncologist 2017, 22, 1197–1211. [Google Scholar] [CrossRef] [PubMed]
- Payne, V.L.; Singh, H.; Meyer, A.N.D.; Levy, L.; Harrison, D.; Graber, M.L. Patient-initiated second opinions: Systematic review of characteristics and impact on diagnosis, treatment, and satisfaction. Mayo Clin. Proc. 2014, 89, 687–696. [Google Scholar] [CrossRef] [PubMed]
- Zan, E.; Yousem, D.M.; Carone, M.; Lewin, J.S. Second-opinion consultations in neuroradiology. Radiology 2010, 255, 135–141. [Google Scholar] [CrossRef] [PubMed]
- DiPiro, P.J.; Krajewski, K.M.; Giardino, A.A.; Braschi-Amirfarzan, M.; Ramaiya, N.H. Radiology Consultation in the Era of Precision Oncology: A Review of Consultation Models and Services in the Tertiary Setting. Korean J. Radiol. 2017, 18, 18–27. [Google Scholar]
- Hatzoglou, V.; Omuro, A.M.; Haque, S.; Khakoo, Y.; Ganly, I.; Oh, J.H.; Shukla-Dave, A.; Fatovic, R.; Gaal, J.; Holodny, A.I. Second-opinion interpretations of neuroimaging studies by oncologic neuroradiologists can help reduce errors in cancer care. Cancer 2016, 122, 2708–2714. [Google Scholar]
- Goebel, E.A.; Ettler, H.; Walsh, J.C. Intradepartmental consultations in surgical pathology: Review of a standardized process and factors influencing consultation rates and practices in an academic and community hospital setting. Pathol. Res. Pract. 2018, 214, 542–546. [Google Scholar]
- Frable, W.J. Surgical pathology--Second reviews, institutional reviews, audits, and correlations: What’s out there? Error or diagnostic variation? Arch. Pathol. Lab. Med. 2006, 130, 620–625. [Google Scholar]
- Strosberg, C.; Gibbs, J.; Braswell, D.; Leslie, R.R.; Messina, J.; Centeno, B.A.; Coppola, D. Second Opinion Reviews for Cancer Diagnoses in Anatomic Pathology: A Comprehensive Cancer Center’s Experience. Anticancer Res. 2018, 38, 2989–2994. [Google Scholar] [CrossRef]
- Renshaw, A.A.; Gould, E.W. Reducing false-negative and false-positive diagnoses in anatomic pathology consultation material. Arch. Pathol. Lab. Med. 2013, 137, 1770–1773. [Google Scholar]
- Tomaszewski, J.E.; Bear, H.D.; Connally, J.A.; Epstein, J.I.; Feldman, M.; Foucar, K.; Layfield, L.; LiVolsi, V.; Sirota, R.L.; Stoler, M.H.; et al. Consensus conference on second opinions in diagnostic anatomic pathology. Who, What, and When. Am. J. Clin. Pathol. 2000, 114, 329–335. [Google Scholar] [CrossRef]
- Wood, J.P. Legal issues for pathologists. Adv. Anat. Pathol. 2011, 18, 466–472. [Google Scholar] [CrossRef] [PubMed]
- Bauer, T.W.; Slaw, R.J.; McKenney, J.K.; Patil, D.T. Validation of whole slide imaging for frozen section diagnosis in surgical pathology. J. Pathol. Inform. 2015, 6, 49. [Google Scholar] [CrossRef] [PubMed]
- Ammendola, S.; Girolami, I.; Bovo, C.; Paini, M.; Castelli, C.; Bruno, C.; Schenal, G.; Brazzarola, P.; Mezzetto, L.; Veraldi, G.F.; et al. Thyroid Fine-Needle Aspiration Cytology: Focusing on Adherence to Guidelines and Hospital Organization. Am. J. Case Rep. 2020, 21, e920933. [Google Scholar] [CrossRef] [PubMed]
- Girolami, I.; Marletta, S.; Pantanowitz, L.; Torresani, E.; Ghimenton, C.; Barbareschi, M.; Scarpa, A.; Brunelli, M.; Barresi, V.; Trimboli, P.; et al. Impact of image analysis and artificial intelligence in thyroid pathology, with particular reference to cytological aspects. Cytopathology 2020, 31, 432–444. [Google Scholar] [CrossRef]
- Eccher, A.; Lombardini, L.; Girolami, I.; Puoti, F.; Zaza, G.; Gambaro, G.; Carraro, A.; Valotto, G.; Cima, L.; Novelli, L.; et al. How safe are organs from deceased donors with neoplasia? The results of the Italian Transplantation Network. J. Nephrol. 2019, 32, 323–330. [Google Scholar] [CrossRef]
- Myron Kauffman, H.; McBride, M.A.; Cherikh, W.S.; Spain, P.C.; Marks, W.H.; Roza, A.M. Transplant tumor registry: Donor related malignancies. Transplantation 2002, 74, 358–362. [Google Scholar] [CrossRef]
- Nalesnik, M.A.; Woodle, E.S.; Dimaio, J.M.; Vasudev, B.; Teperman, L.W.; Covington, S.; Taranto, S.; Gockerman, J.P.; Shapiro, R.; Sharma, V.; et al. Donor-transmitted malignancies in organ transplantation: Assessment of clinical risk. Am. J. Transplant. 2011, 11, 1140–1147. [Google Scholar] [CrossRef]
- Desai, R.; Collett, D.; Watson, C.J.E.; Johnson, P.; Evans, T.; Neuberger, J. Estimated risk of cancer transmission from organ donor to graft recipient in a national transplantation registry. Br. J. Surg. 2014, 101, 768–774. [Google Scholar] [CrossRef]
- Desai, R.; Collett, D.; Watson, C.J.; Johnson, P.; Evans, T.; Neuberger, J. Cancer transmission from organ donors-unavoidable but low risk. Transplantation 2012, 94, 1200–1207. [Google Scholar] [CrossRef]
- Kauffman, H.M.; Cherikh, W.S.; McBride, M.A.; Cheng, Y.; Hanto, D.W. Deceased donors with a past history of malignancy: An organ procurement and transplantation network/united network for organ sharing update. Transplantation 2007, 84, 272–274. [Google Scholar] [CrossRef]
- Eccher, A.; Girolami, I.; Marletta, S.; Brunelli, M.; Carraro, A.; Montin, U.; Boggi, U.; Mescoli, C.; Novelli, L.; Malvi, D.; et al. Donor-Transmitted Cancers in Transplanted Livers: Analysis of Clinical Outcomes. Liver Transpl. 2021, 27, 55–66. [Google Scholar] [CrossRef] [PubMed]
- Eccher, A.; Girolami, I.; Motter, J.D.; Marletta, S.; Gambaro, G.; Momo, R.E.N.; Nacchia, F.; Donato, P.; Boschiero, L.; Boggi, U.; et al. Donor-transmitted cancer in kidney transplant recipients: A systematic review. J. Nephrol. 2020, 33, 1321–1332. [Google Scholar] [CrossRef] [PubMed]
- Ammendola, S.; Barresi, V.; Bariani, E.; Girolami, I.; D’Errico, A.; Brunelli, M.; Cardillo, M.; Lombardini, L.; Carraro, A.; Boggi, U.; et al. Risk factors of extraneural spreading in astrocytomas and oligodendrogliomas in donors with gliomas: A systematic review. World J. Transplant. 2022, 12, 131–141. [Google Scholar] [CrossRef] [PubMed]
- Girolami, I.; Neil, D.; Segev, D.L.; Furian, L.; Zaza, G.; Boggi, U.; Gambaro, G.; De Feo, T.; Casartelli-Liviero, M.; Cardillo, M.; et al. Discovered cancers at postmortem donor examination: A starting point for quality improvement of donor assessment. Transplant. Rev. 2021, 35, 100608. [Google Scholar] [CrossRef]
- Novelli, L.; Mescoli, C.; Malvi, D.; Girolami, I.; Eccher, A. A sticky, palpable area of the perinephric adipose tissue at organ donor procurement: Highlights on the diagnostic challenge and transplant management. J. Nephrol. 2020, 33, 1377–1379. [Google Scholar] [CrossRef]
- Eccher, A.; Carraro, A.; Girolami, I.; Villanova, M.; Borin, A.; Violi, P.; Paro, B.; Mescoli, C.; Malvi, D.; Novelli, L.; et al. Diffuse Micro-Nodules on Peritoneal Surfaces at Donor Organ Procurement: Highlights on the Diagnostic Challenge and Transplant Management. Am. J. Case Rep. 2021, 22, e929348. [Google Scholar] [CrossRef] [PubMed]
- Eccher, A.; Cima, L.; Ciangherotti, A.; Montin, U.; Violi, P.; Carraro, A.; Tedeschi, U.; Nacchia, F.; Fior, F.; Rostand, M.; et al. Rapid screening for malignancy in organ donors: 15-year experience with the Verona “Alert” protocol and review of the literature. Clin. Transplant. 2017, 31, e13045. [Google Scholar] [CrossRef]
- Farris, A.B.; Moghe, I.; Wu, S.; Hogan, J.; Cornell, L.D.; Alexander, M.P.; Kers, J.; Demetris, A.J.; Levenson, R.M.; Tomaszewski, J.; et al. Banff Digital Pathology Working Group: Going digital in transplant pathology. Am. J. Transplant. Settembre 2020, 20, 2392–2399. [Google Scholar] [CrossRef]
- Eccher, A.; Girolami, I.; Brunelli, M.; Novelli, L.; Mescoli, C.; Malvi, D.; D’Errico, A.; Luchini, C.; Furian, L.; Zaza, G.; et al. Digital pathology for second opinion consultation and donor assessment during organ procurement: Review of the literature and guidance for deployment in transplant practice. Transplant. Rev. Orlando Fla 2020, 34, 100562. [Google Scholar] [CrossRef]
- Girolami, I.; Pantanowitz, L.; Marletta, S.; Hermsen, M.; van der Laak, J.; Munari, E.; Furian, L.; Vistoli, F.; Zaza, G.; Cardillo, M.; et al. Artificial intelligence applications for pre-implantation kidney biopsy pathology practice: A systematic review. J. Nephrol. 2022, 35, 1801–1808. [Google Scholar] [CrossRef]
- Armitage, G. Double checking medicines: Defence against error or contributory factor? J. Eval. Clin. Pract. 2008, 14, 513–519. [Google Scholar] [CrossRef] [PubMed]
- Tamuz, M.; Harrison, M.I. Improving patient safety in hospitals: Contributions of high-reliability theory and normal accident theory. Health Serv. Res. 2006, 41 Pt 2, 1654–1676. [Google Scholar] [CrossRef]
- Tremblay, D.; Touati, N.; Kilpatrick, K.; Durand, M.-J.; Turcotte, A.; Prady, C.; Poder, T.G.; Richard, P.O.; Soldera, S.; Berbiche, D.; et al. Building resilience in oncology teams: Protocol for a realist evaluation of multiple cases. PLoS ONE 2022, 17, e0268393. [Google Scholar] [CrossRef] [PubMed]
- Chen Zeng, T.; Cheng, J.T.; Henrich, J. Dominance in humans. Philos. Trans. R. Soc. Lond. B. Biol. Sci. 2022, 377, 20200451. [Google Scholar] [CrossRef] [PubMed]
- White, R.E.; Trbovich, P.L.; Easty, A.C.; Savage, P.; Trip, K.; Hyland, S. Checking it twice: An evaluation of checklists for detecting medication errors at the bedside using a chemotherapy model. Qual. Saf. Health Care 2010, 19, 562–567. [Google Scholar] [CrossRef]
- Hanna, M.G.; Reuter, V.E.; Samboy, J.; England, C.; Corsale, L.; Fine, S.W.; Agaram, N.P.; Stamelos, E.; Yagi, Y.; Hameed, M.; et al. Implementation of Digital Pathology Offers Clinical and Operational Increase in Efficiency and Cost Savings. Arch. Pathol. Lab. Med. 2019, 143, 1545–1555. [Google Scholar] [CrossRef]
- Girolami, I.; Neri, S.; Eccher, A.; Brunelli, M.; Hanna, M.; Pantanowitz, L.; Hanspeter, E.; Mazzoleni, G. Frozen section telepathology service: Efficiency and benefits of an e-health policy in South Tyrol. Digit. Health 2022, 8, 20552076221116776. [Google Scholar] [CrossRef]
- Lujan, G.; Quigley, J.C.; Hartman, D.; Parwani, A.; Roehmholdt, B.; Meter, B.V.; Ardon, O.; Hanna, M.G.; Kelly, D.; Sowards, C.; et al. Dissecting the Business Case for Adoption and Implementation of Digital Pathology: A White Paper from the Digital Pathology Association. J. Pathol. Inform. 2021, 12, 17. [Google Scholar] [CrossRef]
- Sorace, J.; Aberle, D.R.; Elimam, D.; Lawvere, S.; Tawfik, O.; Wallace, W.D. Integrating pathology and radiology disciplines: An emerging opportunity? BMC Med. 2012, 10, 100. [Google Scholar] [CrossRef]
- Zarella, M.D.; Bowman, D.; Aeffner, F.; Farahani, N.; Xthona, A.; Absar, S.F.; Parwani, A.; Bui, M.; Hartman, D.J. A Practical Guide to Whole Slide Imaging: A White Paper from the Digital Pathology Association. Arch. Pathol. Lab. Med. 2019, 143, 222–234. [Google Scholar] [CrossRef]
- Marletta, S.; Pantanowitz, L.; Malvi, D.; Novelli, L.; Mescoli, C.; Cardillo, M.; D’Errico, A.; Girolami, I.; Eccher, A. Validation of portable tablets for transplant pathology diagnosis according to the College of American Pathologists Guidelines. Acad. Pathol. 2022, 9, 100047. [Google Scholar] [CrossRef] [PubMed]
- Ayorinde, J.O.O.; Citterio, F.; Landrò, M.; Peruzzo, E.; Islam, T.; Tilley, S.; Taylor, G.; Bardsley, V.; Liò, P.; Samoshkin, A.; et al. Artificial Intelligence You Can Trust: What Matters Beyond Performance When Applying Artificial Intelligence to Renal Histopathology? J. Am. Soc. Nephrol. 2022, 33, 2133–2140. [Google Scholar] [CrossRef] [PubMed]
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Eccher, A.; Malvi, D.; Novelli, L.; Mescoli, C.; D’Errico, A. Second Opinion in the Italian Organ Procurement Transplantation: The Pathologist Is In. Clin. Pract. 2023, 13, 610-615. https://doi.org/10.3390/clinpract13030055
Eccher A, Malvi D, Novelli L, Mescoli C, D’Errico A. Second Opinion in the Italian Organ Procurement Transplantation: The Pathologist Is In. Clinics and Practice. 2023; 13(3):610-615. https://doi.org/10.3390/clinpract13030055Chicago/Turabian Style
Eccher, Albino, Deborah Malvi, Luca Novelli, Claudia Mescoli, and Antonietta D’Errico. 2023. "Second Opinion in the Italian Organ Procurement Transplantation: The Pathologist Is In" Clinics and Practice 13, no. 3: 610-615. https://doi.org/10.3390/clinpract13030055