The expanded use of social media, especially through the coronavirus disease 2019 (COVID-19) pandemic, has changed the way that humans interact with one another. In 2020, the social media sites Facebook and Instagram reported worldwide user numbers in the billions. Through the course of the pandemic, scientific organizations have gained substantial reach beyond the academic community, with accounts like the World Health Organization (@WHO) now exceeding 10 million followers on Twitter. In parallel, the academic community has become more engaged, with a recent study involving >3000 engineers, scientists, and physicians indicating that most respondents recognize social media as a valid platform for professional engagement.1 Although nearly half of surveyed internal medicine physicians rely on social media for personal use, only 12% use it to search for medical topics and 18% for professional networking.2 In a younger cohort of ophthalmologists, 98% of respondents were using social media professionally, and 58% had changed a part of their practice based on information gathered through social media.3 Given that social media is now an integral part of society, we sought to evaluate the potential impact in the field of transplantation, assessing the perspective of patient outreach, research promotion, and enhancing workforce diversity.
SOCIAL MEDIA TO INCREASE PUBLIC TRANSPLANT AWARENESS
The lack of available deceased donor organs has been a persistent challenge in the transplant community. In the United States, most organs are procured from deceased donors, yet there is reluctance for some to be registered as organ donors. Although most Americans support the concept of transplantation, less than half are listed as organ donors.4 Reasons cited range from an “intention to donate later” among younger people, with middle-aged Americans believing they are too old to donate.4,5 Social media campaigns can be used to help spread a positive message regarding transplantation. One such campaign used Facebook to begin an organ donor initiative and received >13 000 new registrations on the first day; however, the effect seemed to be short lived, as registration rates declined after several days.6 A more recent study analyzing content and user interactions related to transplantation observed that content focus and numbers related to organ transplantation had the largest impact on users.7 This type of outreach is highlighted by the Twitter accounts @DonateLife (and their hashtag #donatelife), with >13 000 followers, and @UNOSNews, with nearly 12 000 followers. The content of those sites focuses on the positive impact organ donation can have on recipients while integrating statistics on the organ shortage crisis, highlighting the impact that 1 donor alone can make.
The advantages of live donor transplants on long-term graft and patient survival outcomes are well recognized.8 A major barrier to pursuing living donation is the reluctance of patients to ask friends and loved ones to donate, as many perceive this interaction as embarrassing.9 In a study by Johns Hopkins in collaboration with Facebook, a smartphone app was developed to help patients create Facebook posts to help identify a potential living donor. Using this approach, patients were 6 times more likely to have a living donor come forward on their behalf.10 This 1 example demonstrates the power of social media to increase the donor pool and help reduce waiting time while also optimizing long-term outcomes.
EDUCATION AND ACCESS TO ACCURATE HEALTHCARE INFORMATION
With increased utilization of social media in health care, there is an opportunity to educate and empower patients on what to expect pre- and posttransplant. Patients also have a chance to identify programs that may cater to their individual healthcare needs and even directly interact with healthcare providers to ask questions about a variety of topics ranging from their disease to emerging treatment options. Along with this ability to broadly disseminate high-quality information to transplant patients comes the accessibility of false information disguised as evidence-based medical advice. Indeed, misinformation on Twitter seems to spread faster than true information.11 COVID-19 vaccine misinformation has promoted vaccine hesitancy, even among some transplant patients who rely heavily on and otherwise trust the healthcare system, ignoring that COVID-19 mortality rates range from 13% to 30% among solid organ transplant recipients.12 Fortunately, there are several strategies to combat misinformation and ensure the delivery of high-quality content through social media platforms (Table 1). (1) Report misinformation: Twitter and Facebook, along with several other social media platforms, allow for users to report any references to misleading information. (2) Promote peer-reviewed literature: dissemination of research via social media can expand reach to patients who are interested in learning about the most updated research. Lay summaries can be provided along with the studies or via a retweet, which further increases the accessibility of information (@TransplantJrnl on Twitter). The Altmetric was developed to produce an Attention Score as a real-time measure of research impact via retweets, media coverage, and geographic range of engagement.13 As an example, an article published in Transplantation in December 2021 that analyzed the role for a fourth dose of COVID-19 vaccine in transplant recipients received an Attention Score of 108, placing it in the top 5% of all research articles, with 136 retweets and news coverage spanning 9 countries.14 This metric offers an indicator of an article’s interest well before it will gain citations in other articles. (3) Providing professional insights into updated recommendations: clinical recommendations often change because of more evidence-based and updated guidelines. Social media can be leveraged to share these updated guidelines not only among professionals but also among patients. (4) Promoting academic societies: academic societies involved in the field of transplantation can be excellent sources of patient education materials and patient advocacy; examples include the American Society of Transplantation (@AST_info), the American Society of Transplant Surgeons (@ASTSChimera), and The Transplantation Society (@ttsorg). (5) Engage professionally: patients look to physicians and other healthcare providers for accurate information. Maintaining a professional demeanor enhances trust and assures that one’s social media profile produces respectful and accurate content. Sharing anecdotes and stories is acceptable if patient and donor privacy is maintained.
TABLE 1. -
Quick tips for success with engaging on social media/Twitter
||Report post or tweet, then select reason for reporting
|Promote transplant-related literature
||Retweet, share, comment, and tag others in transplant community
||@TransplantJrnl, @pedtransjrnl, etc
|Provide expert commentary
||Quote tweet, tweetorial, comment
|Promote professional societies
||Follow and tag societies to increase reach and engagement
||@AST_info, @ASTSChimera, @ttsorg, etc
||Avoid profanity, act cordially, and remain HIPAA compliant
aThese are selected examples, as there are many high-quality transplant-related resources.
HIPAA, Health Insurance Portability and Accountability Act.
PROMOTING TRANSPLANT RESEARCH AMONG PROFESSIONALS
Social media platforms can be a crucial tool to enhancing access to research. Although social media platforms such as ResearchGate are designed specifically for scientists, other platforms such as Twitter offer the opportunity to reach a much wider audience. A 2018 study evaluating 100 biologists on Twitter determined that the “tipping point” to achieving “reach,” that is, engaging with the nonscientist community, was having at least 1000 followers.15 Through the creation of Twitter accounts, journals can highlight new articles and engage with the transplant community. In a recent survey of American transplant surgeons, over half were using social media to interact with other transplant professionals.16 Social media has also led to a new component of article development, the visual abstract (see Supplemental Visual Abstract, SDC, https://links.lww.com/TP/C404). Designed to be a short visual representation of key results, visual abstracts have been shown to increase “impressions” (count of occurrences when a tweet has been seen) >7-fold and increase article visits 2.7-fold.17 Because visual abstracts have been required for Annals of Surgery, the impact factor has increased from 9 in 2016 to 12.9 in 2020. Effective use of visual abstracts and the use of popular hashtags such as #surgtwitter can help to promote research while having a positive impact on professional growth by increasing research metrics, including Altmetric and H-index.18
RECRUITMENT OF A DIVERSE, INCLUSIVE, AND TALENTED WORKFORCE IN TRANSPLANTATION
Diversity in health care is essential for providing a dynamic and innovative workforce to serve the needs of our diverse patient population. This necessity has been brought to attention on Twitter via the viral hashtag #RepresentationMatters and #ILookLikeASurgeon.19 Nevertheless, a recent review found that diversity in transplant surgery has not substantially improved, with 12% identifying as female and only 5.5% identifying as Black and 8% as Hispanic.20,21 Social media can also be leveraged by providing a platform for virtual interaction among students, trainees, and mentors to establish a mentorship relationship and foster a supportive path to a career in transplantation.
Despite being an innovative and exciting multidisciplinary field, resident recruitment to the field of transplantation has been challenging. Transplant surgery is consistently the least competitive surgical subspecialty fellowship.20,22 Reasons for not pursuing a career in transplantation include perceptions of a poor lifestyle, high call burden, poor operative experiences during transplant rotations in medical school or residency, and a limited job market.22,23 Transplant fellowship programs also have an opportunity to use social media, showcasing their unique training environments while providing fellows to highlight their experiences. Within our own program, updating our website and increasing social media engagement have resulted in a 3-fold increase in the number of fellowship applicants in recent years.
Social media has become an integral and broad component of culture, society, and communication. At the same time, the potential for diffuse, poorly regulated postings on social media can overwhelm users, making it challenging to differentiate misinformation from factual or helpful content. Through positive and professional social media content, our transplant community should continue to engage with our patients and other colleagues, increase awareness, publicize significant research advances, advocate for policy changes, and diversify the field of transplantation.
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