{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:12:04Z","timestamp":1792512724779,"version":"4.5.0"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T00:00:00Z","timestamp":1704844800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T00:00:00Z","timestamp":1704844800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100008967","name":"Philipps-Universit\u00e4t Marburg","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100008967","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World J Urol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>To analyze recent trends of surgical access routes, length of hospital stay (LOS), and mortality in kidney transplantation (KT) and living donor nephrectomy (LDN) in Germany.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Materials and methods<\/jats:title>\n                <jats:p>We studied the nationwide German hospital billing database and the German hospital quality reports from 2006 to 2021.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>There were a total of 35.898 KTs. In total, 9044 (25%) were living donor transplantations, while 26.854 (75%) were transplantations after donation after brain death (DBD). The share of open LDN decreased from 82% in 2006 to 22% in 2020 (\u2212\u00a04%\/year; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). The share of laparoscopic LDN increased from 18% in 2006 to 70% in 2020 (+\u20093%\/year; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). The share of robotic LDN increased from 0% in 2006 to 8% in 2020 (+\u20090.6%\/year; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Robotic-assisted KT increased from 5 cases in 2016 to 13 procedures in 2019 (<jats:italic>p<\/jats:italic>\u2009=\u20090.2). LOS was shorter after living donor KT, i.e., 18\u2009\u00b1\u200912.1\u00a0days versus 21\u2009\u00b1\u200919.6\u00a0days for DBD renal transplantation (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Moreover, LOS differed for open versus laparoscopic versus robotic LDN (9\u2009\u00b1\u20093.1 vs. 8\u2009\u00b1\u20092.9 vs. 6\u2009\u00b1\u20092.6; <jats:italic>p<\/jats:italic>\u2009=\u20090.031). The overall in-hospital mortality was 0.16% (<jats:italic>n<\/jats:italic>\u2009=\u20095) after LDN, 0.47% (<jats:italic>n<\/jats:italic>\u2009=\u200942) after living donor KT and 1.8% (<jats:italic>n<\/jats:italic>\u2009=\u2009475) after DBD KT.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>There is an increasing trend toward minimal-invasive LDN in recent years. Overall, in-hospital mortality was low after KT. However, 5 deceased healthy donors after LKD caution that the risks of this procedure should also be taken very seriously.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00345-023-04737-w","type":"journal-article","created":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T15:02:45Z","timestamp":1704898965000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Trends in kidney transplantation and living donor nephrectomy in Germany: a total population analysis from 2006 to 2021"],"prefix":"10.1007","volume":"42","author":[{"given":"Aristeidis","family":"Zacharis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Reimold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cem","family":"Aksoy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Jung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Martin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Eisenmenger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Smita George","family":"Thoduka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christer","family":"Groeben","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Huber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1477-9161","authenticated-orcid":false,"given":"Luka","family":"Flegar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,1,10]]},"reference":[{"issue":"8","key":"4737_CR1","doi-asserted-by":"publisher","first-page":"729","DOI":"10.1056\/NEJMra2014530","volume":"385","author":"S Hariharan","year":"2021","unstructured":"Hariharan S, Israni AK, Danovitch G (2021) Long-term survival after kidney transplantation. N Engl J Med 385(8):729\u2013743. https:\/\/doi.org\/10.1056\/NEJMra2014530","journal-title":"N Engl J Med"},{"issue":"4","key":"4737_CR2","doi-asserted-by":"publisher","first-page":"1663","DOI":"10.1093\/ndt\/gfr524","volume":"27","author":"M Veroux","year":"2012","unstructured":"Veroux M, Grosso G, Corona D, Mistretta A, Giaquinta A, Giuffrida G, Sinagra N, Veroux P (2012) Age is an important predictor of kidney transplantation outcome. Nephrol Dial Transplant 27(4):1663\u20131671. https:\/\/doi.org\/10.1093\/ndt\/gfr524","journal-title":"Nephrol Dial Transplant"},{"issue":"6","key":"4737_CR3","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1089\/lap.2020.0545","volume":"31","author":"U Sozener","year":"2021","unstructured":"Sozener U (2021) Laparoscopic live donor nephrectomy: single-center experience of 200 consecutive cases. J Laparoendosc Adv Surg Tech A 31(6):627\u2013631. https:\/\/doi.org\/10.1089\/lap.2020.0545","journal-title":"J Laparoendosc Adv Surg Tech A"},{"key":"4737_CR4","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1038\/ki.1996.307","volume":"50","author":"A Laupacis","year":"1996","unstructured":"Laupacis A, Keown P, Pus N et al (1996) A study of the quality of life and cost-utility of renal transplantation. Kidney Int 50:235\u2013242","journal-title":"Kidney Int"},{"issue":"5","key":"4737_CR5","doi-asserted-by":"publisher","first-page":"1941","DOI":"10.1016\/j.juro.2010.01.021","volume":"183","author":"JD Harper","year":"2010","unstructured":"Harper JD, Breda A, Leppert JT, Veale JL, Gritsch HA, Schulam PG (2010) Experience with 750 consecutive laparoscopic donor nephrectomies\u2014Is it time to use a standardized classification of complications? J Urol 183(5):1941\u20131946. https:\/\/doi.org\/10.1016\/j.juro.2010.01.021","journal-title":"J Urol"},{"key":"4737_CR6","doi-asserted-by":"publisher","unstructured":"Hamza A, Jurczok A, Rettkowski O, Fischer K, Fornara P (2006) Handassistierte transperitoneale laparoskopische Donornephrektomie [The hand assisted transperitoneal laparoscopic donor nephrectomy]. Urologe A 45(9):1118, 1110\u201322, 1124\u20136 (German). https:\/\/doi.org\/10.1007\/s00120-006-1164-x","DOI":"10.1007\/s00120-006-1164-x"},{"issue":"S2","key":"4737_CR7","doi-asserted-by":"publisher","first-page":"S75","DOI":"10.1089\/end.2021.0227","volume":"35","author":"JM Farrow","year":"2021","unstructured":"Farrow JM, Vasquez R Jr, Zappia JL, Sundaram AC, Sharfuddin AA, Powelson JA, Goggins WC, Sundaram CP (2021) Procedure: laparoscopic donor nephrectomy. J Endourol 35(S2):S75\u2013S82. https:\/\/doi.org\/10.1089\/end.2021.0227","journal-title":"J Endourol"},{"key":"4737_CR8","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1007\/s11934-021-01075-5","volume":"22","author":"A Gallioli","year":"2021","unstructured":"Gallioli A, Rivas JG, Larcher A et al (2021) Living donor robot-assisted kidney transplantation: a new standard of care? Curr Urol Rep 22:58. https:\/\/doi.org\/10.1007\/s11934-021-01075-5","journal-title":"Curr Urol Rep"},{"issue":"2","key":"4737_CR9","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1016\/j.eururo.2017.08.028","volume":"73","author":"A Breda","year":"2018","unstructured":"Breda A, Territo A, Gausa L, Tu\u011fcu V, Alcaraz A, Musquera M, Decaestecker K, Desender L, Stockle M, Janssen M, Fornara P, Mohammed N, Siena G, Serni S, Guirado L, Facundo C, Doumerc N (2018) Robot-assisted kidney transplantation: the european experience. Eur Urol 73(2):273\u2013281. https:\/\/doi.org\/10.1016\/j.eururo.2017.08.028","journal-title":"Eur Urol"},{"issue":"2","key":"4737_CR10","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1111\/j.1432-2277.2009.01027.x","volume":"23","author":"LF Dols","year":"2010","unstructured":"Dols LF, Kok NF, Ijzermans JN (2010) Live donor nephrectomy: a review of evidence for surgical techniques. Transpl Int 23(2):121\u2013130. https:\/\/doi.org\/10.1111\/j.1432-2277.2009.01027.x","journal-title":"Transpl Int"},{"issue":"4","key":"4737_CR11","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1159\/000528559","volume":"107","author":"L Flegar","year":"2023","unstructured":"Flegar L, Thoduka SG, Mahnken AH, Figiel J, Heers H, Aksoy C, Eisenmenger N, Groeben C, Huber J, Zacharis A (2023) Focal therapy for renal cancer: comparative trends in the USA and Germany from 2006 to 2020 and analysis of the German Health Care Landscape. Urol Int 107(4):396\u2013405. https:\/\/doi.org\/10.1159\/000528559","journal-title":"Urol Int"},{"issue":"12","key":"4737_CR12","doi-asserted-by":"publisher","first-page":"405","DOI":"10.5500\/wjt.v12.i12.405","volume":"12","author":"B Mankiev","year":"2022","unstructured":"Mankiev B, Cimen SG, Kaya IO, Cimen S, Eraslan A (2022) Current practice of live donor nephrectomy in Turkey. World J Transplant 12(12):405\u2013414. https:\/\/doi.org\/10.5500\/wjt.v12.i12.405","journal-title":"World J Transplant"},{"issue":"3","key":"4737_CR13","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1111\/ctr.12501","volume":"29","author":"A Rajab","year":"2015","unstructured":"Rajab A, Pelletier RP (2015) The safety of hand-assisted laparoscopic living donor nephrectomy: the Ohio State University experience with 1500 cases. Clin Transplant 29(3):204\u2013210. https:\/\/doi.org\/10.1111\/ctr.12501","journal-title":"Clin Transplant"},{"key":"4737_CR14","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1111\/tri.13506","volume":"33","author":"M Lomero","year":"2020","unstructured":"Lomero M, Gardiner D, Coll E et al (2020) Donation after circulatory death today: an updated overview of the European landscape. Transpl Int 33:76\u201388. https:\/\/doi.org\/10.1111\/tri.13506","journal-title":"Transpl Int"},{"issue":"2","key":"4737_CR15","doi-asserted-by":"publisher","first-page":"346","DOI":"10.2741\/738","volume":"7","author":"S Janki","year":"2015","unstructured":"Janki S, Dor FJ, IJzermans JN (2015) Surgical aspects of live kidney donation: an updated review. Front Biosci (Elite Ed) 7(2):346\u2013365. https:\/\/doi.org\/10.2741\/738","journal-title":"Front Biosci (Elite Ed)"},{"issue":"7","key":"4737_CR16","doi-asserted-by":"publisher","first-page":"892","DOI":"10.1097\/01.tp.0000235511.19629.0d","volume":"82","author":"NF Kok","year":"2006","unstructured":"Kok NF, Weimar W, Alwayn IP, Ijzermans JN (2006) The current practice of live donor nephrectomy in Europe. Transplantation 82(7):892\u2013897. https:\/\/doi.org\/10.1097\/01.tp.0000235511.19629.0d","journal-title":"Transplantation"},{"issue":"6","key":"4737_CR17","doi-asserted-by":"publisher","first-page":"305","DOI":"10.21037\/atm.2020.02.97","volume":"8","author":"M Brunotte","year":"2020","unstructured":"Brunotte M, Rademacher S, Weber J, Sucher E, Lederer A, Hau HM, Stolzenburg JU, Seehofer D, Sucher R (2020) Robotic assisted nephrectomy for living kidney donation (RANLD) with use of multiple locking clips or ligatures for renal vascular closure. Ann Transl Med 8(6):305. https:\/\/doi.org\/10.21037\/atm.2020.02.97","journal-title":"Ann Transl Med"},{"issue":"6","key":"4737_CR18","doi-asserted-by":"publisher","first-page":"1471","DOI":"10.1007\/s11701-022-01393-x","volume":"16","author":"OL Windisch","year":"2022","unstructured":"Windisch OL, Matter M, Pascual M, Sun P, Benamran D, B\u00fchler L, Iselin CE (2022) Robotic versus hand-assisted laparoscopic living donor nephrectomy: comparison of two minimally invasive techniques in kidney transplantation. J Robot Surg 16(6):1471\u20131481. https:\/\/doi.org\/10.1007\/s11701-022-01393-x","journal-title":"J Robot Surg"},{"key":"4737_CR19","doi-asserted-by":"publisher","first-page":"1474","DOI":"10.1097\/00007890-200205150-00018","volume":"73","author":"S Horgan","year":"2002","unstructured":"Horgan S, Vanuno D, Sileri P et al (2002) Robotic-assisted laparoscopic donor nephrectomy for kidney transplantation. Transplantation 73:1474\u20131479","journal-title":"Transplantation"},{"key":"4737_CR20","doi-asserted-by":"publisher","first-page":"2264","DOI":"10.1097\/TP.0000000000001327","volume":"100","author":"K Kortram","year":"2016","unstructured":"Kortram K, Ijzermans JN, Dor FJ (2016) Perioperative events and complications in minimally invasive live donor nephrectomy: a systematic review and meta-analysis. Transplantation 100:2264\u20132275","journal-title":"Transplantation"},{"issue":"6","key":"4737_CR21","doi-asserted-by":"publisher","first-page":"1478","DOI":"10.1111\/j.1600-6143.2010.03116.x","volume":"10","author":"P Giulianotti","year":"2010","unstructured":"Giulianotti P, Gorodner V, Sbrana F, Tzvetanov I, Jeon H, Bianco F, Kinzer K, Oberholzer J, Benedetti E (2010) Robotic transabdominal kidney transplantation in a morbidly obese patient. Am J Transplant 10(6):1478\u20131482. https:\/\/doi.org\/10.1111\/j.1600-6143.2010.03116.x","journal-title":"Am J Transplant"},{"issue":"10","key":"4737_CR22","doi-asserted-by":"publisher","first-page":"1507","DOI":"10.1007\/s00345-017-2006-8","volume":"35","author":"A Breda","year":"2017","unstructured":"Breda A, Territo A, Gausa L, Rodr\u00edguez-Faba O, Caffaratti J, de Le\u00f3n JP, Guirado L, Facundo C, Guazzieri M, Guttilla A, Villavicencio H (2017) Robotic kidney transplantation: one year after the beginning. World J Urol 35(10):1507\u20131515. https:\/\/doi.org\/10.1007\/s00345-017-2006-8","journal-title":"World J Urol"},{"key":"4737_CR23","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.euros.2022.03.007","volume":"39","author":"R Campi","year":"2022","unstructured":"Campi R, Pecoraro A, Li Marzi V, Tuccio A, Giancane S, Peris A, Cirami CL, Breda A, Vignolini G, Serni S (2022) Robotic versus open kidney transplantation from deceased donors: a prospective observational study. Eur Urol Open Sci 39:36\u201346. https:\/\/doi.org\/10.1016\/j.euros.2022.03.007","journal-title":"Eur Urol Open Sci"},{"key":"4737_CR24","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.15000","author":"SS Bakhtiyar","year":"2023","unstructured":"Bakhtiyar SS, Sakowitz S, Verma A, Richardson S, Curry J, Chervu NL, Blumberg J, Benharash P (2023) Postoperative length of stay following kidney transplantation in patients without delayed graft function\u2014An analysis of center-level variation and patient outcomes. Clin Transplant. https:\/\/doi.org\/10.1111\/ctr.15000","journal-title":"Clin Transplant"},{"issue":"6","key":"4737_CR25","doi-asserted-by":"publisher","first-page":"1610","DOI":"10.3390\/jcm9061610","volume":"9","author":"P Zeuschner","year":"2020","unstructured":"Zeuschner P, Hennig L, Peters R, Saar M, Linxweiler J, Siemer S, Magheli A, Kramer J, Liefeldt L, Budde K, Schlomm T, St\u00f6ckle M, Friedersdorff F (2020) Robot-assisted versus laparoscopic donor nephrectomy: a comparison of 250 cases. J Clin Med 9(6):1610. https:\/\/doi.org\/10.3390\/jcm9061610","journal-title":"J Clin Med"},{"issue":"1","key":"4737_CR26","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1159\/000492731","volume":"9","author":"A Goyal","year":"2019","unstructured":"Goyal A, Chatterjee K, Mathew RO, Sidhu MS, Bangalore S, McCullough PA, Rangaswami J (2019) In-hospital mortality and major adverse cardiovascular events after kidney transplantation in the United States. Cardiorenal Med 9(1):51\u201360. https:\/\/doi.org\/10.1159\/000492731","journal-title":"Cardiorenal Med"},{"issue":"12","key":"4737_CR27","doi-asserted-by":"publisher","first-page":"e0243586","DOI":"10.1371\/journal.pone.0243586","volume":"15","author":"YN Kim","year":"2020","unstructured":"Kim YN, Kim DH, Shin HS, Lee S, Lee N, Park MJ, Song W, Jeong S (2020) The risk factors for treatment-related mortality within first three months after kidney transplantation. PLoS ONE 15(12):e0243586. https:\/\/doi.org\/10.1371\/journal.pone.0243586","journal-title":"PLoS ONE"},{"issue":"6","key":"4737_CR28","doi-asserted-by":"publisher","first-page":"1795","DOI":"10.1016\/j.euf.2022.03.021","volume":"8","author":"J Dagn\u00e6s-Hansen","year":"2022","unstructured":"Dagn\u00e6s-Hansen J, Kristensen GH, Stroomberg HV, S\u00f8rensen SS, R\u00f8der MA (2022) Surgical approaches and outcomes in living donor nephrectomy: a systematic review and meta-analysis. Eur Urol Focus 8(6):1795\u20131801. https:\/\/doi.org\/10.1016\/j.euf.2022.03.021","journal-title":"Eur Urol Focus"},{"issue":"1","key":"4737_CR29","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1007\/s00345-020-03520-5","volume":"40","author":"J Branchereau","year":"2022","unstructured":"Branchereau J (2022) Redefining the urologist\u2019s role in kidney transplantation. World J Urol 40(1):301\u2013302. https:\/\/doi.org\/10.1007\/s00345-020-03520-5","journal-title":"World J Urol"},{"key":"4737_CR30","doi-asserted-by":"publisher","first-page":"2456","DOI":"10.1002\/cncr.23452","volume":"112","author":"SH Giordano","year":"2008","unstructured":"Giordano SH, Kuo Y-F, Duan Z, Hortobagyi GN, Freeman J, Goodwin JS (2008) Limits of observational data in determining outcomes from cancer therapy. Cancer 112:2456\u20132466. https:\/\/doi.org\/10.1002\/cncr.23452","journal-title":"Cancer"}],"container-title":["World Journal of Urology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00345-023-04737-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00345-023-04737-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00345-023-04737-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T21:17:47Z","timestamp":1735852667000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00345-023-04737-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,10]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["4737"],"URL":"https:\/\/doi.org\/10.1007\/s00345-023-04737-w","relation":{},"ISSN":["1433-8726"],"issn-type":[{"value":"1433-8726","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,10]]},"assertion":[{"value":"31 July 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 November 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 January 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Mrs. Eisenmenger is founder and director of RI Innovation GmbH. J. Huber is Medical Board member of the \"Urologische Stiftung Gesundheit gGmbH,\" Chairman of the Working Group \"Health Services Research, Quality and Economics\" of the German Society of Urology e. V. and initiator of the \"Entscheidungshilfe Prostatakrebs\" (). The latter is supported by Takeda Pharma, Janssen Cilag GmbH and Apogepha. Further he indicates support of scientific projects outside the submitted work by Intuitive Surgical and Coloplast. Luka Flegar is a consultant for BK Medical. All the other authors have no conflicts of interest to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethics approval was not required.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate:"}}],"article-number":"24"}}