Primary health care personnel faced with cadaveric organ donation: a multicenter study in south-eastern Spain

Abstract: Introduction: Primary health care (PHC) is the first point of contact between the public and the health system and it is an important channel for the communication and promotion of organ donation and transplantation. The objective of this study was to analyze the attitude of PHC personnel toward donation and to determine the psychosocial variables affecting this attitude. Materials and methods: A random sample was stratified by job category and geographical location among PHC personnel (n = 482) from 32 health centers. Attitude was evaluated using a questionnaire validated in our local area. (It was completed anonymously and was self‐administered.) Results: The questionnaire completion rate was 86% (n = 414): 78% (n = 325) are in favor and the remaining 22% (n = 89) are either against or are not sure. The reason given for a negative attitude is fear of apparent death (16%; n = 14). There are many independent factors that affect attitude: (i) job category (OR = 2.4); (ii) knowledge of the concept of brain death (OR = 2.2); (iii) a preference for alternatives to burial (OR = 2.99); (iv) being in favor of cremation (OR = 01.87) and (v) knowledge of the attitude of one’s partner toward organ donation (OR = 0.312). Conclusion: PHC personnel have a favorable attitude toward donation, especially physicians, although it would be useful to provide more information to PHC personnel. Physicians could be a key element in the direct and indirect promotion of donation and transplantation.     

The attitude toward living kidney donation among personnel from units related to donation and transplantation in Spain,Mexico and Cuba

Background: Living kidney donation (LKD) is becoming increasingly necessary as a treatment option for reducing the deficit in transplant organs. Hospital personnel in services related to donation and transplantation play a key role in promoting this kind of donation. Objective: To analyze the attitude toward LKD among hospital workers in services related to donation and transplantation in Spain and Latin America. Methods: Eight hospitals in the “International Collaborative Donor Project” were selected (Spain–Mexico–Cuba). A random sample was taken which was stratified according to the type of service and job category, in transplant-related services. Results: Of the 878 respondents, 90% were in favor of related LKD, and 28% were in favor if the LKD was not related. Attitude was more favorable among Latin Americans workers compared to the Spanish (p?=?0.014). Other factors associated to attitude included: age (p?=?0.004); an attitude in favor of deceased donation and living liver donation (p?p?Conclusions: The attitude toward related LKD was very favorable among hospital personnel in units related to the donation and transplantation process in Spain and Latin America, which means that they could contribute to its promotion particularly at the current time when living kidney donation needs to be expanded.     

Emergency organ transplantation in Spain: liver emergency and outcomes

The 2 main indications for emergency liver transplantation are severe acute hepatic insufficiency and emergency retransplantation. In Spain, since the creation of the National Transplant Organisation (NTO), known as "the Spanish model," there have been high rates of donation, with a mean of 33.9 donors per million inhabitants in 2003 and 34.6 donors per million inhabitants in 2004. According to data provided by the NTO, there were 169 liver emergencies in the 2-year period 2003-2004. The time on the waiting list in an emergency situation was limited; 82.8% of cases were resolved in less than 48 hours. During this 2-year period, there were 2077 liver transplantations, including 128 emergence patients, which accounted for 6.1% of transplantations.     

Attitudes toward living liver donation among hospital personnel in services not related to transplantation

INTRODUCTION: The deficiency in livers and waiting list mortality have encouraged more living liver donation, although it is not exempt from morbidity and mortality. The enthusiasm of transplant teams for this kind of donation is increasing; however, the attitudes toward it are not so clear among other health professionals. Our objective was to analyze the attitudes toward living liver donation among hospital professionals in services without habitual relations with transplantation. MATERIALS AND METHODS: A random sample was stratified for service not related to transplantation and job category, in a third level hospital with a transplant program. Attitudes toward living liver donation were evaluated using a psychosocial questionnaire on living donation. RESULTS: A total of 419 respondents were analyzed (doctors, n = 184; nurses, n = 119; assistant nurses, n = 80; and non-health workers, n = 36), with a mean age of 37 +/- 10 years. The attitude toward living liver donation was favorable in 82% (n = 344). Among the other respondents, half (9%; n = 38) were against and the other half (9%; n = 37) were undecided. No significant differences were found among the doctors, nurses, assistants, and non-health workers. However, when the three categories were grouped in opposition to the non-health workers, there was greater indecision among non-health workers than the others (19% vs 8%; P = .0001). On analyzing the variables that determine this attitude we observed the following: having commented upon and previously discussed donation (P = .016); believing in the possibility of needing an organ oneself (P = .0001); and being in favor of living kidney donation (P = .0001) and cadaveric donation (P = .004). CONCLUSIONS: Hospital personnel in services not related to transplantation favor living liver donation, especially if it is a related donation, despite its greater risk, except among non-health workers. However, it is important to conduct informative and awareness-raising campaigns in hospitals if such a type of transplantation is to be encouraged.     

Benefit of a hospital course about organ donation and transplantation: an evaluation by Spanish hospital transplant personnel

A considerable percentage of hospital personnel are against organ donation, which at a crucial time could act as an obstacle to donation. Moreover, there is often a lack of training of personnel necessary for them to provide accurate information about organ donation and transplantation. Our objective was to determine the acceptability of a training course about organ donation among hospital workers in a center with an ongoing solid organ transplant program. MATERIALS AND METHODS: A random sample (n = 1168) was stratified by type of service and job category among workers in hospital services within an organ transplant program. An evaluation was made of attitudes toward donation and acceptance of a training course using a validated psychosocial questionnaire. Distribution of the survey was made by the head of each service and job category. The survey was completed anonymously and self-administered. RESULTS: Sixty-nine percent (n = 808) of respondents were in favor of donating their own organs. With respect to the benefit of a training course about organ donation and transplantation, 50% (n = 584) of respondents considered it to be a useful idea, whereas 15% (n = 176) did not, and 35% (n = 408) were not sure. An important finding was that 56% (n = 452) of those who are in favor of donation would take part in the course compared to only 37% (n = 132) of those who were against or undecided. There was a significant relationship between those workers who believed that the training course will be of use and the following factors: younger age (P = .000); women (P = .000); single (P = .000); nursing job category (P = .000); a temporary contract (P = .012); a worker in nonsurgical services (P = .000); prior understanding of the concept of brain death (P = .003); favoring cadaveric organ donation (P = .000); performing pro-social voluntary type activities (P = .000); discussions of organ donation and transplantation within the family (P = .022); Catholic religion (P = .001); a partner in favor of organ donation and transplantation (P = .001); and a belief that he may need a transplant (P = .000). CONCLUSIONS: A training course about organ donation and transplantation might be useful given that only half of the workers would be prepared to take part and with respect to the target population, only 37% of them stating that they would participate. Its main use would be to reinforce the positive attitude of those who are already in favor and increase their knowledge about the subject. What is more, if these workers received adequate training they would serve to promote donation both directly and indirectly to the general public and other hospital personnel.     

Simultaneous pancreas-kidney transplantation in a large multicenter study: surgical complications

Simultaneous pancreas-kidney (SPK) transplantation has evolved as an effective treatment modality for patients with end-stage nephropathy owing to type 1 diabetes mellitus. This kidney-pancreas transplant procedure includes a number of risks, one of them being surgical complications, which were analyzed in this large prospective multicenter study. PATIENTS AND METHODS: The analysis included 205 patients randomly assigned to tacrolimus (n = 103) or cyclosporine ME (n = 102) in the Euro-SPK001 study. Surgical complications were defined as any intervention in the postoperative course related to the transplant procedure. RESULTS: The number of patients undergoing relaparotomy was significantly lower among the tacrolimus group (26.2%) as compared to the cyclosporine ME group (43.1%, P = .0109). Relaparotomy was performed earlier in the cyclosporine ME group (day 14 +/- 17) compared to patients in the tacrolimus group (day 26 +/- 26, P = .0506). Graft vessel thrombosis, intra-abdominal hemorrhage, and enteric or ureteral leakage within the first 3 months occurred significantly more frequently in cyclosporine ME-treated patients. Donor age above 45 years showed a negative impact on surgical complications. Relaparotomy had no impact on patient survival but significantly affected pancreas and kidney graft survival in both groups. CONCLUSION: This prospective, randomized, multicenter trial in patients undergoing primary SPK demonstrated a benefit of tacrolimus over cyclosporine ME with regard to the incidence of surgical complications and, consecutively, to kidney and pancreas graft survival.     

General practice consultation in a hospital emergency department. History,evaluation and prospects

INSTALLATION OF A GENERAL MEDICINE CONSULTATION: In 1995, in reaction to an increase of more than 35% over three years, related essentially to out-patient consultations, the installation of a general medicine consultation (GMC) near the emergency unit reception area (EUR) was envisaged. The project, developed over 5 years and based on an epidemiological study, was finally set-up in January 2000. The aims of the GMC are to supply information to the patients, help them in their administrative rights, and their subsequent follow-up by an external physician; the benefits expected by the EUR is the re-concentration on heavier and more urgent pathologies. THE FUNCTION OF THE GMC: Exclusively reserved for CCMU 1 patients (level 1 of the clinical classification of emergency unit patients), the GMC relies on general practice, with the presence of general practitioners installed in the SAU (emergency unit) sector, a double admission method (either via the emergency unit, or directly), a means of payment for the consultation and the absence of priority access to the technical network of the hospital. A social services worker is present. RECRUITMENT: After 18 months of activity, the GMC had managed more than 4500 patients and the method of referral via the SAU, almost exclusive at the beginning, has been reduced to a minority. The patients are generally young; socially close to the underprivileged population surrounding the SAU, but not in a situation of precariousness. The four principle motives for consultation are benign traumas, ENT infections, dermatological affections and pain. A DYNAMIC STRUCTURE: The rapid progress in the context of general medicine, and the observations of the physicians and non-physicians participating in this experience, has progressively modified the aim and mission of this GMC, which is gradually becoming a real structure of permanent care. Its originality is its close link between the town and the hospital, whilst permitting the various actors to remain free and independent. The traditional system of permanent care is no longer adapted to our society, and we must rapidly find solutions. The vocation of the GMC is not to become a universal model, but this new experience opens new horizons for the future.     

Pneumonia in allogeneic stem cell transplantation recipients: a multicenter prospective study

Pneumonia is a common cause of mortality after allogeneic hematopoietic stem cell transplantation (allo-HSCT) but updated and prospective information is partial. The aim of this nationwide prospective study is to determine the current epidemiology, etiology, and outcome of pneumonia in allo-HSCT recipients. From September-2003 to November-2005, 112 episodes in 427 consecutive allo-HSCT recipients were included (incidence 52.2 per 100 allo-HSCT/yr), and 72 of them (64.3%) were microbiologically defined pneumonia. Bacterial pneumonia (44.4%) was more frequent than fungal (29.2%) and viral pneumonia (19.4%). The most frequent microorganisms in each group were: Escherichia coli (n = 7, 8.9%), Streptococcus pneumoniae (n = 4, 5.0%), cytomegalovirus (n = 12, 15.4%), and Aspergillus spp. (n = 12, 15.4%). The development of pneumonia and chronic graft-versus-host disease (GVHD) was associated with increased mortality after allo-HSCT, and the probability of survival was significantly lower in patients that had at least one pneumonia episode (p < 0.01). Pneumonia development in the first 100 d after transplantation, fungal etiology, GVHD, acute respiratory failure, and septic shock were associated with increased mortality after pneumonia. Our results show that pneumonia remains a frequent infectious complication after allo-HSCT, contributing to significant mortality, and provide a large current experience with the incidence, etiology and outcome of pneumonia in these patients.     

Invasive hemodynamic monitoring during cardiopulmonary resuscitation in a community hospital emergency department.

Monitoring the effects of resuscitation efforts in a community emergency department are limited primarily to noninvasive techniques. Coronary perfusion pressure (CCP) has been used as a predictor for successful resuscitation. The authors investigated the feasibility of measuring the CPP in a community emergency department and incorporating the CPP into decisions for managing the resuscitation effort. During a 7-month period, the authors prospectively studied 77 nontraumatic, normothermic adults in cardiopulmonary arrest who were treated in the emergency department. Fifty-one patients underwent invasive monitoring and 26 patients entered a control (noninvasive monitoring) group. Successful CPP monitoring was accomplished in 84% of the patients; the average time to obtain an initial CPP was 12.1 +/- 7.3 minutes. Twenty patients had a return of spontaneous circulation, but no patient survived to hospital discharge. There was no significant difference in return of spontaneous circulation between patients in the invasively monitored and the noninvasively monitored group. Coronary perfusion pressure monitoring had a positive influence on the management of three patients. This study showed that CPP monitoring is feasible in a community hospital, but further studies are needed to better define the effects of CPP in resuscitation effort outcome.     

International multicenter opinion study: administrative personnel from Spanish and Mexican health centers faced with human organ donation for transplantation

Introduction

Administrative personnel from healthcare centers are an important opinion group given their direct relationship to patients and the general public.

Objective

The objective of this study was to analyze the attitudes of administrative personnel in Spanish and Mexican healthcare centers toward various kinds of donation.

Material and Methods

A random selection of 418 administrative staff from 32 primary care centers and 9 hospitals in Spain and Mexico (“Proyecto Donante, Murcia”) used a validated questionnaire to explore attitudes.

Results

Most (76%) respondents favored deceased donation. Mexican workers had the most favorable attitude (P < .001). Factors influencing this attitude (P < .05) were as follows: type of healthcare center, clinical service, personal experience of organ donation and transplantation (ODT), attitude toward living donation, attitude toward the donation of a family member's organs, discussion of ODT, partner's attitude toward ODT, participation in pro-social activities, and variables related to attitudes toward the body. Most respondents (89%) favored related living kidney donation (LKD) and 87% favored living liver donation (LLD). Mexican respondents showed the most favorable attitudes (P < .05). Factors influencing this attitude (P < .05) were as follows: personal experience of ODT, belief that a transplant is needed, willingness to accept a living organ, family discussion about ODT, partner's attitude about the matter, and respondent's awareness of the view of his or her religion toward ODT.

Conclusion

Attitudes toward deceased organ donation were not favorable among administrative personnel from Spanish compared with Mexican centers, although attitudes toward LKD and LLD were favorable in both countries.