Attitude of health care professionals to brain death: influence on the organ donation process

Abstract: Background:  The acceptance and application of the concept that brain death is a valid determination of death is the central issue in organ donation. However, whether attitude to brain death of health care professionals influences the organ procurement process has not been systematically studied.
Methods:  Questionnaires were distributed to health care professionals involved in the organ procurement process (intensive care, internal medicine, emergency room, anesthesia) in all hospitals in Israel. Attitude to brain death (defined as positive if the respondent accepted brain death as a valid determination of death, negative or do not know) and level of comfort in performing key donor-related tasks were analyzed.
Results:  A total of 2366 completed questionnaires were returned (629 doctors and 1737 nurses; response rate 60.3%). Overall, 78.9% of respondents had a positive attitude to brain death. This was significantly associated with increasing age, higher professional status and was most prevalent amongst intensive care unit staff (p < 0.001 for all variables). These respondents felt significantly more comfortable informing the transplant coordinator of a potential donor, explaining brain death to the family, raising the subject of organ donation, approaching the family about donation and providing support to the grieving family. In addition, they believed the transplant coordinator should be involved early in the donation process.
Conclusions:  The understanding and acceptance of brain death as a valid determination of death was associated with a positive effect on the level of comfort of health care professionals in performing key donor-related tasks. Reinforcing a positive attitude to brain death among health care professionals may facilitate the procurement process.     

Knowledge and attitudes toward organ/tissue donation and transplantation among health care professionals working in organ transplantation or dialysis units

Objective

To evaluate the awareness and attitudes of health care professionals toward organ/tissue donation and transplantation.

Methods

We included 309 health care professionals from 27 dialysis centers and eight organ transplantation centers in Istanbu in the present study conducted from April 2008 to August 2008. The 24-item questionnaire, including items concerning sociodemographic features and knowledge about and attitudes toward organ/tissue donation and transplantation, was applied by face-to-face interviews.

Results

An organ/tissue donation card was completed among 77% of subjects, while 90% were identified as supporting transplantation. The main reasons identified for lack of donation were lack of confidence (59.7%), fear of procurement (31.5%), and inappropriate use of harvested organs (18.1%).

Conclusion

In conclusion, targeting health care professionals in the first place and development of nationwide media and educational campaigns on the ethical, moral, as well as religious dimensions of transplantation and donation seem crucial to increase the number of individuals who can act as role models via their positive impact on the general public's attitudes toward organ donation.     

A limited study on the perception and change in attitude about circumcision among health care professionals and their male family members

OBJECTIVES: Millions of male children are circumcised throughout the world. We investigated the opinions and thoughts about the past and future aspects of circumcision by interviewing 100 male family members of the health care staff. METHODS: 100 male volunteers answered a questionnaire comprising questions about their personal observations, feelings, festivities and opinions about their own circumcisions as well as their views about the circumcision phenomenon as a parent, and the legality of circumcision. RESULTS: 81% of the volunteers in our study had been circumcised by traditional circumcisers. The rest had been circumcised by doctors (10%), barbers (7%) and sheikhs (2%). In 90% the circumcision took place at home, 7% in hospitals and in 3% in village squares. While 66% of the subjects do not remember anything, the remaining 33% reported some bad sensations like fear, pain and shame about their circumcisions, and 1 (1%) subject reported happiness. As a parent, they answered the questions on their preferences on the place and performer of the circumcision. 44% preferred to have circumcision performed in the hospital by a physician, 26% at home by a physician, and 30% at home by a circumciser. CONCLUSION: There are significant changes in the attitudes of people in Turkey on circumcision as a traditional culture, though its perception has remained unchanged.     

Complications of brain death: frequency and impact on organ retrieval

Brain death is associated with complex hemodynamic, endocrine, and metabolic dysfunction that can lead to major complications with the potential donor. Untreated, this can progress to cardiovascular collapse with loss of valuable organs for transplantation. We hypothesized that brain death-related complications would have no effect on the number of organs donated if an aggressive donor management protocol was in place. We identified all successful organ donations between January 2000 and December 2003 and evaluated them for brain death-associated complications (defined as vasopressor requirement, coagulopathy, diabetes insipidus, cardiac ischemia, lactic acidosis, renal failure, and acute respiratory distress syndrome) and donated organs per donor. Sixty-nine organ donors were identified. Complications identified were as follows: intravenous vasopressor requirement in 97.1 per cent, coagulopathy in 55.1 per cent, thrombocytopenia in 53.6 per cent, diabetes insipidus in 46.4 per cent, cardiac ischemia in 30.4 per cent, lactic acidosis in 24.6 per cent, renal failure in 20.3 per cent, and acute respiratory distress syndrome in 13 per cent. There was no significant effect of complications on the average number of organs harvested, with the exception of an increase in organs harvested in the presence of diabetes insipidus. With the implementation of an aggressive organ donor management protocol, these complications can be effectively managed with no impact on the number of organs harvested for transplant.     

青海省护理人员安宁疗护知识及临终关怀态度调查分析

目的了解青海省护理人员安宁疗护知识及临终关怀态度,为推动安宁疗护的发展提供参考。方法采用便利抽样法对青海省3所三级医院、16所二级医院1 833名护士进行安宁疗护知识及临终关怀态度调查。结果护理人员安宁疗护知识得分(11.82±3.74)分;临终关怀态度得分(95.06±10.01)分;安宁疗护知识得分与临终关怀态度得分呈正相关(P0.01)。安宁疗护知识的影响因素为医院级别、性别、职称、是否接受过安宁疗护相关培训、宗教信仰和平均月收入;临终关怀态度的影响因素为医院级别、性别、职称、是否接受过安宁疗护相关培训、职务和学历(P0.05,P0.01)。结论青海省护理人员安宁疗护知识及临终关怀态度处于中等水平,受多种人口学因素的影响;应加强相关知识培训,树立正确的死亡观,以推动安宁疗护的发展。     

Intensive care practices in brain death diagnosis and organ donation

We conducted a multicentre study of 1844 patients from 42 Spanish intensive care units, and analysed the clinical characteristics of brain death, the use of ancillary testing, and the clinical decisions taken after the diagnosis of brain death. The main cause of brain death was intracerebral haemorrhage (769/1844, 42%), followed by traumatic brain injury (343/1844, 19%) and subarachnoid haemorrhage (257/1844, 14%). The diagnosis of brain death was made rapidly (50% in the first 24 h). Of those patients who went on to die, the Glasgow Coma Scale on admission was ≤ 8/15 in 1146/1261 (91%) of patients with intracerebral haemorrhage, traumatic brain injury or anoxic encephalopathy; the Hunt and Hess Scale was 4–5 in 207/251 (83%) of patients following subarachnoid haemorrhage; and the National Institutes of Health Stroke Scale was ≥ 15 in 114/129 (89%) of patients with strokes. Brain death was diagnosed exclusively by clinical examination in 92/1844 (5%) of cases. Electroencephalography was the most frequently used ancillary test (1303/1752, 70.7%), followed by transcranial Doppler (652/1752, 37%). Organ donation took place in 70% of patients (1291/1844), with medical unsuitability (267/553, 48%) and family refusal (244/553, 13%) the main reasons for loss of potential donors. All life‐sustaining measures were withdrawn in 413/553 of non‐donors (75%).     

Welsh citizens in south-eastern Spain: a study of attitude toward organ donation

Introduction

The increase in the British population, including Welsh citizens, in the south-east of Spain is generating a new social and healthcare reality that is affecting the world of transplantation.

Objectives

The objectives of this study were as follows: (1) to determine the attitude of the local population originating from Wales toward the donation of their own organs, and (2) to analyze the factors that determine this attitude.

Materials and Methods

A random sample (n = 126) was selected from the population in Murcia originating from Wales (November 2005-March 2006). Attitudes were evaluated using a validated questionnaire. A control group comprised the autochthonous population (n = 2000). The sample was stratified according to age, gender, and geographical location.

Results

In this study 76% (n = 96) had favorable attitudes toward donation, 6% (n = 8) were against, and the remainder 18% (n = 22) were not sure. Attitudes were more favorable than among the Spanish control group (76% vs 63%; P = .045). The following variables were associated with this attitude: (1) knowledge of the concept of brain death (P < .001); (2) having spoken within the family about the subject (P = .005); (3) attitude toward the donation of a family member's organs (P < .001); (4) knowing the attitude of one's religion toward donation (P = .033); and (5) attitude of one's partner toward donation (P < .001).

Conclusion

Welsh citizens who are residents in south-eastern Spain have attitudes toward organ donation that are more favorable than those of the native Spanish population. They seem to be determined by knowing the concept of brain death and positive attitudes of one's family.     

German citizens in southeastern Spain: a study of attitude toward organ donation

Ríos A, Martínez‐Alarcón L, Sánchez J, Jarvis N, Parrilla P, Ramírez P. German citizens in southeastern Spain: a study of attitude toward organ donation.
Clin Transplant 2010: 24: 349–357. © 2009 John Wiley & Sons A/S Abstract: Background: Spain is frequently a place of residence for a high percentage of the German population. Our aim is to analyze the attitude of the German population that is resident in Spain toward organ donation. Methods: A sample of German residents in the south east of Spain was obtained randomly between November 2005 and April 2006 (n = 227). Attitude was evaluated using a validated questionnaire. This survey was self‐administered and completed anonymously. Control group: a sample of 2000 Spanish citizens. Results: There is a favorable attitude toward donation in 64% of respondents, similar to the control group (64% vs. 63%; p = 0.8545). The most important factors that affect such attitude are: (i) having dependents (odds ratio = 4.569); (ii) having talked about donation within the family (OR = 4.132); (iii) being willing to accept an autopsy if one were necessary (OR = 5.952); (iv) having had previous experience of organ donation and transplantation (OR = 5.814); (v) not being concerned about mutilation of the cadaver (OR = 8.792); and (vi) the attitude of one’s partner toward donation, especially when this is negative (OR = 0.002). Conclusions: The attitude toward organ donation of Germans who usually reside in Spain is the same as that described in the native Spanish population, and is determined by many psychosocial factors.     

Attitudes toward death criteria and organ donation among healthcare personnel and the general public

OBJECTIVE: To examine attitudes toward death criteria and their relation to attitudes and behaviors regarding organ donation. DATA SOURCES: This article reviews empirical studies on the attitudes of healthcare personnel and the general public regarding death criteria and organ donation. STUDY SELECTION AND DATA EXTRACTION: The review was restricted to studies that had as a primary focus attitudes toward 1 or more of the following 3 specific criteria for determining death: (1) brain death, the irreversible loss of all functions of the entire brain; (2) higher brain death, the loss of cerebral cortex function alone; and (3) the circulatory-respiratory criteria commonly used in donation after cardiac death. DATA SYNTHESIS: Studies consistently show that the general public and some medical personnel are inadequately familiar with the legal and medical status of brain death; attitudes toward the dead donor rule are strong predictors of willingness to donate organs using controversial criteria; concerns about donation after cardiac death surround the withdrawal of life support more than the actual death criteria used; and concerns about death criteria correlate with less favorable attitudes toward organ donation. CONCLUSIONS: Both general and ethical education may serve to guide policy and facilitate family member requests and informed consent dialogues. Furthermore, helping families to understand and accept not only medical and legal criteria for determining death, but also ethical criteria for withdrawing life support may help them be more comfortable with their decisions.