Public attitudes and behavior regarding organ donation

Organ transplantation has been the subject of much attention; unfortunately, relatively little has been published about public attitudes toward organ donation. To better document public perceptions on organ donation, a telephone survey of a nationally representative sample of 2,056 respondents was conducted. We found that nearly 94% of the population had heard about organ transplantation, but only 19% of these people carried donor cards. The results indicated that people are somewhat more likely to donate the organs of a relative who had just died (53%) than they are to donate their own organs (50%). People were most likely to donate kidneys (50%) and least likely to donate skin (40%). Most respondents (58%) felt that next of kin should not be able to override a person's desire to donate organs as signified by an organ donor card. Few people (7%) supported the concept of presumed consent. We conclude that while the public is supportive of organ transplantation, it is not overly enthusiastic about organ donation. Awareness of this paradox on behalf of the public may actually facilitate organ donation.     

Death, dying and donation: organ transplantation and the diagnosis of death

Refusal of organ donation is common, and becoming more frequent. In Australia refusal by families occurred in 56% of cases in 1995 in New South Wales, and had risen to 82% in 1999, becoming the most important determinant of the country's very low organ donation rate (8.9/million in 1999). Leading causes of refusal, identified in many studies, include the lack of understanding by families of brain death and its implications, and subsequent reluctance to relegate the body to purely instrumental status. It is an interesting paradox that surveys of the public continue to show considerable support for organ donation programmes--in theory we will, in practice we won't (and don't). In this paper we propose that the Australian community may, for good reason, distrust the concept of and criteria for "whole brain death", and the equation of this new concept with death of the human being. We suggest that irreversible loss of circulation should be reinstated as the major defining characteristic of death, but that brain-dead, heart-beating entities remain suitable organ donors despite being alive by this criterion. This presents a major challenge to the "dead donor rule", and would require review of current transplantation legislation. Brain dead entities are suitable donors because of irreversible loss of personhood, accurately and robustly defined by the current brain stem criteria. Even the dead are not terminally ill any more.     

Public awareness of organ donation.

A telephone survey of public attitudes toward organ donation and transplantation was conducted in a community in southwestern Ontario. The subjects were selected at random; the response rate was 57%. Of the 50 respondents 62% stated that they had signed the organ donor card accompanying their driver's licence. These respondents were more likely than those who did not sign it to have discussed organ donation with their families. At least 80% of the respondents said they would agree to donate their organs and those of their next-of-kin, and 80% said that the organ donor card should be considered a legal document. Organ transplantation was regarded by all but one respondent as an acceptable medical procedure. Also discussed were concerns about organ donation and possible strategies to improve the availability of organs for transplantation.     

我国公民逝世后器官捐献移植运作流程分析

随着器官移植技术的飞速发展,我国人体器官的需求量日益增加,为了扭转目前国内器官供需比例严重失调的局面,提高大众时器官捐献的知晓率和认同感,国家先后出台了一系列关于公民逝世后器官捐献移植的法律法规,各省市也根据实际情况先后对器官捐献移植运作流程进行了探索性研究。但是,目前在国家层面,器官捐献移植仍无统一的运作流程,缺乏统一的衡量标准,严重制约了我国器官移植事业的发展、本文从器官捐献的基本概念出发,总结分析了我国公民逝世后器官捐献移植的基本组成结构。以运作流程为视角,将我国公民逝世后器官捐献移植过程划分为器官捐献流程、器官获取流程、器官分配移植流程和器官移植后的总结分析流程,并对每个流程的具体运作过程进行了详细阐述。,     

Organ transplantation: present scenario and future strategies for transplant programme (specially cadaveric) in India: socio-administrative respects

Organ transplantation was enacted by a law "Transplantation of Human Organ Act" in 1994 but still, getting the consent from the relatives of brain dead person is a very difficult task and hence cadaveric transplant accounts for a minimum number. In India, most of the transplantations carried out are related to living donor and very few are cadaveric. The poor status of cadaver transplantation may be attributed to the moral, emotional and religious beliefs and taboos that inhibit the relatives of the deceased to come forward to donate organ(s) of a brain dead person.Non-existence of a trained transplant co-ordinator who is the backbone of any successful transplant programme is another reason for poor response in cadaver transplantation. The great task is to motivate and prepare the relatives for organ donation of their near and dear ones. Transplant co-ordinators are being prepared for motivating individuals or relatives for donation. To promote human organ transplantation government's initiative is very important. Mass media supported by the government can develop better awareness among the people. Non-government organisations (NGOs) can help in the similar ways. All hospitals are not authorised for the procedure of human organ transplantation. Other hospitals can help the process by informing the authorised hospitals about recent admission of potential donor (brainstem death). Role of transplant coordinator is crucial. He/she is the real inspiration to make agree the relatives for organ donation. Overall success of transplant programme is based on co-ordinated activity. Involvement of all agencies to motivate the person to pledge for organ donation during his/her life time is the first and the foremost requirement for successful planning and programme of organ transplantation.     

Non-heart-beating organ donors as a source of kidneys for transplantation: a chart review

BACKGROUND: Organ transplantation is the treatment of choice for patients with end-stage organ failure, but the supply of organs has not increased to meet demand. This study was undertaken to determine the potential for kidney donation from patients with irremediable brain injuries who do not meet the criteria for brain death and who experience cardiopulmonary arrest after withdrawal of ventilatory support (controlled non-heart-beating organ donors). METHODS: The charts of 209 patients who died during 1995 in the Emergency Department and the intensive care unit at the Foothills Hospital in Calgary were reviewed. The records of patients who met the criteria for controlled non-heart-beating organ donation were studied in detail. The main outcome measure was the time from discontinuation of ventilation until cardiopulmonary arrest. RESULTS: Seventeen potential controlled non-heart-beating organ donors were identified. Their mean age was 62 (standard deviation 19) years. Twelve of the patients (71%) had had a cerebrovascular accident, and more than half (10 [59%]) did not meet the criteria for brain death because one or more brain stem reflexes were present. At the time of withdrawal of ventilatory support, the mean serum creatinine level was 71 (29) mumol/L, mean urine output was 214 (178) mL/h, and 9 (53%) patients were receiving inotropic agents. The mean time from withdrawal of ventilatory support to cardiac arrest was 2.3 (5.0) hours; 13 of the 17 patients died within 1 hour, and all but one died within 6 hours. For the year for which charts were reviewed, 33 potential conventional donors (people whose hearts were beating) were identified, of whom 21 (64%) became donors. On the assumption that 40% of the potential controlled non-heart-beating donors would not in fact have been donors (25% because of family refusal and 15% because of nonviability of the organs), there might have been 10 additional donors, which would have increased the supply of cadaveric kidneys for transplantation by 48%. INTERPRETATION: A significant number of viable kidneys could be retrieved and transplanted if eligibility for kidney donation was extended to include controlled non-heart-beating organ donors.     

Attitudes toward organ donation in China

Background  Organ transplantation represents an important advance in modern medical science, and it has benefited many patients with organ failure; however, the severe deficiency of organ sources has been a bottleneck that has limited the benefits this technology can bring. The aim of this study was to show the results of a survey on Chinese people’s awareness and attitudes toward organ donation.

Methods  We designed a questionnaire regarding organ donation consisting of 20 short questions, which were distributed to 10 groups. Most of the questions were multiple-choice; the core question related to people’s attitudes to organ donation and the development of organ donation. The survey was held in the outpatient hall of Beijing Chao-Yang Hospital, a commercial district, and four professional colleges. Participants were randomly selected, and answered questions about gender, age, educational background, profession, and study major.

Results  In all, 2930 valid responses were received. Male:female ratio was nearly 1:1.2 (mean age 38 years). Over 90.0% of participants knew about organ transplantation and which organs could be transplanted; more than 95.0% knew about organ donation, but the time they had been aware of it varied. Nearly 90.0% of the participants approved of deceased organ donation; 73.0% indicated they would like to donate their organs post mortem. Participants who knew more about organ failure and organ transplantation were more likely to support organ donation. College students were very positive about organ donation, though as they gain professional knowledge their attitudes may change. Altogether, 65.3% of participants approved of living organ donation, which was obviously lower than the figure for deceased organ donation (P <0.05). In all, 85.7% of participants approved of compensation to the deceased donor’s family. To promote organ donation in China, 62.9% of participants indicated that the public’s knowledge about organ donation should be increased via the media and various kinds of education. Only 20.0% of the participants believed that legislation was required.

Conclusions  We conclude that at present the Chinese public has a basic understanding about organ transplantation and donation. The majority respondents were in favor of deceased organ donation and were willing to donate their own organs after death.

     

医务人员器官捐献意愿及其影响因素探讨

目的 了解医务人员器官捐献意愿及其影响因素.方法 以北京市一级、二级、三级医院医务人员为研究对象,采用调查问卷方法,分别调查7所医院医护人员的基本资料,及其对器官捐献认知、态度及意愿,并对影响因素进行分析.结果 共调查男性149人(20％),女性596人(80％),受访者平均年龄为(34.6±8.8)岁,75.8％的受访者已婚,98.4％的受访者具有专科以上学历,65.9％的受访者收入在5 000元以上,76.1％的受访者来自三级医疗机构,77.7％的受访者来自内科,54.6％的受访者为医师.影响因素分析结果显示,文化程度、对脑死亡了解程度、对遗体器官捐献态度、是否担心同意捐献后医生为获得器官不尽力医治成为影响捐献意愿的主要因素.结论 应加强器官捐献的宣传工作,提高医务人员对器官捐献的认识.     

Awareness about organ donation among school girls

Prevalence of organ failure is high through out the world. Organ transplantation, the definitive treatment option of organ failure keeps very low due to scarcity of organ. Most of the people are not aware about organ donation. Adolescent girls will be the mother of future nation and they can motivate family members for organ donation. This study was carried out to see attitudes towards organ donation and determine the negative factors of organ donation prevailing among school girls. One hundred sixty eight girls from class VIII to class X of a higher secondary school were participated. A structured questionnaire was filled up by the girls. The data were processed from questionnaire and analyzed. Among study population, most of them (64%) had no idea about on going organ donation and transplantation. The positive attitude of the girls towards organ donation was low when they are live (16%) and their attitudes also kept low even after their death (14%). The girls who did not agree to donate organ were further asked to mention the reasons. The reasons of negative attitude were religious belief, fear of illness and social and familial reservation. The result of this study suggests that among girls, awareness and attitudes about organ donation is poor. There were several reasons identified for low consent rates. Multidisciplinary actions should be taken to improve the awareness of the people about organ donation and motivate them for donation.     

Knowledge and attitudes of healthcare professionals and the impact on willingness to donate organs: a tertiary hospital survey

INTRODUCTIONHealthcare professionals (HCPs) working in critical care areas play an important role in the organ donation (OD) process. We studied HCPs’ own willingness to be organ donors and its association with sociodemographic factors as well as their knowledge and attitudes about OD and transplantation.METHODSA cross-sectional survey of HCPs working in four critical care units in a major transplant centre in Malaysia was undertaken using a validated structured questionnaire. Responses were analysed using multivariable analysis with willingness to donate as the dependent variable.RESULTSOf the 412 respondents (response rate 98.1%), the majority were nurses (60.4%), Malay (71.1%) and female (77.2%). Overall, 68.0% were willing to donate. The independent predictors of willingness to donate were profession (p < 0.001) and the Hindu religion (p = 0.001). Ethnicity (p = 0.003), religious belief (p < 0.001), knowledge (p = 0.016), belief in brain death (p = 0.018) and confidence in transplantation (p < 0.001) also independently correlated with willingness to donate, while attitudes to OD did not. Of those willing to donate, only 37.3% were carrying a donor card and only 63.1% had informed their family of their intention to donate.CONCLUSIONAlthough willingness to donate was higher in critical care HCPs than HCPs in general, significant knowledge gaps as well as certain beliefs and perceptions that could pose a barrier to OD were identified in this group. Measures to improve OD rates in Malaysia should include targeted educational programmes for HCPs working in critical care areas.     

The concept of brain death did not evolve to benefit organ transplants

Although it is commonly believed that the concept of brain death (BD) was developed to benefit organ transplants, it evolved independently. Transplantation owed its development to advances in surgery and immunosuppressive treatment; BD owed its origin to the development of intensive care. The first autotransplant was achieved in the early 1900s, when studies of increased intracranial pressure causing respiratory arrest with preserved heartbeat were reported. Between 1902 and 1950, the BD concept was supported by the discovery of EEG, Crile's definition of death, the use of EEG to demonstrate abolition of brain potentials after ischaemia, and Crafoord's statement that death was due to cessation of blood flow. Transplantation saw the first xenotransplant in humans and the first unsuccessful kidney transplant from a cadaver. In the 1950s, circulatory arrest in coma was identified by angiography, and the death of the nervous system and coma dépassé were described. Murray performed the first successful kidney transplant. In the 1960s, the BD concept and organ transplants were instantly linked when the first kidney transplant using a brain-dead donor was performed; Schwab proposed to use EEG in BD; the Harvard Committee report and the Sydney Declaration appeared; the first successful kidney, lung and pancreas transplants using cadaveric (not brain-dead) donors were achieved; Barnard performed the first human heart transplant. This historical review demonstrates that the BD concept and organ transplantation arose separately and advanced in parallel, and only began to progress together in the late 1960s. Therefore, the BD concept did not evolve to benefit transplantation.     

Danish ethics council rejects brain death as the criterion of death -- commentary 1: wanting it both ways

In this commentary on the recommendations of the Danish Council of Ethics (DCE) concerning criteria for death it is argued that whilst the DCE is correct in stressing the cultural aspects of death, its adoption of cardiac-oriented criteria raises several problems. There are problems with its notion of a 'death process', which purportedly begins with brain death and ends with cessation of cardiac function, and there are serious problems regarding its commitment to a cardiac-oriented definition whilst permitting transplantation when the heart is still beating.     

缺血后处理及其在器官移植术中的应用

缺血后处理的概念自2002年提出后,此后5年间的研究证实其可对器官缺血再灌注损伤起到极为有效的保护作用,作用机制大部分与缺血预处理类似,但仍有其独有的特点.再灌注损伤在器官移植术中不可避免,减轻再灌注损伤程度可促进移植器官功能的迅速恢复.相对于缺血预处理,缺血后处理具有良好的可控性,有望在器官移植术中得到良好的应用前景.深入了解缺血后处理对器官再灌注损伤保护作用的特点及机制,将有利于推动其在器官移植领域中的应用.     

医学新生对尸体器官捐献的态度及其影响因素分析

目的调查医学院校新生对尸体器官捐献的态度及其影响因素。方法随机抽取辽宁省某医学院校大一20个班的学生为研究对象,发放问卷600份进行问卷调查。利用∥检验进行统计分析。结果回收有效问卷564份。其中对尸体器官捐献持赞成态度的为60．64％,表示反对的为20．57％,回答“不知道”的为18．79％。医学院校新生对尸体器官捐献态度与家庭、相关利他行为、尸体器官接受意愿及尸体器官捐献相关教育等因素有关。结论大多数医学院校新生赞同尸体器官捐献。在器官捐献问题上增进与家人的交流、积极参与公益活动有助于提高其尸体器官捐献意愿。此外,医学院校加强对尸体器官移植与尸体器官捐献、利他主义以及思想道德修养等方面的教育对提高尸体器官捐献意愿具有积极作用。     

Potential for organ donation in Victoria: an audit of hospital deaths

OBJECTIVE: To determine the potential for organ donation in 12 Victorian hospitals. DESIGN AND SETTING: Prospective audit of all deaths in 12 major public hospitals in the state of Victoria between January 2002 and October 2004. MAIN OUTCOME MEASURES: Number of organ donors and potential organ donors (patients with brain death or likely to progress to brain death within 24 hours if supportive treatment continued), requests for organ donation and consents. Unrealised potential donors (organ donation not requested) were categorised by an independent panel of intensivists as category A (brain death formally diagnosed); B (brain death not formally diagnosed but criteria likely to be fulfilled); and C (potential to progress to brain death within 24 hours). RESULTS: There were 17,230 deaths, 280 potential organ donors and 220 requests for organ donation. The 60 unrealised potential organ donors were classified as category A (3), B (17) and C (40). Consent rate was 53% to 65%, depending on the definition of potential donor (categories A, B and C or category A only). Consent rate was lower when discussions about organ donation were held by trainees or registrars (21%) than when specialists were present (57%) (P = 0.004). A maximum practically achievable organ donation rate for Victoria was estimated to be 15 to 17 donors per million population (current rate, 9 per million population). CONCLUSIONS: The potential for organ donation in Victoria is limited by a small organ donor pool. There is potential to increase the number of organ donors by increasing the consent rate (lower than expected from public surveys), the identification of potential organ donors (particularly those likely to progress to brain death if supportive treatment is continued), and requests for organ donation.     

四川省大学生对器官移植态度及捐献意愿的调查研究?

目的：了解四川省在校大学生对器官移植的态度及捐献意愿,探讨阻碍器官移植事业发展的可能原因。方法以问卷形式,对四川省内8所在校大学生进行调查研究。结果大学生从媒体宣传中获得器官移植相关知识的人数占39.16%;医学专业学生愿意捐献的人数占41.63%,非医学专业学生愿意捐献的人数占22.35%,医学专业学生的捐献意愿更高;影响大学生器官捐献态度的因素主要是家属意见(52.05%)和对相关机构的不信任(53.79%)。结论大学生器官捐献意愿度低;捐献意识有待提高;非医学院校有必要开展器官移植相关课程;有关政府部门应加大宣传力度,设立合理补偿机制,完善现有体制。     

Online Intervention Study - Willingness to donate organs among the employees of a German University

Background

Organ shortage remains a major challenge in transplantation medicine. The aim of this study was to analyze the public’s willingness to donate organs and to observe whether increased knowledge about organ donation has an effect on the attitude toward organ donation. The study in particular tested the efficacy of using electronic communication as a means to distribute information.

Methods

In 2011, an Email invitation to participate in a survey was sent to the employees of the University Duisburg-Essen. The survey consisted of a two-piece questionnaire with an informational intervention on organ donation between the questionnaires. The technical design ensured that interviewees remained anonymous and could participate only once.

Results

In total, 1,818 interviewees completed the questionnaire. Of the respondents, 42% were organ-donor card holders (which was consistent among genders and age groups), whereas 87% of the interviewees would support an organ donation for themselves. Of the interviewees who did not possess an organ-donor card, 67% were positively inclined toward holding one in future after reading the interventional information.

Conclusions

The considerable improvement in attitude toward carrying an organ-donor card after reading the information illustrates the effectiveness of distributing concise information on organ donation. To increase the willingness to donate organs, it is of great importance to inform the public and facilitate the documentation of a decision to donate. The present study has proven the use of Email communication to be an important asset to this process.     

Barriers to good end-of-life care: a physician survey

Surveyed about barriers to good end-of-life care were 804 Hawaii physicians in specialties most likely to care for dying patients. Responses were received by 367 (46%). The majority attended terminally ill patients within the past year and felt that the physician should be the first to tell a patient that he/she is dying. Yet 86% identified barriers to talking about end-of-life preferences and 94% identified barriers to providing good end-of-life care. Perceived as major barriers were family conflict about the best course of action, patient/family discomfort with or fear of death, and cultural/religious beliefs of the patient or family. Since relatively few respondents supported the concepts of physician-assisted suicide (32%) or physician-assisted death (18%), the alternative is for physicians to join with other concerned entities to help overcome the attitudinal, behavioral, educational, and economic barriers to providing appropriate, humane, and compassionate care for the dying.     

我国器官移植的现状与伦理学思考

探讨促进我国器官移植进一步加快发展的途径，通过对我国器官移植现状以及所面临问题的分析，阐述了人们的传统文化背景，思想观念及伦理道德观是影响我国器官移植发展的因素，提出改变观念、实行科学的脑死亡法，为器官移植立法是我国器官移植腾飞的根本途径。     

Communication strategies for organ donation

A country, state or hospital may have the latest medical technology and infrastructure as well as qualified professionals for organ transplantation, but unless there is an adequate donor population the waiting lists for transplants will continue to be long and for some patients, hopeless. Public and professional awareness programmes are key factor in the donation process. Social education that explains the life-saving benefits of organ transplantation, the enormous need for organ donation, the concept of brain death and religious teachings related to these issues is vital for creating a conducive environment for the organ transplant co-ordinator or physician soliciting the donation. The education of hospital medical, nursing and administrative personnel is also essential to both miximise opportunities for donation, as well as to prevent loss of potential organs after donor consent. Other target populations are medical examiners or coroners, and police personnel under whose jurisdiction the donations occur, as their co-operation and guidance is necessary for meeting statutory requirements. The involvement of government officials and politicians is also valuable, as their active intervention is essential for the introduction and amendment of rules and laws to promote the donation and transplantation of organs. The present paper describes communication strategies for the development of an efficient education plan that will provide information about organ transplantation, explain the desired outcome, address potential queries, misconceptions or obstacles, and identify potential sources of support.