Awareness and attitude of general population regarding allograft skin donation in Riyadh,Saudi Arabia: Cross-sectional study

IntroductionBurns are one of the major health issues that considerably affect variable groups of the population, varying in age and severity. Despite advances in burn surgical and non-surgical treatments, patient's appearance still represents public health issue. In regards to surgical treatment of burns, skin grafting is still considered the gold standard. One of the major burdens in the burn surgical treatments is the availability of the skin for grafting. As for the non-surgical treatment different modalities of skin dressings or substitutes are still available as an option.MethodsA validated questionnaire based study was utilized to acquire assessment of the overall general population knowledge, awareness and attitude toward skin donation. In addition, it surveyed community personal willingness to donate their skin to a skin bank after being deceased, to help solve skin shortages due to the lack of skin banks in Saudi Arabia.ResultsA total of 698 individuals completed the questionnaire over the period of 5 months, from February 2018 till June 2018. Married, postgraduate females, with a history of burn in close family members or similar individuals showed a positive attitude toward skin donation. However, 22% of the participants did not agree to donate their skin due to religious reasons.ConclusionThe study concluded that the majority of participants were willing to donate their skin, and they were aware of the concept of skin donation and its crucial importance in surgical burn management. The current study showed the majority of participants were aware of skin donation and skin use for burn treatment, in addition to having positive attitude toward skin donation. Men were more aware than the women of skin donation. Religious concern was a major reason for participants’ skin donation refusal, an issue that can be addressed by contacting Islamic scholars to issue a Fatwa approving the cause.     

How to improve donor skin availability: Pragmatic procedures to minimize the discard rate of cryopreserved allografts in skin banking

BackgroundMicrobial contamination of human skin allografts is a frequent cause of allograft discard. Our purpose was to evaluate the discard rate of skin bank contaminated allografts and specific procedures used to reduce allograft contamination without affecting safety.MethodsWe conducted at the Lille Tissue Bank a retrospective study of all deceased donors (n = 104) harvested from January 2018 to December 2018. Skin procurement was split into 3 zones: the back of the body and the two legs that were processed separately. It represented 433 cryopreserved skin allograft pouches of approximatively 500 cm² each. Donors were almost equally split between brain-dead (53%, 55/104) and cadaveric (47%, 49/104) donors.ResultsOut of all donors, 42 (40.5%) had at least one sampling zone with a positive microbiological test resulting in 106 (24%) contaminated skin pouches. The contamination rate did not vary according to the harvested zone or type of donor. Traumatic deaths showed significantly less contamination rates than other death types (p < 0.05). Contamination rate decreased with time spent in the antibiotic solution. The risk of having contaminated allografts was five-fold higher when the skin spent less than 96 h in the antibiotic cocktail (p < 0.05). According to our validation protocol, most donors (32/42, 76%) had skin allografts contaminated with bacteria (mainly Staphylococcus spp) compatible with clinical use. No recipient infection was recorded as a result of skin graft contaminated with saprophytic or non-pathogenic germs. By harvesting 3 separate zones per donor, the total surface area for clinical use increased by 53% for contaminated donors. Overall, the proportion of contamination-related discarded allografts was 3.2% (14/433 of pouches).ConclusionFew simple pragmatic measures (including skin incubation in the antibiotic bath for at least 96 h at 4 °C, splitting the skin harvesting areas to minimize the risk of cross-infection and clinical use of allografts contaminated with saprophytic and non-pathogenic germs) can reduce the discard rate of contaminated allografts without affecting clinical safety.     

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.     

重庆市ICU护士器官捐献态度和意愿的现况调查及影响因素分析

目的  调查重庆市重症监护室(ICU)护士对器官捐献态度及意愿的现状并分析其影响因素。方法  本研究整群抽取重庆市具有器官移植资质的全部三甲医院共计4所,采用便利抽样法选取321名在上述医院ICU工作的护士实施问卷调查。统计ICU护士器官捐献态度和意愿的得分情况;采用Spearman相关性分析分析器官捐献态度和意愿的相关性;采用多重线性回归分析器官捐献态度和意愿的影响因素。结果  该组ICU护士器官捐献态度的平均得分为（3.5±0.9）分,器官捐献意愿的中位得分为2（2~3）分。ICU护士的器官捐献态度与意愿呈正相关（P < 0.001）。无偿献血经历、家庭成员对器官捐献的态度、劝捐经历是ICU护士器官捐献意愿的影响因素（均为P < 0.05）,其中无偿献血经历、家庭成员对器官捐献的态度同时也是ICU护士器官捐献态度的影响因素（均为P < 0.05）。结论  ICU护士对器官捐献的态度中立,自身捐献器官的意愿较低,其主要影响因素为无偿献血经历、家庭成员对器官捐献的态度、劝捐经历。     

Attitudes of hospital staff involved in organ donation to the procedure

Hospital staff have a key function in asking for potential organ donors, but little is known about their own attitudes towards donation. In a community hospital with 7–8 multi-organ extraction procedures each year 199 staff members were surveyed. Although only 7 % of the responding staff would personally refuse to donate an organ, 23 % would not give consent to organ donation from a close relative. 47 % of those prepared to be donors had signed a donor card. Donors informed their family more frequently (88 %) about their personal attitude towards organ donation than non-donors (60 %), or undecided personnel (43,8 %; chi-square P = 0,004). No significant difference in attitude according to medical profession subgroups was found. The findings are in line with general population surveys and indicate that much work needs to be done to encourage medical staff involved in organ donation to set an example to the community. Received: 14 June 1999/Revised: 17 February 2000/Accepted: 18 April 2000     

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.     

Prevalence of skin tears in the extremities in inpatients at a hospital in Denmark

The aims of the study were to determine the prevalence of skin tears in the extremities and to explore factors associated with development of skin tears in inpatients at a Danish hospital. The study was designed as a point prevalence survey and included 202 patients in the age range 19–99 (mean: 70·7, SD: 16·5). The patients were assessed for presence of skin tears, numbers, locations and previous skin tears. Data were collected using a data collection sheet developed for a previous study. The survey team consisted of four specialist nurses. Data were collected over a period of 24 hours spread over 3 days. Of the 202 patients, 23 had skin tears, yielding a prevalence of 11·4%. In total, 40 skin tears were observed. Multiple logistic regression analysis showed that previous skin tears (odds ratio (OR): 9·3, 95% confidence interval (CI): 2·6–33·4, P < 0·001), ecchymosis (OR: 5·6, CI: 1·4‐23·2, P < 0·017) and risk of falling (OR: 3·8, CI: 1·2‐12·0, P < 0·021) were significantly associated with development of skin tears. The prevalence of skin tears in this study (11·4%) matches other international observations. The following risk factors were recognised: previous skin tear, ecchymosis and risk of falling. These factors could be used to identify patients requiring prevention of skin tears.     

Exploring the prevalence of skin tears and skin properties related to skin tears in elderly patients at a long‐term medical facility in Japan

The identification of appropriate skin tear prevention guidelines for the elderly requires clinicians to focus on local risk factors such as structural alterations of the epidermis and dermis related to skin tears. The aim of this cross‐sectional study is to explore the prevalence of skin tears and to explore skin properties related to skin tears in elderly Japanese patients at a long‐term medical facility. After doing the prevalence study, 18 participants with skin tears and 18 without were recruited and an evaluation of their skin properties using 20‐MHz ultrasonography, skin blotting and also Corneometer CM‐825, Skin‐pH‐meterPH905, VapoMeter, Moisture Meter‐D and CutometerMPA580 was undertaken. A total of 410 patients were examined, the median age was 87 years and 73·2% were women. The prevalence of skin tears was 3·9%, and 50% of skin tears occurred on the dorsal forearm. The changes in skin properties associated with skin tears included increased low‐echogenic pixels (LEP) by 20‐MHz ultrasonography, decreased type IV collagen and matrix metalloproteinase‐2, and increased tumour necrosis factor‐α by skin blotting. In conclusion, this study suggests that increased dermal LEP, including solar elastosis, may represent a risk factor for skin tears; this indicates that skin tear risk factors might not only represent chronological ageing but also photoageing.     

Potential of organ donation from deceased donors: study from a public sector hospital in India

Deceased donor organ programme is still in infancy in India. Assessing deceased donation potential and identifying barriers to its utilization are required to meet needs of patients with organ failure. Over a 6‐month period, we identified and followed all presumed brainstem dead patients secondary to brain damage. All patients requiring mechanical ventilation with no signs of respiratory activity and dilated, fixed and nonreacting pupils were presumed to be brainstem dead. All events from suspicion of brainstem death (BSD) to declaration of BSD, approach for organ donation, recovery and transplants were recorded. Subjects were classified as possible, potential and effective donors, and barriers to donation were identified at each step. We identified 80 presumed brainstem dead patients over the study period. The mean age of this population was 35.9 years, and 67.5% were males. When formally asked for consent for organ donation (n = 49), 41 patients’ relatives refused. The conversion rate was only 8.2%. The number of possible, potential and effective donors per million population per year were 127, 115.7 and 9.5, respectively. The poor conversion rate of 8.2% suggests a huge potential for improvement. Family refusal in majority of cases reflects poor knowledge and thus warrants interventions at community level.     

The European Donor Hospital Education Programme (EDHEP): addressing the training needs of doctors and nurses who break bad news, care for the bereaved, and request donation

The competence of critical care staff when it comes to death and organ donation can make the difference between a family's agreeing to or refusing the latter. Doctors and nurses often feel uncomfortable approaching relatives about donation and attribute this to a lack of training. Bereaved relatives express dissatisfaction with inappropriate communication and support when brain death is announced and thereafter when a request for donation is made. The European Donor Hospital Education Programme (EDHEP) was designed to meet the training needs of critical care staff in breaking bad news, caring for the bereaved, and requesting donation. EDHEP is a two-part educational package consisting of a presentation about the donor shortage followed by a one-day workshop. The implementation of EDHEP throughout the world has been facilitated through effective national working groups and standardised “train the trainer” courses. Several countries anecdotally report increases in donation following implementation. Controlled evaluation of the effect(s) of EDHEP, which started at the end of 1995, focuses on the satisfaction of the participants with EDHEP, on the competence of the participants in breaking bad news and requesting donation, on the teamwork regarding death and donation, on the satisfaction of bereaved relatives, and on organ donation rates. Received: 5 June 1998 Received after revision: 1 December 1998 Accepted: 18 December 1998     

Family initiated discussions about organ donation at the time of death

Rodrigue JR, Cornell DL, Krouse J, Howard RJ. Family initiated discussions about organ donation at the time of death.
Clin Transplant 2010: 24: 493–499.
© 2009 John Wiley & Sons A/S. Abstract: Some family members initiate organ donation discussions before being approached by donor coordinators or healthcare providers. We examined differences between families that did vs. did not initiate organ donation discussions and factors predicting donation consent among those families that self‐initiated the discussion. Next‐of‐kin of donor‐eligible individuals (147 donors, 138 non‐donors) from one organ procurement organization completed a telephone interview. Seventy‐three families (25.6%) first mentioned organ donation, and 54 (74%) of them consented to donation. Several characteristics of the deceased and next‐of‐kin were associated with whether family members initiated the donation discussion with donation coordinators or healthcare providers. Moreover, family mention of donation was more likely to yield consent when the deceased was younger (OR = 0.95, CI = 0.92–0.99), next‐of‐kin was a registered donor (OR = 3.86, CI = 2.84–6.76), and when family was more satisfied with the healthcare team (OR = 1.20, CI = 1.04–1.39). Knowing the deceased’s donation intentions and being exposed to positive organ donation messages are more likely to trigger families to raise donation with providers. Organ procurement organizations (OPOs) and healthcare providers should work collaboratively to develop strategies for how best to respond to families who initiate this conversation.     

Banking and use of glycerol preserved full-thickness skin allograft harvested from body contouring procedures

Introduction

The use of glycerol preserved skin allograft (GPA) became a main stay in burn treatment. However, harvesting of cadaveric skin is not yet legalized in many countries including Egypt.

Objectives

To estimate the feasibility of using skin harvested from body contouring procedures as a source of GPA and its clinical efficacy.

Patients and methods

Skin harvested from body contouring procedures done in Al-Azhar university hospitals was preserved by glycerolization and used in management of burn and complicated wounds.

Results

In the period between February 2012 and February 2013 skin was harvested from 24 abdomenoplasty cases, 6 bilateral breast reduction cases, and 1 case of thigh lift done in Al-Azhar university hospitals. This yielded about 22,000 cm² of skin preserved by glycerolization. This GPA was used in 15 excised burn wounds, in 9 cases of chronic burn wounds, and in 6 complicated wounds. Partial graft loss occurred in 3 cases and total graft loss occurred in 1 case.

Conclusion

The glycerolized full-thickness skin harvested from body contouring procedures is clinically effective in burn and wound management. In the presence of regional coordination, it can serve as an abundant source for skin banking in where cadaveric skin use is not legalized.     

The silence of Good Samaritan kidney donation in Australia: a survey of hospital websites

It is common for living donor candidates to use the Internet as a tool to enhance their decision‐making process. Specifically, the websites of transplant hospitals can potentially be a vital source of information for those contemplating living donation. In an effort to explore the low incidence of Good Samaritan kidney donation (donations to strangers) in Australia, two raters conducted a nine‐attribute website content analysis for all hospitals which participate in these transplants (n = 15). Overall, the concept of living donation is relatively silent on Australian hospital websites. Only four hospitals mention their living donor program, and only one mentions their Good Samaritan program. No site linked directly to Australia's AKX Paired Kidney Exchange Program – the only program which facilitates pair and chain transplants in Australia. Further, information about deceased donation is nearly absent as well. An individual with the altruistic desire to donate will generally find scant or absent information about donation at the website of their local transplant hospital, although this information could easily be present as an educational tool which supports the consent process. Using a hospital website to educate the public about a clinical service should not be viewed as ethically problematic (solicitation), but rather an ethical essential.     

ICU护士器官捐献知识态度及实践现状调查

目的探究ICU护士对脑死亡患者器官捐献的认知、态度与实践。方法通过方便抽样选取210名ICU护士为研究对象,调查其器官捐献知识、态度及实践现状。结果 ICU护士捐献知识得分为(8.29±1.55)分,捐献态度为(3.62±1.05)分。献血经历、护理过脑死亡患者,捐献知识和年龄是器官捐献态度的主要影响因素(均P0. 01)。只有18.10%的ICU护士劝导过脑死亡患者家属进行器官捐献。结论 ICU护士对脑死亡患者器官捐献认知呈中上水平,态度不太乐观,实践缺乏。应对ICU护士进行器官捐献知识培训,促进其态度及实践行为的改变。     

Attitudes towards organ donation and transplantation – a study involving Baltic physicians

The aim of this study was to identify and describe attitudes towards organ donation and transplantation among a group of Baltic physicians who are involved in this aspect of medical care. A total of 151 neurosurgeons, anesthesiologists, and neurologists anonymously answered a questionnaire between February and March 1995. The majority of physicians said they would be willing to donate their own organs after their death but disagreed with the idea of using organs from a dead person who had had a negative opinion towards organ donation. Given a patient who fulfilled the criteria for brain death, this group of physicians found it widely acceptable to keep the patient on a ventilator until organ donation could take place. We conclude that the participating physicians generally have similar attitudes towards organ donation and transplantation. This study is valuable in that it shows the interest in, and the need for, clinical and research collaboration, including a discussion of ethics, within the area of organ donation and transplantation. This is essential for future collaboration with Western countries. Received: 7 January 1998 Received after revision: 12 May 1998 Accepted: 23 June 1998     

A simple teaching aid for taking multiple skin grafts with a dermatome

Multiple split skin grafts are often required for large wounds such as burns and in necrotizing fascitis. Harvesting multiple skin grafts seamlessly without leaving islands of ‘normal skin’ between adjacent donor sites can be difficult, especially for junior plastic surgery trainees. A seamless donor site helps maximize graft harvest and avoids a ‘patch-work appearance’. We suggest a simple method to avoid this problem when using a three inch Zimmer® dermatome blade.     

Attitudes of resident doctors toward different types of organ donation in a Spanish transplant hospital

OBJECTIVE: Our aim was to analyze acceptance of cadaveric and living organ donation for transplantation among resident doctors, given that they are the new professionals of medicine who will have to encourage and develop transplant programs. MATERIALS AND METHODS: A random survey was performed on resident doctors in a third-level hospital with an organ transplant program which is accredited for undergraduate and postgraduate education (n = 171). Attitudes toward cadaveric and living donation were evaluated using a questionnaire including various psychosocial variables that might affect such attitudes. We used the Student t test and the chi-square test. RESULTS: The sample was composed of responses by 171 resident doctors of mean age 28 +/- 4 years with 56% women. Attitudes toward cadaveric donation were favorable in 92% (n = 157). As for living donation, the percentage in favor of nonrelated donation was low: 23% for kidney and 19% for liver. However, when the donation was from a relative, the percentages increased to levels similar to those of cadaveric donation, namely 88% and 85% for kidney and liver, respectively. No differences were observed in attitudes toward cadaveric or living donation according to various psychosocial variables. CONCLUSIONS: The trainee doctors showed favorable attitudes toward human cadaveric organ donation as well as living related donation, which suggests a relaunch of living donors in the near future. However, there was not much acceptance of nonrelated donation, as has also been seen in studies of the general public in our geographical area.     

Done vida--donate life: a surgeon's perspective of organ donation

BACKGROUND: This report is the Presidential Address of the 59th Annual Meeting of the Southwestern Surgical Congress. Organ donation is discussed from the perspective of a trauma surgeon, a prospective live organ donor and a father of a transplant recipient. Current issues to increase organ donation in the United States are addressed. METHODS: Recent publications of the Institute of Medicine (IOM) with respect to non-heart beating donation and efforts to increase organ donation were reviewed. RESULTS: Data from the Scientific Registry of Transplant Recipients/Organ Procurement and Transplant Network were reviewed and cited in the report. Data also were obtained from the Donor Network of Arizona. CONCLUSIONS: The recommendations provided by the IOM and others should strengthen efforts to increase organ donation. It is hoped that collectively they will help to decrease the disparity between the number of solid organs available and the number of patients on the transplant recipient waiting list. The efforts of the participating organ procurement organization in the breakthrough collaborative are providing evidence that the IOM suggestions can be implemented with success.