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.     

Ancillary hospital personnel faced with organ donation and transplantation

OBJECTIVE: To reduce the number of family organ donation refusals, it is necessary not only to act on the general public but also on the health care system. In this respect, there are data suggesting that the percentage of hospital personnel against donation is high, especially among ancillary personnel. The objective herein was to analyze the attitudes of ancillary hospital professionals toward donation of their own organs and determine factors that conditioned such attitudes. MATERIALS AND METHODS: A random sample in a third-level hospital with a solid organ transplant program was stratified by ancillary services: administrative, porters, maintenance, cleaning, and cooking. Attitudes toward donation of one's own organs after death were evaluated using a questionnaire on psychosocial aspects validated in our area. It included various psychosocial variables that could affect such attitudes. The Student t test and chi-square test were used to evaluate the data. RESULTS: We analyzed 277 respondents of mean age 43 +/- 8 years and 96% women. The level of acceptance of organ donation was 64% (n = 178), whereas 46% were either against or undecided (n = 98). The variables which determined the attitudes were understanding of brain death (P = .004); attitude toward cadaveric manipulation, especially toward autopsy (P = .013) and cremation (P = .004); concern about mutilation after donation (P = .014); religion (P = .032); partner's attitude toward donation (P < .0001); and possibility of needing an organ in the future (P = .031). CONCLUSIONS: Ancillary hospital personnel had similar attitudes toward donation as those of the general public as observed in other studies. The attitudes were determined by many psychosocial factors. A campaign to raise awareness among professionals has become a priority, given that working in a hospital, their unfavorable attitude could have a strong negative impact on the general public.     

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.     

An international opinion poll of well-educated people regarding awareness and feelings about organ donation for transplantation

Despite repeated campaigns promoting transplantation, the high donation refusal rate remains unchanged. We targeted a well-educated population to assess the impact of our current transplantation promoting programs and personal feelings toward new approaches to organ donation. A questionnaire was proposed in five universities to students and university staffs that would have been likely to benefit from previous information campaigns in two South American and three European countries. All of the 2321 people interviewed replied to at least one question. Organ shortage was considered as a serious public health issue. However, there was a widespread ignorance of religious precepts concerning transplantation that contributed to the low acceptance rate of organ sharing after death. Financial rewards for donors or their families remain controversial. There was a general agreement for early educational programs in schools. Most people still consider organ donation as a gift, but many would now agree to readily share body parts after death. This biased population of well-educated people has still little knowledge of organ donation. The negative impact of ignorance surrounding religious precepts and the high acceptance rate of educational programs in schools, justify supporting an intensive international effort in education that should also include Church leaders.     

Faith leaders united in their support for organ donation: findings from the UK organ donation taskforce study

This article reports the findings from the one‐to‐one interviews with the main UK faith and belief leaders, which were commissioned by the Organ Donation Taskforce. Interviews were arranged with the main faith and belief organizations within the UK and covered a range of issues related to organ donation. No faith or belief groups were against organ donation in principle. The interviewees stated that the majority opinion in their faith or belief group is to permit organ donation, with some actively supporting it. Interviewees were keen to stress that there is a broad spectrum of opinions on organ transplantation within each faith and belief group, and that consequently it is difficult to speak on behalf of an entire group. One complication mentioned by interviewees is that as organ transplantation is a relatively new medical procedure, there is no explicit reference to it in many original religious texts. Consequently positions on the receipt and donation of organs are based on interpretation. It was felt that a much greater level of engagement is needed, as organ donation is currently not a priority for many faith and belief groups.     

Public knowledge and attitudes toward organ donation and transplantation: a cross-cultural study

OBJECTIVE: The aim of this study was to determine the knowledge, attitudes, awareness, and determinants of organ donation and transplantation in a Qatari population. DESIGN: This is a cross-sectional study to determine the knowledge and attitude toward organ donation in a Peninsula Arabian Gulf country. SETTING: The setting was Primary Health Care (PHC) Centers and community-based study in Qatar. SUBJECTS: A multistage sampling design was used in a representative sample of 1600 Qataris and non-Qataris, including males and females of at least 17 years of age, from October 2003 to May 2004. In this study a 1305 (81.5%) subjects participated, each giving consent for the study. MEASUREMENTS: Participants completed a questionnaire assessing their knowledge, attitudes, and awareness for organ donation. RESULTS: Of 1305 samples, 637 (48.8%) males and 668 females (51.2%) living in urban and semiurban areas agreed to participate and complete the questionnaire. Of these, 762 (58.4%) were Qataris. There was a significant difference between Qataris and non-Qataris with respect to their age, educational level, monthly income, and occupation. In this study, 31.6% of Qataris and 29.8% of non-Qataris had no idea about the organ donation; 37.8% of Qataris and 32.8% of non-Qataris were willing to donate their organs. The majority of subjects preferred donating organs to their close relatives and friends. However, 83.8% of the studied subjects did not agree with an incentive-based approach for donating organs. CONCLUSION: This study showed that people should not be blamed for not being willing to participate in organ donation, but the health system and health education providers are responsible. A more effective approach should be tried regarding health education.     

Knowledge and opinions about organ donation and transplantation among Vietnamese Americans in Seattle, Washington: a pilot study

BACKGROUND: Racial/ethnic minorities comprise almost 50% of registrants on national waiting lists for organ transplantation in the USA. As the list continues to expand, organ shortage becomes a bigger problem. Increasing donation rates especially among racial minority groups would lower the waiting times for these groups. PURPOSE: Asian Americans are among the fastest growing and most diverse ethnic group in the USA, but research on their knowledge or opinions about organ donation is rare. POPULATION: A non-random sample of 350 Vietnamese American church attendees and students attending a major university in Seattle (Washington), was drawn. METHODS: A self-administered 39-item knowledge/opinion-based survey was conducted during June to August 2003. Results: Of 278 respondents (a 79.7% response rate), 69.1% knew blood-type made a difference in donation (p = 0.000), 61.6% knew transplant survival rates were high (p = 0.000), and 75.9% knew transplants could come from living donors (p = 0.000). But 53.4% also thought organs could be sold for money in the USA (p = 0.000), and 49.8% thought more people died of auto accidents and gunshot wounds than from heart disease (p = 0.000). Those who answered correctly to more than 50% of the knowledge questions were also more likely to favor donation (p = 0.007). CONCLUSION: We found among this study population that having correct knowledge about organ donation related to a willingness to donate.     

Knowledge and behavior among health professionals in relation to cadaveric organ donation and transplantation: a questionnaire-based analysis in Portuguese hospitals

Objective

To assess knowledge and behavior relative to cadaveric organ donation and transplantation among physicians and nurses working at nine Portuguese hospitals.

Methods

This prospective study between May and October 2009 included 495 questionnaires that were returned among 840 that were delivered, a 59% response rate. The transplant questionnaire comprised three main sections: section 1, sociodemographic-professional variables of the participants with nine questions; section 2, generic questions on organ donation and transplantation with 12 questions; and section 3 evaluated knowledge with 20 specific questions on organ donation and transplantation.

Results

Sixty-one percent of the participants were females, with 40% of the overall cohort between 31 and 40 years old; 62% married; 63% working in the emergency department; and 78% nurses. Although 78% of the participants stated that they had undergone specific training on organ donation and transplantation, 62% felt that they needed more training. The reasons evoked for the low rate of donation included difficulties in initiating the process of organ donation, in diagnosing cerebral death and in obtaining necessary human resources. There were no significant differences in knowledge between physicians and nurses concerning specific organ donation and transplantation issues. Having had specific training on organ donation and transplantation was significantly associated with correct answers to several questions, including those pertaining to knowledge of the national legislation on organ donation and transplantation.

Conclusions

The present study showed a lack of specific knowledge and training on organ donation and transplantation issue. It also suggested that for hospital staff to successfully act as initiators of the organ procurement process, more information and education are necessary. This effort could significantly increase the rate of organ donation and transplantation in Portugal.     

Donation and transplantation among personnel in the hospital emergency department: a multicenter study conducted in Spain and Mexico

Introduction

The promotion of different means of procureming both deceased and living organs (kidney and liver) is a necessity given the current organ shortage. Emergency department personnel are involved in the donation and transplantation process. Our objective was to analyze the attitude to the different kinds of organ donation of emergency services personnel in hospital centers in Spain and Mexico.

Materials and Methods

A randomized sample was obtained from the “International Collaborative Donor Project” and was stratified according to emergency services and job category in nine hospitals, in Spain and in Mexico (n = 22). Attitude was evaluated using a validated survey.

Results

Of the respondents, 76% were in favor of deceased organ donation and 24% were not in favor. This attitude toward deceased donation was associated with the respondent's country of origin, age, and job category; Mexicans (P = .036), younger respondents (P = .023), and physicians were most in favor (P < .001). With regard to attitude toward living kidney donation, 89% were in favor of related donation. Regarding living liver donation, 85% were in favor of related donation. In attitude toward living kidney and liver donation, relevant factors were related to donation and transplantation.

Conclusions

Professionals in emergency departments in hospital centers in Spain and Mexico had a favorable attitude toward the different kinds of donation, although it was less favorable than the attitude reported in other professional hospital groups.     

Medical students faced with related and unrelated living kidney donation: a stratified and multicentre study in Spain

Introduction

The attitude of medical students towards living kidney donation (LKD) is of great interest given that they will become promoters of this technique in the near future.

Objective

To analyse the attitude of Spanish medical students towards related and unrelated LKD and to determine the factors affecting this attitude.

Materials and methods

Type of study: A sociological, interdisciplinary, multicentre, and observational study. Study population: Medical students enrolled in Spain (n = 34.000). Sample size: A sample of 9598 students (99 % confidence and precision of ±1 %), stratified by geographical area and academic year. Measurement instrument: A validated questionnaire (PCID-DVR RIOS) was administered and completed anonymously.

Results

There was a completion rate of 95.7 % (n = 9275); 93 % (n = 8630) were in favour of related LKD, and 30 % (n = 2784) were in favour of unrelated LKD. The following factors were associated with this attitude: (1) age (p = 0.008); (2) sex (p < 0.001); (3) year of university degree (p < 0.001); (4) a belief that a transplant might be necessary in the future (p < 0.001); (5) attitude towards deceased organ donation (p < 0.001); (6) a willingness to accept a kidney from a living donor (p < 0.001); (7) attitude towards living liver donation (p < 0.001); (8) a partner’s attitude towards donation (p < 0.001); (9) having spoken about the subject with one’s family (p < 0.001), or friends (p < 0.001); (10) pro-social behaviour (p < 0.001); (11) the respondent’s religious attitude (p < 0.001); and (12) fear of possible mutilation of the body after donation (p < 0.001).

Conclusions

The attitude of medical students towards LKD is very favourable when it is the related kind of donation, and it is associated with factors of general knowledge about organ donation and transplantation and social interaction and religion.

     

A household study to determine attitudes and beliefs related to organ transplantation and donation: a pilot study in Yapracik Village, Ankara, Turkey

Rural areas display adverse attitudes toward organ donation. Through a population-based cross-sectional study of people 18 years of age or older in the rural area of Ankara, Yapracik Village, Turkey, we identified the attitudes and beliefs of people related to organ transplantation and organ donation. The research universe included 87 people in 75 households. The research instrument was a questionnaire. None of the respondents had been involved in organ donation. The percentage of willingness to donate an organ was 47% which was significantly associated with younger age, including 34.4% who expressed willingness while alive. Twenty-five percent believed that their religion is adverse to transplantation, 28% thought it would create pain in death, 20% were afraid, and 83% believed in life afterwards, 15% said that their custom and usage were adverse to organ donation, 50% stated that they can accept organ donation from other races, and 65% stated that they can request organs from their friends. Eighty percent thought that organ donation is a gift given to a human; 34% of them stated that they can be a donor while they are alive. Fifty-four percent of respondents stated that they wanted to get information about organ donation and transplantation. Therefore basic educational campaigns targeting the increase of knowledge about organ donation are warranted in the rural population. There is a need to increase awareness about organ donation and transplantation. Findings like those in this study will help campaigns conducted for organ donation.     

Normothermic machine perfusion for the assessment and transplantation of declined human kidneys from donation after circulatory death donors

Background

A significant proportion of donation after circulatory death (DCD) kidneys are declined for transplantation because of concerns over their quality. Ex vivo normothermic machine perfusion (NMP) provides a unique opportunity to assess the quality of a kidney and determine its suitability for transplantation.

Methods

In phase 1 of this study, declined human DCD kidneys underwent NMP assessment for 60 min. Kidneys were graded 1–5 using a quality assessment score (QAS) based on macroscopic perfusion, renal blood flow and urine output during NMP. In phase 2 of the study, declined DCD kidneys were assessed by NMP with an intention to transplant them.

Results

In phase 1, 18 of 42 DCD kidneys were declined owing to poor in situ perfusion. After NMP, 28 kidneys had a QAS of 1–3, and were considered suitable for transplantation. In phase 2, ten of 55 declined DCD kidneys underwent assessment by NMP. Eight kidneys had been declined because of poor in situ flushing in the donor and five of these were transplanted successfully. Four of the five kidneys had initial graft function.

Conclusion

NMP technology can be used to increase the number of DCD kidney transplants by assessing their quality before transplantation.     

Endothelial activation in the transplanted human heart from organ retrieval to 3 months after transplantation: an observational study.

BACKGROUND: Endothelial activation in the donor heart has been described variably after brain death and transplantation. We aimed to characterize the time course of endothelial activation in right ventricle (RV) and left ventricle (LV) during the acute phase of clinical transplantation. METHODS: We studied biopsy specimens from the RVs and the LVs of 40 donor hearts: at initial assessment of the donor, at end-ischemia, and after 10 minutes of reperfusion. We also included follow-up RV biopsy specimens at 1 week, 1 month, and 3 months after surgery. Six of the patients had cystic fibrosis and were domino donors. RESULTS: P-selectin and vascular cell adhesion molecule 1 (VCAM-1), but not E-selectin were up-regulated in brain-dead and in domino donors vs controls. Unused donor hearts (n = 6) had significantly less up-regulation of P-selectin and of VCAM-1. We found no difference between the RV and the LV during surgery, but we did see important time-dependent variations. P-selectin was present in 85% of vessels throughout transplantation and decreased to approximately 60% after transplantation (p < 0.001). We initially detected VCAM-1 in 20% of vessels, which decreased to 5% during storage, then increased to 47% at reperfusion, and gradually decreased thereafter (p < 0.001). E-selectin expression increased progressively from 15% initially to 45% at reperfusion and then decreased after surgery (p = 0.001). Thrombomodulin expression was decreased at baseline, and the decrease was accentuated afterward (p = 0.02). Patients with donor organ failure did not have a specific pattern of endothelial activation. CONCLUSION: Cardiac transplantation is associated with marked endothelial activation, with no difference between the two ventricles. The changes persist in the post-operative period, even in the absence of acute rejection.     

Dental care and oral health in solid organ transplant recipients: a single center cross-sectional study and survey of German transplant centers

Aim of this study was to collect information about oral health of patients before and after SOT as well as information about center‐based recommendations for dental care. In a single center cross‐sectional study, the oral situation of 20 patients before and 20 after SOT were examined including dental (DMF‐T), periodontal (PSR^®/PSI), and oral hygiene findings (modified QHI). In a second project, a survey among 50 transplant centers in Germany was questioned regarding their recommendations for dental care of SOT recipients. Patients before and after SOT showed similar quality of dental findings (DMF‐T), but worse compared to the general population. In addition, most patients in both groups showed pronounced periodontal treatment need (PSR^®/PSI score 3 or 4). Oral hygiene findings (modified QHI) after SOT were significantly worse than in patients on the waiting list (P = 0.032). In a second project, the questionnaire was returned by 28 of 50 centers. Interpretation of data showed that 89% carry out a dental examination before SOT and 67% contacted the patients’ dentists. After SOT, 83% of the transplant centers recommend antibiotic cover before dental measures. The results of our study revealed lacks in the dental care of SOT recipients. Consistent recommendations regarding the dental care of patients before and after SOT should be determined.     

Fate of infants with hypoplastic left heart syndrome listed for cardiac transplantation: a multicenter study.

BACKGROUND: Infants with hypoplastic left heart syndrome (HLHS) commonly undergo cardiac transplantation as primary management. METHODS: We examined outcomes of primary transplantation for unpalliated HLHS. We analyzed data from the 20 institutions of the Pediatric Heart Transplant Study Group, from January 1, 1993, through December 31, 1998, using actuarial and parametric survival analysis and competing outcomes analysis. RESULTS: During the 6 years studied, 1,234 patients were listed for cardiac transplantation; 262 patients (21.2%) had unpalliated HLHS. The number (and percentage) of patients with HLHS decreased from 58 (27% of patients listed) in 1993 to 30 (14%) in 1998. Overall, 25% of infants with HLHS died while waiting; primary cause of death was cardiac failure (50%). Of the remaining patients awaiting transplantation, 23 (9%) underwent Norwood/Fontan-type surgeries as interim palliation: 52% died. Ultimately, 175 patients underwent cardiac transplantation (67%); 50% received organs by 2 months after listing. Post-transplant actuarial survival was 72% at 5 years, with 76% of deaths (35/46) occurring within 3 months; early mortality was caused primarily by graft failure within the first 30 days after transplantation (in 54%). Among 1-month survivors, survival at 1 and at 5 years was 92% and 85%, respectively. Of the 262 patients listed with unpalliated HLHS, overall survival, taking into account mortality after listing and after transplantation, was 68% at 3 months and 54% at 5 years. CONCLUSIONS: Cardiac transplantation offers good intermediate survival for infants with unpalliated HLHS.     

Efficacy of an educational programme for secondary school students on opinions on renal transplantation and organ donation: a randomized controlled trial.

CONTEXT: Organ shortage for transplantation is a crucial problem; educational interventions may increase donations and decrease opposition. OBJECTIVE: To test the efficacy of an educational programme on opinions on organ transplantation and kidney donation. DESIGN AND PARTICIPANTS: Cluster Randomized Controlled Trial: eight intervention and eight control schools were randomly selected from the 33 public schools that agreed to participate. Targets: students in the last 2 years of secondary school (17-18 years); seven schools per group completed the study. EDUCATIONAL PROGRAMME: Intervention: first questionnaire (anonymous); 2 h lesson in each class; 2 h general session with patients and experts; second questionnaire. CONTROL: questionnaires. MAIN OUTCOME MEASURES: Differences between questionnaires (comparative analysis); interest; satisfaction with the programme; (cross-sectional analysis). RESULTS: 1776 first, 1467 second questionnaires were retrieved. Living kidney donation: at baseline 78.8% of students would donate a kidney to a relative/friend in need. The answers were unaffected by type of school but depended on sex (females more prone to donate, P<0.001); the answers did not change after the lessons. Cadaveric kidney donation: baseline opinions were mixed (intervention schools: 31.5% yes, 33.7% no, 34.8% uncertain), depending on type of school (classical-scientific high schools more positive than technical institutes, P<0.001), sex (males more prone to donate, P<0.001). Answers on living and cadaveric donation were correlated (P<0.001). The educational intervention increased favourable (31.5 to 42.9%) and uncertain (34.8 to 41.1%) opinions and decreased negative ones (33.7 to 16%) (P<0.001). CONCLUSIONS: Educational interventions are effective in increasing interest and improving opinions about cadaveric organ donation.     

Italian continuing medical education program: an evidence-based course for surgeons and health personnel of a regional transplantation center

In the organ transplantation area the application of the evidence-based medicine (EBM) methods may be limited by several, heterogeneous conditions, eg, mandatory laws and protocols, logistic concerns, as well as donor/recipient matching. In this report we have described the results of a first EBM-oriented course for surgeons and health personnel in a regional transplantation center under the Italian Continuing Medical Education (CME) program. The course was formally approved for 25 credits. It included a maximum of 70 medical and nursing staff registrants; 50 of the spots were reserved for our transplantation center. The course was scheduled in 10 sessions from June to November 2010. Each session was composed of 2 phases: (1) first, computer-assisted education including slide presentations (2 hours); and (2) subsequent discussion led by experts (1.5 hours). The registered participants were expected to be able to correctly answer a multiple-choice, 10-question questionnaire at the end of each session. The majority of the participants considered the course relevant to their need to be updated and effective to improve their clinical skills. The requirements to obtain credits by the Italian CME program for live events were overall presence ≥80% and correct responses in the postsession questionnaires ≥70%. However, among the initially registered participants 31.5% failed at least one of these requirements. The main reason for failure was exceeding the maximum number of absences. Paradoxically, the absences were largely caused by the simultaneous execution of surgical/medical transplantation procedures. For professional figures engaged in complex medical activities, the Italian CME program should consider different threshold limits for the maximum number of absences allowed at live events.