Obstacles to organ donation

Attitudes towards transplantation were investigated in national surveys of the general public (n = 1471), the medical profession (n = 590) and key clinical staff in units referring potential organ donors (n = 380). A clear majority of doctors would like to see more transplants. Only 16 per cent of doctors opposed them on cost grounds, and a 50 per cent 5-year survival rate is seen as more than adequate clinical justification. However, doctors are less supportive of liver and heart grafts than of kidney and cornea grafts. Few lay people would refuse donation of specific organs, but 30 per cent worry that doctors might be pressured into removal of organs when they are not sure the patient is dead. Religious or moral objection is rare. Intensive care unit staff felt the most important factor restricting organ harvest in their own units was dislike of adding to relatives' distress, followed by lack of training in approaching relatives and adverse media publicity. Only 11 per cent thought reservations on brain stem death a likely or possible influence. Enhanced public awareness of the need for transplants was seen as the most important means of increasing organ harvest. Required request would be controversial and perhaps impossible to implement. We conclude that the time, effort and expense involved in potential organ donation do not play a substantial part in limiting referral. Neither do reservations about brain stem death. Increased training of staff (both in communication skills and in the professional responsibility to encourage donation) and greater public awareness are seen as the twin foundations of a realistic approach to enhancing referral.     

Incentives to promote organ donation

The worldwide shortage of organs has led to the development of incentives to promote organ donation. These incentives vary widely in nature ranging from financial remuneration to preferential access to conditional donation. Such strategies to increase organ donation present a variety of ethical dilemmas challenging traditional concepts of justice and equity of access. In addition, there are legal and logistic considerations that must be discussed. The case is made that schemes using incentives to promote organ donation must meet the requirements of society for justice, equity of access, and avoidance of racial or other bias.     

Strategies to optimize deceased organ donation

Organ shortage is one of the main limitations to deal with in organ transplantation. Although the number of patients in the waiting list increases over time, the number of transplants performed does not increase or increases at a much lower rate because of the scarcity of organs to fulfil the demands. Several classic approaches have proven to have a limited or transient impact on the figures of organ donation. The sustained increase in deceased organ donation rates in Spain during the last years, reaching values of 33 to 35 donors per million population, obeys to the implementation of a set of measures, mainly of organizational nature, that is internationally known as the Spanish Model of Organ Donation. With the creation of the National Transplant Organization in 1989, always acting as an agency in support of the process of donation besides organ sharing, a network of highly trained and motivated physicians with the main responsibility of developing a proactive donor detection program was established. A continuous audit of brain death in intensive care units of transplant procurement hospitals has been applied in the last 7 years as a valuable tool to evaluate the potential of donation and the weaknesses of the process, identifying areas to be improved. Great effort in training and education, close attention to the mass media, and reimbursement to procurement and transplant centers for the developed activity have been other measures indeed contributing to the successful Spanish results. The application of the Spanish Model of Organ Donation to other regions and countries across the world, such as the region of Tuscany in Northern Italy and some Latin American countries, has proven to be feasible always that minimal requirements are fulfilled. What these figures show is that a positive change in organ donation rates can be achieved if steps are taken into the right direction.     

The Latin American population in Spain and organ donation. Attitude toward deceased organ donation and organ donation rates

The Latin American (LA) population has similarities with the Spanish population which makes its integration into Spanish society easier. Objective: to analyze the attitude toward organ donation among Latin American citizens residing in Spain, to determine the psychosocial variables which affect this attitude, and to examine the correlation between donation rates of LA citizens in Spain and in their countries of origin. A random sample of LA residents in Spain was taken and stratified according to the respondent's nationality (n = 1.314), in the year 2010. Attitude was assessed using a validated questionnaire (PCID‐DTO Dr Rios). The survey was self‐administered and completed anonymously. Statistical analysis: Student's t‐test, the χ² test, and logistic regression analysis. There was a 94% completion rate (n = 1.237). Attitude toward donation was favorable in 60% of cases (n = 745), 12% (n = 145) were against, and 28% (n = 347) were undecided. The following variables were associated with attitude toward donation: sex (P = 0.038), level of formal education (P < 0.001), country of origin (P = 0.002), attitude toward the donation of a family member's organs (P < 0.001), having discussed donation with the family (P < 0.001), carrying out prosocial activities (P = 0.025), attitude toward cremation of the body (P < 0.001), attitude toward burial of the body (P < 0.001), attitude toward having an autopsy carried out (P < 0.001), previous experience of the organ donation and transplantation process (P < 0.001), fear of mutilation after donation (P < 0.001), knowledge that the Church has a positive attitude toward organ donation and transplantation (P < 0.001), knowledge of one's partner's attitude toward organ donation (P < 0.001), and a belief that one might need a transplant in the future (P < 0.001). The donation rates in this population group in Spain are higher than those recorded in their countries of origin (55.76 vs. <10 pmp; P < 0.001). The attitude toward organ donation among LA citizens residing in Spain is slightly worse than that reported in the native Spanish population and is determined by many psychosocial factors. The donation rates of LA citizens in Spain are higher than those in their countries of origin.     

Consent for organ donation

Improving the consent rate for solid organ donation from deceased donors is a key component of strategies in the UK and other countries to increase the availability of organs for transplantation. In the UK, the law is currently clear on what forms consent may take, with the views of the individual expressed previously in life taking priority. Such views may have been expressed prospectively, via membership of the Organ Donor Register or by talking to family members. The factors determining such actions include both positive altruistic motives and negative psychological responses. Studies have examined why some families of potential donors refuse consent, while others have demonstrated a key set of 'modifiable' factors relating to the family approach. These include ensuring the right timing of a request in an appropriate setting, providing emotional support, and imparting specific information, particularly concerning the nature of brain death. If these are optimized and the right personnel with adequate training are involved in a planned process, then consent rates may be improved as reported in other countries with organized donation systems.     

人类器官移植供体来源的发展历程

移植器官来源模式是科学技术发展和人文精神升华完美结合的产物.移植器官来源经历了异种动物、死刑遗体、亲属活体、脑死亡供体、亲属活体+非亲属活体、心死亡供体、多种来源这7个不同的历史阶段.异种移植离临床应用遥远;死刑来源倍受批评;活体移植伤害健康人.器官捐献移植发展史证明,公民逝世后器官捐献值得大力推广.以美国全脑死亡器官捐献和英国脑干死亡器官捐献为代表的美-欧模式,均为生前自愿同意,且绝对无偿.公民认为任何形式的补偿都会改变捐献行为本来的性质.心死亡器官捐献是脑死亡器官捐献的补充,适用于既不符合脑死亡标准又无法救治,同时家属又有强烈捐献意愿者.