Veterinary Spanish Students’ Attitude Toward Presumed Consent in Organ Donation

Veterinarians often are involved in transplantation research projects. They are a fundamental social group who can influence public opinion about organ donation and transplantation (ODT). Objective. The objective was to determine the knowledge of Spanish veterinary students about the concept of brain death and the law of presumed consent.MethodsA sociologic, multicenter, and observational study was carried out in the veterinary students enrolled in Spain (n = 9000) in a complete academic year. A sample of 2815 students was stratified by geographic area and academic year. The students’ attitudes on the psychosocial aspects of ODT were evaluated using a psychosocial validated questionnaire (PCID-DTO Rios). It was self-administered and completed anonymously. Veterinary schools were randomly selected. The questionnaire was applied to each academic year at compulsory sessions.Statistical analysisStudent t test, χ2 test, and logistic regression analysis were used.ResultsThe completion rate was 91% (n = 2558). Of students, 66% (n = 1664) understood the concept of brain death, 30% had doubts, whereas 5% believed that a person with brain death can recover and lead a normal life. Concerning legislation, 63% (n = 1615) were against the law of presumed consent, and 37% were in favor. An analysis of variables determining more favorable acceptance of the law showed that year of study (P = .000), knowing a donor (P = .020), and attitude toward ODT (P = .000) did have an effect on acceptance. Most students, 71% (n = 1875), were interested in attending a talk about ODT.ConclusionOnly 37% of Spanish veterinary students would accept the law of presumed consent. Most students were interested in attending an informative talk about ODT.     

Financial Incentives for Organ Donation: A Slippery Slope Toward Organ Commercialism?

Financial incentives for organ donation (from living or brain-dead donors) have been considered ethically acceptable by some authors and have been accepted locally in some countries. In the United States of America, eight federal proposals have been rejected, while some kind of incentives have been approved at a local or state level. There is still a widespread concern that the acceptance of economic incentives could bring a commodification of the human body, constituting a “slippery slope” toward organ commercialism.     

Increasing Consent and Assent Rate for Organ and Tissue Donation: Communication About Donation–Telephone Advice by Psychologist

A high percentage of family refusal is found for several outcomes in the Donor Register. Misconceptions and concerns regarding donation impede next of kin from making a well-considered decision. The donation request is the moment in which such concerns should be addressed by the requestor. The Communication about Donation–Telephone Advice by Psychologist (CaD-TAP) is a direct telephone intervention for requestors who are about to request the relatives for donation. The aim of this intervention is to improve requestors' communication skills regarding the donation request and thereby increase the consent rate for organ and/or tissue donation. The intervention started on the April 1, 2014, and lasted until December 31, 2014. To determine the effects, the consent and assent rates were compared between requestors who received the CaD-TAP intervention and those who did not. The requestors who received the CaD-TAP intervention (N = 141) had a significantly (P < .001) higher consent rate (58%) compared with the group who did not receive the intervention (N = 1563, consent rate: 34%). More tissue donor requestors received the intervention (74%) and most interventions took place outside office hours (82%). No significant difference was found in the effect of the intervention with regard to type of donation, time, or day. Furthermore, the intervention increased requestors' self-confidence in requesting for donation (P < .001), and a higher self-confidence indicated a significant association with increased consent rate. The intervention is unanimously experienced as positive and valuable by users. Based on these results the intervention is effective in increasing the consent rate for organ and tissue donation.     

Long-Term Consequences of Complex Living Renal Donation: Is It Safe?

Introduction

As there is a paucity of literature regarding the long-term outcomes of complex living donors, we conducted this study to assess the effect of kidney donation on the complex living kidney donor.

Prophylactic Mastectomy: Is It Worth It?

Background  

Breast cancer is the second mortality-related cancer and the leading cause of general mortality in women aged 40–55. Prophylactic mastectomy has proved to be effective in several clinical scenarios but is still a somewhat controversial procedure.     

Hepatic Metastasectomy for Soft-Tissue Sarcomas: Is It Justified?

Background   Except for patients with gastrointestinal stromal tumors (GIST), systemic chemotherapy in patients with liver metastasis of soft-tissue sarcoma (STS) is not effective. Therefore, all patients with resectable liver metastases underwent surgical therapy. We present our experience with this approach during the last 13 years. Methods   All patients (n = 45) with liver metastasis of STS undergoing surgical therapy were prospectively analyzed. Clinical and histopathological parameters as well as the postoperative course were recorded. Survival data were analyzed by using the Kaplan-Meier method and the log-rank test. Results   Twenty-seven of 45 patients with liver metastasis underwent hepatic resection; 59% of these patients had a solitary metastasis, 22% had two metastases, and 18% had three or more metastatic nodules. The surgical perioperative mortality was 7%. The median survival was 44 (range, 1–123) months, and the 5-year survival was 49%. Repeated resection for recurrent tumor was performed in eight patients, which yielded a median survival of 76 months. Conclusions   Patients who have hepatic metastases that are functionally and technically resectable should be considered for surgery because this treatment offers the chance for long-term survival (>5 years). Supported by the Günther-Haenisch Forschungs- und Studienstiftung der Vereinigung Nordwestdeutscher Chirurgen (MP).     

Extended Resection: Is It Feasible for Pulmonary Metastases?

Background  

Extended resections may be necessary to achieve tumor-free borders for secondary pulmonary malignancies. This study was performed to analyze the outcomes that result from extended resections of pulmonary metastases.     

Reoperative Surgery for Chronic Pancreatitis: Is It Safe?

Introduction Eleven percent to fifty-six percent of patients do not achieve adequate pain relief with initial operative treatment for chronic pancreatitis, and reoperations for recurrent or persistent pain are common. This study evaluates the influence of prior pancreatic procedures on operative morbidity for chronic pancreatitis. Methods The records of 336 consecutive patients who underwent pancreaticoduodenectomy (PD, n = 78), lateral pancreaticojejunostomy (LPJ, n = 152), distal pancreatectomy (DP, n = 83), transduodenal sphincteroplasty (SP, n = 20), and total pancreatectomy (TP, n = 3) for chronic pancreatitis were retrospectively reviewed and analyzed. Results Seventy-four patients underwent reoperation after failed prior pancreatic surgery. Patients with de novo pancreatic operations had a similar complication rate as those with reoperation (PD: 48% versus 65%, P > 0.05; LPJ: 23% versus 23%, P > 0.05; DP: 26% versus 28%, P > 0.05; SP: 21% versus 100%, P > 0.05). Major complications such as pancreatic leak or abdominal abscess were similar in the two groups. Minor complications such as delayed gastric emptying or wound infections were more common in the reoperation group. There was no difference in postoperative hospital length of stay. Conclusions Patients who undergo reoperative surgery for chronic pancreatitis have an increased risk for minor perioperative complications. The overall complication rate and the incidence of major complications are similar compared to de novo procedure. Reoperative surgery therefore appears feasible and safe in experienced hands.     

Sports Brassiere: Is It a Solution for Mastalgia?

Abstract: Breast pain is a very common complaint in women presenting to the outpatient department. It causes a certain degree of discomfort, anxiety leading to repeated investigations, and to some degree disturbs their lifestyle. This prospective study was carried out at King Fahd Hospital of the University, Alkhobar. Two hundred women presenting to the outpatient surgical department with mastalgia were included; 100 women received treatment with danazole, and the other 100 were asked to wear sports brassieres for 12 weeks. They were requested to answer a structured questionnaire during the specified period, and an extensive review of the literature was also performed. Patients were compliant with the instructions. The first group had 58% relief of symptoms, but 42% experienced drug side effects; in the second group, all participants had some degree of initial discomfort followed by relief of symptoms in 85% of cases. Most patients claimed that their lifestyle had changed dramatically after using the sports brassieres. Mastalgia is a common disease that may run a chronic course. Many patients are unsatisfied with prescribed medications and tend to discontinue treatment when side effects develop. Active breast movement on its weak suspensory ligaments may contribute considerably to mastalgia. Good external support by sports brassieres can relieve most of the patient's symptoms.     

University Hospital Doctors: What Are Their Beliefs About Organ Donation?

IntroductionOrgan and human tissue donation is not well developed in Morocco. This is due in part to the refusal of families, but also to a lack of awareness. We conducted a survey of a representative sample of doctors more exposed to the donation process to assess their knowledge and attitudes toward organ donation and their training needs.MethodsThis is a cross-sectional study of physicians in Marrakech University Hospital. An anonymous questionnaire adapted to Moroccan context, assessing the knowledge, opinions, attitudes, and needs regarding organ donation was given to doctors.ResultsAmong 130 distributed questionnaires, we collected 115 completely answered surveys. Respondees were as follows: 60.8% were females, 87 were residents and 28 interns, 80% were aged from 25 to 34 years, and 60% had practiced their profession for 1 to 5 years. Results showed that 28% don't know that tissue and organ donation from a cadaver is authorized in Morocco, 6% are aware of the organs and tissues that can be taken, 76% know the definition of brain death, 35% don't believe in this concept, 88% were favorable for the removal of organs and tissue of deceased persons, 10% ignore that Islam allows organ donation, 62% will give their organs and tissues after death, 25% refuse organ donation of a parent, and 30% refuse it of their children after death.ConclusionsOur findings show that there is discordance between knowledge and attitudes of doctors in our hospital toward organ donation. The promotion of organ donation requires good training of our teams to sensitize the population.     

Organ Donation: New Hope Through the Expected Amendment in Germany?

Introduction

The current organ donor shortage in Germany results in the death of 1000 patients on the transplant waiting list every year. In response, a recent amendment to the German Transplant Act aiming to increase donor rates was passed. Among a number of other measures, Germans are asked to decide whether they choose to donate organs or not in the event of a brain death or whether they would like to designate someone who should decide for them in this situation. The objective of this study was to collect and evaluate data on the public's attitude toward organ donation before the expected amendment.

Methods

A survey on the subject of organ donation was conducted in 2011 among clients of a public pharmacy in a major city in the federal state North Rhine-Westphalia, Germany. Data regarding sex, age, health behavior, and attitude toward the amendment were collected and association organ donor card possession was analyzed.

Results

A total of 1485 questionnaires were evaluated. Of those surveyed, only 14.1% had an organ donor card. No statistically significant associations between sex (P value .3045), age (P value .1453) and the possession of a donor card were observed. We found that 72.5% of respondents stated that they appreciated the expected amendment, and in the case of implementation, the majority would obtain an organ donor card.

Discussion

The future success of transplantation medicine relies on an increase in the public's overall willingness to donate organs. Educating the public and ensuring transparency in transplantation medicine are vital to achieving higher donation rates. The new German transplantation act may be an important step to increase society's awareness and participation in organ donation.     

Does Death Anxiety Affect the Attitude Towards Organ Donation?

BackgroundIt is important to determine the attitudes of nurse candidates towards organ transplantation and their death anxiety levels to help patient families make an informed decision about organ donation.AimThe aim of this study is to examine nurse candidates' public knowledge and attitude towards organ donation.MethodsThe research was conducted with nursing students at the Faculty of Health Sciences, between December 2021 and February 2022. Data were collected using a personal information form, Fear of Death Scale (FODS), and Organ Donation Attitude Scale (ODAS).ResultsOur study determined that the percentage of students who wanted to donate organs and the death anxiety average of students were moderate. It was determined that students' positive attitudes towards organ donation were high and negative attitudes were low, and there was a negative relationship between them (p<0.001). In this study, in the comparison of death anxiety by gender, the mean scores of women's death anxiety, thinking about death and witnessing death, suffering, and uncertainty of death were found to be higher than men's, and the difference was significant (p<0.001).ConclusionAs a result, it is thought that improving the attitudes of future nurse candidates towards organ transplantation will significantly affect their organ transplantation decisions. Education is required for students with insufficient experience.     

Hepatic Resection for Metastatic Renal Tumors: Is It Worthwhile?

Background: Liver metastases of malignant renal tumors are regarded as having an ominous prognosis because they are infrequently amenable to radical surgery and respond poorly to chemotherapy. Little is known of the outcome of isolated metastases to the liver for which resection is potentially curative.Methods: Data on 14 patients with liver metastases from renal tumors who underwent a liver resection in a single center between 1982 and 2001 were analyzed retrospectively.Results: There was no operative or postoperative mortality. The median survival was 26 months, with a survival rate of 69% at 1 year and 26% at 3 years. The curative pattern of hepatectomy (2-year survival, 69% vs. 0%; P = .001), an interval between the nephrectomy and the diagnosis of liver metastases in excess of 24 months (2-year survival, 71% vs. 25%; P = .05), tumor size <50 mm (2-year survival, 83% vs. 17%; P = .006), and the possibility of achieving a repeat hepatectomy in the case of recurrence (2-year survival, 100% vs. 21%; P = .02) were associated with a better outcome after the liver resection. Four patients were alive without evidence of disease at 6, 12, 26, and 96 months after the first hepatic resection, and one was alive with hepatic recurrence 18 months after resection.Conclusions: In patients with liver metastases of malignant renal tumors, an aggressive policy for achieving tumor eradication seems to offer a chance for long-term survival, especially after a long disease-free interval from the nephrectomy. However, despite an aggressive policy for achieving tumor eradication, recurrence frequently occurs after liver resection.