Attitudes toward living liver donation among hospital personnel in services not related to transplantation

INTRODUCTION

The deficiency in livers and waiting list mortality have encouraged more living liver donation, although it is not exempt from morbidity and mortality. The enthusiasm of transplant teams for this kind of donation is increasing; however, the attitudes toward it are not so clear among other health professionals. Our objective was to analyze the attitudes toward living liver donation among hospital professionals in services without habitual relations with transplantation.

MATERIALS AND METHODS

A random sample was stratified for service not related to transplantation and job category, in a third level hospital with a transplant program. Attitudes toward living liver donation were evaluated using a psychosocial questionnaire on living donation.

RESULTS

A total of 419 respondents were analyzed (doctors, n = 184; nurses, n = 119; assistant nurses, n = 80; and non-health workers, n = 36), with a mean age of 37 +/- 10 years. The attitude toward living liver donation was favorable in 82% (n = 344). Among the other respondents, half (9%; n = 38) were against and the other half (9%; n = 37) were undecided. No significant differences were found among the doctors, nurses, assistants, and non-health workers. However, when the three categories were grouped in opposition to the non-health workers, there was greater indecision among non-health workers than the others (19% vs 8%; P = .0001). On analyzing the variables that determine this attitude we observed the following: having commented upon and previously discussed donation (P = .016); believing in the possibility of needing an organ oneself (P = .0001); and being in favor of living kidney donation (P = .0001) and cadaveric donation (P = .004).

CONCLUSIONS

Hospital personnel in services not related to transplantation favor living liver donation, especially if it is a related donation, despite its greater risk, except among non-health workers. However, it is important to conduct informative and awareness-raising campaigns in hospitals if such a type of transplantation is to be encouraged.

Pathology findings in a model of auxiliary liver transplantation with portal vein arterialization in pigs

OBJECTIVE

To determine the histological findings and temporal evolution that occur in auxiliary liver grafts as a consequence of arterialization of the portal vein (PVA).

MATERIALS AND METHODS

We evaluated 10 auxiliary heterotopic liver transplants with arterialization of the PVA. The histological study was performed using an optical microscope to process liver samples with staining using hematoxylin and eosin. A biopsy of native liver tissue was used as a control.

RESULTS

Two animals were excluded from the study, one due to ischemic necrosis of the graft and one that died 4 hours after transplant. All of the remaining eight animals underwent a histological study at 1 day, 7 days, and 14 days. The most significant histological findings were: (1) dilation of portal areas and sinusoids, which were detected at 24 hours and persisted; (2) thickening of the interlobular septum, which was observed after day 7 and progressively increased to day 14; (3) bile duct hyperplasia detected at the seventh day.

CONCLUSIONS

The consistent, early findings in a pig liver with PVA included vascular dilation of the portal area and the sinusoids, with bile duct hyperplasia extending progressively and the thickening of interlobular connective tissue septa with a generalized perilobular connective tissue reaction, which did not seem to alter the internal structure of the lobule, which showed histologically normal hepatocytes. The fibrous reaction may be the first stage in chronic hepatopathy. Further long-term studies are required in this model.

Influence of residency training on personal stress and impairment in family life: analysis of related factors

OBJECTIVES

This cross-sectional study was designed to assess the level of stress among residents and stress-related impairment of family life.

SUBJECTS AND METHODS

A 41-item anonymous questionnaire was designed to determine the level of stress and its effects on the residents' family as well as factors associated with stress during residency training in a tertiary-care hospital accredited with official resident training 'Medicos Internos Residentes' in Murcia, Spain. Questionnaires were distributed in sealed nominal envelopes during February and March 2002 to 227 eligible residents.

RESULTS

Of the 227 residents, 175 (77%) completed and returned the questionnaires. Forty-two percent of residents recognized that residency training caused an important level of stress and 21% felt that stress interfered with family relationships. Both factors were significantly associated. Feelings of being unsatisfied with supervision of care and achievement of training objectives as well as low satisfaction with residency training and poor assessment of the hospital were significant stressors. Impairment in family life was significantly dependent on degree of satisfaction with residency training and evaluation of the hospital.

CONCLUSION

The data showed that residency training generated stress and impaired family life. These were closely associated with perception of being unsatisfied with the residency training and evaluation.

The primary care physician faced with organ donation: attitudinal study in South-Eastern Spain

INTRODUCTION

Attitude of health personnel, especially of physicians, has a significant influence on populational attitude towards organ donation and transplantation. The objective here is to analyse the attitude of Primary Care (PC) physicians towards cadaveric organ donation and transplantation and to determine the factors which condition this attitude.

MATERIALS AND METHODS

A random sample was stratified by geographical location (six health areas of our community) among PC physicians. A total of 155 responses from 32 health centres were collected. Attitude towards donation was evaluated using a psychosocial attitudinal questionnaire about donation validated in our geographical area. The co-ordinator of physicians in each centre was contacted in each centre and was made responsible for distribution and collection of the questionnaires which were completed anonymously. The chi2 test and Student's t-test were applied.

RESULTS

88% (n=136) of the PC physicians are in favour of organ donation, 1% (n=2) are against and 11% (n=17) are undecided. Up to 84% of the PC physicians (n=130) have attended to transplant patients, although this fact is not related to a more positive attitude towards donation (p=0.059). In addition, 64% (n=99) have provided favourable information about organ donation and transplantation to their patients and one of the physicians admits having provided unfavourable information about the matter. On analysing the psychosocial variables which influence such an attitude, a relationship has only been found with respect to two variables: attitude towards cadaveric manipulation (p=0.035) and a partner's opinion towards the subject (p=0.006).

CONCLUSIONS

PC physicians have a very favourable attitude towards donation of their own organs and constitute a positive source of information on the subject for the general public.

Attitudes Toward Xenotransplantation Among Nonhealth Service Workers in a Hospital With a Preclinical Xenotransplantation Program

INTRODUCTION

Our hypothesis was that nonhealth workers (NHW) in our hospital should have a more favorable opinion toward xenotransplantation than the general population, given that this group is in closer contact with a preclinical xenotransplantation program. Therefore, our objective was to determine the attitude of NHW in a hospital with a preclinical liver xenotransplantation program and to determine the factors that influenced this attitude.

MATERIALS AND METHODS

A random sample of 276 subjects in nonhealth services was used. For the distribution of the questionnaire, we contacted the head of each of the services and explained the project. They became responsible for the distribution and collection of the questionnaires in randomly selected work shifts. A random sample of 250 individuals from our community was used as a control group.

RESULTS

As for animal organ donation for humans, if the results could be superimposed on those achieved by human donors, 63% would be in favor, 30% undecided, and the remaining 7% against. The attitude toward xenotransplantation was more favorable in the control group (74% versus 63%, P < .05). On analyzing the variables that influence attitudes toward xenotransplantation, we found that there is no significant relationship to the classical psychosocial variables (P > .05). However, there is a relationship to prior attitudes toward different types of human organ donation and the possibility of needing a transplant oneself.

CONCLUSIONS

The attitudes toward xenotransplantation among NHW are not as favorable as in the general population.

Attitude Survey of Hospital Workers in the Surgical Services Toward Living Kidney Donation

INTRODUCTION

A living donor kidney is currently the most accepted kind of solid organ donation, given the low level of morbidity and mortality and the good results in the recipient. In Spain, its use is still scarce; even many health service workers are not in favor. Our objective was to analyze the attitudes toward living kidney donation in a surgical department.

MATERIALS AND METHODS

A random sample was stratified according to surgical services and job category in a tertiary hospital with an solid organ transplant program. Attitudes toward living kidney donation were evaluated using a questionnaire on donation and transplantation, which evaluated various psychosocial variables. Student's t test and the Chi square test were used.

RESULTS

Two hundred sixty-three respondents of mean age 40 +/- 10 years were analysed for attitudes toward living kidney donation. The level of acceptance was 87% (n = 229) versus 13% undecided or against the procedure (n = 34). No differences were observed according to job category. The variables that showed a relationship with the attitude were the partner's attitude toward donation (P = .049); the possible need for an organ oneself (P = .0001); and belief that medical errors occur (P = .001). The attitude toward cadaveric organ donation was not reflective of that toward living kidney donation (P = .241).

CONCLUSIONS

A favorable attitude toward living kidney donation was high among hospital staff of the surgical department. Those for whom it was not favorable were influenced by personal factors such as partner's attitude and the possibility of needing a kidney in the future.

Attitude Toward Deceased Organ Donation and Transplantation Among the Workers in the Surgical Services in a Hospital With a Transplant Program

INTRODUCTION

There are data that suggest that the percentage of hospital workers not in favor of donation is relatively high, even in services that are directly related to transplantation. The objective was to analyze attitudes toward decreased organ donation in the surgical services.

MATERIALS AND METHODS

A random sample was stratified by the surgical service and the job category (n = 263) in a third-level hospital with a transplant program assessed attitudes toward the donation of ones own organs after death using a questionnaire including psychosocial factors as validated in our geographic surroundings. Student t test and the chi-square test were used for data analysis.

RESULTS

Favorable attitudes toward donation were observed in 68% (n = 178) as opposed to 32% with an attitude that was undecided or against the act (n = 85). The psychosocial variables that showed significant relationships with this attitude were age (most in favor are younger; P = .021); nonmedical surgical staff (50% against donation; P = .0001); resident physicians (94% in favor; P = .001); discussion and prior consideration of donation (P = .016); knowledge of the concept of brain death (an important factor in nonhealth staff; P = .010); attitude toward manipulation of the deceased (P = .011) and concerns about mutilation (P = .026); partner's opinion toward organ donation (P = .0001); and existence of frequent medical errors (P = .003). No significant differences were found, depending on whether the services were involved in a specific transplant program (P = .853).

CONCLUSIONS

Favorable attitudes toward donation among the hospital staff on surgical services, including those who perform transplants, did not reach more than 70% and was determined by multiple psychosocial factors. Donation promotion activities are necessary for these services, given the importance that this group's negative attitude could have on the attitude of the general population.

Attitude Toward Living Related Donation of Patients on the Waiting List for a Deceased Donor Solid Organ Transplant

INTRODUCTION

Spain is the country with the highest rate of donation from deceased individuals. However, given the deficit in organs, living donation is being encouraged. Our objective was to analyze attitudes toward living donation among patients on the waiting list for a transplant.

MATERIALS AND METHODS

Patients on the waiting list for a kidney or liver transplant (n = 96; 46 kidney and 50 liver) in the last year had their attitudes toward living donation evaluated through a psychosocial survey performed in a direct interview with an independent health professional from the transplant unit and analyzed by Student t test and the chi-square test.

RESULTS

Ninety-one percent were in favor of donating their organs when they die, 6% had doubts, and the remaining 3% were against it. Twenty percent would accept living donation from a family member (32% in liver vs 7% in kidney; P < .05), despite 89% of them accepting that there would be a risk to the family member. Twenty percent reported that a family member had suggested donating, but the patient was opposed. Finally, only 6% considered living donation to be their first choice, 42% did not consider this option. Up to 96% would donate an organ to a family member if they were requested to do so.

CONCLUSION

Patients on the waiting list are not favorable to living related donation for themselves, although members of their family have proposed it to them. However, the liver patient is more prepared to accept it, possibly because that patient has no other alternative as do kidney patients have dialysis. Even so, they are favorable toward donating a living organ if a family member were to request one. In general, living donation is not being proposed to these patients as a real option, partly because of their doctors.

Attitude of Primary Care Nurses Toward Living Kidney Donation

INTRODUCTION

Nursing is a fundamental service in caring for the health of the public. The opinion of nurses toward a certain type of donation may have a strong population impact. In this respect, living kidney donation is increasing in Spain; it is important to raise awareness at all levels. The objective here was to analyze the attitudes of primary care nursing personnel toward living kidney donation and to their determinants.

MATERIALS AND METHODS

A random sample of primary care nurses stratified by geographical location (six health areas in our community), included 139 nurses from 32 health centres. Attitudes toward living donation were evaluated using a questionnaire with various psychosocial variables. For the distribution of the questionnaires, contact was made with the nursing coordinator in each centre. They were completed anonymously. The chi-squared test and Student's t test were applied.

RESULTS

The attitudes toward living kidney donation were favorable in 93% of those questioned (n = 129), mainly when the donation is related (78%, n = 109). Only one nurse was against the idea of donating a kidney from a living person (1%); nine had doubts about this kind of donation (7%). Seventy-six percent (n = 106) have cared for patients awaiting a transplant; however, no relationship was found with attitude toward this type of donation (P = .209). Of all analyzed variables, there was only a significant relationship with concern about possible body mutilation (P < .0005) and partner's opinion about the matter (P < .0005). We wish to highlight that no relationship was found with attitudes toward cadaveric organ donation (P = .712).

CONCLUSIONS

Attitudes of primary care nursing personnel toward living kidney donation were favorable, especially if it was related donation.

Attitude Toward Xenotransplantation Among Residents

INTRODUCTION

The deficit in transplant organs has made it necessary to search for alternatives, among them research into xenotransplantation. However, the use of animal organs may cause rejection in society and among health professionals. The objective was to analyze the acceptance of this therapy among Residents, given that they would be the professionals most involved in its application if such a therapy proves to be useful.

MATERIALS AND METHODS

A random sample stratified by the services of the Residents in a third-level hospital with an organ transplant program and accredited for teaching at undergraduate and postgraduate levels (n = 171). The attitude toward xenotransplantation was evaluated using a questionnaire that analyzes different pychosocial variables that may influence such attitude.(5)

RESULTS

The sample consisted of 171 residents (mean age 28 +/- 4 years; 56% women). Attitudes toward xenotransplantation, whether the results were similar to those obtained with human organs, were positive in 81% (n = 138) of cases, with 16% (n = 27) having doubts and 3% (n = 6) being against. The attitude was more favorable among residents in favor of cadaveric donation (83% vs 57%; P < .05) and of living donation either of the kidney (90% vs 55%; P < .001) or of the liver (88% vs 56%; P < .001), and among those who consider that they might need a transplant at a given point in the future (88% vs 73%; P < .05).

CONCLUSION

Residents have a positive attitude toward the application of a possible xenotransplantation in safe conditions similar to those that currently exist in human organ donation. Such a favorable attitude was greatly influenced by a positive attitude toward human organ donation, in cadaveric as well as in living donation, and when considering oneself to be a possible candidate for a transplant.

Attitude Toward Xenotransplantation in Kidney and Liver Patients on the Transplant Waiting List

INTRODUCTION

The deficit in transplant organs is encouraging research into stem cells and xenotransplantation. However, many studies have shown that using animals for human transplantation could be rejected by society. The objective here was to analyze the attitude of patients on the waiting list toward a possible transplant of an organ of animal origin.

MATERIALS AND METHODS

Patients on the waiting list for kidney and liver transplants including last year (n = 96) underwent a direct interview by an independent health professional from the transplant unit. Using a psychosocial survey, an evaluation was made of attitudes toward donation of organs of animal origin and its various options. Student t test and the chi-square test were used for analysis.

RESULTS

If results from xenotransplantation could be superimposed onto those of human transplantation, 71% would accept such an organ. In the case of the kidney, 83% would accept, 4% would not, and 13% have doubts; as opposed to 60%, 12%, and 28%, respectively, of liver cases (P < .05). Supposing that the results were worse than in human organs, only 26% would accept an animal organ. Thus, for kidney, 33% would accept it, 48% would not, and 20% would have doubts; and for liver, it would be 20%, 50%, and 30%, respectively. In a life-threatening situation 98% would accept an animal organ as a bridge of hope in the wait for a human organ. In addition, if the organ functioned correctly, 98% would keep the animal organ, thus avoiding an intervention to substitute a human organ.

CONCLUSION

If xenotransplantation became a clinical reality, acceptance of an animal organ by patients on the waiting list would be low, especially if the results could not be superimposed onto human ones. Only its use as a bridge until the arrival of a human organ would increase its acceptance.

Acceptance Level of Living Liver Donation Among Primary Care Nursing Personnel

INTRODUCTION

Living liver donation is not exempt from risks to the donor, although it is currently ethically accepted. It is important to examine the level of acceptance among the different health levels toward this therapeutic option, in order to design promotion and awareness-raising activities. The objective herein was to analyze the attitudes and the factors that condition them among nursing personnel in Primary Care (PC) toward living liver donation.

MATERIALS AND METHODS

This random survey was stratified by geographical location (6 health areas in our community) among PC nurses, obtaining a total of 139 nurses from 34 health centers. Attitudes toward living liver donation were evaluated using a questionnaire on donation which included different psychosocial variables. For the distribution of the questionnaire, the nursing coordinator of each centers was contacted to distribute questionnaires which were completed anonymously. The chi-square test and Student t test were applied.

RESULTS

Attitudes toward living liver donation were favorable in 89% of those questioned (n = 124) if it is related donation; 3% (n = 4) were against donating a living hemiliver and 8% (n = 11) had doubts. It is important that up to 76% (n = 106) have cared for transplant patients or patients awaiting transplant, however, no relationship was observed with attitude to this type of donation (P = .489). Of all the analyzed variables, there was only a significant relationship between attitudes and concern about possible body mutilation (P < .0005), and partners attitudes toward this matter (P < .0005). It is noteworthy that no relationship was found with attitudes toward cadaveric donation (P = .062).

CONCLUSION

Despite the risk of morbidity and mortality in the donor, the attitude of the PC nursing personnel toward living liver donation was favorable, especially if the donation is related.

Rural Primary Care Centers as a Source of Information About Organ Donation

INTRODUCTION

Primary care is an important way of promoting health in the community, and this includes organ donation. In rural areas, this way of promoting health acquires special importance. Our objective was to analyze attitudes toward organ donation among primary care workers in rural health centers to assess their importance in circulating information about donation.

MATERIALS AND METHODS

A random sample, stratified according to job category among the primary care staff (n = 160), of workers in rural areas in our autonomous community (population < 10,000 inhabitants), evaluated attitudes toward donation using a questionnaire validated in our geographic area. To distribute the questionnaire it was necessary to contact the following in each health center: the coordinating physician, the nursing coordinator, and an administrative worker.

RESULTS

Of those questioned, 78% (n = 124) were in favor of donation, as opposed to 22% (n = 36) who are against it or undecided. As for the job category, physicians and nurses showed a more favorable attitude than nonhealth workers (90% and 80% vs 61%; P = .000). The psychosocial variables that were related to such an attitude were knowledge of the concept of brain death (P = .013) and lack of fear of manipulation of the deceased person (P = .002). Regarding information about organ donation and transplantation, 54% (n = 86) reported having been provided favorable information, with up to a quarter of the physicians considering other programs to be of greater interest for primary care than organ donation and transplantation.

CONCLUSION

Attitudes toward organ donation were favorable among a high percentage of primary care workers in rural centers; more than 50% have circulated favorable information on the subject. However, there is a high percentage with a negative or undecided attitude, especially among nonhealth workers, which should be reversed with promotional activities at the level of the health center.

Use of non-aqueous capillary electrophoresis for the quality control of commercial saffron samples

A non-aqueous capillary electrophoresis (NACE) method for quantifying the seven crocin metabolites that are the major biologically active ingredients of saffron was developed. Separation is done by using a fused silica capillary filled with a 12.5 mM H3BO3/37.5 mM sodium tetraborate methanolic solution as background electrolyte. The results obtained were compared with the total index "safranal value", widely used as a quality measure of saffron products. The comparison revealed that the proposed NACE method provides useful information not obtained in the safranal value. Infact, samples with a similar safranal value can contain crocin metabolites in different concentrations and relative proportions. This new method is very useful for quality control in commercial saffron samples.

Expression of HLA-G in inflammatory bowel disease provides a potential way to distinguish between ulcerative colitis and Crohn's disease

In addition to being involved in nutrient uptake, the epithelial mucosa constitute the first line of defense against microbial pathogens. A direct consequence of this physiological function is a very complex network of immunological interactions that lead to a strong control of the mucosal immune balance. The dysfunction of immunological tolerance is likely to be a cause of inflammatory bowel disease (IBD), ulcerative colitis (UC) and Crohn's disease (CD). HLA-G is a non-classical major histocompatibility complex (HLA) class I molecule, which is highly expressed by human cytotrophoblast cells. These cells play a role in immune tolerance by protecting trophoblasts from being killed by uterine NK cells. Because of the deregulation of immune system activity in IBD, as well as the immunoregulatory role of HLA-G, we have analyzed the expression of HLA-G in intestinal biopsies of patients with UC and CD. Our study shows that the differential expression of HLA-G provides a potential way to distinguish between UC and CD. Although the reason for this differential expression is unclear, it might involve a different mechanism of immune regulation. In addition, we demonstrate that in the lamina propria of the colon of patients with UC, IL-10 is strongly expressed. In conclusion, the presence of HLA-G on the surface of intestinal epithelial cell in patients with UC lends support to the notion that this molecule may serve as a regulator of mucosal immune responses to antigens of undefined origin. Thus, this different pattern of HLA-G expression may help to differentiate between the immunopathogenesis of CD and UC.

[Multivariate study of the psychosocial factors affecting public attitude towards organ donation]

INTRODUCTION

Organ transplantation is a therapy which depends on society for its development. The objectives here are: 1) to understand the structure of public opinion towards organ donation in the population aged over 15 years of age in our Community; 2) to analyse the psychosocial variables which affect this opinion and 3) to define the population profiles on this matter.

MATERIALS AND METHODS

Random sample (n = 2.000) stratified for age, sex and geographical location (error for 95.5%, e +/- 2.24) to whom we apply a questionnaire about the psychosocial aspects of organ donation. Descriptive statistics, Student's t-test, Chi-squared test and logistical regression analysis.

RESULTS

63% have a favourable attitude towards organ donation, of which 11% have a donor's card. A statistical association has been observed between favourable public opinion and different psychosocial variables (p < 0.05), with some independent variables persisting in the multivariate analysis such as age, level of education (OR = 1.78), information given by family members (OR = 1.62), health workers (OR = 2.01) and talks in educational centres (OR = 2.13); previous experience with donation and transplantation (OR = 2.02), knowledge of the concept of brain death (OR = 1.4); partner's favourable opinion towards donation (OR = 2.6), being a blood donor (OR = 3), taking part in prosocial activities (OR = 1.6) and attitude towards incineration of the cadaver after death (OR = 1.8).

CONCLUSIONS

The profile of a person who is against donation is of a man or woman, > 50 years of age, with primary studies or below, with no previous experience of the matter, who does not understand the concept of brain death nor their partner's opinion towards donation, who has not found out any information about donation through specialised forums, with an unfavourable opinion towards blood donation or pro-social activities and who is fearful of manipulation of the cadaver after death.