[Acceptance of post-mortem organ donation in Germany : Representative cross-sectional study]

Attitudes and factors influencing organ donation decision-making in Damascus, Syria: a cross-sectional study

Organ donation is vital to saving lives, but its success depends on people's willingness to donate organs. This descriptive cross-sectional survey aimed to investigate attitudes towards organ donation in Damascus, Syria. Understanding attitudes is crucial for the success of organ donation programs, especially in countries with similar settings. This study was a descriptive cross-sectional survey aimed at understanding patients' attitudes towards organ donation in Damascus, Syria. Data was collected through a carefully constructed validated survey through face-to-face interviews. 600 participants were randomly interviewed, 62.8% agreed to donate their organs after death, with helping others being the primary reason. Religious beliefs were the primary reason for organ refusal in males, while for females, it was lack of knowledge and religious beliefs. However, there were no significant differences between genders or educational level and age groups in the acceptance of organ donation. The percentage of those who agree to donate their organs after death encourages taking an effective step to build an integrated donation system, not just a center. Bearing in mind that there is no correlation with age, gender or even educational level, which means that the system may include different groups of society.

[Assessment and operationalization of the characteristic "gender" in representative population-based surveys: challenges and implications with the example of the GeSiD study]

Repräsentative quantitative Surveys erheben das Geschlecht der Teilnehmenden, um geschlechtsspezifische Analysen im Hinblick auf die jeweiligen Fragestellungen zuzulassen und Rückschlüsse auf die Populationen zu ziehen. Dies ist wichtig, um zielgruppenspezifische Informationen und Angebote zu entwickeln. Doch obwohl Geschlecht nicht mehr ausschließlich als ein binäres Konstrukt betrachtet wird, wird es noch oft durch eine binäre Variable mit den Antwortmöglichkeiten Frau/Mann oder weiblich/männlich erhoben. In diesem Artikel erörtern wir, warum dieses Vorgehen veraltet bzw. unvollständig und eine Abkehr von diesem Ansatz wichtig und notwendig ist. Anhand der GeSiD-Studie zu „Gesundheit und Sexualität in Deutschland“ zeigen wir in diesem Diskussionsbeitrag exemplarisch auf, wie Geschlecht anhand eines zweistufigen Modells erhoben werden kann, bei dem im ersten Schritt das bei der Geburt zugewiesene Geschlecht und im zweiten Schritt die subjektive Geschlechtszugehörigkeit abgefragt wird. Gleichzeitig erörtern wir die Herausforderungen, die dieser Ansatz mit sich bringt. Die Erfahrungen aus der GeSiD-Studie setzen wir in einen größeren Kontext und diskutieren die Implikationen und Möglichkeiten zur Operationalisierung von Geschlecht in repräsentativen Befragungen.

Experiences from six years of quality assured Model of End Stage Liver Disease (MELD) diagnostics

BACKGROUND

The model of end-stage liver disease (MELD) score was established for the allocation of liver transplants. The score is based on the medical laboratory parameters: bilirubin, creatinine and the international normalized ratio (INR). A verification algorithm for the laboratory MELD diagnostic was established, and the results from the first six years were analyzed.

METHODS

We systematically investigated the validity of 7,270 MELD scores during a six-year period. The MELD score was electronically requested by the clinical physician using the laboratory system and calculated and specifically validated by the laboratory physician in the context of previous and additional diagnostics.

RESULTS

In 2.7% (193 of 7,270) of the cases, MELD diagnostics did not fulfill the specified quality criteria. After consultation with the sender, 2.0% (145) of the MELD scores remained invalid for different reasons and could not be reported to the transplant organization. No cases of deliberate misreporting were identified. In 34 cases the dialysis status had to be corrected and there were 24 cases of oral anticoagulation with impact on MELD diagnostics.

CONCLUSION

Our verification algorithm for MELD diagnostics effectively prevented invalid MELD results and could be adopted by transplant centers to prevent diagnostic errors with possible adverse effects on organ allocation.

Effects of Humor in Health Communication: Experimental Evidence for Video Sequences Aiming to Increase the Willingness to Donate Organs

Humor has been proven to provide support when dealing with fear-related aspects of life. Therefore, it might be a useful communication strategy for addressing the need for donated organs. We conducted an experimental study among University students in Germany (n = 236) aged about 25 years (M = 24.60, SD = 5.86) investigating the effects of four video sequences related to organ donation on the willingness to donate organs. Based on random allocation, each study participant received one video sequence. The video sequences were presented by either a prominent or non-prominent speaker and included either humorous or neutrally framed information related to organ donation. An online survey was conducted before and after the intervention. A follow-up to investigate long-term effects was conducted 4-6 weeks later. Overall, the four interventions led to high proportions of self-reported willingness to think about organ donation and talk about it with relatives and friends subsequent to the respective intervention. Appraisals beneficial to organ donation improved significantly only in the non-humorous interventions. It seems to be of little relevance whether the humorous message was communicated by a prominent or non-prominent person. However, future investigations should focus on sample populations with lower education, because they are less likely to possess an organ donor card and more likely to have lower levels of positive attitudes toward organ donation and may, therefore, show different results regarding the effectiveness of humorous interventions.

Knowledge and Attitudes of Health Care Professionals and Laypeople in Relation to Brain Death Diagnosis and Organ Donation in Hungary: A Questionnaire Study

OBJECTIVES

The aim of the present work was to assess the knowledge and attitudes of different health care workers and laypeople toward the donation and transplantation procedure.

SUBJECTS AND METHODS

A survey consisting of questions regarding brain death diagnosis, legal organization or organ donation, and the transplantation procedure were sent to participants: 56 intensive care unit (ICU) doctors, 76 ICU nurses, 188 sixth-year medical students, and 320 general practitioners (GPs). Laypeople were also asked to complete the survey.

RESULTS

The majority of participants reported being aware of legal regulations for organ donation in Hungary (88.5%). Roughly 25% of GPs and 60% of laypeople were unaware of the opt-out system effective in the country. Less than one-third of ICU physicians (26.9%) and nurses (34.7%) were able to list the organs that may be transplanted from a deceased donor; GPs (22.4%) and medical students (20%) performed even worse on this item. The willingness of ICU specialists (57%) and ICU nurses (45%) to support donating their own organs was moderate.

CONCLUSIONS

The results of this survey indicate a need for graduate and postgraduate education and regular teaching programs regarding organ donation and transplantation. More active use of modern media is proposed to improve public awareness and acceptance of organ donation.

Attitudes and knowledge about post-mortem organ donation among medical students, trainee nurses and students of health sciences in Germany

Objective

In 2018 Germany had the lowest rate of post-mortem organ donation in the Eurotransplant network. Healthcare trainees and students will be important advisors on organ donation for patients in the future. This study aimed to examine 1) attitudes and knowledge about post-mortem organ donation, 2) how past transplantation scandals have affected those attitudes and 3) how satisfied respondents were with the knowledge provided on the courses.

Methods

A cross-sectional study was conducted between 20 March and 8 July 2019 at a university hospital and nursing schools in Berlin and Potsdam, Germany. Study participants were 209 medical students, 106 health sciences students and 67 trainee nurses.

Results

Of the respondents 29.3 and 50.8% knew the tasks of the German Organ Transplantation Foundation and Eurotransplant, respectively. All brain death questions were correctly answered by 56.3% of the medical students, 25.7% of the health sciences students and 50.9% of the trainee nurses (Fisher’s exact test p < 0.001, Cramer’s V = 0.242). Transplantation scandals had damaged attitudes towards organ donation for 20.7% of the medical students, 33.3% of the health sciences students and 13.6% of the trainee nurses (χ²-test p = 0.001, Cramer’s V = 0.164). Asked whether post-mortem organ donation was sufficiently addressed in their courses, 39.5% of the medical students, 60.4% of the health sciences students and 51.9% of the trainee nurses said this was not or tended not to be the case (Kruskal-Wallis H-test p < 0.001, Spearman’s rho r = −0.112).

Conclusion

Given the knowledge gaps identified and the respondents’ dissatisfaction with the knowledge they received, organ donation should be better integrated into curricula and training programs.

Risk Factors for High Mortality on the Liver Transplant Waiting List in Times of Organ Shortage: A Single-Center Analysis

BACKGROUND Germany has the highest rate of patients dying or becoming unfit for transplant while waitlisted within the Eurotransplant region. Therefore, the aim of the current study was to analyze mortality as well as risk factors for mortality of candidates listed for liver transplantation at our center. MATERIAL AND METHODS Between 01/2011 and 12/2013, 481 adult patients were listed for primary liver transplantation (LT) at a single German center. Clinical and laboratory parameters were prospectively collected and retrospectively analyzed by univariable and multivariable logistic regression and Cox proportional hazards. RESULTS The mean model for end-stage liver disease (MELD) score of all liver transplant waitlist registrants (52.4 years, 60.1% male) was 16.9 (±10.2) at time of listing, with 10% of the listed patients having a MELD score of >32. After waitlisting, 133 (27.7%) candidates died within the follow-up period. Three-month-survival after listing for transplantation was 89% for patients ultimately receiving LT vs. 71.2% that did not receive LT (p<0.001). Multivariable analysis identified clinical parameters such as ICU treatment, preceding abdominal surgery, variceal bleeding, and ascites, as well as hydropic decompensation, as independent risk factors for waitlist mortality. CONCLUSIONS Consideration of independent risk factors of mortality within the MELD-based allocation system potentially improves assessment of individual urgency and might improve utilization of available organs.