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

Nurse knowledge and attitudes towards organ donation and deemed consent: the Human Organ and Tissue Donation Act in Nova Scotia

PURPOSE

In April 2019, the Human Organ and Tissue Donation Act (HOTDA) in Nova Scotia was modified to incorporate a deemed consent model. In this study, we sought to understand intensive care unit (ICU) and emergency department (ED) nurses' knowledge of and confidence around organ donation and transplantation, experiences with organ donors and recipients, attitudes toward organ donation and deemed consent, and perceived opportunities and barriers to a deemed consent approach in view of the legislative change.

METHODS

We sent an electronic, self-administered survey to all ICU and ED nurses in Nova Scotia. The survey queried respondents on their knowledge of, experience with, and attitudes around organ donation and HOTDA, and opportunities and barriers to the implementation of HOTDA in clinical practice. Survey results were analyzed using descriptive statistics.

RESULTS

One-hundred and ninety-four nurses responded to the survey. Nearly all (98%) supported organ donation, with 86% having signed an organ donor card to donate organs and/or tissues after death. A considerable majority (89%) also supported the new legislation. Nevertheless, a minority of respondents (13%) believed that deemed consent legislation would be considered a violation of the general principles of freedom and autonomy. The three most identified topics for ongoing training were coordination of the donation process (70%), clinical management of donors (70%), and family issues in decision-making (70%).

CONCLUSION

Intensive care unit and ED nurses had positive attitudes toward organ donation, including deemed consent model. The findings should inform educational initiatives in Nova Scotia and beyond to optimize organ donation processes and outcomes.

Impact of Catholicism on the Attitude Toward the Donation of Organs Among African Residents in Spain

INTRODUCTION

The African population is one of the largest immigrant groups in Europe. Religious beliefs are deeply rooted in most African societies and condition their attitude toward organ donation.

OBJECTIVE

We sought to analyze the influence of Catholicism in the attitude toward organ donation among Africans residing in Spain.

MATERIALS AND METHODS

Study participants were born in Africa and were residents in Spain. Data were obtained from the database of the International Donor Collaborative Project, which includes a sample of the population for 15 years, stratified by those who were born in Africa, as well as age and sex. The instrument used was a validated attitude questionnaire toward living kidney donation (PCID-DTO-Ríos).

RESULTS

Of the population under study, 13% are Catholics (n = 475) and 80% (n = 2896) are Muslims. The favorable attitude toward the donation of cadaver organs is 53.7% (n = 255) among Catholics compared with 25.6% (n = 742) among Muslims (P < .001). On the contrary, 17.7% of Catholics have an unfavorable opinion (n = 84), while 45.5% (n = 1280) of Muslims have an unfavorable opinion; 28.6% of Catholics and 29.2% of Muslims are undecided. In addition, among Catholics who believe that their doctrine accepts organ donation and transplantation, 70.6% (n = 132) are in favor of donating a corpse compared to those who believe that Catholic doctrine is against (P < .001 ), with only 35% (n = 7) in favor of the donation.

CONCLUSIONS

Africans who have converted to Catholicism have a more favorable attitude toward donating their own organs than those who continue in Islam.

Knowledge and attitudes of healthcare professionals and the impact on willingness to donate organs: a tertiary hospital survey

INTRODUCTION

Healthcare professionals (HCPs) working in critical care areas play an important role in the organ donation (OD) process. We studied HCPs' own willingness to be organ donors and its association with sociodemographic factors as well as their knowledge and attitudes about OD and transplantation.

METHODS

A cross-sectional survey of HCPs working in four critical care units in a major transplant centre in Malaysia was undertaken using a validated structured questionnaire. Responses were analysed using multivariable analysis with willingness to donate as the dependent variable.

RESULTS

Of the 412 respondents (response rate 98.1%), the majority were nurses (60.4%), Malay (71.1%) and female (77.2%). Overall, 68.0% were willing to donate. The independent predictors of willingness to donate were profession (p < 0.001) and the Hindu religion (p = 0.001). Ethnicity (p = 0.003), religious belief (p < 0.001), knowledge (p = 0.016), belief in brain death (p = 0.018) and confidence in transplantation (p < 0.001) also independently correlated with willingness to donate, while attitudes to OD did not. Of those willing to donate, only 37.3% were carrying a donor card and only 63.1% had informed their family of their intention to donate.

CONCLUSION

Although willingness to donate was higher in critical care HCPs than HCPs in general, significant knowledge gaps as well as certain beliefs and perceptions that could pose a barrier to OD were identified in this group. Measures to improve OD rates in Malaysia should include targeted educational programmes for HCPs working in critical care areas.

Assessment of Attitude and Knowledge of Personnel in the Intensive Care Unit of Tabriz University of Medical Sciences Hospitals Toward Organ Donation

BACKGROUND

The increasing gap between organ supply and demand remains a worldwide problem and can be attributed to several reasons. Because health care workers play an important role in management of brain dead patients, we performed a survey to evaluate the attitude and knowledge of personnel in the intensive care unit (ICU) at Tabriz University of Medical Sciences hospitals toward organ donation.

MATERIALS AND METHODS

This cross-sectional study was included personnel from 8 university affiliated ICUs in Northwest of Iran from May to July 2014. The questionnaire included parts of demographic data and socioeconomic situations as well as status of knowledge and attitude of personnel regarding organ donation.

RESULTS

Gender, age, marital status, and type of department in which personnel work did not affect attitude toward organ donation. The most common reasons for disagreement for organ donation were religious considerations, fear of surgery, and body mutilation. Nurses have a better acceptance rate than assistants and nonmedical personnel.

CONCLUSIONS

Increasing the knowledge of health care workers in ICUs has strong impact on transplantation rate. The most important thing that should be clarified for this group is the concept of brain death to achieve a multidisciplinary team that believes in organ donation and transplantation.

Knowledge, Attitudes, and Willingness Toward Organ Donation Among Health Professionals in China

BACKGROUND

The purposes of this study were to assess the knowledge, attitudes, and willingness toward organ donation among the health professionals in China.

METHODS

Questionnaires were delivered to 400 health professionals from 7 hospitals in Dalian and 1 hospital in Chaozhou of China between October 2013 and January 2014.

RESULTS

In all, 400 health professionals were approached, 373 valid responses were returned. Over 90% of the participants knew about organ donation, but only 17.4% had taken part in some training courses or lectures about organ donation. Health professionals (64.9%) knew the shortage status of organ, and doctors knew more than nurses and nonclinical staffs (P < 0.01). Health professionals (97.3%) knew brain death, and 68.9% professionals thought brain death was the reasonable criteria to judge death. Doctors showed a higher knowledge level about brain death than nurses and nonclinical staffs (P < 0.01). Altogether, 60.1% approved deceased donation; however, only 48.5% approved living donation. Doctors' attitudes were more positive than nurses and nonclinical both in deceased donation (P < 0.01) and in living donation (P < 0.05). In all, 49.3% were willing to donate their own organs postmortem, and doctors had higher willingness to donation postmortem compared with nurses and nonclinical staffs (P < 0.01). The most (49.2%) commonly cited reason for refraining from donation was: "afraid that organs would be picked up inhumanely and body would be disfigured".

CONCLUSIONS

Health professionals showed lower favorable attitudes and willingness toward organ donation than Chinese general public. A proportion of Chinese health professionals' knowledge about organ donation was limited.

Organ Donation Among Tiers of Health Workers: Expanding Resources to Optimize Organ Availability in a Developing Country

The global increase in end organ failure but disproportional shortage of organ donation calls for attention. Expanding the organ pool by assessing and improving health workers' attitude at all levels of care may be a worthwhile initiative.

METHODS

A questionnaire-based cross sectional study involving tertiary, secondary, and primary health institutions in Southwestern Nigeria was conducted.

RESULTS

Age range was 18 to 62 (36.7 ± 9.2) years. Only 13.5%, 11.7%, and 11.2% from primary, secondary, and tertiary health centers, respectively, would definitely donate despite high level of awareness (>90%) at each level of care. Participants from primary health care are of low income (P < 0.05), and this cohort is less likely to be aware of organ donation (P < 0.05). At each level of care, permission by religion to donate organs influenced positive attitudes (willingness to donate, readiness to counsel families of potential donors, and signing of organ donation cards) toward organ donation. Good knowledge of organ donation only significantly influenced readiness to counsel donors (P < 0.05) and not willingness to donate (P > 0.05). At each level of health care, young health care workers (P < 0.05) and women (P > 0.05) would be willing to donate, whereas men show positive attitude in signing of organ donor cards (P < 0.05) and counseling of families of potential donors (P > 0.05).

CONCLUSIONS

Knowledge and willingness to donate organs among health care levels were not different. Considering the potential advantage of community placement of other tiers of health care (primary and secondary) in Nigeria, integrating them would be strategically beneficial to organ donation.

A multicenter study on attitude toward organ donation in Spain and Latin America between the surgical units of 12 hospitals

INTRODUCTION

Medical advances and improvements in surgical techniques have transformed transplantation into an ever safer therapeutic option. However, its main limitation is the shortage of available organs. Therefore, it is necessary to join forces to achieve optimal deceased donation and prevent the loss of potential donors. We sought to analyze the acceptance of deceased organ donation (OD) among hospital personnel in surgical units in hospitals in Spain and Latin America.

METHOD

A random sample (n = 554) was taken was stratified according to surgical services and job category in 12 hospitals-4 in Spain (n = 294 participants), 5 in Mexico (n = 202), 2 in Cuba (n = 41), and 1 in Costa Rica (n = 17). Attitude was assessed using a questionnaire validated, which was completed anonymously and self-administered. The χ(2) test, Student t test, and a logistic regression analysis were used.

RESULTS

Overall, 75% of respondents (n = 417) were in favor of deceased OD and 25% were against it (n = 137). Regarding the respondent's country, there was a favorable attitude among 88% of Cubans, 85% of Mexicans, 82% of Costa Ricans, and 67% of Spaniards (P < .001). The physicians were most in favor of OD with 87% supporting it (n = 149), followed by nurses (n = 182) and ancillary personnel (n = 28) both at 74%, and the health care assistants at 59% (n = 58; P < .001). The following factors affect attitude toward OD: young age (37 ± 10 years; P = .001), being a male (P = .018), having an unstable job situation (P = .009), a belief that one might need a future transplant (P = .036), having a favorable attitude toward living donation (P < .001), being in favor of donating a family member's organs (P < .001), having had a family discussion about OD (P < .001), and a partner's favorable attitude (P < .001).

CONCLUSIONS

Attitude toward OD among surgeons in hospitals in Spain and Latin America was not as favorable as we might have expected.

Attitudes of medical students and staff toward organ donation in cases of brain death: a survey at Shiraz University of Medical Sciences

CONTEXT

Organ transplant is one of the most important management strategies for end-of-life patients. The demand for organs in patients awaiting transplant is increasing, and many of these patients die before a donor is found.

OBJECTIVE

To determine the attitudes of medical students and staff at clinical institutions affiliated with a large medical university in the Eastern Mediterranean region toward organ donation in cases of brain death.

PARTICIPANTS

A total of 500 medical students, physicians, and nurses recruited at hospitals and medical centers affiliated with Shiraz University of Medical Sciences in Shiraz, Iran.Design and Setting-Information about participants' demographic characteristics, knowledge of organ donation, and willingness to donate their own organs after death was collected by using self-administered questionnaires.

RESULTS

Most participants (78%) had favorable attitudes toward donating their own organs after brain death. However, only about 25% of them carried an organ donation card. In addition to public media, the main sources of information about organ donation after brain death were their professors and textbooks. An association in charge of improving public awareness and facilitating the process of registration and issuance of donation cards appears to be necessary.

Spanish-Latin American multicenter study of attitudes toward organ donation among personnel from hospital healthcare centers

INTRODUCTION

Hospital personnel are a group which has an influence on the opinion of the rest of the population about healthcare matters. Any unfavorable attitude of this group would be an obstacle to an increase in organ donation.

OBJECTIVE

To analyze the attitude of hospital workers toward the donation of one's own organs in Spanish and Latin American hospitals and to determine the factors affecting this attitude.

MATERIAL AND METHOD

Eleven hospitals from the "International Collaborative Donor Project" were selected, 3 in Spain, 5 in Mexico, 2 in Cuba and one in Costa Rica. A random sample was stratified by the type of service and job category. Attitude toward donation and transplantation was assessed using a validated survey. The questionnaire was completed anonymously and was self-administered.

STATISTICAL ANALYSIS

Student's t-test, the χ2 test and logistic regression analysis.

RESULTS

Of the 2,785 workers surveyed, 822 were from Spain, 1,595 from Mexico, 202 from Cuba and 166 from Costa Rica and 79% (n=2,191) were in favor of deceased organ donation. According to country, 94% (n=189) of Cubans were in favor, compared to 82% (n=1,313) of the Mexicans, 73% (n=121) of the Costa Ricans and 69% (n=568) of the Spanish (P<.001). In the multivariate analysis, the following variables had the most specific weight: 1) originating from Cuba (odds ratio=8.196; P<.001); 2) being a physician (OR= 2.544; P<.001); 3) performing a job related to transplantation (OR = 1.610; P=.005); 4) having discussed the subject of donation and transplantation within the family (OR= 3.690; P<.001); 5) having a partner with a favorable attitude toward donation and transplantation (OR= 3.289; P<.001); 6) a respondent's belief that his or her religion is in favor of donation and transplantation (OR= 3.021; P=.001); 7) not being concerned about the possible mutilation of the body after donation (OR= 2.994; P<.001); 8) the preference for other options apart from burial for treating the body after death (OR= 2.770; P<.001); and 9) acceptance of carrying out an autopsy if one were needed (OR= 2.808; P<.001).

CONCLUSIONS

Hospital personnel in Spanish and Latin American healthcare centers had a favorable attitude toward donation, although 21% of respondents were not in favor of donating. This attitude was more favorable among Latin American workers and was very much conditioned by job-related and psychosocial factors.

Honoring Deceased Donors with a Unique Family-Designed Statement Followed by a Moment of Silence: Effect on Donation Outcomes

Context

Studies indicate that donor families and hospital staff, particularly operating room staff, fear that organ donors will not be treated with dignity, honor, and respect.

Objective

The ritual of a unique, family-designed statement of honor followed by a 15-second moment of silence in the operating room before organ recovery was implemented to honor organ donors and their families. The purpose of this study was to describe the development of the ritual and to investigate its impact on donation rates in the California Transplant Donor Network's service area.

Design

Cross-sectional observational study.

Setting

The California Transplant Donor Network, an organ procurement organization.

Participants

58 organ donors and families in 39 donor hospitals.

Main Outcome Measures

Variables of interest included hospital rate of referral and of timely referral to their organ procurement organization, collaborative conversion rates, and donor families' response to implementation of the new ritual.

Results

The ritual was implemented in 2011 in several randomly selected hospitals locally. Seventy-one unique rituals were performed in 22 local hospitals in the trial period. No families or health care providers declined to participate. Families reported that the ritual honored their loved ones. Although the collaborative conversion rates were similar in hospitals before implementation (2010), implementation of the ritual affected donation rates in 2011.

Conclusions

The 15-second moment of silence honors deceased donors and their families and improves donation rates in donor hospitals.

Multivariate analysis to determine the factors affecting the attitudes toward organ donation of healthcare assistants in Spanish and Mexican healthcare centers

BACKGROUND

Healthcare assistants are an important group of workers who can influence public opinion. Their attitudes toward organ donation may influence public awareness of healthcare matters; negative attitudes toward donation and transplantation could have a negative impact on public attitudes. Our objective was analyze the attitudes of healthcare assistants, in Spanish and Mexican healthcare centers toward organ donation and determine factors affecting them using a multivariate analysis.

MATERIAL AND METHODS

As part of the "International Collaborative Donor Project," 32 primary care centers and 4 hospitals were selected in Spain and 5 hospitals in Mexico. A randomized sample of healthcare assistants was stratified according to healthcare services. Attitudes were evaluated using a validated questionnaire of the psychosocial aspects of donation, which was self-completed anonymously by the respondent. Statistical analysis used the chi-square test, Student t test, and logistic regression analysis.

RESULTS

Of 532 respondents, 66% in favored donation and 34% were against it or undecided. Upon multivariate analysis, the following variables had the most weight: 1) country of origin (Mexicans were more in favor than Spanish; odds ratio [OR]) = 1.964; P = .014); 2) a partner with a favorable attitude (OR = 2.597; P = .013); 3) not being concerned about possible bodily mutilation after donation (OR = 2.631; P = .006); 4) preference for options apart from burial for handling the body after death (OR = 4.694; P < .001) and 5) accepting an autopsy if one was needed (OR = 3.584; P < .001).

CONCLUSIONS

The attitudes of healthcare assistants toward organ donation varied considerably according to the respondent's country of origin. The psycho-social profile of a person with a positive attitude to donation was similar to that described within the general public.

Secondary school teachers' assessment of the introduction of an educational program about organ donation and transplantation

INTRODUCTION

It is essential to provide information about organ donation and transplantation (ODT) to encourage school pupils to have favorable attitudes toward this matter in the future. The role of the teacher is crucial in this respect. The objective of this study was to determine acceptance by secondary school teachers of an educational program about ODT.

MATERIALS AND METHODS

A random sample of secondary school teachers was taken from 10 secondary schools in the southeast of Spain. A total of 288 teachers were surveyed using a questionnaire that assessed the following; (1) acceptance of the educational program; (2) who should carry it out; and (3) some psychosocial variables related to ODT.

RESULTS

Of the 288 secondary teachers surveyed, 283 of them responded to the acceptance of an educational program on ODT. Approximately half (54%) of the respondents believed that it would be appropriate to introduce an educational program about ODT in secondary schools, 22% believed that there were currently other more important educational considerations, 20% had doubts, and 4% believed that it would not be useful. The vast majority (71%) believed that a collaborator from the Regional Transplant Team would be the best person to carry out the program followed by any teacher (11%) or a teacher of ethics (9%). The remaining 9% were not sure. There was greater acceptance of an educational program about ODT among teachers who had a favorable attitude toward the matter (P = .003).

CONCLUSIONS

An educational program about ODT in secondary education was not equally accepted by all teachers. Most teachers believed that the program should be delivered by the Transplant Coordination Center rather than teachers themselves.

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 procuring 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.

Evaluation of the law of presumed consent after brain death by Spanish journalism students

INTRODUCTION

Information provided by journalists is crucial to create a climate of social opinion. This is important in organ donation and transplantation (ODT), wherein the participation of the general public is essential to obtain organs.

OBJECTIVE

The objective of this study was to determine the knowledge of students taking a degree in journalism about the concept of brain death and the law of presumed consent.

MATERIALS AND METHODS

The study involved 129 journalism degree students in the 2005-2006 academic year from a university in the south-east of Spain. Attitudes on the psychosocial aspects of ODT were evaluated using a validated questionnaire. The self-administered survey was completed anonymously in classes and compulsory practical sessions.

RESULTS

The questionnaire completion rate was 98% (n=126). Of the students surveyed, 43% (n=54) understood the concept of brain death, 44% (n=56) stated that they had doubts, whereas 13% (n=16) believed that a person with brain death can recover and lead a normal life. Their knowledge was more accurate in the final than in the first year (54% vs 47%; P=.016). Most students 66% (n=83) believed that it would be interesting to receive an informative talk about ODT. Concerning legislation, 75% of students were against the law of presumed consent, whereas 25% were in favor.

CONCLUSION

More than 50% of journalism students do not understand the concept of brain death. Furthermore, up to 75% do not accept the law of presumed consent that donation must be made.

From where do our children receive information about organ donation and transplantation?

INTRODUCTION

The information provided about organ donation and transplantation (ODT) affects whether it is viewed favorably or unfavorably.

OBJECTIVES

The objective of this study was to determine the means by which each source of information about ODT influenced attitudes of children.

MATERIAL AND METHODS

Ten secondary schools from the south-east of Spain were stratified geographically. We performed a random selection of pupils from the first 4 years of compulsory secondary range, education (age 11-15 years). A validated self-administered questionnaire about attitudes toward ODT was completed anonymously.

RESULTS

The adolescents had received information about ODT through several sources. The most frequent sources were television (86%), films (59%), and magazines (56%). Positive information from information sources was associated with more favorable attitudes toward ODT (P<.05); those who received negative information had more unfavorable attitudes (P<.05).

CONCLUSIONS

Most information about ODT that reaches our children is through audiovisual means. Attitudes were more favorable among adolescents who have received positive information through the mass media, with more negative attitudes among those who received negative information.

A hierarchical communication model of the antecedents of health care professionals' support for donations after cardiac death

Using structural equation modeling, the direct and indirect impact of five variables on the support of donation after cardiac death from the perspective of health care professionals were investigated: knowledge, trust in the transplant team, whether patients are in a state of irreversibility, whether health care professionals participate in a patient's death, and perceptions about the brain death versus cardiac death donation process. In total, 10/15 relationships posited in the model had significant pathways. The results provide insight into sequential communication strategies for generating support for donations after cardiac death.

Attitude of Nursing Staff toward Organ Donation in a Spanish Hospital with a Solid-Organ Transplant Program

Context

Nursing personnel are fundamental in the organ donation and transplantation process, and their attitude toward donation has a decisive effect on patients, patients' families, and the general public.

Objective

To analyze the attitudes of nursing personnel toward donation in a transplant hospital and the factors that determine those attitudes.

Materials and Methods

A random sample of 305 nurses in different hospital services was taken and stratified by type of service. A validated psychosocial questionnaire was used to evaluate attitudes toward donation. The survey was completed anonymously and was self-administered. Student t test, χ2 test, and logistic regression analysis were used for statistical analysis.

Results

Most respondents (63%) favored organ donation. The following variables affected attitude: (1) having a favorable attitude toward donation of a family member's organs ( P < .001), (2) knowing the concept of brain death ( P < .001), (3) having discussed organ donation and transplantation within the family ( P = .001), (4) having a favorable attitude toward autopsy ( P = .006), (5) fearing mutilation of the body ( P < .001), (6) a partner's attitude toward organ donation and transplantation ( P < .001), and (7) the respondent's religion ( P = .009). Multivariate analysis yielded the following significant factors: (1) fear of mutilation of the body (odds ratio, 9.5), (2) partner's attitude toward organ donation and transplantation (odds ratio, 0.2), and (3) respondent's religion (odds ratio, 2.7).

Conclusions

Attitudes toward organ donation among nurses are similar to attitudes of the general public in Spain. Given the influence of nurses on the general public, promotional campaigns directed at nurses are a priority.

Increasing organ donations after cardiac death by increasing DCD support among health care professionals: a case report

This case report focuses on the University of Wisconsin Hospital and Clinics Organ Procurement Organization (UWHC-OPO) efforts to produce a verifiable and demonstrable increase in organ donations by developing a replicable, transferable and feasible model intervention for increasing health care professionals' support for donation after cardiac death (DCD). A grant from the US Department of Health and Human Services funded a 3-year study allowing the UWHC-OPO to (i) identify barriers to and opportunities for increasing DCD support among those involved in the donation request process, (ii) implement this better understanding of these support factors in the creation of intervention materials designed to increase knowledge of and support for DCD and finally (iii) to track and document the progress made in increasing knowledge, support, number of hospitals with DCD protocols, actual requests made and number of DCD donors. The results of the model intervention were extremely positive, showing lasting increases in DCD knowledge and support, adoption of DCD protocols and referrals in the two tracking survey stages following the intervention. Perhaps most notably, DCD donor numbers within the UWHC-OPO region increased 93% in the year following the intervention and 179% to date.

An empirical examination of the antecedents of the acceptance of donation after cardiac death by health care professionals

Findings are reported from a US Department of Health and Human Services (DHHS) funded study to identify barriers to increasing support for donations after cardiac death by health professionals. A donations after cardiac death (DCD) acceptance model is conceptualized and tested via 806 survey responses from certified requestors, all of whom had their identities protected through Institutional Review Board (IRB) protocol. The overall model was significant and explained 35% of the variation in DCD support. Greater knowledge about DCD, greater trust in the organ procurement organization (OPO) and a belief that futility has been reached were all positively associated with DCD acceptance. Negative perceptions of DCD versus brain death, transitioning from caregiving to donation advocate, concerns about the DCD process and the idea that DCD leads to active participation in the death reduced its support. The three greatest impediments to support of DCD exist when health professionals feel they are playing an active role in killing the patient, that a state of death has not yet been reached, and that DCD has more psychological barriers than does the brain death donation process. Opportunities and strategic initiatives are discussed to overcome these barriers, including the value of communication and education initiatives and the need for well-trained requestors. The implementation of these strategic guidelines helped to increase the number of DCD donors by 225%.

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.

Are personnel in transplant hospitals in favor of cadaveric organ donation? Multivariate attitudinal study in a hospital with a solid organ transplant program

INTRODUCTION

A considerable number of professionals who work in a hospital could be against organ donation, which means that when the time comes, they could act as an obstacle to donation. The objective of this study was to analyze the attitude of hospital professionals toward organ donation and to determine the factors that influence this attitude in a Spanish center with a transplant program.

MATERIALS AND METHODS

The study was carried out in a third-level Spanish hospital with a solid organ transplant program. A random sample was taken (n = 1262) and stratified by job category and type of service. Attitude was evaluated using a validated questionnaire. Contact was made in each service with the person responsible for each of the job categories in order to distribute the survey. The survey was completed anonymously and was self-administered. Student's t-test, the chi-squared test, and logistic regression analysis were applied in the statistical analysis.

RESULTS

The survey completion rate was 93% (n = 1168). Most respondents were in favor of donation [69% (n = 808)]. Of those who are not in favor, 29% (n = 105) provide fear of apparent death as the reason whilst most do not give a reason (negative assertion; 57%; n = 206). There are many factors related to this attitude toward donation, which are evident in the multivariate analysis: (i) job category, in which physicians are twice as likely to be in favor of donation than ancillary personnel (OR = 2.02); (ii) a respondent's knowledge of brain death (OR = 1.64); (iii) having discussed the matter of organ donation and transplantation within the family (OR = 1.89); (iv) a preference for other options apart from burial (OR = 3.66); (v) being in favor of the performance of autopsy if it were necessary (OR = 2.76); (vi) not being concerned about mutilation of the cadaver (OR = 2); and (vii) having a partner with a favorable attitude toward donation (OR = 2.2).

CONCLUSIONS

Attitude toward cadaveric organ donation among personnel in a transplant hospital is similar to that described in the general public and is determined by many factors. The following factors are most noteworthy: (i) job category; (ii) knowledge of the concept of brain death; (iii) consideration of the matter of donation in the family; and (iv) fear of manipulation of the cadaver. In view of this attitude, which is similar to that of the general public, it is necessary to carry out promotion activities if we want to increase cadaveric donation rates.