Remapping the organ donation ethical climate: a care ethics consideration

Organ donation has gained much attention as the need for transplant exceeds the supply of organs. Various proposals have been put forward to address the organ shortage challenge, ranging from offering incentives to donors, addressing family refusals to donations and instituting presumed consent laws. Presumed consent as the favoured approach has not been universally effective in increasing actual transplants despite its appeal. Few considerations have been given to the broader ethical climate influencing the organ donation debate. This paper examines the ethical climate surrounding organ donation and identifies the challenges existing within such environments. It explores care ethics and its application to the donation system, demonstrating how it can influence the organ donation phases. The conclusion drawn from the analysis is that a caring ethical climate in the pre, during and post-transplant system respects donor autonomy, addresses family reluctance to agree to donation, facilitates the needs of the donee and creates an environment that promotes non-maleficence for all stakeholders.

Attitude of Older People Toward Living Donation

BACKGROUND

Living donation is a potential source of organs that could help to reduce the organ transplant deficit. Given that we have a worldwide aging population, it is important to assess the opinion of older people toward this type of donation.

OBJECTIVES

To analyze the attitude of people aged > 65 years toward living kidney donation (LKD) and living liver donation (LLD) and to investigate the variables affecting their attitudes.

METHODS

A multicentric study was carried out using a representative sample of people > 65 years stratified by sex and geographic location in southeastern Spain (n = 420). The measurement instrument was a validated questionnaire about LKD and LLD. Statistics were analyzed using SPSS version 21.0 (IBM Corp, Armonk, NY, United States) software. Descriptive analysis was carried out using Student t test, χ² test, and a multivariate analysis.

RESULTS

The questionnaire completion rate was 84% (n = 351) with 88% (n = 310) in favor of LKD, and 89% (n = 311) in favor of LLD. Favorable attitude decreased to 3% when the donation under consideration was unrelated. Attitudes toward LKD and LLD were associated with having received information from the television (P = .016 and P = .045) and from friends (P = .017 and P = .03); accepting an autopsy after death (P = .001 and P = .002); and not being worried about scars (P = .015 and P = .044). In the multivariate analysis, the following variables continued to be significant: having received information from the television (odds ratio [OR], 2) and from friends (OR, 10.3); and the acceptance of an autopsy (OR, 2).

CONCLUSIONS

Older people are in favor of both LKD and LLD, assuming it is a related donation. In addition, the information the elderly population receives regarding organ donation and transplantation affects their attitudes.

Are Ghanaians Residing in Spain Aware of the Donation of Living Related Kidney?

INTRODUCTION

The population of Ghana has an emerging migratory flow to Europe and especially to Spain. Therefore, there is an increase in waiting lists in kidney transplantation.

OBJECTIVE

To analyze the attitude toward related living kidney donation (LKD) among the population born in Ghana and residing in Spain.

MATERIAL AND METHODS

Population under study. Population born in Ghana and resident in Spain.

INCLUSION CRITERIA

Sample of population over 15 years stratified by age and sex, according to census data and immigrant assistance associations.

INSTRUMENT

Validated attitude questionnaire toward LKD "PCID-DVR-Ríos." Field work. Random selection of people to be surveyed according to stratification.

RESULTS

A total of 237 respondents have been included in the study. 72% are in favor of LKD, not just related. The remaining 28% do not accept the related living donation or have doubts about it. Respondents in favor of the related LKD have a more positive attitude toward ODT (P < .001). The attitude toward related LKD is linked to socio-personal factors, knowledge factors about the donation and organ transplantation process, social interaction factors, attitude factors toward the body, religious factors, and the risk assessment that comes with a living donation (P < .05). In the multivariate analysis persists: the attitude toward the cadaveric OTD (odds ratio [OR] = 6.993), perform pro-social activities (OR = 14.084), fear of body mutilation (OR = 20.408) and renal risk (OR = 29.411).

CONCLUSIONS

The Ghanaian population immigrating to Spain has an unfavorable attitude toward related LKD compared with existing studies of Western European and Spanish populations, which is conditioned by multiple psychosocial factors.

Sensitization Toward Organ Donation Among Medical Students in Spanish Regions With More Than 50 Donors Per Million Population

The awareness of organ donation among health professionals is important at the time of transplant promotion. In this sense, the training and awareness of the professionals in training is fundamental.

OBJECTIVE

To analyze the differences in the attitude toward organ donation and the factors that condition it among medical students of regions with donation rates >50 donors per million population (pmp) with respect to those with rates <40 donor pmp.

METHOD

Population under study: medical students in Spanish universities. Database of the Collaborative International Donor Project, stratified by geographic area and academic course. The completion was anonymous and self-administered. Groups under study: Group 1 (n = 1136): students in universities of regions with >50 donors pmp. Group 2 (n = 2018): university students in regions with <40 donors pmp. Assessment instrument: attitude questionnaire for organ donation for transplant PCID-DTO-Ríos.

RESULTS

The attitude toward organ donation for transplantation is similar among students from the autonomous communities with >50 donors pmp and with <40 donors pmp. In group 1, 79% (n = 897) of students are in favor compared with 81% (n = 1625) of group 2 (P=.29). The psychosocial profile toward donation is similar in both groups relating to the following variables (P < .05): sex, having discussed transplantation with family and as a couple, considering the possibility of needing a transplant, involvement in prosocial activities, attitude toward the manipulation of corpses, knowledge of the brain death concept, and religion.

CONCLUSIONS

The awareness of organ donation in Spanish medical students is quite homogeneous and is not related to the local donation rates of each region.

Are High Rates of Deceased Donation Conditioning the Attitude Toward Liver Donation Among Medical Students?

The involvement of health professionals from their training period is important for the promotion of living liver donation. There are data that indicate that the awareness of living donation is lower in areas with high rates of deceased donation.

OBJECTIVE

To analyze the attitude toward living liver donation among Spanish medical students, according to donation rates of their regions.

METHOD

Population under study: Medical students in Spanish universities. Database of the Collaborative International Donor Project, stratified by geographic area and academic course. The completion was anonymous and self-administered. Groups under study: group 1 (n = 1136): students in universities of regions with >50 donors per million population (pmp); group 2 (n = 2018): students in region universities with <40 donors pmp. Assessment instrument: the attitude questionnaire for living liver donation Proyecto Colaborativo Internacional Donante sobre Donación de Vivo Hepático-Ríos (PCID-DVH Ríos).

RESULTS

The attitude toward related liver donation is more favorable among the students of regions with <40 donors pmp than among those of >50 donors pmp. Thus, in group 1, a total of 88% (n = 1002) of students are in favor compared with 91% (n = 1831) of group 2 (P=.02). The psychosocial profile of each study group about their attitude toward living related liver donation is analyzed. There is a similar profile between the 2 groups, although there are differences in some variables such as age, a belief that one might need a transplant, family discussion about donation and transplantation, discussion with friends about donation and transplantation, and knowing about a donor.

CONCLUSIONS

The awareness of living related donation among Spanish medical students is greater among the regions with lower organ donation rates.

Gypsy Population With University Studies Is a Key Ethnic Subgroup for the Promotion of Organ Donation Among the Gypsy Population

INTRODUCTION

The refusal to consider death and the donation and transplantation of organs make Gypsies one of the subpopulation groups with the lowest donation rates in Europe. The approach of this social group implies the support of the most favorable social groups within their own ethnic group. In this sense, the young population with a high level of education is usually the most favorable toward organ donation.

OBJECTIVE

To analyze the attitude toward the donation of one's own organs for transplantation among the Gypsy population under 45 years and with secondary or university studies.

METHOD

Population under study: The Gypsy population under 45 years old with secondary or university studies who currently reside in Spain. Assessment instrument: The attitude questionnaire for organ donation for transplantation PCID-DTO Ríos. Fieldwork: A random selection based on stratification. Anonymity and self-administered fulfillment.

STATISTICS

Student t test and χ².

RESULTS

A total of 44 Gypsy people under 45 years of age were surveyed (mean age 31 ± 8.9 years); 66% were women, and the rest were men. Of these, 20 had university studies, and 24 had secondary or vocational studies. The attitude is favorable toward organ donation in 64% of the respondents, with 80% among university students and 50% among those with secondary or vocational education (P < .005).

CONCLUSIONS

The young Gypsy population with university studies has a very favorable attitude toward organ donation. This population subgroup must be key in the promotion of organ donation in the Gypsy population, so the transplant coordinators must request their collaboration in the promotion campaigns of organ donation and transplantation.

Attitude Toward Organ Donation in the Population of Cienfuegos, Cuba

INTRODUCTION

The sensitization of the population toward organ donation is fundamental; for that reason, it is important to determine the factors that condition the opinion toward donation on the population scope in order to carry out cost-effective campaigns.

OBJECTIVE

To analyze the attitude toward the donation of the proper organs for transplantation among the population residing in Cienfuegos, Cuba.

METHOD

Population under study: Population who reside in Cienfuegos, Cuba.

INCLUSION CRITERIA

Population over 15 years old as stratified by age and sex. Assessment instrument: The attitude questionnaire for organ donation for transplant-PCID-DTO Ríos. Fieldwork: A random selection based on stratification. The available data from the census were used. The completion was anonymous and self-administered. Verbal consent was requested to collaborate in the study.

STATISTICS

Student t test, χ², Fisher, and a logistic regression analysis.

RESULTS

A sample of 636 respondents was included in the study, of which 71% (n = 453) are in favor of donating their organs after death, 16% (n = 103) are against, and 13% (n = 80) are undecided. This attitude is associated with different psychosocial variables (P < .001): age, marital status, having offspring, level of studies, carrying out prosocial activities, discussing with the family the subject of donation and transplantation, knowledge of the concept of brain death, the attitude toward the manipulation of the corpse, the religion of the respondent, and the attitude of the couple toward organ transplantation. The main independent factors obtained in the multivariate analysis (odds ratio >2.5): knowledge of the brain death concept, attitude toward the manipulation of the corpse, religion, and attitude of the couple toward transplantation.

CONCLUSIONS

The attitude toward organ donation among the population of Cienfuegos, Cuba, is favorable and is conditioned by several psychosocial factors.

Gypsy Population Presents a Favorable Attitude Toward Related Living Donation

INTRODUCTION

Negative organ donation rates among the Gypsies is much higher than that of any other social group in Spain. However, living donation rates have not been raised much in this social group, despite the existence of several Gypsy patients on the waiting list for transplantation.

OBJECTIVE

To analyze the attitude toward related living donation among the Gypsy population who reside in Spain.

METHODS

This type of study is an observational sociological study. The study consisted of the adult Gypsy population residing in Spain, and a random sampling of 230 adult gypsies was conducted. Attitude questionnaires for live donation, both hepatic PCID-DVH-Ríos and renal PCID-DVR-Ríos, were used, and random selection was based on stratification. Questionnaires were self-administered and completed anonymously. Student t test, χ2, Fisher, and a logistic regression analysis were used.

RESULTS

A sample of 206 Gypsies (52% women) with a mean age of 34 years is obtained. Seventy-two percent (n = 150) would donate an organ to a relative in life, 8% (n = 16) would not donate it, and 20% (n = 41) have doubts. Respondents with a favorable attitude toward living donation presented a more favorable attitude toward cadaveric organ donation (55% vs 0%, P < .001). The attitude toward living kidney donation was more favorable (81% in favor) than toward living liver donation (P < .001).

CONCLUSIONS

The Gypsy ethnic group is sensitized to live donor transplantation. The family and cultural roots of Gypsy people could condition this favorable attitude, a fact to be taken into account to sensitize this social group and promote donation campaigns with the aim of increasing donation rates.

Attitudes of Latin American Immigrants Resident in Florida (United States) Toward Related Living Kidney Donation

INTRODUCTION

Latin American immigrants comprise an important population group in the United States. The purpose of this study was to analyze the attitude toward living kidney donation found among Latin American citizens who are residents in Florida and to identify the psychosocial variables affecting their attitude.

MATERIAL AND METHODS

A sample of Latin American residents in the state of Florida was randomly obtained and stratified by nationality, age, and sex (n = 1524). Attitude was assessed through a validated questionnaire that was self-administered and completed anonymously. Descriptive, Student t test and the χ² test were used to analyze findings.

RESULTS

The questionnaire completion rate was 94% (N = 1433), with 59% (n = 845) in favor of related living donation, 40% (n = 571) were opposed to donation, with the remaining 1% (n = 17) undecided. The following variables were related to attitude toward living donation: country of origin (P < .001), marital status (P < .001), having descendants (P = .004), educational background (P < 0.001), having had previous experience of donation and transplantation (P < .001), attitude toward deceased donation (P < .001), considering the possibility of needing a transplant (P < .001), the respondent's partner's opinion (P < .001), having considered the subject with one's family (P < .001), having carried out prosocial type activities (P < .001), the respondent's religion (P < .001), knowing that one's religion is in favor of this therapy (P < .001), concern about mutilation after donation (P < .001), and considerations of the risks of living donation (P < .001).

CONCLUSIONS

The attitude toward related living kidney donation of Latin American residents in Florida is not very favorable (only 59%).

Multivariate Analysis of Factors Affecting Attitude Toward Living Kidney Donation Among the Puerto Rican Population Resident in Florida

Puerto Rican and Cuban populations are 2 of the most important migration groups in Florida. Awareness about organ donation among them is fundamental. It is important to determine the factors that influence attitudes toward organ donation.

OBJECTIVE

To analyze the attitude toward living kidney donation (LKD) among Florida's Puerto Rican residents.

METHODS

Study population: Population born in Puerto Rico resident in Florida (United States).

INCLUSION CRITERIA

A sample of population older than 15 years was obtained randomly and stratified by age and sex. Instrument valuation: LKD attitude questionnaire Proyecto Colaborativo Internacional Donantesobre Donación de Vivo Renal, Rios.

SETTING

for the study: Random selection based on stratification. Immigration support associations in Florida were needed to locate potential respondents. Anonymized and self-administered with verbal consent completion.

RESULTS

Of the 259 respondents, 55% (n = 143) are in favor of related LKD (family or friends). The following factors were associated with this attitude: marital status (P = .008); educational level (P < .001); personal experience with organ donation and transplantation (P < .001); attitude toward deceased organ donation (P < .001); realization of prosocial activities (P = .02); family comments about organ donation (P < .001) and comments within couples (P < .001); not being concerned about possible mutilation of the body after donation (P < .001); believing that one's own religion was in favor of donation and transplantation (P < .001); economic incentives of donation (P < .001), and evaluation of the risk from living kidney donation (P < .001). In the multivariate analysis, only marital status is featured as an independent variable (odds ratio, 32.258; P < .001).

CONCLUSIONS

The attitude toward related LKD among the Puerto Rican population who resides in Florida is not very favorable; only 55% would do it.

Nigerian Residents in Spain Have Poor Awareness of Organ Donation and Transplantation

INTRODUCTION

The number of people of Nigerian origin in Europe is growing. However, there are no studies that have analyzed their awareness of organ donation and transplantation.

OBJECTIVE

To analyze the attitude toward organ donation among Nigerian-born population living in Spain.

METHODS

The sample population was a selection of people born in Nigeria who are now living in Spain. A sample of this cohort older than 15 years was obtained randomly and stratified by age and sex. Attitude was assessed using a validated questionnaire on the psychosocial attitudes toward organ donation (PCID-DTO-Ríos). A random selection of people from this cohort was surveyed.

RESULTS

A sample of 183 respondents was included in the study. Of their attitudes toward cadaveric donation, 33% were in favor of it, 34% were against it, and 33% were undecided. The variables associated with having a more favorable attitude (P < .001) were: 1. Knowledge related to donation and transplantation; 2. attitude toward the body; 3. religion; and 4. social interaction. In the multivariate analysis, the main independent factor associated with the attitude toward organ donation was the knowledge of the concept of encephalic death. Respondents who are familiar with the concept of brain death are 10 times more likely to be in favor of donation than those who are not.

CONCLUSIONS

The attitude toward organ donation among the Nigerian-born population living in Spain is not very favorable and is associated with psychosocial factors. A campaign to raise awareness among Nigerian residents in Spain has become a priority.

Are Senegalese Immigrants Residing in Spain in Favor of Organ Donation?

The Senegalese population is an emerging group in Europe. The number of foreign residents in Spain, France, and Italy has increased significantly. However, there are no studies that analyze their awareness of organ donation and transplantation.

OBJECTIVE

To analyze the attitude toward organ donation among the population born in Senegal residing in Spain.

METHODS

The study population was born in Senegal and resides in Spain. A sample of the population older than 15 years was obtained randomly and stratified by age and sex according to census data and immigrant support associations. Attitude was assessed using a validated questionnaire on psychosocial aspects toward organ donation (PCID-DTO Rios). A random selection of people to be surveyed was carried out. Assistance from African immigration support associations in Spain was needed to advise on the location of potential respondents. The survey was self-administered and completed anonymously.

RESULTS

A sample of 295 respondents was included in the study. Attitude toward deceased donation was favorable in 37% (n = 109) of respondents; 35% (n = 104) were against and 28% (n = 82) were undecided. Several variables were associated with having a more favorable attitude (P < .05): sex, having discussed donation with the family, not being concerned about the possible mutilation of the body after donation, the respondent's religion, and knowledge of one's partner's attitude in favor of organ donation.

CONCLUSIONS

The attitude toward organ donation among the population born in Senegal and residing in Spain is unfavorable, and it is associated with psychosocial factors.

Factors That Condition the Attitude Toward Living Related Kidney Donation Among Santiago of Cuba's Population

INTRODUCTION

Living kidney donation is currently the most important kidney donor source in Latin America, and it is necessary to further increase its rates.

OBJECTIVE

To analyze the attitude toward living kidney donation among the Santiago de Cuba's population and to determine the sociopersonal factors with which it is associated.

METHOD

The population over 15 years old residing in Santiago de Cuba, stratified by sex and age, was screened. The "PCID-LKD Ríos" attitude questionnaire toward living kidney donation was administered to a random selection of the people surveyed according to the stratification and the census data. The completion was anonymized and self-administered. Verbal consent was obtained.

RESULTS

The study was completed by 445 people, of whom the 86% (n = 389) were in favor of living related kidney donation. This attitude is associated with the level of education (P < .001); previous experience with organ donation (P = .006); attitude toward cadaveric organ donation (P < .001); carrying out of prosocial activities (P = .010); discussion of the issue with the family (P < .001) and the significant other (P < .001); concern about mutilation after donation (P = .001); religious beliefs (P = .001); and assessment of the risk of living kidney donation (P < .001). In the multivariate study, the following variables persisted: (1) level of education; (2) attitude of cadaveric donation; (3) carrying out of prosocial activities; and (4) risk assessment of living donation.

CONCLUSIONS

Living related donation is very well accepted among the Santiago de Cuba's population.

Factors That Affect the Attitudes of the Bolivian Population in Spain With Regard to Organ Donation for Transplant

BACKGROUND

The Bolivian population is an emerging Latin American immigrant group in Spain, several of whom have been transplanted or are awaiting transplant. We aimed to assess attitudes toward organ donation among Bolivians currently residing in Spain.

METHOD

The population screened was born in Bolivia but living in Spain, stratified by gender and age. The appraisal tool used was a questionnaire that assesses attitudes toward organ donation for transplant ("PCID-DTO Ríos"). Support from immigration associations in Spain was needed for advice on locations of potential respondents. Survey participation was anonymized and the questionnaire was self-administered. Verbal consent was obtained before participation.

RESULTS

There were 206 respondents: 49% (n = 101) in favor of donating their organs after death; 21% (n = 44) against donation; and 30% (n = 61) undecided. Their attitudes were found to be associated with level of education (P = .008), previous experience with donation and transplant (P = .011), concern regarding mutilation after donation (P = .002), knowing the attitude of their religion toward transplant (P = .001), the opinion of their partner (P < .001), and the possibility of needing a future transplant (P = .050). In the multivariate study, the main factor was having a partner in favor of organ donation (odds ratio = 16.129; P = .003).

CONCLUSION

Attitudes toward organ donation among Bolivians residing in Spain are far more negative compared with rest of the Spanish population, due to various factors.

Multivariate Analysis of Factors That Influence the Attitude of the Ecuadorian Population Resident in Spain Toward Living-Related Kidney Donation

BACKGROUND

The Ecuadorian population is the largest Latin-American immigrant group in Spain. Currently, several Ecuadorians have received transplants or are awaiting transplants in Spain. The aim of this work was to analyze the attitude toward living kidney donation among the Ecuadorian population residing in Spain.

METHODS

The population screened were born in Ecuador, residing in Spain, and >15 years old, stratified by gender and age, and appraised with the use of the questionnaire on attitude toward organ donation for transplantation "PCID-DVR-Ríos." Support from immigration associations in Spain was used to advise on the location of potential respondents. The completion was anonymous and self-administered. Verbal consent was obtained. Statistics included Student t test, χ², Fisher exact test, and logistic regression analysis.

RESULTS

A total of 461 respondents were included: 80% (n = 367) were in favor of living-related kidney donation (for a relative or close friend). This attitude was associated with psychosocial variables that persisted in the multivariate study: 1) female gender (odds ratio [OR], 3.086; P = .001); 2) considering oneself a potential kidney receptor in the future (OR, 16.949; P = .002); 3) economic incentive in the donation (OR, 100; P = .004); and 4) knowing the attitude of their religion toward transplantation (OR, 32.258; P < .001).

CONCLUSIONS

Living-related donation is accepted among the Ecuadorian population residing in Spain and is associated with sociopersonal and religious factors.

Veterinary Students' Attitude Toward Living Kidney Donation: A Multicenter Stratified Study From Spain

Living kidney related donations (LKRD) should be promoted because of the current deficit of organs for transplantation. The objective of the study was to analyze the attitude of Spanish veterinary students toward LKRD, because they may influence public opinion in the future, and to determine the factors that condition it.

METHODS

A sociological, interdisciplinary, multicenter, and observational study was carried out in the veterinary students enrolled in Spain (n = 9000) in the university academic year 2010-2011. A sample of 2815 students was stratified by geographical area and academic year. The students' attitude toward LKRD was assessed using a psychosocial validated questionnaire (PCID-DVR Rios), was self-administered, and was completed anonymously. Veterinary schools were randomly selected. The questionnaire was applied to each academic year at compulsory sessions. Statistical analysis was preformed using t test, χ² test, and logistic regression analysis.

RESULTS

The completion rate was 95% (n = 2683); 93% (n = 2504) were in favor of LKRD and 36% (n = 945) supported unrelated living kidney donation. The following variables were associated with having a more favorable attitude: (1) sex (P < .001), (2) being a student of southern universities (P = .03), (3) attitude toward deceased donation (P < .001), (4) having a father (P < .001) or a mother (P < .001) in favor of organ donation, and (5) having discussed the subject with friends (P = .03) or family (P = .02). However, only 60% would accept a kidney from a relative.

CONCLUSION

Spanish veterinary students have a favorable attitude toward LKRD. However, only 60% would accept a kidney from a relative.

What Do Future Nursing Professionals Believe About Living Donor Kidney Transplantation? An Analysis of Attitudes of Nursing Students of the Medical University of Poznan in Western Poland

BACKGROUND

Living donor kidney transplantation (LDKT) is the best treatment option in the late stage of chronic kidney disease. The objective of the study was to analyze the attitudes of nursing students at the Medical University of Poznan toward living donation of kidney.

METHODS

Sampling points were compulsory attendance in the 5 nursing courses of the degree of fulfilment of 80%. The validated questionnaire (PCID-DVR Rios) was self-administered and anonymous.

RESULTS

The completion rate was 92% (324 of 354). Among the students, 91% (n = 296) were in favor of LDKT, 5% (n = 15) were undecided, and 4% (n = 11) remained is against. When the living kidney donor is not related, 57% (n = 185) of respondents were in favor. The factors that are associated with a more favourable attitude are 1) the needs of organs for transplantation are covered (P = .012); 2) attitude in favor of organ donation and transplantation (P ≤ .001); 3) attitude toward living liver donation (P = .001); 4) attitude in favor of acceptance of LDKT for a relative (P ≤ .001); 5) discussing organ donation and transplantation with friends (P = .002); and 6) attitude in favor of organ donation from a family member (P = .011). In the multivariate analysis, highlights are acceptance of the donation of a living kidney donor from a family member [OR = 9.900 (35.714-2.770); P ≤ .001] and donating a piece of liver in life [OR = 50 (166.666-14.492); P ≤.001].

CONCLUSIONS

Among the nursing students, 91% are in favor of living kidney donation.

[Hospital-based multicenter study in Spain, Mexico and Cuba on attitudes to living liver donation]

INTRODUCTION

Given the lack of a sufficient number of livers available for transplantation, living liver donation (LLD) is being developed in the Spanish-speaking world. To do this, it is essential that health workers in hospitals are in favor of such donation, given that they are a key component in this treatment and that their attitudes influence public opinion.

OBJECTIVE

To analyze attitude toward LLD among hospital personnel from healthcare centers in Spain and Latin America.

MATERIAL AND METHOD

Ten hospitals were selected from the «International Donor Collaborative Project»: 3 from Spain, 5 from Mexico and 2 from Cuba. Random sampling stratified by type of service and job category was used. Attitudes to LLD were evaluated through a validated questionnaire on psychosocial aspects. The questionnaire was anonymous and self-administered. Statistical tests consisted of Student's T test, the chi-square test and logistic regression analysis.

RESULTS

Of the 2,618 employees surveyed, 85% (n=2,231) were in favor of related LLD; of these, 31% (n=804) were in favor of unrelated LLD. No association was found between the country of the interviewed, personal-social variables or work-related variables. The following factors were associated with a favorable attitude toward related LLD donation: having had personal experience of donation and transplantation (P<.001); being in favor of deceased donation (P<.001); believing that one might need a possible transplant (P<.001); being in favor of living kidney donation (P<.001); being willing to accept a liver from a living donor (P<.001); having discussed the matter of donation and transplantation within the family (P<.001) and with one's partner (P<.001); carrying out pro-social type activities (P<.001); being Catholic (P=.040); believing that one's religion is in favor of donation and transplantation (P<.001); and not being concerned about the possible mutilation of the body after donation (P<.001).

CONCLUSIONS

Hospital personnel from Spain and Latin America had a favorable attitude toward LLD, which was associated with factors directly and indirectly related to donation and transplantation, family and religious factors, and attitudes toward the body.

Public awareness and attitudes to living organ donation: systematic review and integrative synthesis

BACKGROUND

The deceased-donor organ shortage has driven widespread adoption of living-donor transplantation. Yet, public views on living donation are not well understood. This study aims to synthesize studies on public awareness and attitudes toward living organ donation.

METHODS

Electronic databases and reference lists were searched to September 2012. Summary estimates from survey data were obtained by random effects meta-analysis. Qualitative descriptive synthesis of each study was performed.

RESULTS

Forty-seven studies involving 34,610 respondents were included. The proportion of respondents aware of living organ donation was 76.7% (4 studies, n=3248; 95% confidence interval, 46.2%-97.0%; I=99.7%). The majority were in favor of living directed donation (85.5% (11 studies, n=15,836; 95% confidence interval, 81.6%-89.6%; I=98%), with recipient and community benefit as the rationale provided. However, barriers included fear of surgical and health risks, lack of knowledge, respect for cultural norms, financial loss, distrust in hospitals, and avoiding recipient indebtedness. The public voiced concern about possible risks or an obligatory pressure exerted on the donor. Many supported reimbursement for out-of-pocket expenses, paid leave, wait-listing priority, health insurance, and donor acknowledgment. There was strong opposition to financial incentives, which they believed risked exploitation and inequity and diminished voluntary altruistic donation.

CONCLUSIONS

The public is generally supportive of living donation and articulated important equity and ethical considerations for protecting the health and safety of living donors. This supports increased public engagement and strengthening of a shared view among professionals and the public in living donation practice and policy.

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.

Attitudes toward living kidney donation in transplant hospitals: a Spanish, Mexican, and Cuban multicenter study

INTRODUCTION

Living donor kidney (LKD) transplantation provides better results than deceased donor donation, involving minimum risk for the donor. However, LKD donation rates are low in most countries. We analyzed attitudes toward LKD in transplant hospitals in Spain, Mexico, and Cuba.

MATERIALS AND METHODS

Data were obtained from five transplant hospitals through the International Collaborative Program "Proyecto Donante Vivo, Murcia" in three countries: Spain (n = 1168), Mexico (n = 903), and Cuba (n = 202). The random sample (2273 employees) was stratified according to job category. The instrument used to evaluate attitude was a validated questionnaire. Statistical analysis included Student t test, the chi(2) test, and multivariate analysis.

RESULTS

Eighty eight percent (n = 2002) of Spanish, Mexican, and Cuban transplant hospital personnel were in favor of related LKD and 24% nonrelated LKD (n = 555). Attitudes were more favorable among centers in Cuba 97% (n = 195), followed by Mexico 88% (n = 793) and by Spain 87% (n = 1014; P < .001). According to job category, 91% (n = 617) of physicians were in favor, 88% (n = 543) of nurses, 85% (n = 198) of health care assistants, and 85% (n = 198) of auxiliary personnel. Attitudes were related to variables of: attitude toward deceased donation (P < .001), discussion about organ donation and transplantation (P < .001), concern about body mutilation after donation (P = .001), a possible need for a transplant in the future (P < .001), and attitude toward living liver donation (P < .001).

CONCLUSIONS

Attitudes toward LKD in Hispanic/Latin Transplant Hospitals were favorable and could encourage an increase in LKD in the coming years assuming suitable sociopolitical and economic condition, as well as support from nephrologists.

Attitude of Scottish residents living in southeastern Spain toward organ donation

BACKGROUND

Southeastern Spain is a habitual area of residence for the native population of Scotland.

OBJECTIVE

To assess the attitude toward donation in the immigrant population in our regional community who were born in Scotland and to analyze the variables that influence this attitude.

MATERIALS AND METHODS

A random sample was taken (n = 350) of the population group born in Scotland and living in southeastern Spain. The instrument used to measure attitude was a previously validated questionnaire, which was self-administered and completed anonymously between December 2005 and March 2006. For a control group, we used a sample of the autochthonous population (n = 2000). Statistical analysis included Student t test, the chi(2) test, Fisher exact test, and logistical regression analysis.

RESULTS

The attitude toward donation was favorable among 73% of respondents (n = 237), with 7% (n = 22) against and 21% (n = 68) undecided. The attitude was more favorable than among the Spanish control group (73% vs 63%; P = .002). The following variables were related to this attitude: an understanding of the concept of brain death (P = .025); having discussed the matter within the family unit (P < .001); a partner's attitude toward donation (P < .001); being in favor of donating a family member's organs (P < .001); attitude toward cremation (P < .001); attitude toward autopsy (P = .002); and concern about mutilation after donation (P < .001).

CONCLUSIONS

The attitude of Scottish residents in southeastern Spain is more favorable than that of the Spanish population. It is mainly affected by factors related to the family and to the attitude toward manipulation of the cadaver.