The Influence of Age, Gender and Religion on Willingness to be an Organ Donor: Experience of Religious Muslims Living in Sweden

The transplantation of organs is one of the most successful medical advances in recent decades, and transplantation is the treatment of choice for severe organ failure worldwide. Despite this situation and the general acknowledgment of organ donation (OD) as a global priority, the demand for organs outstrips the supply in virtually every country in the world. The study aims to elucidate whether age, gender and religion influence decision-making about organ donation in religious Muslims living in Sweden Data were collected through three group interviews using open-ended questions and qualitative content analysis. Twenty-seven participants, 15 males and 12 females from four countries, participated in the focus group interviews. The analysis of the collected data resulted in three main categories: "Information and knowledge about organ donation," "The priorities when deciding about organ donation" and "The religious aspects of organ donation," including a number of subcategories. Good information about and knowledge of OD, priorities in OD, importance of the fact that religion must be studied and taught daily and religious education were only a few of the factors informants emphasized as predictors of the total and successful donation of organs. Age, gender or religion did not have an impact on organ donation. High levels of education through religious education and good information via various media, as well as a good knowledge of the Swedish language, are predictors of improved OD. In order to overcome religious ideology as a source of misinformation relating to OD and to promote increased OD in the future, specific intervention studies and the improved involvement of religious communities and education in schools and the healthcare system are vital and must be a starting point for improved OD.

Attitudes and Knowledge of Healthcare Professionals Regarding Organ Donation. A Survey of the Saolta University Health Care Group

Organ donation saves lives and healthcare professionals (HCPs) play a vital role in that process. Therefore, the purpose of this study was to assess the attitudes and level of knowledge of HCPs regarding organ donation. An online anonymous self-administered questionnaire containing 40 questions on organ donation using google forms was created. The survey was distributed to HCPs working in the Saolta University Health Care Group. A hundred and thirty-nine responses were received giving a response rate of 11.8%. HCPs willingness to donate their organs was at 93% compared to 97% willing to receive a transplant. More HCPs understood or had knowledge of the term donation after brain death (64%) than donation after circulatory death (49%). HCPs working in intensive care knew more about the management of brain dead donors than other specialties (p<0.0001). Over 60% of HCPs when asked either disagreed or strongly disagreed with the adequacy of training in organ donation and transplant. Overall, HCPs surveyed had positive attitudes towards organ donation but there was a lack of knowledge particularly among non-intensive care professionals. This study highlights the need to increase awareness along with implementation of educational programmes among HCPs regarding organ donation and transplant.

Facial Disfigurement and Identity: A Review of the Literature and Implications for Facial Transplantation

Facial disfigurement can significantly affect personal identity and access to social roles. Although conventional reconstruction can have positive effects with respect to identity, these procedures are often inadequate for more severe facial defects. In these cases, facial transplantation (FT) offers patients a viable reconstructive option. However, FT's effect on personal identity has been less well examined, and ethical questions remain regarding the psychosocial ramifications of the procedure. This article reviews the literature on the different roles of the face as well as psychological and social effects of facial disfigurement. The effects of facial reconstruction on personal identity are also reviewed with an emphasis on orthognathic, cleft, and head and neck surgery. Finally, FT is considered in this context, and future directions for research are explored.

Health-related quality of life and perceived need for mental health services in adolescent solid organ transplant recipients

The purpose of the current investigation was to assess interest in mental health services among parents of adolescent solid organ transplant recipients and the relationship between parent perceived need for mental health services and patient health-related quality of life (HRQOL). Sixty-three parents rated interest in receiving 10 mental health services, and patient HRQOL ratings were gathered from adolescent transplant recipients and their parents. Ninety-four percent of parents expressed some level of interest in at least one of the proposed services, with over 40 % indicating maximum interest. Parents' perceived need for mental health services was inversely related to adolescent and parent reports of HRQOL on the behavior, mental health, family cohesion, and parental impact-emotional domains. Results suggest that parents of adolescent solid organ transplant recipients are interested in receiving mental health services for their families. Assessment of need for mental health services and HRQOL may inform the medical team of families requiring intervention.

[Attitudes towards transplantation and organ donation in high school graduates of math gymnasium in Osijek]

OBJECTIVE

Testing attitudes and opinions ofgraduate students in Osijek towards organ donation and transplantation. Examinees and methods: The research included 99 students of math gymnasium in Osijek (54 males and 45 females, mean age 18 years). They fulfilled an anonymous questionnaire, consisted of 24 questions about transplantation, willingness to donate organs, consciousness of importance of donating organs and attitudes of religion towards organ donation. Statistical analysis was made by SPSS 16.0 computer program using Chi-square test.

RESULTS

Most of the gymnasium students (80.8%) have already heard about organ donation, 76.8% of them have received information by television. 59.4% students know how a transplantation is being performed, but the majority (64.6%) of them don't know whom to address to receive additional information about organ donation. 27.3% students have discussed transplantation inside their families and 17.2% examinees know someone who signed the donor card. 55.6% examinees are convinced that transplantation procedure is safe and efficient. 41.4% thinks that family should give permission for explantation of a deceased patient's organs, while 33.3% consider it not necessary. Regarding the question whether examinees think that organ transplantation was a mutilation, 91.9% of them answered "no". Although 55.6% students believe that doctors would put the same effort in saving patients, independent whether they possessed donor card or not, there were 60.6% that thought it was possible to obtain organ in Croatia by illegal ways. Nevertheless, 79.8% students would receive organ from a deceased person, 64.6% would donate organs after their death. Observing ethical and religious attitudes, 92.9% are sure that organ donation is a humane gesture. 82.8% examinees were believers and 60.6% of them didn't know attitudes of their religion towards organ donation. Women have significantly more willingness to donate their organ to family member during their lives (97.8%), while 81.5% males would do the same, p=0.035. Lower percentage of atheists were found among women (6.7%) than in men (25.9%), p=0.011. 53.7% males consider their religion to be against organ donation, while only 17.8% females, p=0.046.

CONCLUSION

High school graduates have mostly heard about organ transplantation (many of them by television) and the majority has positive attitude and are willing to donate theirs and to receive organs from another person. Such willingness and tendency towards organ donation should be taken with reserve, because it was relatively young population, without life experience in similar situations. Within their population, believers are predominating, and they often don't know whether their religion is pro organ donation or against it. Smaller proportion, but still the majority of the examinees, considers the transplantation to be a safe procedure. Women and men show differences regarding information, attitudes and willingness to make a sacrifice. Women are more willing to donate organs to a family member. Still, there is not enough discussion about transplantation inside each family. Rate of ignorance and lack of information about transplantation and organ donation, indicates a need for better representation of this topic in media, schools, religious institutions and inside family.

Mass-media and the transplantation crisis: the example of Poland

Organ transplantation is a treatment method that is very sensitive to public opinion. Information regarding misconduct in the recovery and transplant of organs very often leads to a definite decrease in the numbers of operations. In 2007 in Poland, the national media reported numerous controversial transplantation incidents. Directly after these occurrences, the number of transplantations fell sharply. Public opinion worsened as did the level of trust placed in doctors. Social psychology explains the mechanisms responsible for this phenomenon through the notion of cognitive schemata. Their permanence is explained through selective perception, memory and the effect of persistence.

Social support, coping, and psychological distress in mothers and fathers of pediatric transplant candidates: a pilot study

Both parents and children report significant psychological difficulties and family disruption prior to transplantation; however, there have been fewer studies examining predictors of distress in both mothers and fathers and across multiple transplant groups. Thirty-four mothers and 22 fathers participated in this pilot study. Parents completed measures during a routine tertiary pretransplant psychological evaluation. Paired sample t-test results indicated that mothers and fathers differed significantly on specific coping strategies employed, with fathers less likely to use engagement strategies than mothers. Correlation analyses demonstrated strong associations between engagement coping strategies and less psychological distress and the reverse with disengagement coping strategies for both mothers and fathers. Social support was associated with less psychological distress for mothers, but was unrelated to distress for fathers. Using regression analyses, for mothers, lack of social support, and disengagement coping predicted poor psychological outcomes. Taken together, these results suggest that assessing specific coping strategies employed by both mothers and fathers is an essential component of the pretransplant evaluation process. This study delineates areas for intervention that impact adjustment in parents of pediatric transplant candidates.

Psychosocial implications of disfigurement and the future of human face transplantation

Although the first face transplants have been attempted, the social and psychological debates concerning the ethics and desirability of the procedure continue. Critics contend that these issues have not yet been sufficiently addressed. With this in mind, the present article seeks to elaborate on key psychological and social factors that will be central for addressing the ethical and psychosocial challenges necessary to move face transplantation into mainstream medicine. The goals of this article are to (1) discuss the psychosocial sequelae of facial disfiguration and how face transplantation may relieve those problems, and (2) delineate inclusion and exclusion criteria for the selection of research subjects for face transplantation. The article uses concepts from symbolic interaction theory in sociology to articulate a theoretically coherent scheme for comprehending the psychosocial difficulties of facial disfiguration and the advantages offered by facial transplantation. The authors conclude that the psychosocial implications of disfigurement warrant surgical intervention and that research in the area of face transplantation should continue.

Coping Strategies in Intestinal Transplantation

The psychological construct of coping has been studied extensively in other medical populations and has more recently been applied in the field of transplant psychology. Coping can be defined as all abilities used by people to face problematical and stressful situations, as the data in literature describe the experience of transplantation. The purpose of this study was to describe the coping styles used by 25 intestinal transplant recipients. To assess the coping strategies, we used the Italian version of Coping Orientation to Problems Experienced (COPE) by Sica, Novara, Dorz, and Sanavio (1997). The authors divided these strategies into three classes: problem-focused, emotion-focused, and potentially disadaptive strategies. This questionnaire is usually used in a medical setting. Even if the long process of psychological-clinical adaptation required by intestinal transplantation put patients in a passive acceptance of their situation and their incapacity to face it, our patients showed high levels of problem-focused strategies, indicators of positive outcomes for this intervention. Anyway, this is a slow and gradual path that goes with the psychological distress and the need for a peculiar psychological support of problem-focused strategies. The result suggested that assessment of coping strategies should be explored in intestinal transplant to encourage the use of action-oriented methods and discourage those with possible negative effects.

Becoming a mother by non-anonymous egg donation: secrecy and the relationship between egg recipient, egg donor and egg donation child

The object of the study was to investigate secrecy in non-anonymous egg donation, to explore some characteristics of this kind of egg donation arrangement and the relationship of the recipient with her non-genetic child. Forty-four egg recipients and 62 IVF patients with a child conceived through egg donation and/or IVF were recruited. A semi-structured questionnaire was sent to all the participants. Chi-square and T-tests were used to examine the differences between the groups. There were no significant differences on the following aspects. The same high proportion of egg donation mothers (77%) and IVF mothers (87%) had the intention of telling their child about the conception but most women thought disclosure at a later time preferable. Two thirds of the recipients and IVF mothers said the way of conception had no influence on the relationship with their child. The two groups differed however in their argumentation about secrecy and named different feelings. Egg donation mothers expressed more denial and showed more defensive reactions, anxieties and uncertainty. It is suggested that recognition of a certain difference between a natural conception and egg donation could be helpful in early disclosure and could help to diminish anxieties in egg donation mothers.

An international opinion poll of well-educated people regarding awareness and feelings about organ donation for transplantation

Despite repeated campaigns promoting transplantation, the high donation refusal rate remains unchanged. We targeted a well-educated population to assess the impact of our current transplantation promoting programs and personal feelings toward new approaches to organ donation. A questionnaire was proposed in five universities to students and university staffs that would have been likely to benefit from previous information campaigns in two South American and three European countries. All of the 2321 people interviewed replied to at least one question. Organ shortage was considered as a serious public health issue. However, there was a widespread ignorance of religious precepts concerning transplantation that contributed to the low acceptance rate of organ sharing after death. Financial rewards for donors or their families remain controversial. There was a general agreement for early educational programs in schools. Most people still consider organ donation as a gift, but many would now agree to readily share body parts after death. This biased population of well-educated people has still little knowledge of organ donation. The negative impact of ignorance surrounding religious precepts and the high acceptance rate of educational programs in schools, justify supporting an intensive international effort in education that should also include Church leaders.

Medication Noncompliance and its Implications in Transplant Recipients

The transplant patient's therapeutic regimen consists of a lifelong drug therapy, including immunosuppressive drugs, prophylactic antimicrobials and often medications for the treatment of hypertension, diabetes mellitus and other comorbid diseases. Regular clinic appointments are required to monitor for signs and symptoms of immunological injury, recurrent disease and adverse drug effects. Patients are instructed to avoid risk factors for cardiovascular disease and cancer (e.g. diet, exercise, sun protection and not smoking). Noncompliance with all aspects of this regimen is substantial. Medication noncompliance leads to an increased incidence of acute rejection, chronic rejection and graft loss. Undoubtedly, many practitioners fail to appreciate the extent of noncompliance as the signs are often subtle and most patients are unwilling to disclose deliberate or widespread disregard for medication use. Newer immunosuppressive agents, particularly once-daily medications and long-acting antibody preparations offer convenience and monitoring that may improve compliance. This review focuses on the prevalence, correlates and consequences of medication nonadherence after organ transplantation. Current recommendations to enhance adherence are discussed.

Prevalence and impact of pain on the quality of life of lung transplant recipients: a prospective observational study

STUDY OBJECTIVE

To study the prevalence and impact of pain on the quality of life (QOL) of lung transplant recipients.

DESIGN AND PATIENTS

Prospective, observational, cross-sectional study. Ninety-six lung transplant recipients (> 3 months after transplantation) completed questionnaires measuring the severity and impact of pain (Brief Pain Inventory), anxiety (State Trait Anxiety Inventory), QOL (Short Form-36 version 2 [SF-36v2]), and depression (Beck Depression Inventory [BDI]).

SETTING

University medical center lung transplant outpatient clinic.

RESULTS

The prevalence of pain in lung transplant recipients was 49%. Patients with pain were older, more likely to have undergone unilateral lung transplantation (64% vs 40%, p = 0.03), and were more likely to have lung emphysema (55% vs 38%, p = 0.004). Only a pulmonary diagnosis of lung emphysema remained an independent predictor for postoperative pain in a logistic regression model. Average (+/- SD) score of the BDI was 9.6 +/- 7.8 and 5.8 +/- 5.8 (p = 0.005) for patients with and without pain, respectively. Patients with and without pain did not significantly differ in terms of anxiety. Pain-free patients had a significantly higher physical component score than patients with pain in the SF-36v2 (mean, 48.7 +/- 8.6 vs 38.6 +/- 9.8, p < 0.0001, respectively), while the mental component scores were not statistically different between the two groups.

CONCLUSIONS

Lung transplant recipients have a high prevalence of pain. Patients with lung emphysema as their preoperative diagnosis are more likely to have pain. The occurrence of pain is associated with a decreased QOL in lung transplant recipients.

Information requested about organ donation in primary health care centers

Information provided by primary care workers about organ donation significantly affects the attitude of the general public. The objective of this study was to evaluate information about donation requested by the general public in health centers in an autonomous community (region) of Spain and to find out how many workers provided relevant information.

MATERIALS AND METHODS

A random sample was taken and stratified by sex, job category, and geographical location (six health areas of our autonomous regional community, 45 municipal councils), among primary care health workers in order to obtain a total of 428 respondents in 34 primary care centers. A study was undertaken of information requested and provided about organ donation and transplantation. The chi square test was applied and differences were considered significant at levels of P < .05.

RESULTS

Forty-three percent (n=185) of the workers surveyed indicated that information had been requested from them about organ donation and transplantation. This request for information was much greater from physicians than from the other types of workers (P = .015). Furthermore, 54% of primary care health workers (n=229) reported having provided information about donation, especially physicians (64%), with this being mainly favorable. Information had also been provided by nurses (59%) and ancillary staff (34%).

CONCLUSION

Information requested from primary care health workers by the general public about organ donation and transplantation is increasing when we compare it to data from previous years. Around half of primary care workers have offered information about transplantation. Therefore, it is fundamental that these workers have adequate and correct information to provide patients and families.

Review of evidence that posttransplantation psychiatric treatment commonly affects prolactin levels and thereby influences graft fate

Delirium, depression and other psychiatric difficulties are commonly encountered by posttransplantation patients, and antipsychotic medicines are frequently used to treat these difficulties. This article reviews previous research data concerning the immunological effects of these medicines, with particular focus on the consequences of prolactin elevation. Unproven but of concern is that these effects may influence graft fate. Older antipsychotic medicines such as haloperidol and chlorpromazine have a high likelihood of elevating prolactin. Prolactin is an immunologically active molecule generally promoting bone marrow function. This may be of benefit post-stem-cell transplant, helping engraftment, but could further rejection of solid-organ transplants. Elevated prolactin is implicated in the facilitation of graft-versus-host disease. Aripiprazole is the antipsychotic medicine least likely to increase prolactin (and may actually decrease prolactin); risperidone, the most likely to increase prolactin. Olanzapine, quetiapine and ziprazadone are antipsychotic medicines with a lower likelihood of elevating prolactin. Older ("neuroleptic") antipsychotics, such as chlorpromazine, droperidol and haloperidol, perphenazine and many others, are likely to elevate serum prolactin. Among antidepressants, most serotonin reuptake inhibitors, with the exception of sertraline, can slightly elevate prolactin. The atypical (i.e., alone in their class) antidepressants bupropion and mirtazapine are prolactin neutral. The immunological consequences of psychiatric medicines should be considered when treating transplant patients for delirium, depression and thought disorders; in addition, if elevation of prolactin is thought to be of immunological importance during psychiatric treatment, then it should be monitored and treated. The dopamine agonists used to treat Parkinson's disease--bromocriptine, pergolide, pramipexole, ropinerole--usually reverse antipsychotic-induced prolactin increases without compromising psychiatric effectiveness.

Poor uptake of reproductive health screening services by female renal transplant recipients

Women with functioning renal transplants are a high-risk group for de novo malignancies and other gynaecological health problems. The objective of this study was to assess patients' awareness of gynaecological issues, and to assess uptake of cervical and breast cancer screening services. A structured questionnaire on family planning, menopausal issues and knowledge/use of cervical and breast cancer screening was administered to 64 female renal transplant recipients. 58 (91%) responded to the questionnaire. Mean age at first transplantation was 35 years (range 11 - 69). 84% were aware as to why they should have regular cervical smears. 15 (26%) had, however, never had a smear and only 9 (16%) were having yearly smears. 12 of 28 postmenopausal women entered the menopause under the age of 41 years, but only 5 of these had received Hormone Replacement Therapy. Breast self examination is practiced by 71%, but only 26% have had mammograms. These figures suggest that female renal transplant patients are not adequately screened for cervical and breast cancer. The results also indicate a need for further education regarding family planning issues and menopausal health concerns. We conclude that formal gynaecological review should be routinely available for women with renal transplants.

Investigation of risk acceptance in hand transplantation

PURPOSE

Twenty-four hands have been transplanted in 18 individuals and clinicians continue to debate whether the risks justify the benefits in these procedures. To assess quantitatively the risks versus benefits in hand transplantation we used a validated instrument (Louisville Instrument for Transplantation) to measure the degree of risk individuals are willing to accept to receive different types of transplantation procedures.

METHODS

The Louisville Instrument for Transplantation contains 237 standardized questions that incorporate modified standard gamble and time trade-off outcome measures and questions that assess body image perception, depression, self-esteem, optimism, socially desirable responding, and demographics. Respondents were questioned on the extent to which they would trade off specific numbers of life-years or sustain other costs in exchange for receiving 7 different transplantation procedures. For this study we questioned 227 individuals in 4 study populations with differing life experiences: healthy individuals, organ transplant recipients, upper-extremity amputee patients, and lower-extremity amputee patients.

RESULTS

All populations questioned perceived risk similarly despite their differing life experiences and would accept differing degrees of risk for the different transplantation procedures. Organ transplant recipients were the most risk-tolerant group whereas upper-extremity amputee patients were the most risk adverse, even when considering a single hand transplant. All groups that were questioned would accept a higher degree of risk to receive a double versus a single hand transplant.

CONCLUSIONS

By questioning individuals who have experienced directly the risks of immunosuppression and those who could benefit from hand transplantation, this study presents an empiric basis for assessing risk versus benefit in this procedure.

Die „Medikamenten-Erfahrungs-Skala für Immunsuppressiva” (MESI) - erste Ergebnisse zu einem neuen Screeninginstrument in der Transplantationsmedizin

BACKGROUND

After an organ transplant, immunosuppressants must be taken on a regular basis to prevent rejection of the transplanted organ. To our knowledge, there have been no studies to date on how transplant recipients experience the effects and side effects of immunosuppressants. The present study tested a newly developed screening instrument that records the subjective experiences and cognitive attitudes of patients vis-à-vis their immunosuppressive medication.

METHOD

98 patients were questioned before a heart, lung, liver or kidney transplant and 12 months after the transplant by means of various psychosocial measuring instruments (Sense of Coherence, SOC; Hospital Anxiety and Depression Scale, HADS-D; Quality of Life, SF-36; Satisfaction with Life, FLZ; Social Support, F-SOZU). 12 months after the transplants were performed, seven further items intended to measure the subjective experiences and cognitive attitudes of the patients vis-à-vis their immunosuppressive medication were used. The treating doctors assessed patients' overall compliance 12 months after the transplant operation.

RESULTS

Die "Medication Experience Scale for Immunosuppressants" (MESI) showed an internal consistency (Cronbach's alpha) of 0.78. Its values correlated significantly negatively with the sense of coherence recorded before the transplant. There were also significantly negative correlations with physical functioning, mental health, satisfaction with life and social support, as well as significantly positive ones with anxiety and depression 12 months post-transplant. In a comparison of organ groups, lung-transplant patients exhibited the highest MESI values. Patients whose compliance was assessed as "very good" experienced the effects of the immunosuppressants less intensely than patients with "good" to "moderate" compliance. Sensitivity of the MESI scale with regard to compliance was 0.81, with a specificity of 0.71, a positive predictive value of 0.68, and a negative predictive value of 0.83. The cut-off value between "very good" and "limited" compliance was a scale score of 15 points.

CONCLUSION

The MESI is a short, easy-to-use screening instrument for recording the subjective experiences and attitudes of patients after an organ transplant. Of clinical significance is the correlation with compliance. Patients with a scale score of > 15 in particular should be spoken to by their treating doctor with regard to their attitudes to and experiences of the immunosuppressants, as well as with regard to their compliance behaviour.

Parents and clinicians underestimate distress and depression in children who had a transplant

The present study examined whether there are differences in reporting of depressive and post-traumatic stress symptoms between children who had a transplant and children who had other medical illnesses. We evaluated both the child's report about her/his symptoms and the parent or the clinician's report about these symptoms in the child. Scores on measures of depression (clinician rated vs. child rated) and post-traumatic stress (parent rated vs. child rated) were compared between medically ill children who have vs. have not had a solid organ transplant. The findings of a psychiatric evaluation are also reported. Children who have vs. have not received a solid organ transplant reported the same levels of depression and post-traumatic stress, while adults (their parents or clinicians who evaluated them) reported lower levels of depression and post-traumatic stress in the transplant group. The psychiatric evaluation revealed no differences between the groups. Children view their post-transplant course differently from adults caring for these children. Adults tend to underestimate the child's post-transplant emotional symptoms, possibly because they focus on the improved prognosis (whereas the children focus on the concrete experience of illness). The child's report of his or her emotional symptoms should be directly sought post-transplant.

Ethical considerations in the early composite tissue allograft experience: a review of the Louisville Ethics Program

This paper reviews the formulation and evolution of the ethical component in one of the earliest clinical composite tissue allograft (CTA) programs, the hand transplantation program in Louisville, Kentucky, USA. The purpose was to derive lessons and define principles to give guidance for future programs and introduction of new CTA. We reviewed the initial ethical considerations, including input from respected ethical scholars, guidelines for innovative procedures transparency in public and professional scrutiny, and compliance with human studies regulations (IRB approval). We found the initial focus on ethics, scholarly input, guidelines for innovative procedures, and human studies protection regulations to be valid. Moreover, we noted the effect of autonomy in subjective, quality-of-life benefits on equipoise and effective risk-benefit analysis in effective informed consent. We found that psychiatric screening and support to be exceptionally valuable in protecting autonomy, suitability for participation, assessing personality organization, and determining compliance ability. We conclude that the program ethical principles were validated. For future CTA programs and procedures, we recommend an ethical emphasis with adherence to high standards and transpire to independence to scrutiny and oversight. We recommend protection of autonomy judgments in equipoise judgment and informed consent. We recommend skilled psychiatric screening and support. We endorse scholarship, scientific accuracy, and data sharing.

Transplantation und Explantation aus psychosomatischer Sicht

Auf den ersten Blick hat die Transplantationsmedizin wenig mit der Psychosomatik zu tun. In dieser Übersicht soll gezeigt werden, welchen Beitrag die Psychosomatik zu der Transplantationsmedizin zu leisten vermag. Ein besonderes Augenmerk liegt auf den Organspendern, die in den üblichen Beiträgen zur Transplantationsmedizin nicht die Aufmerksamkeit bekommen, die ihnen gebührt.

Medication non-adherence in the adolescent renal transplant recipient: a clinician's viewpoint

Recent advancements in immunosuppression and surgical techniques have significantly improved the outcome of kidney transplantation in the pediatric population. Adolescents enjoy the best 1-year graft survival of any age group. However, the long-term transplant outcome in adolescents is disappointing. Non-adherence with immunosuppressive medications is one of the most important contributing factors for graft rejection and loss in teenagers. The impact of non-adherence is perceived to be far more powerful in adolescent transplant recipients than in the transplant population as a whole. To better understand adolescent non-adherence, the process of transplantation must be placed in the context of adolescent development. Adolescents try to establish their identity and autonomy separately from the parents; however at the same time, adolescents with chronic illness require help, support and guidance from adults, including parents and medical personnel. Adolescents have limited ability to anticipate abstractly the long-term consequences of their immediate actions. This inconsistency can create frustration in both adolescents and in the supporting systems around them. Despite the significant consequences of adolescent non-adherence, research in this area is scarce. There are still no established definitions, standardized diagnostic methods and effective interventions to treat and prevent this problem. We propose the recommendations to approach the problems of adolescent transplant non-adherence from the transplant clinician's viewpoint. With early identification and appropriate interventions, significant improvement in adolescent graft survival is possible.

Organ donation and transplantation within the Zulu culture

Greater knowledge and technological advancement in the field of transplantation has increased the demand for organ donation beyond the supply of organs, especially among the black communities. This imbalance arises from the few sources of organs, limitations on the techniques of organ retrieval, disparities in the allocation of organs and socio-cultural factors. The aim of this study was to investigate the extent to which Zulu cultural norms and social structures influence an individual's decision to donate an organ or to undergo transplantation. A qualitative approach using an ethno-nursing method was selected. Semi-structured interviews were conducted with a transplant co-ordinator representing the professional sector, with traditional healers and religious leaders representing the folk sector, and with the general public representing the popular sector of the health care system. Both urban and rural settings were used. Conclusions arrived at showed that knowledge was lacking among Zulu speaking people about organ donation and transplantation and misconceptions about the topic were related to Zulu life patterns, beliefs about death, burial and life hereafter, and values and social structures. Recommendations with regard to the promotion of organ donation and transplantation among Zulu speaking people were made based on culture-sensitive and culture-congruent principles.

A National Study of Burnout Among American Transplant Surgeons

This study examines burnout in a national sample of transplant surgeons. Data analyses were conducted on a sample of 209 actively practicing transplant surgeons. Measures included the Maslach Burnout Inventory, a demographic survey, and the Surgeon Coping Inventory. Burnout was reflected in 38% of surgeons scoring high on the Emotional Exhaustion dimension, whereas 27% showed high levels of Depersonalization, and 16% had low levels of Personal Accomplishment. Several significant predictors of emotional exhaustion were identified and included questioning one's career choice, giving up activities, and perceiving oneself as having limited control over the delivery of medical services (R2= 0.43). Those who perceived themselves as having a higher ability to control delivery of medical services and who felt more appreciated by patients had lower levels of depersonalization and were less likely to question their career choice (R2= 0.16). Surgeons with high personal accomplishment experienced greater professional growth opportunities, perceived their institution as supportive, felt more appreciated by patients, and were less likely to question their career (R2= 0.24). The prioritization of goals to reflect both professional and personal values accounted for a significant amount of the variance in predicting both emotional exhaustion and personal accomplishment in separate regression equations. Recommendations to decrease burnout would include greater institutional support, increased opportunities for professional growth, and greater surgeon control over important services to facilitate efficient work. Coping strategies to moderate stress and burnout are also beneficial and should include prioritizing goals to reflect both professional and personal values.

Influence of Socioeconomic and Ethical Factors on People's Behaviour Regarding the Use of Cadaveric Organs

An organ donation is based on feelings of human solidarity and altruism. This approach, however, has not improved the organ shortage problem. The following suggestions might help to dismantle the persistent barrier linked to organ donation. (1) Society should be aware that during our lifetime we might be as much potential organ recipients as organ donors. (2) Educational campaigns should integrate the notion that cadaver organs are an irreplaceable source of health for every member of society. (3) Communication campaigns should illustrate that in allowing the use of our organs after death, we are, in fact, sharing a chance to prolong health for everybody, including perhaps ourselves. Furthermore, people need to acknowledge that using body parts is acceptable, and part of a tacit agreement between all members of society. Making a live organ donation to which the donor is emotionally related is a pressure-free decision. On the contrary, the donation of cadaver organs is influenced by negative factors. Conversely, self-interest and resistance to offering the body of a loved one to a stranger may make donation much more difficult if the current message is not modified. In an international survey of 242 transplantation professionals, with a 57% response rate, 70% to 83% agreed with this proposal. An international public survey has recently been finished, showing some results about the public's knowledge about religious opinions concerning transplantation, suggesting that religious institutions should assume a leadership role to give information about their positions. On the other hand, partial results concerning public attitudes regarding economic support to organ donation indicate that final data may be of interest. The creation of a Task Force with representatives from the World Health Organization, UNESCO, churches, and leaders of the global transplantation community may be key to joint efforts as a means to modify negative attitudes, to develop a new philosophy, and to deliver a new message to society.

Face transplantation: Part II-an ethical perspective

In May 2004, researchers at the University of Louisville Medical Center in Kentucky submitted a 30-page detailed document to the University's Institutional Review Board (IRB) that outlines their plan for the first face transplant. Despite the fact that both the Royal College of Surgeons in England in 2003 and France's Comite Consultatif National d'Ethique in 2004 issued reports saying that the risks of this surgery far outweigh the benefits tojustify it at the present time, the IRB at the University of Louisville is presently studying the proposal. Even though the microsurgical skills and anatomical knowledge is well established, face transplantation is more than a matter of technical achievement. The psychological impact on recipients and donor families as well as the long-term risks of a lifetime of immunosuppressant drugs must also be considered. More time is needed to perfect this surgery so that the rejection rate can be lowered and the patient's immune system can be taught to permanently tolerate the transplanted face. An ethical analysis will show that more time is needed to perfect this surgery so that the rejection rate can be lowered and the patient's immune system can be taught to permanently tolerate the transplanted face. To permit this surgery now, when there are so many unknown, life-threatening dangers would be medically irresponsible and ethically objectionable.

Public opinion and organ donation suggestions for overcoming barriers

Getting organs for transplantation depends on people's decision; thus, public opinion is essential to finding a solution to this problem. Efforts to improve organ shortage focus on: 1) Living, unrelated donation, 2) increasing marginal donors and 3) proposing economic support for donors. Paradoxically, no initiative has been suggested to modify public opinion towards cadaver donors. Several reasons explain the resistance to donating cadaver organs: Lack of awareness, religious uncertainties, distrust of medicine, hostility to new ideas, and misinformation. Education should be used to reshape public opinion about the use of organs for transplantation. Society should accept that "using" body parts is moral and offers a source of health for everybody. The concept that using cadaver organs implies sharing a source of health might be a social agreement between all members of Society. Suggestions for improving organ shortage include: 1) Society should understand that during one's life one may be just as easily a potential organ receiver as one is an organ donor. 2) Cadaver organs are an irreplaceable source of health. 3) As self-interest is one obstacle to donating cadaver organs, the "concept that allowing the use of our organs after death represents a chance of sharing health for everybody" may be useful for a change of attitude. Even though a poll among transplant professionals supported this suggestion, an international public survey should be carried out to evaluate people's reaction to this message.

Role of patient-support groups in the Thailand transplant program

Thailand started kidney transplantation in 1972 when vascular and nonvascular transplant programs were first established. Presently, we have 27 kidney, 6 liver, and 6 intrathoracic private or governmental transplantation centers, all approved and members of the Organ Donation Centres Thai Red Cross Society (ODC). They also provide organ procurement teams to the ODC. The Thai Medical Council has issued and supervised the criterion of brain death and ethical rules of transplantation to all practicing physicians since 1989. All recipients must register at these selected transplantation centers and at the ODC. When the potential donor arrives from any hospital in Thailand, the donor hospital notifies the ODC and organ procurement teams are sent out to harvest organs and transfer them to the recipient transplantation centers. The ODC computerizes and shares organs according to ABO, HLA typing, and crossmatching results. After transplantation all patients register with the Thai Transplantation Society (TTS) and the ODC. The TTS, the Thai Transplant Coordinator Society, and the ODC are responsible for the education of surgeons, physicians, nurses, patients, the public, and mass media to improve our transplant program. Bone marrow transplantation has separate regulations. Pooled, nonrelated bone marrow donors are registered at the blood-bank of the Thai Red Cross Society to provide donors for bone marrow transplantation. Financially, government support recipients only if they are state enterprise workers or civil servants. Public fund support through the ODC for organ procurement and the Kidney Foundation of Thailand is available for kidney transplantation. The ODC and the transplantation centers are the main patient-support groups for transplant programs in Thailand.

Pediatric cardiothoracic domino transplantation: the psychological costs and benefits

The first domino transplants were carried out in the UK in 1987, since which time 52 such procedures have been carried out involving patients within the paediatric cardiothoracic transplant programmes of Harefield and Great Ormond Street Hospitals. Although there are medical advantages in using domino organs--such as the ability for preoperative cross-matching, the heart not being subjected to the biochemical changes of brain death and less post-transplant coronary artery disease in the recipients of domino hearts compared with the recipients of hearts from cadaveric donors--the psychological sequelae for both donor and recipient have not been previously studied. The objective of this study was to identify the main psychological themes for patients involved in the domino programmes at the two hospitals, focusing on those situations where both patients were cared for in the same tertiary centre. Patients and their families were interviewed during routine outpatient clinic visits. Negative themes identified by patients included anxiety, guilt, resentment and anger if either patient had a poor outcome or suffered significant complications, disappointment and low self-esteem for potential donors whose heart was not used and recipient awareness of donor characteristics. Positive themes included gratefulness, comfort for the recipient that someone had not had to die for them directly and the benefit to the donor of giving their heart to another patient. In conclusion, domino transplantation has many medical advantages but there are significant negative psychological concomitants which need to be addressed within the multi-disciplinary management of these patients.

Factors influencing the willingness to donate body parts for transplantation

Three hundred and thirty-six people representing three ethnic groups (White, Asian, and Afro-Caribbean) were asked to rank their preferences concerning various incentives that might induce them to agree to the posthumous donation of their body parts. A conjoint analysis of the responses suggested that 'self centred' options (notably upfront cash payments and priority on waiting lists) were generally more popular than 'altruistic' alternatives. Members of the sample already possessing donor cards were more knowledgeable about the issue of organ transplantation than others, were less squeamish, and had relatives who favoured organ donation. The strength of a person's desire to donate body parts was related positively to self-respect and whether the individual was 'religious'; and negatively to (i) squeamishness and (ii) having relatives who objected to transplantation. Altruistic preferences vis-à-vis organ donation were associated with knowledgeability, self-esteem, family background, low levels of squeamishness, and the extent to which a person experienced 'helper's high.' People who were financially well-off were the most self-centred in the organ donation context. Overall the results imply substantial disparities between public policy and contemporary public opinion regarding transplant donation incentives.

Life and death decisions: using school-based health education to facilitate family discussion about organ and tissue donation

Public education that encourages family discussions about organ and tissue donation can enhance understanding, facilitate a donor's wishes and increase the numbers of donations. Action research methods were used to explore the impact of a student-initiated family discussion about donation. Most discussions were positive; only 7% middle school and 4% high school participants described them as "terrible." "Getting it started" was the most difficult. High school students felt "very" or "somewhat" prepared, whereas middle school students only felt "somewhat prepared". Guided family discussions ensure that families have accurate information about donation and an opportunity to talk about end-of-life choices in a non-crisis situation.

???Don???t Know Enough about It!???: Awareness and Attitudes Toward Organ Donation and Transplantation among the Black Caribbean and Black African Population in Lambeth, Southwark, and Lewisham, United Kingdom

BACKGROUND

The current demand for transplant organs, particularly kidneys, far outweighs the supply in the United Kingdom. This problem is particularly severe for the black African and black Caribbean population, who have been shown to have a disproportionately greater presentation on kidney transplant waiting lists in some regions of the United Kingdom. The situation is clear: There is an urgent need to address the number of black African and black Caribbean patients requiring a kidney transplant, otherwise the human and economic costs will be high.

METHODS

An exploratory study was undertaken to assess the current awareness of organ donation and transplantation and to explore attitudes toward these issues in a cross-section of the black African and black Caribbean population in Lambeth, Southwark, and Lewisham.

RESULTS

It was found that there was a lack of available information for the black African and black Caribbean communities. This precipitated low levels of awareness about organ donation and transplantation issues.

CONCLUSIONS

In an effort to redress this, effective methods for targeting black African and black Caribbean groups are required. From this study, there are indications that appeals for organ donors may be more effectively communicated by using a grass-roots, community-network approach. For this reason, consideration should be given to language and cultural needs, and to the provision of culturally sensitive material and information.

Evolutionary ethics: can values change

The hypothesis that values change and evolve is examined by this paper. The discussion is based on a series of examples where, over a period of a few decades, new ethical issues have arisen and values have changed. From this analysis it is suggested that there are a series of core values around which most people would agree. These are unlikely to change over long time periods. There are then a series of secondary or derived values around which there is much more controversy and within which differences of view occur. Such changes need to be documented if we are to understand the process involved in the evolution of differences in ethical views.

Opinions on renal transplantation and organ donation in high school students in two large northern (Torino) and southern (Napoli) Italian cities

Organ shortage for transplantation has focused attention on educational interventions. Italy is a nonhomogenous country whose cultural and economic differences are reflected in the health-care system: dialysis is mainly public in the north versus private in the south; and transplantation rates display a wide range from 3.4 to 37.8 per million people in 2002. The aim of the present study was to analyze the opinions of population of high school students (last two years) in two large cities: northern (Torino) and southern (Napoli) Italy, as a knowledge base for a randomized controlled trial on the efficacy of educational interventions on renal replacement therapy and organ donation, targeted to high school students.

METHODS

This preliminary study included eight public high schools that completed a first and anonymous semistructured questionnaire. Five hundred and eighty nine questionnaires were retrieved in Torino and 539 in Napoli. In both cities most students answered that they would give a kidney to a brother, sister, or partner needing dialysis (Torino: yes 80.6%; no 2.2%, uncertain-blank 17.2%; Napoli: yes 86.1%, no 1.1%; uncertain-blank 12.8%). Only 36.3% of the students in Torino and 37.7% in Napoli answered that they would consent to organ donation, if they had to choose for a strict relative with brain death. Opposition was 28% in Torino and 23.7% in Napoli; 35.7% in Torino and 38.6% in Napoli were blank-uncertain. These data underline the need for detailed information on the opinions of the overall population as basis for tailored educational campaigns.

To give or to receive? opinions of teenagers on kidney donation

BACKGROUND

The attitude toward living donation varies widely in the world, for economic and cultural reasons. In Italy, as in other Mediterranean settings, the role of living kidney donation is minor.

AIM

To analyze the reasons for this attitude, we gathered data in a general population sample of high school students in a large northern Italian industrial city (Torino, about 900,000 inhabitants).

METHODS

Semistructured questionnaires (n = 1676), gathered in 2001 to 2002 in 14 high schools, in the context of an educational program on dialysis, renal transplantation, and organ donation, were analyzed presumably reflecting opinions gathered before the educational intervention.

RESULTS

Most students, in the case of a close relative or partner needing dialysis, answer that they would donate a kidney (yes: 78.2%, no: 2.9%, uncertain-blank: 18.9%); receiving a living donor kidney is felt as disturbing: only 57.5% of the students would accept it (no: 5.9%, uncertain-blank: 36.6%), mainly because of fear of long-term problems for the donor. Donation from an older to a younger person is seen more positively than vice versa.

CONCLUSION

In our settings, the attitude of the teenagers on living donation is positive; however, while "giving" is positively seen, the presence of unresolved fears is witnessed by the lower acceptance of the idea of "taking." These data suggest to focus on the risks of kidney donation in educational campaigns and in patient-physician information. The positive attitude shared by the teenagers supports the working hypothesis that lack of information is one of the determinants of the low living donor transplantation rate in our area.

Commodification and exploitation: arguments in favour of compensated organ donation

This paper takes the view that compensated donation and altruism are not incompatible. In particular, it holds that the arguments against giving compensation stand on weak rational grounds: (1) the charge that compensation fosters "commodification" has neither been specific enough to account for different types of monetary transactions nor sufficiently grounded in reality to be rationally convincing; (2) although altruism is commendable, organ donors should not be compelled to act purely on the basis of altruistic motivations, especially if there are good reasons to believe that significantly more lives can be saved and enhanced if incentives are put in place, and (3) offering compensation for organs does not necessarily lead to exploitation-on the contrary, it may be regarded as a necessity in efforts to minimise the level of exploitation that already exists in current organ procurement systems.

Avoiding steroids in solid organ transplantation

The excellent results obtained today in solid-organ transplantation allow the envisaging of an improvement in long-term quality of life with a functioning graft. One way for this to be achieved is by the reduction, or even better, the avoidance, of steroid-based immunosuppression. Avoidance of steroids is indeed known to enhance the physical and psychological well being of the allograft recipient. This paper reviews the current status of steroid-free immunosuppression in renal, pancreatic, hepatic, intestinal, and cardiac transplantation.