A. López-Navas

A Multicentre and stratified study of the attitude of medical students towards organ donation in Spain

ABSTRACT Introduction: Medical students represent a new generation of medical thought, and if they have a favourable attitude towards organ donation this will greatly encourage its promotion. Objective: To analyse the attitude of medical students in Spanish universities towards the donation of their own organs and to determine the factors affecting this attitude. Material and Methods: Type of study: A sociological, interdisciplinary, multicentre, and observational study in Spain. Study population: Students studying a degree in medicine enrolled in Spain (n = 34,000). Sample size: A sample of 9598 students (confidence of 99% and precision of ±1%), stratified by geographical area and academic year. Instrument of measurement: A validated questionnaire of attitude towards organ donation and transplantation (PCID-DTO RIOS) was self-administered and completed anonymously. Results: The questionnaire completion rate was 95.7% (n = 9.275). 80% were in favour of donation, 2% against and 18% were undecided. The following main variables were related to a favourable attitude: being of the female sex (Odds Ratio = 1.739); being in the sixth year of the degree (OR = 2.506); knowing a donor (OR = 1.346); having spoken about the subject with one’s family (OR = 2.132) and friends (OR = 1.333); having a family circle that is in favour, more specifically, having a father (OR = 1.841), mother (OR = 2.538) or partner in favour (OR = 2.192); being a blood donor (OR = 2.824); acceptance of the mutilation of the body if it were necessary (OR = 2.958); and being an atheist or an agnostic (OR = 1.766). Conclusions: Spanish medical students generally have a favourable attitude towards organ donation, although 20% are not in favour.

Psychological characteristics of patients on the liver transplantation waiting list with depressive symptoms.

INTRODUCTION Untreated psychiatric morbidity can worsen the quality of life in the posttransplantation stage. Therefore, it is important to detect and treat alterations associated with depression in transplantation patients from the beginning of the process. The objective of this study was to determine the psychological characteristics of patients on the liver transplantation waiting list with emotionally depressed symptoms. MATERIAL AND METHODS We evaluated 70 patients on the liver transplantation waiting list for psychopathological symptoms of depression using the Symptom Assessment-45 Questionnaire (González and Cuevas) using chi-squared tests, Student t tests, and logistic regression analysis. RESULTS Forty-seven percent of the patients on the liver transplantation waiting list showed relevant depressive-type psychopathological symptoms. The presence of the following factors were associated with the emotionally depressed characteristics of these patients: psychiatric mental disorders (P = .015); no partner (P = .009); and alcohol abuse (P = .050). Other related factors included the following: obsessive-compulsive-type emotional alterations (P = .001); interpersonal sensitivity (P < .001); anxiety (P < .001); hostility (P = .017); phobic anxiety (P = .017); and paranoid ideation (P = .029). With regard to coping strategies, these patients used defenselessness (P < .001) and anxious preoccupation (P = .016). With regard to the social-family setting, emotionally depressed patients had nonfunctional family and/or social support, according to the global MOS (Medical Outcomes Study-Social Support Survey) index (P = .008) and the total Apgar Family Score (P < .001). CONCLUSIONS Almost half of the patients on the liver transplantation waiting list showed emotionally depressed-type symptoms. Other emotional-type alterations were related to this psychological profile: coping strategies of defenselessness and anxious preoccupation as well as nonfunctional social and/or family support.

The Attitude of Future Journalists Toward Living Donation

INTRODUCTION The attitude of journalism students toward living donation (LD) could influence public opinion and help to promote this treatment option. We sought to analyze the attitude of journalism students toward LD and the factors that affect this attitude. METHODS We surveyed journalism students in the academic year 2005-2006 (N = 129). We used a validated psychosocial questionnaire (self-administered and anonymous) about organ donation and transplantation. Students were recruited in compulsory classes; the Student t-test and the chi(2) test were applied. The control group consisted of a sample of the native population (n = 2000). RESULTS The questionnaire completion rate was 98% (n = 126). Regarding related living liver donation, 75% (n = 94) would be willing to donate a liver segment; 25% (n = 31) would refuse. Only 14% (n = 18) would donate part of their liver to an unrelated person if needed, 24% (n = 30) are against, and 62% (n = 78) are undecided. For living kidney donation, 85% (n = 107) would donate a kidney to a family member; 15% (n = 19) would refuse. Only 24% (n = 31) are in favor if donation were unrelated, 17% (n = 21) against, and 59% (n = 74) have doubts. The attitude toward LD is more favorable among those who would be willing to donate their organs upon death (P = .012 for the liver and P = .000 for the kidney); those who would accept part of a liver from a family member (P = .000); or those who would accept a kidney (P = .001); or would donate a kidney to an unrelated recipient while alive (P = .001) and liver (P = .003). CONCLUSION Journalism students have a favorable attitude, which could be useful to keep society informed about the matter.

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.

Do Future Journalists Have a Favorable Attitude Toward Deceased Donation

INTRODUCTION The information provided by future journalists is fundamental for promoting healthcare and their attitude toward organ donation and transplantation (ODT) could affect public opinion. The objective of this study was to analyze the attitude of students of journalism toward ODT and the factors affecting this attitude. MATERIALS AND METHODS The subjects of this study were students doing a degree in journalism in 2005-2006 (N = 129). A self-administered questionnaire about ODT was completed anonymously. For statistical analysis we used Student t test and the χ(2) test. RESULTS The questionnaire completion rate was 98% (n = 126). Most students (78%; n = 98) would be willing to donate their organs, although 22% (n = 28) would not. Attitude was more favourable among those respondents who knew a transplant recipient (100% vs 71%; P = .002), had a favourable attitude toward donating a family members organs (P = .000), and had discussed ODT within the family (P = .000). Those who had a positive attitude toward living donation had a more favourable attitude toward deceased ODT (P = .000 for kidney and P = .003 for liver). Most respondents (56%; n = 70) believed that the general information they received about ODT was limited and 9% (n = 11) believed that it was good. Most (83%; n = 104) had never received a talk about the subject, although 90% (n = 113) believed that receiving one would be very interesting. CONCLUSION Attitude toward ODT is favorable in a high percentage of students of journalism. This is positive if we want these professionals to inform society about the subject. They should be provided with clear and concise information.

Psychological Care: Social and Family Support for Patients Awaiting a Liver Transplant

INTRODUCTION In patients awaiting a transplant, the help received from friends and/or family members is considered to be an important factor in the transplantation process. Our objective was to determine the level of social/family support for patients on the liver transplant waiting list and to determine the relationship between clinical psychopathology and the level of social/family support. MATERIALS AND METHODS The study population consisted of 70 patients on the liver transplant waiting list. We used the following instruments: (1) Medical Outcomes Study-Social Support Survey (MOS) Questionnaire. For size of the social network, four support dimensions and a global support index for emotional support, material/instrumental support, leisure/free time activities, and love/care; (2) Family Apgar Questionnaire for personal perception of family function; (3) SA-45 questionnaire of psychopathologic symptoms for somatizations, obsessive-compulsivity, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. RESULTS The MOS showed that the mean size of the social network of these patients was 12 people. In these patients, social/family support was nonfunctional in 20% of the cases. By dimensions, the patients had the following percentage of nonfunctional support: 24% in emotional support; 10% material/instrumental support; 23% social relations of leisure/free-time activities; and 11% compassionate love/care support. The patients with nonfunctional support had the following associated psychopathologic symptoms (SA-45): depression (79% vs 39%; P = .008), anxiety (86% vs 46%; P = .008), hostility (43% vs 12%; P = .009), and psychoticism (14% vs 2%; P = .039) compared to functional patients. The Family Apgar showed that 27% of patients perceived a family dysfunction. These patients had greater interpersonal sensitivity-type emotional symptoms (32% vs 8%; P = .012), depression (79% vs 35%; P = .001), anxiety (79% vs 45%; P = .011), and hostility (42% vs 10%; P = .002) compared to normally functioning patients. CONCLUSIONS Nearly a quarter of patients on the liver transplant waiting list have social/family support that is nonfunctional, which leads to greater emotional psychopathologic symptoms that would need to be treated.

Evaluation of Attitudes Toward Living Organ Donation: A Multicenter Study of Compulsory Secondary School Education Teachers

BACKGROUND There is a considerable transplant organ deficit. To offset the organ shortage, living donation is being encouraged. Young persons form a sector of the population in whom early awareness is important to encourage favorable attitudes toward donation. Teachers play important roles in education and in generating attitudes. PURPOSE We analyzed the attitudes of secondary school teachers toward living organ donation and sought to determine the psychosocial variables that affect these attitudes. MATERIALS AND METHODS We randomly selected Teachers from 10 secondary schools in southeastern Spain. Their attitudes toward living donation were evaluated using a validated questionnaire, which was self-administered anonymously. The statistical tests were Student t test and the χ2 test. RESULTS Regarding living kidney donation, 92% of teachers were in favor of related donation, decreasing to 16% when it was not from a related individual. In contrast, regarding related donations, 7% were not in favor, and 1% undecided. Teachers who had discussed the matter with their family and friends had more favorable attitudes (P<.05). In the case of living liver donations, 91% were in favor of related donation (falling to 20% if not related), 7% were not in favor, and 2% had doubts. Attitudes were more favorable among women, teachers with children, and those who had discussed the matter with their family and friends (P<.05). CONCLUSIONS Teachers had favorable attitudes toward living related kidney or liver donation. Their students would receive positive information when they request relevant information.

Knowledge of the Brain Death Concept Among Adolescents in Southeast Spain

BACKGROUND The concept of brain death (BD) is not very well known in the population, making it one of the main psychosocial barriers to favorable attitudes toward donation. Adolescents are a key sector of the population for future organ donation. For this reason it is important to find out what they know about this concept. OBJECTIVES The aim of this study was to analyze the concept of BD among adolescents in the southeast of Spain and to determine their influence on attitude toward organ donation. METHODS In the southeast of Spain a random sample was stratified according to Compulsory Secondary Education (CSE) schools. In the 10 selected schools, we performed a random sampling of each of the classes from the 1st to the 4th years of CSE. Knowledge of the concept of BD and attitude toward donation were analyzed with the use of a validated questionnaire, which was self-administered and completed anonymously. Statistical analyses used the Student t test and the χ(2) test. RESULTS Of 3,547 adolescents surveyed, 38% (n = 1,337) of the respondents knew the BD concept, considering it to be the death of an individual. Of the rest, 54% (n = 1,930) did not know this concept and the remaining 8% (n = 280) thought it did not mean a persons death. The respondents who were more in favor of deceased donation had a better knowledge of the concept of BD than those who had doubts (40% vs 35%, respectively; P = .007). The knowledge of the concept of BD was associated with variables directly and indirectly related with donation and transplantation (P < .05). CONCLUSIONS Most adolescents in the southeast of Spain do not know the concept of BD, and this adversely affects the attitude toward organ donation.

Secondary School Teachers' Assessment of the Introduction of an Educational Program About Organ Donation and Transplantation

INTRODUCTION It is essential to provide information about organ donation and transplantation (ODT) to encourage school pupils to have favorable attitudes toward this matter in the future. The role of the teacher is crucial in this respect. The objective of this study was to determine acceptance by secondary school teachers of an educational program about ODT. MATERIALS AND METHODS A random sample of secondary school teachers was taken from 10 secondary schools in the southeast of Spain. A total of 288 teachers were surveyed using a questionnaire that assessed the following; (1) acceptance of the educational program; (2) who should carry it out; and (3) some psychosocial variables related to ODT. RESULTS Of the 288 secondary teachers surveyed, 283 of them responded to the acceptance of an educational program on ODT. Approximately half (54%) of the respondents believed that it would be appropriate to introduce an educational program about ODT in secondary schools, 22% believed that there were currently other more important educational considerations, 20% had doubts, and 4% believed that it would not be useful. The vast majority (71%) believed that a collaborator from the Regional Transplant Team would be the best person to carry out the program followed by any teacher (11%) or a teacher of ethics (9%). The remaining 9% were not sure. There was greater acceptance of an educational program about ODT among teachers who had a favorable attitude toward the matter (P = .003). CONCLUSIONS An educational program about ODT in secondary education was not equally accepted by all teachers. Most teachers believed that the program should be delivered by the Transplant Coordination Center rather than teachers themselves.

Factor Analysis of Sources of Information on Organ Donation and Transplantation in Journalism Students

BACKGROUND Journalists and the information they disseminate are essential to promote health and organ donation and transplantation (ODT). The attitude of journalism students toward ODT could influence public opinion and help promote this treatment option. OBJECTIVE The aim of this study was to determine the media through which journalism students receive information on ODT and to analyze the association between the sources of information and psychosocial variables. METHODS We surveyed journalism students (n = 129) recruited in compulsory classes. A validated psychosocial questionnaire (self-administered, anonymous) about ODT was used. Student t test and χ(2) test were applied. RESULTS Questionnaire completion rate was 98% (n = 126). The medium with the greatest incidence on students was television (TV), followed by press and magazines/books. In the factor analysis to determine the impact of the information by its source, the first factor was talks with friends and family; the second was shared by hoardings/publicity posters, health professionals, and college/school; and the third was TV and radio. In the factor analysis between information sources and psychosocial variables, the associations were between information about organ donation transmitted by friends and family and having spoken about ODT with them; by TV, radio, and hoardings and not having spoken in the family; and by TV/radio and the fathers and mothers opinion about ODT. CONCLUSIONS The medium with the greatest incidence on students is TV, and the medium with the greatest impact on broadcasting information was conversations with friends, family, and health professionals. This could be useful for society, because they should be provided with clear and concise information.