E.J. Ramírez

Knowledge of the brain death concept by personnel in Spanish and Latin-American healthcare centers

Background The knowledge and acceptance of the concept of brain death (BD) among health care personnel is fundamental. Objective To analyze the level of understanding of the BD concept among personnel in Spanish and Latin American healthcare centers and to determine the factors affecting this attitude. Material and methods Data from 12 hospitals and 32 primary care centers in 4 countries within the International Collaborative Donor Project were selected (Spain, Mexico, Cuba and Costa Rica (n = 4378)). Results 62% of the personnel (n = 2714) understood BD and believed that this was the death of an individual. Of the rest, 30% (n = 1 333) did not understand it and the remaining 8% (n = 331) believed it did not mean the death of a patient. 83% (n = 931) of physicians understood BD, compared to 75% (n = 895) of nurses, 55% (n = 299) of healthcare assistants, 53% (n = 108) of non-healthcare university-educated personnel and 36% (n = 481) of those without a university education (p<0.001). 68% (n = 1084) of Mexicans understood BD compared to 66% (n = 134) of Cubans, 58% (n = 1411) of Spaniards, and 52% (n = 85) (p<0.001) of Costa Ricans. There were significant relationships between knowledge of the concept and the following: type of healthcare center (p<0.001), clinical service (p<0.001), having spoken about organ donation within the family (p<0.001) and ones partners attitude to the subject (p<0.001). A direct relationship has been found between understanding the concept and attitude toward deceased donation (p<0.001). Conclusions The understanding of BD by personnel from healthcare centers was not as good as expected. There were marked differences depending on job category.

Level of acceptance of solid organ xenotransplantation among personnel in Spanish, Mexican, and Cuban hospitals

Xenotransplantation is still a long way from becoming a clinical reality. However, in an emergency situation, it could be used as a bridge for replacing vital organs until the arrival of a human organ. To analyze the attitude toward xenotransplantation among hospital personnel from several hospitals in Spain and Latin America.

Spanish and Latin American Nursing Personnel and Deceased Organ Donation: A Study of Attitude

OBJECTIVE To analyze the attitude of nursing personnel about organ donation and transplantation in hospitals in Spain and Latin America, and factors that affect this attitude. METHODS Data were selected from 12 hospitals and 32 primary care centers participating in an international study (Proyecto Donante, Murcia) in 4 countries including Spain (n = 650), Mexico (n = 428), Cuba (n = 89), and Costa Rica (n = 27). The sample was random and stratified by type of service among nursing personnel (n = 1194). Attitude was evaluated using a psychosocial questionnaire. RESULTS Of nursing personnel surveyed, 77% (n = 922) were in favor of organ donation. No differences were found according to whether they were directly involved in transplantation-related services (P < .05). Attitude in favor of organ donation varied between countries: 92% in Cuba, 85% in Costa Rica, 80% in Mexico, and 73% in Spain (P < .001) This attitude was also related to donation of a family members organs (P < .001), having discussed organ donation and transplantation within the family (P < .001), the concept of brain death (P < .001), fear of body mutilation (P < .001), and manipulation of the body after death (P = .001). CONCLUSION Attitude toward deceased organ donation among nurses varies between countries. There is a discrepancy between those in favor vs actual donation rates in countries and work centers. These fears may become worse when donation is seen as common in daily clinical practice.

Level of Acceptance of a Clinical Solid Organ Xenotransplantation Program Among Personnel in Organ Transplant-Related Services in Spanish, Mexican, and Cuban Hospital Centers

INTRODUCTION Xenotransplantation is far from becoming a clinical reality. However, in vital organs it could be used as a bridge until a human organ becomes available, in an emergency situation. We analyzed the attitude toward xenotransplantation among personnel in transplant-related services in several hospitals in Spain and Latin America. METHODS A random sample stratified by type of service and job category (n = 738), in transplant-related services (procurement units, transplant units, and transplant patient follow-up units) was examined in eight hospital centers from three different countries: Spain (n = 349), Mexico (n = 269), and Cuba (n = 120). A self-administered validated questionnaire was completed anonymously. RESULTS Based on the assumption that all the results of xenotransplantation were similar to those achieved with human donors, most respondents [66% (n = 484)] would be in favor. The employees from Cuban centers had the most favorable attitudes (72% in favor), followed by the Spanish (64%) and the Mexicans (61%; P = .013). However, the differences were mainly determined by job category: Physicians showed the most favorable attitudes and auxiliary staff the least (67% vs 40%; P = .010). Attitudes were significantly related to beliefs about different types of human donation [deceased (P < .001) and living (P < .001)], the possibility of needing a transplant for oneself (P < .001), and a favorable attitude toward donating the organs of a deceased family member (P = .004). CONCLUSIONS Currently, a third of health care employees working in transplant-related services are not in favor of xenotransplantation. More information should be provided about the subject, especially in centers with preclinical xenotransplantation programs.

Opinion toward living liver donation of hospital personnel from units related to organ donation and transplantation: a multicenter study from Spain and latin-america.

Background: Hospital personnel of services related to donation and transplantation process play a fundamental role in the development of transplantation. Objectives: The aim of this study was to investigate the attitude toward living liver donation (LLD) among hospital personnel from services related to donation and transplantation in hospital centers in Spain and Latin America. Materials and Methods: Eight hospitals within the “International Donor Collaborative Project” were selected, three in Spain, three in Mexico and two in Cuba. The study was performed in transplant-related services, using a randomized sample, which was stratified by the type of service and job category. Results: In total, 878 workers were surveyed of which 82% (n = 720) were in favor of related LLD, 10% (n = 90) were against and 8% (n = 68) undecided. Attitudes toward related LLD were more favorable in the following groups: the Latin Americans (86% in favor vs. 77% among the Spanish; P = 0.007); younger people (37 vs. 40 years, P = 0.002); those in favor of either deceased donation (P < 0.001) or living kidney donation (P < 0.001); those who believed that they might need a transplant in the future (P < 0.001); those who would accept a liver from a living donor (P < 0.001); those who discussed the subject of donation and transplantation with their families (P = 0.040); and those whose partner was in favor of donation and transplantation (P = 0.044). Conclusions: Personnel from donation and transplantation-related units had a favorable attitude toward LLD. This attitude was not affected by psychosocial factors, although it was influenced by factors directly and indirectly related to the donation and transplantation process.

Attitude toward living liver donation in transplant hospitals in Spain, Mexico and Cuba.

BACKGROUND Transplantation hospitals have played a key role in developing deceased organ donation and transplantation (ODT). To reduce the number of deaths on the transplant waiting list, it is essential to encourage living liver donation (LLD). Involvement of personnel in these hospitals is crucial. PURPOSE We analyzed the attitudes toward LLD among hospital personnel in Spain, Mexico, and Cuba. MATERIALS AND METHODS Data were obtained from 5 transplant hospitals in Spain, Mexico, and Cuba. The sample was stratified according to job category and type of service (n=2273). A validated questionnaire about living donation was used as the instrument. RESULTS Most respondents (82%) were in favor of related LLD. If the LLD was not related, acceptance fell to 21%. A total of 85% of physicians, 79% of nursing personnel, 74% of nursing assistants, and 83% of auxiliary staff were in favor (p<.001). A favorable attitude toward LLD was associated (P<.05) with age (37±10 y vs 39±10 y), a favorable attitude toward deceased donation, a belief that a possible transplant is needed, acceptance of LLD if necessary, a favorable attitude toward living kidney donation, family discussion about ODT, a partners favorable attitude toward ODT, an intention to participate in prosocial activities, being a Catholic, and a belief that ones religion is in favor of ODT. CONCLUSIONS Personnel from Spanish, Mexican, and Cuban transplantation hospitals have favorable attitudes toward LLD. This suggests that there may be an increase in LLD in the future, provided that there is the necessary sociopolitical and economic support.

The attitude toward living kidney donation among personnel from units related to donation and transplantation in Spain, Mexico and Cuba.

Abstract Background: Living kidney donation (LKD) is becoming increasingly necessary as a treatment option for reducing the deficit in transplant organs. Hospital personnel in services related to donation and transplantation play a key role in promoting this kind of donation. Objective: To analyze the attitude toward LKD among hospital workers in services related to donation and transplantation in Spain and Latin America. Methods: Eight hospitals in the “International Collaborative Donor Project” were selected (Spain–Mexico–Cuba). A random sample was taken which was stratified according to the type of service and job category, in transplant-related services. Results: Of the 878 respondents, 90% were in favor of related LKD, and 28% were in favor if the LKD was not related. Attitude was more favorable among Latin Americans workers compared to the Spanish (p = 0.014). Other factors associated to attitude included: age (p = 0.004); an attitude in favor of deceased donation and living liver donation (p < 0.001); and acceptance of a kidney from a donor (p < 0.001). Conclusions: The attitude toward related LKD was very favorable among hospital personnel in units related to the donation and transplantation process in Spain and Latin America, which means that they could contribute to its promotion particularly at the current time when living kidney donation needs to be expanded.

El personal no sanitario de hospitales españoles y latinoamericanos ante la donación de vivo renal relacionada

INTRODUCTION Ancillary hospital personnel represent an important body of opinion because as they work in a hospital their opinion has more credibility for the general public as a result of their activity in hospitals. However, in most cases they do not have any health care training which means that their attitude could be based on a lack of knowledge or unfounded fears. OBJECTIVE To analyze the attitude toward living kidney donation (LKD) among ancillary personnel in Spanish and Latin-American hospitals and to analyze the variables that might influence such attitude. PATIENTS AND METHOD from «International Collaborative Donor Project» a random sample was taken among ancillary personnel in Spain, Mexico and Cuba hospitals. Attitude towards LKD was evaluated using a validated, anonymously filled and self-administered survey. RESULTS 951 professionals were surveyed (Spain: 277, Mexico: 632, Cuba: 42). 89% (n=850) are in favor of related kidney donation, lowering to 31% (n=289) in non-related donation. Of the rest, 8% (n=78) are not in favor and the 3% (n=23) are unsure. By country, Cubans (98%) and Mexicans (91%) are more in favour than Spanish (84%) (P=.001). The following variables are related to favourable attitude towards LKD: female sex (P=.017), university degree (P=.010), work in health services (P=.035), labour stability (P=.016), personal experience in donation and transplantation (P=.001), positive attitude toward cadaveric donation (P<.001), belief that he or she might need a transplant in the future (P<.001), positive attitude towards living liver donation (P<.001), a willingness to receive a donated living liver if needed (P<.001), having discussed the subject of organ donation and transplantation within the family (P<.001), partners positive attitude towards the subject (P<.001), participation in voluntary type pro-social activities (P=.002) and not being concerned about possible mutilation after donation (P<.001) CONCLUSIONS: The attitude toward living related kidney donation is favourable among ancillary personnel in Spanish and Latin-Americans hospitals. Because living donation is a better source of organs than cadaveric ones, this favourable predisposition can be used as promoting agent of living donation in order to develop it in Spanish-speaking countries.