Organ Transplant Programs Research Articles

Attitude of Personnel in Hospital Cadaveric Organ Transplant-Related Units Faced with Living Kidney Donation in a Hospital with a Living Kidney Donor Transplantation Program

Introduction: The attitude of health care personnel is fundamental for the procurement of organs, especially when they are based in transplant-related services. The objective of this study is to assess the attitude of hospital personnel in transplant-related services toward living kidney donation in a hospital with a cadaveric and living solid organ transplant program. Materials and Methods: A random sample was taken and stratified by type of service and job category (n = 330) in transplant-related services (procurement units, transplant units and follow-up units). The attitude toward cadaveric organ donation was evaluated using a validated psychosocial questionnaire. Student’s t test, χ² test, and logistic regression analysis were applied for statistical analysis. Results: The questionnaire completion rate was 94% (n = 309). Most respondents (87%, n = 268) are in favor of related living kidney donation. However, only 17% (n = 53) of respondents are in favor if this donation is unrelated. Of the rest, 4% (n = 12) of respondents would not accept a donated living kidney organ and the remaining 9% (n = 29) are undecided. Only two variables are significantly related to attitude towards living kidney donation: age (p = 0.013) and a willingness to receive a donated living organ on the part of the respondent, if a transplant organ were needed (p < 0.001). Both variables persist as significant independent variables in the logistic regression analysis. There is also a close relationship between attitude toward living kidney donation and attitude toward living liver donation (p < 0.001). Conclusions: The personnel in donation and transplantation units tend to have a favorable attitude towards living kidney donation making them a key element in the current promotion of living kidney donation. Moreover, the youngest workers in these units are those who tend to be more in favor, thus offering a promising future for this type of kidney donation which is becoming more of a necessity given the cadaveric organ deficit.

The D&amp;T Report

The D&amp;T Report

Hospital Personnel in Surgical Services in a Transplant Hospital Faced With Living Liver Donation: An Attitudinal Survey

Living liver donation is becoming a more widely accepted practice given the decrease in donor morbidity and mortality and the beneficial results in the recipient. Use of this technique is unusual in Spain. There are a number of workers against its use within the health care system. The objective of this study was to analyze attitudes toward and the variables that affect them concerning living liver donation among surgical services in a transplant hospital. Materials and Methods A random survey was stratified by surgical area and job category in a Spanish third-level hospital with an ongoing solid organ transplant program. Attitudes toward living liver donation were assessed using a questionnaire about organ donation and transplantation that evaluated various psychosocial variables. Student’s t test and the chi square test were used. Results A total of 263 workers were surveyed (mean age as 40 ± 9 years). Regarding attitudes toward living liver donation, the level of acceptance was 80% ( n = 211) of respondents, whereas 10% were undecided ( n = 26), and another 10% were against ( n = 26), assuming that the donations were related. When we asked about unrelated living donation, the percentage in favor decreased to 10% ( n = 27). No differences were found with respect to job category or type of service. The variables that are related to such an attitude are the following: (1) possibility of respondent needing an organ ( P = .001); (2) favorable attitude toward living kidney donation ( P < .000); and (3) a belief that medical errors exist ( P = .004). An important finding was that attitudes toward living liver donation were not more favorable according to whether the respondent was in favor or against cadaveric organ donation ( P = .175). Conclusion There was a highly favorable attitude toward living liver donation among hospital personnel in surgical services, which is an important factor to take into account if this type of donation is to be encouraged in Spain.

The changing epidemiology of gout

Gout is one of the most common inflammatory arthritides, which is considered to be a true crystal deposition disorder caused by the formation of monosodium urate crystals in and around joints. A number of epidemiological studies from a diverse range of countries suggest that gout has increased in prevalence and incidence in recent years and that the clinical pattern of gout is becoming more complex. In particular, the greatest increase has been observed in primary gout in older men. Robust epidemiological studies have established risk factors for gout including genetic factors, excess alcohol consumption, purine-rich diet, the metabolic syndrome (obesity, hypertension, hyperlipidemia and insulin resistance), use of diuretics and chronic renal failure. Trends in alcohol use, diet, obesity and the metabolic syndrome in the general population might explain changes in the prevalence and incidence of gout in the community. Osteoarthritis, which is thought to predispose patients to monosodium urate crystal deposition in their joints, is becoming more prevalent as a consequence of increased longevity. In hospital settings, widespread diuretic use, increasing prevalence of end-stage renal failure and the success of organ transplant programmes have led to an increase in clinical complexity. Suboptimal management of gout is likely to have contributed to the rise in the prevalence of clinically overt, symptomatic, chronic gout.

Benefit of a Hospital Course About Organ Donation and Transplantation: An Evaluation by Spanish Hospital Transplant Personnel

A considerable percentage of hospital personnel are against organ donation, which at a crucial time could act as an obstacle to donation. Moreover, there is often a lack of training of personnel necessary for them to provide accurate information about organ donation and transplantation. Our objective was to determine the acceptability of a training course about organ donation among hospital workers in a center with an ongoing solid organ transplant program. Materials and Methods A random sample ( n = 1168) was stratified by type of service and job category among workers in hospital services within an organ transplant program. An evaluation was made of attitudes toward donation and acceptance of a training course using a validated psychosocial questionnaire. Distribution of the survey was made by the head of each service and job category. The survey was completed anonymously and self-administered. Results Sixty-nine percent ( n = 808) of respondents were in favor of donating their own organs. With respect to the benefit of a training course about organ donation and transplantation, 50% ( n = 584) of respondents considered it to be a useful idea, whereas 15% ( n = 176) did not, and 35% ( n = 408) were not sure. An important finding was that 56% ( n = 452) of those who are in favor of donation would take part in the course compared to only 37% ( n = 132) of those who were against or undecided. There was a significant relationship between those workers who believed that the training course will be of use and the following factors: younger age ( P = .000); women ( P = .000); single ( P = .000); nursing job category ( P = .000); a temporary contract ( P = .012); a worker in nonsurgical services ( P = .000); prior understanding of the concept of brain death ( P = .003); favoring cadaveric organ donation ( P = .000); performing pro-social voluntary type activities ( P = .000); discussions of organ donation and transplantation within the family ( P = .022); Catholic religion ( P = .001); a partner in favor of organ donation and transplantation ( P = .001); and a belief that he may need a transplant ( P = .000). Conclusions A training course about organ donation and transplantation might be useful given that only half of the workers would be prepared to take part and with respect to the target population, only 37% of them stating that they would participate. Its main use would be to reinforce the positive attitude of those who are already in favor and increase their knowledge about the subject. What is more, if these workers received adequate training they would serve to promote donation both directly and indirectly to the general public and other hospital personnel.

Improving the Organ Transplantation Program in Greece: Institution of Local Transplant Coordinators’ Network

The success of a transplantation program depends upon the quality and effectiveness of the donation process, whereby the key role is assigned to the local transplant coordinator (TxC). This important professional figure was only recently established in Greece. The local TxC duties were outlined alongside those of the Hellenic Transplant Organization (HTO) foundation in 1999, whereby three different transplant coordinator positions—central, local, and clinical—were specified. In 2002, the above-mentioned positions were legally consolidated. Local TxCs had to be doctors or nurses, in a 70%-30% ratio, already working in intensive care unit (ICU) and had to be appointed by the hospital and ICU directors in each hospital as requested by the HTO. By the end of 2004, this network consisted of 122 TxCs located in 74 ICUs, especially trained in donation procedures and ethics. Half of the doctors were ICU directors, especially appointed to influence ICU personel. Furthermore in 2005, the board of directors of HTO decided that there should be closer cooperation between the 45 most donor generating ICUs and their TxCs. It was decided that the local TxCs would work part-time and receive a monthly grant. The 45 ICU network started in 2005, resulting in an 154% increased rate of potential donor referrals and a 33% and almost 38% increase in actual donors and transplantations, respectively, compared to 2004. This substantial increase was achieved by the institution of TxC network.

Personnel in cadaveric organ transplant‐related hospital units faced with living liver donation: an attitudinal study in a Spanish hospital with a cadaveric and living liver transplant programme

The attitude of health-care personnel is fundamental for the procurement of transplant organs, especially in those services that are related to transplantation. The objective of this study is to find out the attitude towards living liver donation among personnel who work in transplant-related services in a hospital with a cadaveric and living organ transplant programme. A random sample was taken and stratified by type of service and job category (N=330), in services related to transplantation (procurement units, transplant units and follow-up units). Attitude was evaluated using a validated psychosocial questionnaire. a random sample of personnel in clinical services that do not have any direct contact with solid organ transplantation. Student's t-test and the chi(2) test complemented by a logistical regression analysis were applied in the statistical analysis. The questionnaire completion rate was 94% (N=309). Only 10% (N=31) of respondents are in favour of living liver donation if it is unrelated, but another 67% (N=207) are in favour if donation were for a relative. Of the rest, 11% (N=33) do not agree with living liver donation and the remaining 12% (N=38) are undecided. In the control group, attitude towards living liver donation is favourable in 82% (N=344) (P=0.0908). An analysis of the variables that influence attitude shows that the following factors are significantly related: (1) age (P=0.037); (2) a respondent's belief that he or she may need a transplant in the future (P=0.013); and (3) if it were necessary, a willingness to receive a donated living liver organ (P=0.000). Of the variables that have the most influence on attitude towards living liver donation in the bivariate analysis, there are two variables that are statistically significant in the multivariate analysis: (1) age and (2) willingness to accept a donated living liver organ from a relative if it were needed (OR=14.19). There is also a close relationship between attitude towards living liver donation and attitude towards living kidney donation (P=0.000) CONCLUSIONS: There is a favourable attitude towards living liver donation among personnel in units related to the transplantation and donation process, although it is less favourable than expected. Therefore, it will be necessary to increase this level of acceptance and to improve information about the matter if we want to encourage living liver donation. The youngest workers in these units are those who are most in favour, which leads us to believe that there is a hopeful future for this type of liver donation that is so necessary given the cadaveric organ deficit.

Immunosuppressive Therapy and Malignancy in Organ Transplant Recipients

Post-transplant malignancy is recognised as being a major limitation to the success of solid organ transplantation and it is currently considered one of the unavoidable costs of long-term immunosuppressive therapy. However, the continual introduction of new immunosuppressive drugs and the growing knowledge about their different oncogenic profiles, requires a continuous evaluation of the available evidence on this topic. The incidence and risk of malignancy is elevated in solid organ transplant recipients compared with the general population. As proof of the relationship between immunosuppressive therapy and post-transplant malignancy, epidemiological data reveal that the length of exposure to immunosuppressive therapy and the intensity of therapy are clearly related to the post-transplant risk of malignancy, and that once cancer has developed, more intense immunosuppression can translate into more aggressive tumour progression in terms of accelerated growth and metastasis and lower patient survival. The association between malignancy and immunosuppressive therapy is mediated through several pathogenic factors. Indirectly, immunosuppressive drugs greatly increase the post-transplant risk of malignancy by impairing cancer surveillance and facilitating the action of oncogenic viruses. However, the direct pro- and anti-oncogenic actions of immunosuppressants also play an important role. The cancer-promoting effect of calcineurin inhibitors, independently of depressed immunosurveillance, has been demonstrated in recent years, and currently only mammalian target of rapamycin (mTOR) inhibitors have shown simultaneous immunosuppressive and antitumour properties. Reports of the initial results of the reduced incidence of cancer in organ transplant recipients receiving mTOR inhibitor therapy strongly indicate separate pathways for pharmacological immunosuppression and oncogenesis. The role of mTOR inhibitors has been firmly established for the treatment of post-transplant Kaposi's sarcoma and its role in the management of patients with other post-transplant malignancies should be clarified as soon as possible. Prevention of morbidity and mortality resulting from post-transplant malignancy should become a main endpoint in solid organ transplant programmes, and the choice and management of immunosuppressive therapy in each phase of transplantation plays a central role in this objective. Although comprehensive and rigorous information about the management of immunosuppressive therapy in transplant recipients at risk of or affected by cancer is still lacking, new experimental and clinical data about mTOR inhibitors offers novel approaches to this problem.

Actitud hacia la donación renal de vivo entre el personal sin relación con el trasplante en un hospital con programa de trasplante de órganos sólidos de cadáver y de vivo

Introduction Because of the shortage of kidney organs available for transplantation and the favorable outcomes described in living donation, this type of donation is necessity in Spain. However, living donation has yet to be developed and this may be partly because hospital personnel do not have an entirely favorable attitude toward this type of donation. The objective of this study was to analyze attitudes toward living kidney donation among health workers in services that are not usually in contact with transplantation services in a hospital with a cadaveric and living donor solid organ transplant program. Materials and methods A random sample of hospital staff was taken and stratified according to service and job category. Attitudes toward living kidney donation were evaluated using a psycho-social questionnaire about living donation. The questionnaire was completed anonymously and was self-administered. Student’ t-test and the χ 2 test were applied. Results A total of 419 respondents were analyzed (physicians n = 184, nurses n = 119, healthcare assistants n = 80 and ancillary personnel n = 36), with a mean age of 37 ± 10 years (63 % were women). Most respondents [88 % (n = 372)] were in favor of living kidney donation if it was for a relative. Of the remaining respondents 5 % (n = 19) were against and 7% (n = 28) were undecided. No significant differences were found according to job category among physicians, nurses, healthcare assistants or ancillary personnel. Analysis of the variables influencing attitude showed an association with the following 3 variables only: a respondent's belief that he or she might need an organ (p = 0.000), being in favor of living liver donation (p = 0.000), and being in favor of cadaveric donation (p = 0.020). Conclusions Hospital personnel who are not in contact with transplant-related services are in favor of related living kidney donation and therefore constitute a subgroup that could act in the direct or indirect promotion of this type of donation. However, it would be useful to organize awareness-raising campaigns in the hospital to encourage and strengthen support for this type of donation.

Attitude of hospital personnel faced with living liver donation in a Spanish center with a living donor liver transplant program

In Spain, despite its high rate of cadaveric donation, death while on the liver transplant waiting list is high. For this reason, living liver donation is being encouraged despite of the risk of morbidity for the donor. The objective of this study was to analyze attitudes toward living liver donation among hospital personnel in a hospital with a recently authorized living donor liver transplantation program. A random sample was taken and was stratified by type of service and job category (n = 1,262). Attitude was evaluated by means of a validated psychosocial questionnaire. The questionnaire was completed anonymously and was self-administered. Statistical analysis included the Student t test, the chi(2) test, and logistical regression analysis. The questionnaire completion rate was 93% (n = 1,168). Only 15% (n = 170) of respondents were in favor of living liver donation if it were unrelated. An additional 65% (n = 766) were in favor if this donation, but only for relatives. Of the rest, 9% (n = 107) did not agree with living liver donation, and the remaining 11% (n = 125) were undecided. The variables related to this attitude were age (P = 0.044); job category (P = 0.002); type of service (according to whether it is related to organ donation and transplantation) (P = 0.044); participation in prosocial activities (P = 0.026); attitude toward cadaveric organ donation (P <0.001); attitude of a respondent's partner toward organ donation (P = 0.010); a respondent's belief that in the future, he or she may need a transplant (P < 0.001); and a willingness to receive a donated living liver organ if one were needed (P < 0.001). There is also a close relationship between attitude toward living kidney donation and living liver donation (P < 0.001). In the multivariate analysis, the only common independent variable from the bivariate analysis was a willingness to receive a living donor liver transplant if one were needed (odds ratio = 9.3). Attitude toward living liver donation among hospital personnel in a hospital with a solid organ transplant program is favorable and is affected by factors related to cadaveric donation, altruistic activity, and feelings of reciprocity. Physicians and the youngest hospital workers are those who are most in favor, which leads us to think that there is a promising future for living liver transplantation, which is essential given the cadaveric organ deficit and the high mortality rate while on the waiting list.

Ancillary personnel faced with living liver donation in a Spanish hospital with a transplant program

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. The objective of this study is to analyze the attitude toward living liver donation among ancillary personnel in a hospital with a cadaveric and living liver organ transplant program and to analyze the variables that might influence such attitude. A random sample was taken which was stratified by service (n=401) among ancillary personnel in the hospital. Attitude was evaluated using a survey that was validated in our geographical area. A representative from each service was contacted. This person was given an explanation of the study and was made responsible for the distribution of the questionnaire in selected work shifts. The survey was completed anonymously and was self-administered. The c2 test, Student s t-test and logistical regression analysis were used in the statistical analysis. The questionnaire completion rate was 94% (n=377). Of all the respondents, 20% (n=74) are in favor of donating a living hemi-liver, but an additional 62% (n=233) are in favor if donation is for a relative. Of the rest, 8% (n=30) do not accept this type of donation and the remaining 11% (n=40) are unsure. The following variables are related to attitude toward living liver donation: attitude toward cadaveric donation (p=0.002); a respondent s belief that he or she might need a transplant in the future (p<0.001) and a willingness to receive a donated living liver if one were needed (p<0.001). In the multivariate analysis the following have been found to be significantly related variables: a) a respondent s belief that he or she might need a transplant in the future (OR=1.5); and b) a willingness to receive a living donated kidney if one were needed (OR=16.2). Attitude toward living liver donation is fairly favorable among ancillary personnel in a transplant hospital and is not affected by the psychosocial factors found to be related to attitude toward donation in previous studies. However, if we want to encourage this type of transplantation with living donors it will be necessary to carry out informative campaigns to raise awareness within the hospital.

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

A considerable number of professionals who work in a hospital could be against organ donation, which means that when the time comes, they could act as an obstacle to donation. The objective of this study was to analyze the attitude of hospital professionals toward organ donation and to determine the factors that influence this attitude in a Spanish center with a transplant program. The study was carried out in a third-level Spanish hospital with a solid organ transplant program. A random sample was taken (n = 1262) and stratified by job category and type of service. Attitude was evaluated using a validated questionnaire. Contact was made in each service with the person responsible for each of the job categories in order to distribute the survey. The survey was completed anonymously and was self-administered. Student's t-test, the chi-squared test, and logistic regression analysis were applied in the statistical analysis. The survey completion rate was 93% (n = 1168). Most respondents were in favor of donation [69% (n = 808)]. Of those who are not in favor, 29% (n = 105) provide fear of apparent death as the reason whilst most do not give a reason (negative assertion; 57%; n = 206). There are many factors related to this attitude toward donation, which are evident in the multivariate analysis: (i) job category, in which physicians are twice as likely to be in favor of donation than ancillary personnel (OR = 2.02); (ii) a respondent's knowledge of brain death (OR = 1.64); (iii) having discussed the matter of organ donation and transplantation within the family (OR = 1.89); (iv) a preference for other options apart from burial (OR = 3.66); (v) being in favor of the performance of autopsy if it were necessary (OR = 2.76); (vi) not being concerned about mutilation of the cadaver (OR = 2); and (vii) having a partner with a favorable attitude toward donation (OR = 2.2). Attitude toward cadaveric organ donation among personnel in a transplant hospital is similar to that described in the general public and is determined by many factors. The following factors are most noteworthy: (i) job category; (ii) knowledge of the concept of brain death; (iii) consideration of the matter of donation in the family; and (iv) fear of manipulation of the cadaver. In view of this attitude, which is similar to that of the general public, it is necessary to carry out promotion activities if we want to increase cadaveric donation rates.

Implications of ABO Error Rates in Proficiency Testing for Solid Organ Transplantation

Implications of ABO Error Rates in Proficiency Testing for Solid Organ Transplantation

Strategies for Establishing Organ Transplant Programs in Developing Countries: The Latin America and Caribbean Experience

The Latin America and Caribbean region is composed of 39 countries. It is remarkable the progress of transplantation in the region in despite of the low economic resources when compared to other regions. The criteria for brain death are well established and culturally accepted. The consent for retrieval is based on required family consent in most countries. The regulations for living donors are also well established, with restrictions to unrelated donors and prohibition of any kind of commerce. The access to transplant is limited by the model of public financing by each country, and those with public universal coverage have no financial restrictions to cover the costs for any citizen; in countries with restricted coverage, the access is restricted to the employment status. There is a progressive increment in the annual number of solid organ transplants in Latin America, reaching near 10,000 in 2004, accomplished by adequate legislation that is also concerned with the prohibition of organ commerce.

A Report of the Vancouver Forum on the Care of the Live Organ Donor: Lung, Liver, Pancreas, and Intestine Data and Medical Guidelines

An international conference of transplant physicians, surgeons, and allied health professionals was held in Vancouver, Canada, on September 15 and 16, 2005 to address the care of the live lung, liver, pancreas, and intestine organ donor. The Vancouver Forum was convened under the auspices of the Ethics Committee of The Transplantation Society. Forum participants included over 100 leaders in organ transplantation, representing many countries from around the world, including participants from the following continents: Africa, Asia, Australia, Europe, North and South America. The objective of the Vancouver Forum was to develop an international standard of care for the live lung, liver, pancreas and intestinal organ donor. This Vancouver Forum followed a conference convened in Amsterdam on the care of the live kidney donor (1, 2). There were four organ specific work groups at the Vancouver Forum: lung, liver, pancreas and intestine. Each organ work group addressed the following topics in concert and reported their findings in a plenary presentation to all participants:

Brain donation for research: Who donates and why?

Understanding what influences people to donate or not donate body organs is critical for the future of transplant surgery and medical research. Are people involved with a brain donor program for research influenced by the same factors, and are they also donors for organ transplantation? Using web-based technology, people involved in an Australian brain donation program (for research) were asked to complete a questionnaire designed to elicit demographic information, motivational factors and information about involvement in organ transplantation programs. The response rate was 82%. The majority of people involved in the program are young, well-educated Australian females. Seventy-eight percent are involved in other organ and tissue donation programs. People involved in the ‘Using our Brains’ program are the same group as those who are organ and tissue donors. An improvement in the overall donation rate might be possible if the resources of the research and transplant organisations were combined.

Attitudes of Resident Doctors Toward Different Types of Organ Donation in a Spanish Transplant Hospital

Objective Our aim was to analyze acceptance of cadaveric and living organ donation for transplantation among resident doctors, given that they are the new professionals of medicine who will have to encourage and develop transplant programs. Materials and Methods A random survey was performed on resident doctors in a third-level hospital with an organ transplant program which is accredited for undergraduate and postgraduate education (n = 171). Attitudes toward cadaveric and living donation were evaluated using a questionnaire including various psychosocial variables that might affect such attitudes. We used the Student t test and the chi-square test. Results The sample was composed of responses by 171 resident doctors of mean age 28 ± 4 years with 56% women. Attitudes toward cadaveric donation were favorable in 92% (n = 157). As for living donation, the percentage in favor of nonrelated donation was low: 23% for kidney and 19% for liver. However, when the donation was from a relative, the percentages increased to levels similar to those of cadaveric donation, namely 88% and 85% for kidney and liver, respectively. No differences were observed in attitudes toward cadaveric or living donation according to various psychosocial variables. Conclusions The trainee doctors showed favorable attitudes toward human cadaveric organ donation as well as living related donation, which suggests a relaunch of living donors in the near future. However, there was not much acceptance of nonrelated donation, as has also been seen in studies of the general public in our geographical area.

Ancillary Hospital Personnel Faced With Organ Donation and Transplantation

Objective To reduce the number of family organ donation refusals, it is necessary not only to act on the general public but also on the health care system. In this respect, there are data suggesting that the percentage of hospital personnel against donation is high, especially among ancillary personnel. The objective herein was to analyze the attitudes of ancillary hospital professionals toward donation of their own organs and determine factors that conditioned such attitudes. Materials and Methods A random sample in a third-level hospital with a solid organ transplant program was stratified by ancillary services: administrative, porters, maintenance, cleaning, and cooking. Attitudes toward donation of one’s own organs after death were evaluated using a questionnaire on psychosocial aspects validated in our area. It included various psychosocial variables that could affect such attitudes. The Student t test and chi-square test were used to evaluate the data. Results We analyzed 277 respondents of mean age 43 ± 8 years and 96% women. The level of acceptance of organ donation was 64% (n = 178), whereas 46% were either against or undecided (n = 98). The variables which determined the attitudes were understanding of brain death ( P = .004); attitude toward cadaveric manipulation, especially toward autopsy ( P = .013) and cremation ( P = .004); concern about mutilation after donation ( P = .014); religion ( P = .032); partner’s attitude toward donation ( P < .0001); and possibility of needing an organ in the future ( P = .031). Conclusions Ancillary hospital personnel had similar attitudes toward donation as those of the general public as observed in other studies. The attitudes were determined by many psychosocial factors. A campaign to raise awareness among professionals has become a priority, given that working in a hospital, their unfavorable attitude could have a strong negative impact on the general public.

Attitude Toward Xenotransplantation Among Residents

Introduction The deficit in transplant organs has made it necessary to search for alternatives, among them research into xenotransplantation. However, the use of animal organs may cause rejection in society and among health professionals. The objective was to analyze the acceptance of this therapy among Residents, given that they would be the professionals most involved in its application if such a therapy proves to be useful. Materials and methods A random sample stratified by the services of the Residents in a third-level hospital with an organ transplant program and accredited for teaching at undergraduate and postgraduate levels ( n = 171). The attitude toward xenotransplantation was evaluated using a questionnaire that analyzes different pychosocial variables that may influence such attitude. 5 Results The sample consisted of 171 residents (mean age 28 ± 4 years; 56% women). Attitudes toward xenotransplantation, whether the results were similar to those obtained with human organs, were positive in 81% ( n = 138) of cases, with 16% ( n = 27) having doubts and 3% ( n = 6) being against. The attitude was more favorable among residents in favor of cadaveric donation (83% vs 57%; P < .05) and of living donation either of the kidney (90% vs 55%; P < .001) or of the liver (88% vs 56%; P < .001), and among those who consider that they might need a transplant at a given point in the future (88% vs 73%; P < .05). Conclusion Residents have a positive attitude toward the application of a possible xenotransplantation in safe conditions similar to those that currently exist in human organ donation. Such a favorable attitude was greatly influenced by a positive attitude toward human organ donation, in cadaveric as well as in living donation, and when considering oneself to be a possible candidate for a transplant.

Use of Quality Index in the Evaluation of Organ Procurement and Transplant Programs in a University Hospital

Aim To evaluate organ procurement efficiency at Hospital Clinic of Barcelona (HCP), a University Hospital, in 2000 and 2003 compared with other Catalan, other Spanish, and American (US) results. Methods Efficacy rate of the donor procurement was calculated per million population per year (pmp/y). Efficacy rate in kidney, liver, and heart transplantation was calculated also in pmp/y. We evaluated 1-year graft survival. Results During this period, the average rate number of donors was 49.1 pmp/y in HCP, 38 in Catalonia, 33.4 in Spain, and 21.7 in the United States. The average rate of kidney transplantation was 74 pmp/y in HCP, 55 in Catalonia, 47 in Spain, and 24.6 in the United States. The average rate of liver transplantation was 44.5, 26.6, 23.2, and 18 pmp/y, respectively. The average rate of heart transplantation was 13.3, 8.5, 7.8, and 6.4 pmp/y, respectively. One-year graft survival in HCP was 90.6% for kidney, 89.5% for liver, and 88.2% for heart transplants. Discussion The results show that organ procurement and transplantation programs in HCP are efficient. The organizational model is based on a hospital transplant coordinator and efficient, well-trained transplant teams.