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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#44; </span></p><p class="elsevierStylePara">There are not enough organ donations to cover the needs of transplants&#46; For this reason&#44; it is important to promote living donation&#44; to try to meet these needs&#46;<span class="elsevierStyleSup">1&#44;2</span>&#160;In Spanish-speaking countries&#44; living donation is still in its infancy&#46; In this respect&#44; cadaveric donor procurement units have played a key part in promoting organ transplants&#44; and could possibly do the same for developing living donation&#46;<span class="elsevierStyleSup">3</span>&#160;The aim of this study is to analyse the attitude towards living kidney &#40;LKD&#41; and liver &#40;LLD&#41; donation among hospital professionals in the cadaveric donor procurement units of Spain and Latin America&#44; and to analyse the variables that bring about this attitude&#46;</p><p class="elsevierStylePara">From the International Donor Collaboration Project&#44; seven hospitals with cadaveric donor procurement units &#40;intensive care unit&#44; surgical resuscitation unit&#44; and neurosurgery unit&#41; were selected&#58; 2 in Spain&#44; 3 in Mexico&#44; and 2 in Cuba&#46; Random sampling stratified by professional category was performed in these units&#46; The field study was carried out in 2006&#46; Attitude was assessed with a validated survey<span class="elsevierStyleSup">4-6</span>&#160;which was self-administered and completed anonymously&#46; A descriptive analysis was performed&#44; and the student T and the Chi-square tests were applied&#46;</p><p class="elsevierStylePara">The survey was completed by 283 professionals from the procurement units&#46; Of these&#44; 90&#37; &#40;n&#61;254&#41; were in favour of related LKD&#44; 6&#37; &#40;n&#61;16&#41; against&#44; and 4&#37; &#40;n&#61;13&#41; undecided&#46; By countries&#44; 95&#37; &#40;n&#61;71&#41; of Cubans were in favour&#44; 92&#37; &#40;n&#61;44&#41; of Spaniards&#44; and 87&#37; &#40;n&#61;139&#41; of Mexicans &#40;<span class="elsevierStyleItalic">P</span>&#62;&#46;05&#41;&#46; No significant differences were observed with regard to sociopersonal or occupational variables&#44; except for employment conditions&#46; The medical professionals with a permanent post were more in favour of this kind of donation than those with a temporary post &#40;95&#37; vs 85&#37;&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;007&#41; &#40;Table 1&#41;&#46; Among the rest of the variables&#44; a more positive attitude is seen among&#58; those who are in favour of cadaveric donation &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#59; those who would accept a kidney from a living donor if it were necessary &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#59; those in favour of LLD &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#59; those whose partner has a positive attitude toward donation and transplantation &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;001&#41;&#59; and those who perform or have performed prosocial activities &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;013&#41; &#40;Table 1&#41;&#46;</p><p class="elsevierStylePara">As for related LLD&#44; 84&#37; &#40;n&#61;237&#41; were in favour&#44; 11&#37; &#40;n&#61;32&#41; against&#44; and 5&#37; &#40;n&#61;14&#41; undecided&#46; By countries&#44; 87&#37; &#40;n&#61;65&#41; of Cubans were in favour&#44; 85&#37; &#40;n&#61;41&#41; of Spaniards&#44; and 82&#37; &#40;n&#61;131&#41; of the Mexicans &#40;<span class="elsevierStyleItalic">P</span>&#62;&#46;05&#41;&#46; No significant correlations were observed between sociopersonal and occupational variables&#46; Among the rest of the variables&#44; a more positive attitude is seen among&#58; those with personal experience with donation and transplants &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;032&#41;&#59; those in favour of cadaveric organ donation &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;001&#41;&#59; those in favour of LKD &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#59; those whose would accept a liver from a living donor if necessary &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;001&#41;&#59; and those who perform or have performed prosocial activities &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41; &#40;Table 1&#41;&#46;</p><p class="elsevierStylePara">Hospital staff from cadaveric donor procurement units in Spain and Latin America have a very positive attitude towards both living kidney and liver donation&#46; Their attitude is more favourable than that observed in other studies using the same questionnaire&#46;<span class="elsevierStyleSup">4</span>&#160;The data obtained by our group<span class="elsevierStyleSup">3</span>&#160;in 2003 showed that 86&#37; had a favourable attitude towards LKD and 68&#37; towards LLD&#46; Therefore&#44; expectations for this kind of donation are becoming more and more positive and optimistic&#46; LKD is generally more accepted than LLD&#44; possibly due to the lower risk<span class="elsevierStyleSup">6&#44;8</span>&#160;for the donor&#46;</p><p class="elsevierStylePara">Attitudes towards living donation have been shown not to be influenced by sociopersonal or religious factors&#44; or attitudes towards the body&#46;<span class="elsevierStyleSup">7&#44;9</span> However&#44; there is a significant association between attitudes towards LKD and LLD&#46; Therefore&#44; it seems clear that the main problem of living donation is accepting it&#46; It is worth noting that no differences exist with regard to occupational category&#44; nor between healthcare professionals and those working in other settings&#46;<span class="elsevierStyleSup">6&#44;9</span></p><p class="elsevierStylePara">In conclusion&#44; we can declare that the attitude of the staff of cadaveric donor procurement units in Spain and Latin America towards living donation is very favourable&#46; Thus&#44; they could play an important role in its promotion in these times of a desire to develop living donation&#44; 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Journal Information
Vol. 30. Issue. 6.November 2010
Pages 599-714
Vol. 30. Issue. 6.November 2010
Pages 599-714
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Cadaveric donor procurement units faced with living donation
Las unidades generadoras de donantes de órganos de cadáver ante la donación de vivo
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PROYECTO COLABORATIVO INTERNACIONAL DONANTE, A.. Ríosb, A.I.. López-Navasb, P.. Ramírezb, P.. Parrillab
b Unidad de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia
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To the Editor,

There are not enough organ donations to cover the needs of transplants. For this reason, it is important to promote living donation, to try to meet these needs.1,2 In Spanish-speaking countries, living donation is still in its infancy. In this respect, cadaveric donor procurement units have played a key part in promoting organ transplants, and could possibly do the same for developing living donation.3 The aim of this study is to analyse the attitude towards living kidney (LKD) and liver (LLD) donation among hospital professionals in the cadaveric donor procurement units of Spain and Latin America, and to analyse the variables that bring about this attitude.

From the International Donor Collaboration Project, seven hospitals with cadaveric donor procurement units (intensive care unit, surgical resuscitation unit, and neurosurgery unit) were selected: 2 in Spain, 3 in Mexico, and 2 in Cuba. Random sampling stratified by professional category was performed in these units. The field study was carried out in 2006. Attitude was assessed with a validated survey4-6 which was self-administered and completed anonymously. A descriptive analysis was performed, and the student T and the Chi-square tests were applied.

The survey was completed by 283 professionals from the procurement units. Of these, 90% (n=254) were in favour of related LKD, 6% (n=16) against, and 4% (n=13) undecided. By countries, 95% (n=71) of Cubans were in favour, 92% (n=44) of Spaniards, and 87% (n=139) of Mexicans (P>.05). No significant differences were observed with regard to sociopersonal or occupational variables, except for employment conditions. The medical professionals with a permanent post were more in favour of this kind of donation than those with a temporary post (95% vs 85%; P=.007) (Table 1). Among the rest of the variables, a more positive attitude is seen among: those who are in favour of cadaveric donation (P<.001); those who would accept a kidney from a living donor if it were necessary (P<.001); those in favour of LLD (P<.001); those whose partner has a positive attitude toward donation and transplantation (P=.001); and those who perform or have performed prosocial activities (P=.013) (Table 1).

As for related LLD, 84% (n=237) were in favour, 11% (n=32) against, and 5% (n=14) undecided. By countries, 87% (n=65) of Cubans were in favour, 85% (n=41) of Spaniards, and 82% (n=131) of the Mexicans (P>.05). No significant correlations were observed between sociopersonal and occupational variables. Among the rest of the variables, a more positive attitude is seen among: those with personal experience with donation and transplants (P=.032); those in favour of cadaveric organ donation (P=.001); those in favour of LKD (P<.001); those whose would accept a liver from a living donor if necessary (P=.001); and those who perform or have performed prosocial activities (P<.001) (Table 1).

Hospital staff from cadaveric donor procurement units in Spain and Latin America have a very positive attitude towards both living kidney and liver donation. Their attitude is more favourable than that observed in other studies using the same questionnaire.4 The data obtained by our group3 in 2003 showed that 86% had a favourable attitude towards LKD and 68% towards LLD. Therefore, expectations for this kind of donation are becoming more and more positive and optimistic. LKD is generally more accepted than LLD, possibly due to the lower risk6,8 for the donor.

Attitudes towards living donation have been shown not to be influenced by sociopersonal or religious factors, or attitudes towards the body.7,9 However, there is a significant association between attitudes towards LKD and LLD. Therefore, it seems clear that the main problem of living donation is accepting it. It is worth noting that no differences exist with regard to occupational category, nor between healthcare professionals and those working in other settings.6,9

In conclusion, we can declare that the attitude of the staff of cadaveric donor procurement units in Spain and Latin America towards living donation is very favourable. Thus, they could play an important role in its promotion in these times of a desire to develop living donation, provided the socio-political and economic conditions are right for it.

10590_108_11423_en_10590_t1_en.doc

Table 1. Livng donation in donor procurement units in Spain and Latin America

Bibliography
[1]
 
[2]
Organización Nacional de Trasplantes. Memoria de actividades ONT 2009. Rev Esp Traspl 2009;14(1). (Monográfico).
[3]
Ríos A, López-Navas A, Ayala-García MA, Sebastián MJ, Abdo-Cuza A, et al. Attitudes toward living kidney donation in transplant hospitals: a Spanish, Mexican, and Cuban multicenter study. Transplant Proc 2010;42:228-32. [Pubmed]
[4]
Ríos A, Ramírez P, Rodríguez MM, Parrilla P. Las unidades generadoras de donantes de órganos de cadáver ante la donación de vivo. Nefrologia 2007;27:230-1. [Pubmed]
[5]
Conesa C, Ríos A, Ramírez P, Rodríguez MM, Parrilla P. Socio-personal factors influencing public attitude towards living donation in south-eastern Spain. Nephrol Dial Transplant 2004;19:2874-82. [Pubmed]
[6]
Ríos A, Ramírez P, Rodríguez MM, Martínez L, Rodríguez JM, et al. Attitude of hospital personnel faced with living liver donation in a Spanish center with a living donor liver transplant program. Liver Transpl 2007;13:1049-56. [Pubmed]
[7]
Ríos A, Ramírez P, Rodríguez MM, Martínez L, Montoya MJ, et al. Attitude of ancillary personnel faced with living kidney donation in a hospital with a living donor kidney transplant program. Transplantation 2007;83:336-40. [Pubmed]
[8]
Ríos A, Cascales P, Martínez L, Sánchez J, Jarvis N, et al. Emigration from the British Isles to south-eastern Spain: a study of attitudes toward organ donation. Am J Transplant 2007;7:2020-30. [Pubmed]
[9]
Hashikura Y, Ichida T, Umeshita K, Kawasaki S, Mizokami M, et al. Donor complications associated with living donor liver transplantation in Japan. Transplantation 2009;88:110-4. [Pubmed]
[10]
Ríos A, Ramírez P, Martínez L, Montoya MJ, Lucas D, et al. Are personnel in transplant hospitals in favor of cadaveric organ donation? Multivariate attitudinal study in a hospital with a solid organ transplant program. Clin Transplant 2006;20:743-54. [Pubmed]
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