Attitude Toward Living Liver Donation in Transplant Hospitals in Spain, Mexico and Cuba

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    Purpose. We analyzed the attitudes toward LLD among hospital personnel in Spain,Mexico, and Cuba.



    310Materials 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 notrelated, 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 favorableattitude toward LLD was associated (P .05) with age (37 10 y vs 39 10 y), a favorableattitude toward deceased donation, a belief that a possible transplant is needed, acceptance ofLLD if necessary, a favorable attitude toward living kidney donation, family discussion aboutODT, a partners favorable attitude toward ODT, an intention to participate in prosocialactivities, being a Catholic, and a belief that ones religion is in favor of ODT.Conclusions. Personnel from Spanish, Mexican, and Cuban transplantation hospitalshave favorable attitudes toward LLD. This suggests that there may be an increase in LLDin the future, provided that there is the necessary sociopolitical and economic support.

    ptimal organ donation occurs when there is the bestresult for the patient who needs the organ and no

    rm to the donor. Therefore, as far as the liver is con-ned, deceased donation is better, given that it does notolve the mutilation of a living being and that it canprove the recipients health and quality of life.13 How-r, due to the organ deficit from deceased donors and thetained increase in demand, together with increasedrtality on the liver transplant waiting list, an attempt isng made by most countries to encourage living livernation (LLD).4,6 For example, transplantation of theht liver lobe from a living donor to an adult recipient isreasing in Japan, the USA, and some European coun-s.46 In Spain, despite initial enthusiasm, this type ofnation is currently minimal0.6 per million populationp).7 In Mexico (0.07 pmp in 2008)8 and Cuba, the rates

    of LLD are also minimal, in spite of the fact that livingkidney donation rates are higher than those in Spain (0.6pmp) (15.92 pmp in 2008 in Mexico,8 2.5 pmp in 2008 inCuba9).

    From the Hospital Universitario Virgen de la Arrixaca, Coordi-nacin Autonmica de Trasplantes, Murcia, Spain (A.R., A.L.-N.,L.M.-A., G.R., P.R., P.P.); Hospital Regional de Alta Especialidaddel Bajo y Universidad de Guanajuato, Len, Guanajuato, Mex-ico (M.A.A.-G., B.G., E.J.R., G.M., J.S.R., M.A.M., A.N.); Coor-dinacin de Donacin y Trasplantes, UMAE Hospital de Espe-cialidades no. 25 IMSS, Monterrey, Mexico (M.J.S., A.C.); Centrode Investigaciones Mdico-Quirrgicas, Cuba (A.A.-C., R.C.);and the Hospital Hermanos Ameijeiras, Cuba (J.S.-L.).

    Address reprint requests to Dr. Antonio Ros Zambudio, la Libertad 208, Casillas, Murcia 30007, Spain. E-mail:arzrios@teleline.esttitude Toward Living Liver Donatiain, Mexico and Cuba

    Ros, A. Lpez-Navas, M.A. Ayala-Garca, M.J. SeGonzlez, E.J. Ramrez, G. Muoz, A. Camacho, JA. Martnez, A. Nieto, G. Ramis, P. Ramrez, and P


    Background. Transplantation hospitals havorgan donation and transplantation (ODT)transplant waiting list, it is essential to encourof personnel in these hospitals is crucial.1-1345/10/$see front matter:10.1016/j.transproceed.2010.05.074

    2in Transplant Hospitals in

    in, A. Abdo-Cuza, L. Martnez-Alarcn,rez-Lpez, R. Castellanos, J.S. Rodrguez,rrilla

    ayed a key role in developing deceasedreduce the number of deaths on theiving liver donation (LLD). Involvement 2010 by Elsevier Inc. All rights reserved.360 Park Avenue South, New York, NY 10010-1710

    Transplantation Proceedings, 42, 31023105 (2010)

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    TRANSPLANTATION STAFF ATTITUDES TOWARD LIVING LIVER DONATION 3103ne possible barrier to the development of LLD may bespital professionals, who are not always in favor. It wasrefore important to discover the attitudes of personneltransplantation hospitals, because they would contributewhether living donation gains greater importance. Thejective of this study was to analyze the attitudes towardD among personnel from transplantation hospitals withr programs in Spain, Mexico, and Cuba.

    TERIALS AND METHODSdy Population

    ta were obtained as part of the Proyecto Donante Vivo,rcia international collaborative program of 5 transplantationpitals, each having a liver program. The hospitals were in 3ntries: 1 in Spain (n 1,168), 2 in Mexico (n 903), and 2 inba (n 202). The random sample in these centers was stratifiedording to job category: physician, nursing personnel, nursingistant, and auxiliary personnel. The total number of respondentss 2,273.

    inion Survey and Study Variables

    alidated survey previously used in our workplace was used to evaluatetudes toward living donation.1,3,13,21 The self-administered surveys completed anonymously. The dependent variables were atti-e toward related and unrelated LLD. The independent vari-es were grouped as: 1) demographic variables; 2) sociopersonaliables; 3) job variables; 4) variables of knowledge about andtude toward donation and transplantation; 5) variables of socialraction and prosocial behavior; 6) religious variables; and 7)iables of attitude toward the body.

    tistical Analysis

    e data were analyzed using the SPSS 15.0 statistical package. Acriptive statistical analysis included the bivariate Student t testchi-squared test as well as logistic regression analysis. P values.05 were considered to represent statistically significant asso-tions.

    SULTSitudes Toward Living Liver Donation

    st hospital personnel (82%; n 1,861) surveyed were inor of related LLD, although only 21% (n 478) were inor if it was unrelated. Only 10% (n 226) were againstated LLD, and 8% undecided (n 186).

    ariate Analysis of the Factors Affecting Attitudes

    the analysis of variables affecting LLD the followingportant significant associations were observed:

    ) Demographic variables: Although attitudes towardLLD were somewhat more favorable among hospitalpersonnel from Cuban (86%; n 174) than Mexican(83%; n 751) or Spanish (80%; n 936) centers,the differences were not significant (P .05).

    ) Sociopersonal variables: Younger workers were morewilling to accept LLD than older respondents (37 y vs

    39 y; P .004). 3.0) Job variables: Physicians had the most favorableattitudes toward LLD (85%; n 508). Resultsamong the other job categories were: staff 83% (n 618), nursing staff 79% (n 490), and health careassistants 74% (n 173; P .001). The remainingjob variables showed no important associations.

    ) Variables of knowledge about and attitudes towarddonation and transplantation: Those in favor of LLDalso seemed to be in favor of deceased organ dona-tion (86% vs 69%; P .001) and living kidneydonation (92% vs 11%; P .001). Those who hadconsidered the possibility of needing a transplant inthe future had more favorable attitudes toward LLDthan those who had not (89% vs 70%; P .001).Regarding a willingness to accept a liver from a livingdonor, those who would be willing to accept one weremore in favor of LLD than those who were unde-cided (96% vs 61%; P .001).

    ) Social interaction and prosocial behavior activities:Those respondents who had discussed the subject ofdonation and transplantation within the family weremore in favor of LLD (84% vs 78%; P .001). Apartners attitude also influenced acceptance of thistype of donation. Those whose partner had a favor-able attitude toward donation and transplantationwere more in favor of LLD than those whose partnerwas against it (89% vs 78%; P .001). Participation(or a willingness to participate) in prosocial activitieswas positively associated with favorable attitudestoward LLD compared with those who had nevertaken part and had no intention of doing so (84% vs73%; P .001).

    ) Religious variables: Catholics were more in favor ofLLD than followers of other religions (86% vs 73%;P .034). Moreover, if respondents believed thattheir religion had a positive view of donation andtransplantation, they tended to have a more favor-able acceptance rate of LLD compared with thosewho believed that their religion did not have afavorable view of donation (87% vs 74%; P .035).

    ) Variables of attitude toward the body: Those whowere not worried about mutilation of the body afterdonation had a more favorable attitude toward LLDthan those who were worried about it (87% vs 82%;P .019).

    ltivariate Analysis

    ltivariate analysis (Table 1) showed the following vari-es to be significantly associated with attitudes towardD: 1) attitudes toward living kidney donation (odds ratioR] 47.619; P .001); 2) willingness to accept part of ar from a living donor if one were needed (OR 9.615; P1); 3) family discussion about donation and transplanta-n (OR 1.522; P .038); and 4) catholic religion (OR

    67; P .029).

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    ing liver transplantation is an alternative therapy toceased liver transplantation, although some controversyl exists, mainly because of the risks involved in the donorgery and the inferior results compared with deceasednation.1,10,11 Consequently, although most countries haveD programs, they are insufficient with only a few LLDs.n Spain, this type of donation is currently minimal. Popu-on studies in Spain have shown that the general public havevorable attitude toward living donation, provided it is for aation or family member.3,12 In those cases, attitudesard living donation were higher than those reported fororts in favor of deceased donation.12,14 Studies amongployees from hospital centers have shown favorableitudes,1,16,1820 although this possibility is not considereddaily clinical practice as a real alternative option toceased donation.15 In Mexico, the rate is 0.07 pmp8; it islusively destined for pediatric patients, because of thertage of deceased donor organs for them.ur data showed that the attitudes toward LLD among

    spital personnel from liver transplantation centers inain, Mexico, and Cuba were favorable, especially amongysicians. This is important, because physicians are essen-l to promote and apply this therapy.f particular interest was the strong association between

    itudes toward the different kinds of donation, ie, de-sed and living. An important aspect seems to be accept-that extraction of healthy organs is a correct and ethicalrapeutic option. This way of thinking is part of anruistic concept of life; if a person is able to accept onee of donation he or she generally accepts the other type.1

    elings of reciprocity, treating others in the same way weuld like to be treated, are also included. For example, inpresent study it was seen that the hospital personnelveyed had more favorable attitudes toward LLD wheny believed that they themselves may need a transplant ate time.he donation process involves many factors, including

    Table 1. Factors Affecting Attitude Toward Living Liver



    itude toward living kidney donationot in favor (n 271)

    n favor (n 2,002) 3.86eptance of part of a donated living liverdont know (n 692)es, I would accept it (n 1,279) 2.26o, I would wait on the waiting list (n 302) 0.28ily discussion about donation and transplantationo (n 613)es (n 1,660) 0.42pondents religionther religion (n 48)atholic (n 1,780) 1.12gnostic (n 328) 0.30attitudes of family members. Family discussion about pernation and transplantation encouraged its acceptanceR 1.522; P .038). It was also seen that family consid-tion and comment had a promotional effect and was ay of encouraging acceptance of donation in our study.1,11

    areness is also necessary of the attitudes shown bytients on the transplant waiting list, given that the atti-es of a Spanish patient16 are not the same as those iner countries, where the deceased organ donation rate is.6,12 Patients in Spain know that in a relatively shortriod they can obtain a deceased donor organ and that itl probably not be necessary for a family member to donateorgan while alive. In other countries, living donation isetimes the only likely way of achieving a transplantation.iven that LLD has important risks for the donor and

    rse results in the recipient, it is ethically unacceptable.wever, it must be encouraged to avoid mortality on theiting list if no deceased donor is available.13,17 We shouldto complement deceased donation with living donationprevent mortality on the waiting list while taking intoount the need to prevent morbidity and mortality amongnors. In Spain, mortality on the liver transplant waitingis 10%, which would give us an objective to achieve inr transplantation. In Mexico and Cuba, the reality isferent and regardless of whether living liver donation iscessary or not, it is necessary to encourage deceasednation and transplantation as the first and fundamentalp.n conclusion, attitudes toward LLD among personnelm Spanish, Mexican, and Cuban transplant hospitals wereorable, forming an essential part of the current importantmotion of this type of transplantation activity. Thesets suggest that there may be an increase in living livernsplantation in the coming years, provided that there isnecessary social, political, and economic support.


    . Ros A, Ramrez P, Rodrguez MM, et al: Attitude of hospital

    tion in Transplant Hospitals: Multivariate Analysis


    Odds Ratio(Confidence Interval) P Value

    10.280 47.619 (83.33327.777) .001

    10.237 9.615 (15.1516.024) .0010.220 1.334 (0.8672.052) .190

    10.202 1.522 (2.2571.024) .038

    10.512 3.067 (8.3331.122) .0290.595 1.360 (4.3660.423) .605livedifnedosteI




    sonnel faced with living liver donation in a Spanish center with

  • a living donor liver transplant program. Liver Transplant 13:1049,20072. Ros A, Martinez L, Snchez J, et al: Factors that influence

    the attitude of East European residents in Spain toward livingkidney donation. Transplant Int 22:707, 20093. Conesa C, Ros A, Ramrez P, et al: Socio-personal factors

    influencing public attitude towards living donation in south-easternSpain. Nephrol Dial Transplant 19:2874, 20044. Settmacher U, Theruvath T, Pascher A, Neuhaus P: Living-

    donor liver transplantationEuropean experiences. Nephrol DialTransplant 19:16, 20045. Tanaka K, Kiuchi T, Kaihara S: Living related liver donor

    transplantation: techniques and caution. Surg Clin North Am84:481, 20046. Ros A, Cascales P, Martnez L, et al: Emigration from the

    British Isles to southeastern Spa...


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