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Public Knowledge and Attitudes on Organ Donation Do Not Differ in Germany and Spain
H. Schauenburg and A. Hildebrandt ABSTRACT Background. The background of this study was the inadequate supply of donor organs in Germany. In Spain, by contrast, a strong increase of organ donors over the past years has created a satisfactory supply situation. Because both countries have similar legal situations,the causes for the drastic differences in organ donation rates remain unclear. The main issue of our study was to investigate the intellectual attitudes toward various aspects of postmortem donations in the populations of both countries as a causative factor for the observed differences. Methods. We studied 726 persons by questionnaire. Probands, matched for age and gender, were recruited amongmedical students, in a public library and in a general medical practice in both Germany and Spain. Results. We found no differences in the attitudes toward postmortem organ donation between the two countries. Differences among the social groups within the countries were apparent in the expected direction. Conclusion. A higher level of knowledge or a difference in attitudes toward organ donation isprobably not the reason for the higher donation rate in Spain. The cause appears to be rather at the organizational level.


BJECT OF THE STUDY was to assess whether better public knowledge or positive attitudes toward organ donation was responsible for the higher organ donation rate in Spain compared to Germany. In Germany, the number of postmortem organ donations between 1993 and 2002varied from 12 to 13 per million people (PMP). The legal basis for organ donation is based on the principle of expanded consent. The preparation and implementation of organ donation is coordinated by the German Foundation for Organ Donation (DSO). When the intensive care unit of a hospital contacts the DSO, coordinators travel to the site for consultation with family members to clarify the indicationsfor or against organ donation in the case of patients with acute or secondary brain damage. Any organ explantation is planned by the coordinator responsible for the case in consultation with the hospital. As a rule, the explantation is carried out by a regional explantation team from the appropriate transplantation center. Since the DSO assumed the role of coordination for organ transplantation inthe year 2000, there has been no appreciable increase in the rate of organ donation in Germany.

In Spain the overall rate of organ donation has increased from 14 PMP (1989) to 33.7 PMP in the year 2002. The massive increase in the rate of organ donation is closely correlated with the creation of the Organizacion Nacional de Trasplantes (ONT) in the year 1989, which provided a coordinationnetwork effective at national, regional, and local levels. The Spanish parliament passed a transplantation law in 1979, which was based on the principle of presumed consent. It allowed the removal of organs from a deceased person, provided this person did not object while still alive. Lack of any previous statement on the part of the deceased is thus treated as consent. In practice, however, mostcases follow the principle of expanded consent. Family members of a potential organ donor are asked whether the

From the Clinic for Psychosomatics and General Clinical Medicine, University of Heidelberg, Germany. Address reprint requests to Henning Schauenburg, Clinic for Psychosomatics and General Clinical Medicine, University of Heidelberg, Thibautstr. 2, 69115 Heidelberg, Germany. © 2006 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710 Transplantation Proceedings, 38, 1218 –1220 (2006)

0041-1345/06/$–see front matter doi:10.1016/j.transproceed.2006.02.105 1218



deceased made any statements for or against organ donation prior to death.1...
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