The Crucial Role of Empowerment in Engaging Adolescents and Young Adults for Independence: Essential Strategies and Skills for a Successful Transition.

BACKGROUND: An increasing number of pediatric solid organ transplant (SOT) recipients are surviving into adolescence and young adulthood. The transition from pediatric to adult-oriented care occurs during a unique and vulnerable period. METHODS: Presented here is a structured approach to healthcare transition (HCT) for adolescent and young adult SOT recipients aimed at optimizing independence in order to assist young patients with adherence, self-management, and improved quality of life. RESULTS: Close attention must be paid to neurocognitive development, mental well-being, and social determinants of health. CONCLUSIONS: These efforts require a multidisciplinary team approach as well as collaboration between pediatric and adult providers in order to achieve these goals and patient longevity.

Psychological Health of the Adolescent Transplant Recipient.

BACKGROUND: Solid organ transplant recipients experience a period of unique vulnerability during adolescence, when normative developmental changes intersect with health-related variables to influence psychological health. METHODS: This article builds on previous reviews of psychological health in solid organ transplant recipients and proposes opportunities for clinical intervention during adolescence. RESULTS: Transplant recipients often experience neurocognitive changes, particularly with respect to executive functions, that impact health management tasks and autonomous care. Recipients should be monitored for the development of anxiety, depression, and posttraumatic stress symptoms during adolescence, which in turn can negatively impact adherence to immunosuppression. Recent research in posttraumatic growth and resiliency factors may represent a promising avenue of intervention, leveraging normative developmental processes during this time period. CONCLUSIONS: As pediatric transplant providers, adolescence represents a developmental period for targeted interventions to foster adjustment and adherence and promote a successful transition to adult care.

Increasing positive attitudes towards organ donation and improving the competence of coping with death through organ transplant nursing course: A two-group quasi-experimental study.

AIM: The aim of the study was to determine the effect of an organ transplant nursing course offered to nursing students on increasing positive attitudes towards organ donation and developing competence in coping with death. BACKGROUND: Incorporating organ donation education into undergraduate nursing curricula and promoting of coping mechanisms for coping with death, has been emphasized as a critical foundation for the preparating of the next generation of nurses. DESIGN: Two-groups pre- and post-intervention evaluation quasi-experimental design study. METHODS: This study was conducted between February and July 2023 with a total of 237 nursing students studying at two different universities, 116 of whom took the organ transplant course and 121 of whom did not take the course. Sociodemographic Characteristics Form, Coping with Death Scale-Short Form and Organ Donation Attitudes Scale were used for data collection. Mann-Whitney U test, Chi-Square, t-test, Pearson correlation and linear regression were used to analyze the data. RESULTS: There was a statistically significant difference between the students who took organ transplant nursing courses and those who did not in terms of the mean scores of coping with death competence and positive and negative attitudes toward organ donation (p<0.05). It was found that taking an organ transplant nursing course affected nursing students' coping with death competence and their positive and negative attitudes toward organ donation (p <0.01). CONCLUSION: Taking the organ transplant nursing course was associated with improved competence in coping with death a increased positive and decreased negative attitudes.

Why Altruistic Organ Donations Are Not Meeting Demands.

Solid-organ transplantation remains the optimal therapeutic option for end-stage organ disease. Altruistic donation represents the ultimate sign of generosity and the most important gift of life. Currently, <10% of the global needs for transplant are fulfilled. Organ shortages result from an inability to provide an adequate organ supply to match demands. The recently observed stagnation in living kidney donations in the United States is related to a drop in all types of organ donations from living related donors, which has been paralleled with a steady and continuous increase in all living unrelated donations. Some forms of living unrelated donation represent a financially driven survival system within which wealthy recipients exploit poor donors. Low rates of altruistic donation are related to cultural barriers, religious obstacles, fear, and consequent distrust in the system. The low rate indicates a state of lack of societal solidarity, a consequence of the state of subconsciousness at the individual and collective levels that humanity is living in. Human domestication, the conditioning process that humans go through since birth and the primary facilitator of this subconscious state, is guarded through familial, social, cultural, religious, political, and mass media organizations, which are all under the influence of the monetary establishment. Acquired beliefs, mainly during the domestication process, influence our perception of the environment, our values, and ultimately our way of life. Unfortunately, this conditioning process is negatively enforced, leading to a stressful state. The powerful subconscious mind places humans in a permanent survival mode, resulting in loss of intelligence, indispensable for well-being and happiness. Altruistic donation requires a close cooperation between all parties involved in the donation process and necessitates a positive reprograming of our subconscious based on sharing, generosity, satisfaction, gratitude, trust, inner peace, and ultimately happiness, well-known constituents of unconditional love, which represents the peak of consciousness.

Perception and Willingness Regarding Organ Transplantation/donation among Medical Students of Maharajgunj Medical Campus: A Cross-sectional Study.

BACKGROUND: Organ transplant is the procedure of replacing a failing or damaged organ with a functioning one. Positive attitude and awareness about donation are a must for donor organs to be available. This study explored the level of knowledge, perception and willingness regarding organ donation among medical students in Nepal. METHODS: A descriptive cross-sectional study was conducted with 180 medical students using a self-administered questionnaire. Descriptive statistics were used, and Pearson correlation was applied to examine the relationship between knowledge and perception of organ transplantation. Independent samples t-test and ANOVA was used to compare scores among year of study and gender. RESULTS: Results indicated that 86.1% of participants were aware of the need for organ donation, and 83.3% knew that both living and deceased individuals could be donors. While 93.9% believed in the need for effective laws, 72.8% perceived risks for donors. However, only 74.4% were willing to donate their organs, though 91.7% expressed willingness to promote organ donation among friends and family. Participants showed a positive perception towards organ donation. CONCLUSIONS: Despite a high level of awareness and knowledge regarding organ donation, participants exhibited a lower level of willingness to donate organs. Perceived risks for donors and a lack of robust laws and regulations presented significant barriers. Nevertheless, an inclination to promote organ donation was observed. This underlines the need for enhanced education and policy reform to increase organ donation rates.

A cross-sectional study of university students' awareness, knowledge, and attitudes on organ donation and transplantation in Northern Cyprus.

BACKGROUND: Understanding the knowledge and attitudes of university students regarding organ transplantation and donation is crucial, as these students can significantly influence public opinion and behavior. This study aims to assess the knowledge and attitudes of North Cyprus University students towards organ transplantation and donation. METHODS: A cross-sectional study was conducted with 400 students from Northern Cyprus University, divided into medical and social science faculties. A structured questionnaire was utilized to assess their knowledge and attitudes towards organ transplantation and donation. Descriptive statistics, Chi-square tests, and effect size calculations were employed for data analysis. RESULTS: Among the 400 students, 27% demonstrated sufficient knowledge of organ transplantation, and 62.7% had positive views on organ donation. Willingness to donate was expressed by 37% as living donors and 64% as deceased donors. There were no significant differences in knowledge and attitudes between medical and social science students. Factors such as sex, marital status, faculty, and contact with individuals with end-stage organ failure did not significantly influence the knowledge and attitudes. CONCLUSIONS: This study highlights the necessity for educational interventions and awareness campaigns to improve understanding and attitudes towards organ donation among Northern Cyprus University students. Incorporating organ donation education into university curricula, providing accurate online information, addressing misconceptions, and promoting awareness of donation centers and transplant hospitals are essential steps to mitigate organ shortages. Public engagement should be encouraged to foster a supportive environment for organ donation.

Personal Resources and Expectations and Health Behaviors Among Solid Organ Transplant Recipients-A Multicenter Study.

BACKGROUND: The long-term success of organ transplantation (Tx) depends on the transplant recipient's ability to self-manage symptoms, treatment, lifestyle changes, and psychosocial consequences. Health behavior (HB) determinants include personality traits such as optimism, self-efficacy, and health locus of control. PURPOSE: Assessing the relationship between personal resources and expectations and health behaviors of organ transplant recipients. MATERIAL AND METHODS: The study was conducted between 01/04/2018 and 30/10/2019 at 3 transplant centers in Poland. The study group consisted of 243 Tx recipients of kidney, heart, liver, and lung. The Health Behavior Inventory, Multidimensional Health Locus of Control Scale (MHLC), General Self-Efficacy Scale, Dispositional Optimism Scale, and Hospital Anxiety and Depression Scale were used to collect data. FINDINGS: The study group had medium levels of dispositional optimism (mean 15) and high levels of self-efficacy (mean 30.18). The MHLC scale was dominated by a belief in the influence of others and an internal locus of control over one's health. The respondents presented a high level of HB (mean 92.09). A positive relationship was found between personal resources (self-efficacy and optimism), MHLC and HB. The presence of depression and anxiety negatively affected personal resources and internal locus of health control and HB in terms of a positive mental attitude. Type of Tx differentiated internal locus of health control and HB. Predictors of HB were dispositional optimism, self-efficacy, influence of others with health locus of control, symptoms of depression, age and time since transplantation-explaining between 6.1% and 14.5% of health behavior categories. CONCLUSIONS: To improve health practices among organ recipients, strengthening their personal resources is recommended. It is necessary to form an internal locus of control for adherence to positive HB.

The effectiveness of current informative material in improving awareness and opinion of undergraduate students towards organ donation: a comparative, randomized survey study

OBJECTIVES: Despite the contribution of awareness campaigns to the rise of organ donation rates in Brazil, younger folks are subject to few awareness actions. Records on the effect of informative campaigns at improving opinion and knowledge of undergraduates about organ donation are scarce. This study aimed to assess the effect of informative material about organ donation on changes in the trend of answers to a questionnaire compared to the answers of a control group. METHODS: Two randomized groups were compared, receiving the same standardized questionnaire. One group was supplied informative material on the subject, while the other was not. The questionnaire was sent to undergraduate students from two Brazilian universities. Statistical analysis was performed using Student's t-test, Chi-square test and multinomial regression tests. Adopted significance was 5%. RESULTS: There were 739 responses to the questionnaire. Mean age was 22 years, with a majority of women. Six of 14 questions displayed a change in the answer pattern of the experimental group compared to controls (p<0.05). Opinion on organ donation had changes in 2 of 7 analyzed questions (p<0.05). Knowledge on the subject had a shift in answer patterns in 4 of 7 questions. Regression demonstrated 3 items that were not influenced by respondents' age. CONCLUSION: There is controversy regarding the benefit of exposure to informative material. Negative changes were noted in the trust in transplantation as a safe treatment. Positive results regarding technical knowledge were obtained. Better results may be obtained by designing informative material tailored towards the student's specific concerns.

Análise epidemiológica dos candidatos à doação de órgãos nos estados do Ceará, São Paulo e Acre / Epidemiological analysis of candidates for the donation of organs in the states of Ceará, São Paulo and Acre / Análisis epidemiológica de los candidatos a la donación de órganos en los estados del Ceará, São Paulo y Acre

Objetivo: Analisar aspectos epidemiológicos de candidatos a doação de órgãos do Ceará, comparando com os estados de melhor e pior desempenho quanto ao transplante. Método: Estudo Transversal descritivo com abordagem quantitativa realizado com dados do Registro Brasileiro de Transplantes publicados em 2016. Resultados: O pior e melhor estado em relação às doações de órgãos foram Acre e São Paulo, respectivamente. O número de doadores efetivos por milhão de população no Ceará foi superior ao de São Paulo. A recusa familiar representou a maioria das causas de não concretização dos transplantes nos três estados. O Acidente Vascular Cerebral foi a principal causa de morte em São Paulo e Acre, enquanto no Ceará foi o Traumatismo crânio encefálico. Ceará e Acre apresentaram faixa etária predominante de 18-34 anos. Conclusão: O desempenho do Ceará quando comparado com os outros estados foi superior em relação a transformação de potenciais doadores em doadores efetivos

Objective: To analyze the epidemiological aspects of candidates for donation of organs from Ceará, comparing them with the best and worst performing states regarding transplantation. Methods: A descriptive cross-sectional study with a quantitative approach was performed with data from the Brazilian Transplant Registry published in 2016. Results: The worst and best condition in relation to organ donations were Acre and São Paulo, respectively. The number of effective donors per million population in Ceará was higher than in São Paulo. Family refusal accounted for most of the causes of non-transplantation in the three states. Cerebral Vascular Accident was the main cause of death in São Paulo and Acre, while in Ceará it was traumatic brain injury. Ceará and Acre had a predominant age group of 18-34 years. Conclusion: The performance of Ceará when compared to the other states was higher in relation to the transformation of potential donors into effective donors

Objetivo: Analizar aspectos epidemiológicos de candidatos a la donación de órganos de Ceará, comparando con los estados de mejor y peor desempeño en cuanto al trasplante. Métodos: Estudio Transversal descriptivo con abordaje cuantitativo realizado con datos del Registro Brasileño de Trasplantes publicados en 2016. Resultados: El peor y mejor estado en relación a las donaciones de órganos fueron Acre y São Paulo, respectivamente. El número de donantes efectivos por millón de población en Ceará fue superior al de São Paulo. La negativa familiar representó la mayoría de las causas de no concreción de los trasplantes en los tres estados. El Accidente Vascular Cerebral fue la principal causa de muerte en São Paulo y Acre, mientras que en Ceará fue el Traumatismo cráneo encefálico. Ceará y Acre presentaron rango de edad predominante de 18- 34 años. Conclusión: El desempeño de Ceará cuando comparado con los otros estados fue superior en relación a la transformación de potenciales donantes en donantes efectivos

A vivência da família no processo de recepção do transplante de órgãos / The family experience in the process of organ transplant reception / La experiencia de la familia en el proceso de recepción del trasplante de órganos

Objetivo: compreender a história de vida da família que vivenciou o processo de transplante de órgãos. Método: estudo qualitativo, descritivo e exploratório, com abordagem metodológica baseada na História Oral de Vida, realizado com transplantados e seus familiares, com o referencial teórico de Callista Roy. O instrumento de coleta de informações será um formulário de entrevista livre, guiado pela seguinte pergunta norteadora: "Conte-me sua história vivida durante o processo de transplante do órgão". Esse projeto foi aprovado pelo Comitê de Ética em Pesquisa, CAAE 451489915.1.0000.5013, e será desenvolvido no período de janeiro a junho de 2016. Resultados esperados: espera-se com este estudo oferecer subsídios para uma assistência de enfermagem adequada ao receptor de órgãos e sua família, proporcionando melhores condições para suportar as situações vivenciadas.(AU)

Objective: to understand the family's life history that experienced the organ transplant process. Method: this is a qualitative, descriptive and exploratory study, with a methodological approach based on Oral History of Life, performed with the transplanted and their families, with the theoretical framework of Callista Roy. The instrument for information collecting will be a free interview form, guided by the following guiding question: "Tell me your story lived during the organ transplant process." This project was approved by the Research Ethics Committee, CAAE 451489915.1.0000.5013, and will be developed in the period from January to June 2016. Expected results: it is expected from this study to provide subsidies for a proper nursing care to the organ recipient and their family, providing better conditions to support the experienced situations.(AU)

Objetivo: comprender La historia de vida de la familia que pasó por el proceso de trasplante de órganos. Método: estudio cualitativo, descriptivo y exploratorio, con abordaje metodológico basado en la Historia Oral de Vida, realizado con trasplantados y sus familiares, con el referencial teórico de Callista Roy. El instrumento de recolección de informaciones será un formulario de entrevista libre, guiado por la siguiente pregunta de orientación: "Cuénteme su historia vivida durante el proceso de trasplante del órgano". Ese proyecto fue aprobado por el Comité de Ética en Investigación, CAAE 451489915.1.0000.5013, y será desarrollado en el período de enero a junio de 2016. Resultados esperados: se espera con este estudio ofrecer subsidios para una asistencia de enfermería adecuada al receptor de órganos y su familia, proporcionando mejores condiciones para soportar las situaciones vividas.(AU)

O preparo emocional dos profissionais de saúde na entrevista familiar: estudo hermenêutico / Emotional preparedness of health professionals in family interviews: a hermeneutic study / La preparación emocional de los profesionales de salud en la entrevista familiar: estudio hermenéutico

A entrevista familiar para doação de órgãos comporta grande carga emocional e é realizada por coordenadores avançados em transplantes. OBJETIVO: compreender como se dá o preparo emocional dos coordenadores avançados em transplantes para realizar a entrevista familiar. MÉTODO: abordagem qualitativa, estudo hermenêutico; aprovado pelo Comitê de Ética UFF/HUAP nº 321/11. Os dados foram obtidos por entrevista semiestruturada contendo oito questões abertas com 24 sujeitos no período de janeiro a maio de 2012. RESULTADOS: a maioria dos entrevistados não faz qualquer preparo para a entrevista familiar e reconhece a necessidade da implantação de um serviço de suporte para as demandas emocionais advindas do trabalho. CONCLUSÃO: Embora não realizem preparação emocional, os profissionais entendem a relevância do suporte que promova seu autoconhecimento e os faça sentir mais seguros e aptos para as entrevistas familiares.

Approaching families in order to convince them to donate organs is always a conversation filled with a heavy emotional load, and it is performed by experienced transplant coordinators. AIM: to understand the emotional preparedness of experienced transplant coordinators when approaching families of possible donors. METHOD: This study has a qualitative approach, in a hermeneutic method; the Committee of Ethics at UFF/HUAP approved it of under protocol #321/11. The data was obtained through semi-structured interviews, with eight open questions and 24 individuals, between January and May 2012. RESULTS: The majority of the interviewees do not prepare themselves before approaching families and they also recognize the necessity to implement a support system to assist the emotional demands generated by their workload. CONCLUSION: Despite the fact they do not prepare themselves emotionally, professionals see the relevance of support to promote their own self-understanding and that makes them feel safer and prepared to approach families at such a sensitive moment.

La entrevista familiar para donación de órganos implica gran carga emocional y es realizada por coordinadores avanzados en trasplantes. OBJETIVO: comprender como se da la preparación emocional de los coordinadores avanzados en transplantes para realizar la entrevista familiar. MÉTODO: enfoque cualitativo, estudio hermenéutico; aprobado por el Comité de Ética UFF/HUAP nº 321/11. Los datos fueron obtenidos por entrevista semiestructurada conteniendo ocho cuestiones abiertas con 24 individuos en el período de enero a mayo de 2012. RESULTADOS: la mayoría de los entrevistados no hace ninguna preparación para la entrevista familiar y reconoce la necesidad de la implantación de un servicio de apoyo para las demandas emocionales que surjan del trabajo. CONCLUSIÓN: Aunque no realicen preparación emocional, los profesionales entienden la relevancia del apoyo que promueve su autoconocimiento y los hace sentir más seguros y aptos para las entrevistas familiares.

Percepción de beneficios y bienestar en niños con enfermedades amenazantes para la vida: Un estudio integrador / Benefit finding and well-being in children with life threatening illnesses: An integrative study

Objective. We examined whether benefit finding (BF) in children with a life-threatening illness (such as cancer or organ transplantation) would be related to a wide range of positive and negative measures of psychological functioning and some medical variables. Methods. A sample of children with a life threatening illness (N=67, ages 7-18 years) completed the Benefit Finding Scale for Children (BFSC) and other positive and negative measures of psychological functioning. Results. Children exposed to a moderate severity of their disease had the strongest levels of BF. While BF was positively associated with different dimensions of well-being, it was generally not related to distress with some exceptions in the health-related quality of life domain. Conclusion. Our results showed that BF reflects a positive outcome in its own right and not just a mere reduction of distress. Yet, there are some health-related domains of quality of life that should be considered in therapeutic intervention to facilitate BF.

Objetivo. Examinamos en qué medida la percepción de beneficios o benefit finding (BF) en niños con una enfermedad amenazante para la vida (como el cáncer o el trasplante de órganos) estaría relacionado con un rango de medidas positivas y negativas de funcionamiento psicológico así como con algunas variables médicas. Método. Una muestra de niños con una enfermedad amenazante para la vida (N=67, edad entre 7 y 18 años) completaron la Escala de Percepción de Beneficios para Niños (Benefit Finding Scale for Children, BFSC) y otras medidas positivas y negativas de funcionamiento psicológico. Resultados. Los niños expuestos a una enfermedad de gravedad moderada mostraron niveles más altos de BF. BF se asoció positivamente a diferentes dimensiones de bienestar. Sin embargo, no se encontró relación con medidas de malestar, a excepción de algunos dominios de calidad de vida relacionados con la enfermedad. Conclusión. Estos resultados mostraron que el BF refleja un resultado positivo en sí mismo y no una mera reducción de malestar. A pesar de eso, deben considerarse algunos dominios de calidad de vida relacionados con la salud a la hora de realizar intervenciones terapéuticas para facilitar la percepción de beneficios.

Trasplante de órganos, una mirada desde el judaísmo en el siglo XXI / The point of view of Judaism on organ donation

Background: Organ transplantation frequently constitutes a source of public concern. Dealing with such a complex medical problems requires a process of recognition of the different attitudes that social groups have toward organ transplantation attitudes which might vary accordingly to cultural and religious diversity. Judaism is the focus of this review. Our objective is to contribute to the knowledge that Chilean health professionals have about the Jewish point of view on organ transplantation. The supreme value of life is a premise of Judaism, so saving a life should precede the enforcement of certain Old Testament's prohibitions. However, it is difficult and misleading to attempt to define a unique point of view-even though there is an overwhelming majority who are in favor of organ donation-because different theological interpretations and recommendations are continuously in debate. We conclude that the mainstream Jewish position is not significantly different from the contemporary Western thought, even though a minority in Judaism is opposed to cadaveric organ donation.

Principales motivos de negativa ante la donación de órganos en población de la Región de los Ríos: marzo a mayo 2012 / Main reasons for organ donation refusals of population from Region de los Ríos: March to May 2012

INTRODUCCIÓN: La Región de los Ríos tiene uno de los pocos centros de trasplante del país. Es necesario conocer la postura de su población respecto a la donación de órganos, ya que la tasa de donantes ha bajado considerablemente. OBJETIVO: Conocer los principales motivos de negativa ante la donación de órganos, en población de la Región de los Ríos durante marzo-mayo 2012.MATERIAL Y MÉTODO: Estudio descriptivo de corte trasversal. Se aplicaron 264 encuestas a residentes de la Región de los Ríos con edades entre 18 y 65 años, sin limitaciones para responder el instrumento. Se abordaron antecedentes demográficos de los encuestados (comuna, edad, género, nivel educacional); nivel de conocimiento del sistema de donación de órganos, opinión de la familia y situación actual de registro del donante. El tamaño de muestra fue determinada a través del programa Epi info 3,2TM,con un intervalo de confianza de 95 por ciento y un error de 6 por ciento. A través del programa IBM SPSS Statistics 20, se determinó significancia estadística mediante test de x2 (p<0,05). RESULTADOS: La disposición regional a ser donantes en caso de fallecimiento es de 75 por ciento; un 33 por ciento afirma no estar dispuesto a donar para que luchen más por su vida en caso de accidente y un 31 por ciento no estaría dispuesto a donar por motivos religiosos. DISCUSIÓN: Si bien las cifras apuntan a una disposición positiva a la donación, es necesario informar en forma adecuada a la población acerca del funcionamiento del programa de trasplante, para así disminuir la negativa ante la donación de órganos.

INTRODUCTION: Region de los Ríos has one of the few transplant centers in the country; considering the decreased number of organ donors in recent years, it is necessary to understand the attitude of the population towards organ donation. OBJECTIVE: To understand the main reasons for organ donation refusals in Región de los Ríos population in March-May 2012 period. MATERIAL AND METHOD: Cross-sectional study. There were filled 264 survey forms by Región de los Ríos residents between 18 and 65 years of old, excluding people who could not answer the survey. Demographic parameters (municipality, age, gender, educational level), level of knowledge about organ donation process, family’s opinion, rate of consent to donate their own organs and those of relatives where analyzed. Sample size was determined using Epi Info 3.2TM software, using a confidence interval of 95 percent and an error of 6 percent. Statistical significance was determined via a x2 statistical test (p<0.05). The test was performed using IBM SPSS Statistics software. RESULTS: The average consent to become a donor in case of death in Región de los Ríos is 75 percent 33 percent of them, said they do not consent organ donation so that doctors would strive more for their lives in case of an accident and 31percent did not agree to organ donation because of religious beliefs. DISCUSSION: Although numbers indicate a positive attitude towards donation, it is necessary to increase population’s knowledge and understanding in transplant matters in order to reduce organ donation refusal.

Para além do transplante hepático: explorando a adesão ao tratamento / Beyond liver transplant: exploring adherence to treatment

Esta pesquisa busca compreender o significado de adesão ao tratamento atribuído por transplantados hepáticos. A Análise de Conteúdo foi utilizada como metodologia para a apreciação dos relatos das entrevistas realizadas com pacientes identificados como não aderentes pela equipe de saúde do Centro de Transplante de Fígado do Ceará. Os pacientes expressaram que a adesão esta relacionada com diversos fatores, como por exemplo, o apoio familiar e o relacionamento com os profissionais de saúde, mas que também é algo que depende "da natureza de cada um". Percebe-se que a forma como lidam com a adesão é a maneira que encontram para incluir em suas vidas as exigências advindas do tratamento. Ao final do artigo, são discutidas estratégias visando à promoção da adesão entre os pacientes. (AU)

This research aims to comprehend the meaning of adherence to the treatment, attributed by liver transplant patients. The Analysis of Content was the used methodology to analyze the reports of the interviews with patients who were identified as non-adherents by the health team of the Liver Transplant Center of Ceará. The patients expressed that adherence is related to many factors, for example, as the support of the family and the relationship with health professionals, but it is also something that depends on one's "nature". It is possible to note that the way they deal with adherence is the way they find to include the demands of the treatment in their lives. At last, will be discussed strategies that aim the promotion of adhesion among patients. (AU)

O impacto do transplante hepático infantil na dinâmica familiar / The impact of pediatric liver transplantation on family relations

O presente estudo buscou compreender o impacto do transplante hepático infantil (THI) na dinâmica familiar. Participaram da pesquisa seis mães de crianças transplantadas de fígado. O tempo pós-transplante variou entre um e seis anos. As mães foram entrevistadas a respeito do relacionamento familiar no contexto do THI. Análise de conteúdo qualitativa revelou que a relação genitores-criança doente foi permeada pelo medo da morte, levando a atitudes permissivas e superprotetoras, na tentativa de poupar o filho de mais sofrimentos, sendo que este padrão de relacionamento manteve-se presente mesmo após o transplante e a melhora do quadro de saúde dos filhos. A relação do casal tendeu a fortalecer-se e centrar-se nas preocupações a respeito da doença e do transplante, havendo mais diálogo e união. A relação com os filhos sadios passou para segundo plano, surgindo sentimentos de desamparo, ciúmes e rivalidade nas crianças. A família extensiva, por sua vez, tendeu a tornar-se mais próxima e apresentou um importante papel de apoio. Os resultados apontaram que toda a família foi afetada, havendo necessidade de reestruturação familiar, o que reforça a importância do acompanhamento psicológico precoce e sistemático às famílias, visando facilitar a adaptação à situação de doença, prevenindo o desenvolvimento de problemas emocionais. (AU)

This study attempts to understand the impact of pediatric liver transplantation on family relations. Six mothers of two-parent families whose children had been submitted to liver transplant within the last six years participated in the study. Mothers were interviewed about family relationships in the context of pediatric liver transplantation. Qualitative content analysis of the interviews revealed that parents-child relationship was marked by fear of death, leading to permissive and overprotective attitudes in order to reduce the child's suffering. It was noted that this pattern of behavior was maintained even after transplantation and patient's recovery. Parents' relationship tended to fortify and focus on the child's transplant and illness. Parents' relationship with their healthy children was affected. These children developed feelings of abandonment, competition and rivalry. Relatives tended to become closer and played an important supportive role. The results showed that all family members were affected and needed restructuring which reinforces the importance of early and systematic psychological assistance to the families aiming at a better adaptation to the child's condition, preventing the development of emotional problems. (AU)

Intervención psiquiátrica en programa de trasplantes / Psychiatric intervention in a transplantation program

En los últimos años la Psiquiatría de Enlace e Interconsulta ha experimentado un salto cualitativo, acercándose al espacio común del resto de las especialidades médicas: el hospital general. La participación de psiquiatras en programas clínicos específicos como las unidades de trasplantes de órganos sólidos tiene fundamentaciones técnicas precisas dada la correlación entre síntomas psíquicos y las características clínicas específicas de las enfermedades médicas que requieren de este procedimiento. Cada vez hay una mayor preocupación en los clínicos y cirujanos en relación a los factores psíquicos que obstaculizan la adherencia a los tratamientos e indicaciones médicas tanto antes como después de efectuado el trasplante. La población de pacientes pre y post-trasplantados exhiben elevadas tasas de cuadros psiquiátricos específicos que ameritan un tratamiento coordinado multidisciplinario. El objetivo de este trabajo es mostrar la experiencia inicial que estamos desarrollando en la Unidad de Trasplantes de Clínica Las Condes.

In recent years consultation-liaison psychiatry has experienced a quantum leap closer to the common space of the other medical specialties: the general hospital. The participation in clinical programs such as the units of solid organ transplants have required technical arguments given the correlation between psychiatric symptoms and the clinical features of specific medical illness that require this procedure. During the last time, there have been and increasingly concern among clinicians and surgeons in regard to the psychological factors that affect the adherence to treatment and medical advice before and after transplant. The population concerning pre and post transplantation issues, exhibits significant rates of specifics psychiatric disorders which require evaluation and drug treatment specialist coordination. The aim of this paper is to show the initial experience we have developed in the transplant unit of Clínica Las Condes, concerning psychiatric and psychosocial issues.

A tomada de decisão das famílias para a doação de órgãos / La toma de decisión de las familias para la donación de órganos / Families' decision making for organs donation

Trata-se de um estudo descritivo e qualiquantitativo com o objetivo de identificar facilidades e dificuldades dasfamílias para a tomada de decisão quanto à doação órgãos. A amostra foi composta de 16 familiares que realizaram a doaçãoem uma Organização de Procura de Órgãos do município de São Paulo, em 2007. Procedeu-se a coleta por meio deentrevista e a análise dos dados por meio da Análise de Conteúdo. O altruísmo e a participação de toda a família favorávelforam os principais facilitadores (62,50%); as principais dificuldades foram familiares contrários à doação (18,75%) e asdúvidas com relação à morte encefálica (12,50%); a maioria faria a doação novamente (87,50%). O conhecimento dessassituações permite oferecer elementos que norteiem a atuação dos enfermeiros junto às famílias na tomada de decisão.

This descriptive and quail-quantitative study aims to identify the families? facilities and difficulties for thedecision making about organs donation. The sample was constituted by 16 families that made a donation in an OrganProcurement Organization in the city of São Paulo - Brazil, in 2007. Data collection was performed through individualinterview and the information analysis, using the Content Analysis technique with a structured instrument about thedecision-making of families for organs donation. The altruism and the participation of all family members were the mainfactors that facilitated the organ donation (62,50%), while, the main difficulties were family against the donation (18,75%)and the uncertainties about the brain death (12,50%). However, most of the interviewed families would make the donationagain (87,50%). The knowledge about these situations allows to offer elements to guide the action of the nurses withfamilies in decision-making.

Se trata de un estudio descriptivo y cualicuantitativo con el objetivo de identificar las facilidades y dificultadesde las familias para la toma de decisión cuanto a la donación de órganos. La muestra fue compuesta de 16 familiares querealizaron la donación en una Organización de Busca de Órganos en la ciudad de San Paulo, en 2007. Se procedió a lacolecta mediante entrevista y análisis de los datos a través del Análisis de Contenido. El altruismo y la participación detoda la familia favorable fueron los principales facilitadores (62,50%); las principales dificultades fueron familiares contrariosa la donación (18,75%) y las dudas sobre la muerte encefálica (12,50%), la mayoría haría la donación nuevamente (87,50%).El conocimiento de esas situaciones permite proporcionar elementos que orientan la actuación de los enfermeros con lasfamilias en la toma de decisión.

Tres factores que influyen en la actitud de las personas ante la donación de órganos: [revisión] / Three influencing factors in people's attitude towards organ donation: [revision]

Se analiza la donación de órganos de cadáver para trasplantes a partir de tres postulados: 1) la influencia de la religión en la donación, particularmente del catolicismo; 2) la organización del sistema de información y acercamiento al donante y su familia, y 3) la formación personal de los miembros del equipo de salud. En la religión se encuentra una disociación entre la norma moral propuesta y la visión de los fieles. España, con su modelo de la Organización Nacional de Trasplantes, es el referente con una alta tasa de donación de órganos y gran credibilidad social en el sistema. El último postulado hace referencia a la importancia de contar con profesionales especialmente capacitados en la materia y en habilidades de comunicación. Se plantea la necesidad de tomar medidas administrativas y educativas que abarquen los puntos discutidos, con el fin de promover eficazmente la donación y aumentar el éxito de los programas de trasplante.

Cadaver organ donation for transplants is analyzed based on three factors: 1) Religious influence. The Catholic Church, as well as other Christian churches, accept transplants and organ donation as a sign of generosity; 2) An efficient information system for donors and families is necessary for obtaining potential donors; 3) The training of all members of the health team, and their personal views are of great importance to donors and family's decisions. There is a dissociation between religious moral principies and believer's perceptions. Spain, with its National Transplant Organization, has become the main point of reference, having a high rate of organs donation and great credibility. The third factor emphasizes the importance of having well trained professionals with the highest communication skills. Educational and management measures are needed for more successful organ donation and transplant programs.

Conhecimento e opinião de estudantes de medicina sobre doação e transplante de órgãos / Attitude and opinion of medical students about organ donation and transplantation

OBJETIVOS: Analisar o conhecimento e a opinião de estudantes de medicina sobre doação e transplante de órgãos. MÉTODOS: Trezentos e quarenta e sete estudantes responderam, voluntariamente, questionário com 17 perguntas sobre doação e transplante de órgãos. Eles foram avaliados globalmente, para verificar tendências gerais, e agrupados de acordo com o seu ano no curso médico (primeiro ao sexto), para avaliar diferenças entre os períodos. Alunos do quinto e sexto ano foram reunidos em um só grupo. Os resultados foram analisados pelo teste Qui quadrado. RESULTADOS: A intenção de ser doador post mortem foi de 89 por cento e intervivo de 90 por cento, contudo, apenas 62 por cento sabiam dos riscos da doação intervivo. Entre os 347 estudantes, 70 por cento admitiram conhecimento regular, ruim ou péssimo do assunto, 90,2 por cento consideraram importante o tema transplante para a graduação médica, 76,9 por cento consideraram o consentimento informado/expresso como o melhor critério de doação e 64,3 por cento optaram pela gravidade da doença do paciente como melhor forma de alocação. O entendimento sobre transplante aumentou conforme o avanço no curso de graduação. Estudantes do quarto, quinto e sexto ano adotaram atitude negativa, em comparação aos dos anos iniciais, quanto à doação de órgãos para pacientes alcoólatras, não doadores, usuários de drogas ilícitas, estrangeiros e criminosos. CONCLUSÃO: Este trabalho demonstrou grande interesse e atitude positiva dos estudantes de medicina sobre doação e transplante de órgãos, embora a maioria tenha declarado conhecimento deficiente sobre o tema. Observamos também atitude negativa dos estudantes do quarto, quinto e sexto ano médico em relação à doação para alcoólatras, não doadores, usuários de drogas ilícitas, estrangeiros e criminosos.

We analyzed the opinion and understanding of medical students about organ donation and transplantation. METHODS: 347 students voluntarily completed a questionnaire with 17 queries concerning organ donation and transplantation. They were analyzed to identify general tendencies and divided into five groups, according to their year of study (first through sixth year), to assess differences among the years. Students of the fifth and sixth years were placed in the same group. RESULTS:were analyzed by the Chi-square test. RESULTS: The intention to become a post mortem or living donor was of 89 percent and 90 percent respectively; however, only 62 percent were aware of living donation risks. 70 percent of the 347 students admitted regular or little knowledge of the subject, 90.2 percent considered organ transplantation an important issue for a medical graduation program, 76.9 percent considered informed/expressed consent the best organ donation criterion and 64.3 percent of them chose severity of patient disease as the best allocation condition. As students progressed in their studies their understanding about transplantation improved. Students of the fourth, fifth and sixth year manifested a negative attitude about organ donation to alcohol addicts, non donors, drug users, law offenders and foreigners. CONCLUSION: This data show the great interest and positive attitude of medical students toward organ donation and transplantation, despite the fact that most of them admitted having insufficient knowledge on the subject. A negative attitude by students of the fourth, fifth and sixth year on organ donation to alcohol addicts, non donors, drug users, law offenders and foreigners was also observed.