Parental Attitudes and Medication Adherence in Groups of Adolescents After Liver and Kidney Transplantations.

The objective of the study was to determine the connection between parental attitudes and medication adherence and the selected aspects of treatment in groups of adolescents after kidney and liver transplantations, in comparison with adolescents with diabetes and inflammatory bowel disease. Attitudes were assessed using M. Plopa's Parental Attitudes Scale, which distinguishes 5 types of attitudes. Medication adherence was evaluated on the basis of the Morisky Medication Adherence Scale (MMAS-8), used with the author's consent. With the 4-item scale developed by the authors, the following aspects of treatment were assessed: the patient's level of knowledge about the disease, treatment effects, and physician's satisfaction with patient cooperation. In both groups of adolescents after transplantation, 2 types of parental attitudes were found to correlate with medication adherence: the Accepting Attitude and the Overly Protective Attitude. The results of other studied aspects varied in terms of gender, age, and chronic disease type.

Psychological Aspects of Living Kidney Donation in Poland: Experience of One Center.

BACKGROUND: Living kidney transplantation is the optimal treatment of end-stage renal disease. The benefits for recipients are obvious. The psychological consequences for living kidney donors in Poland are not known. OBJECTIVE: The objective of the study was to evaluate the psychological aspects of living kidney donation in Poland. PATIENTS AND METHODS: A total of 66 living donor open nephrectomies were performed in our institution between 1995 and 2005. The psychological aspects were assessed in 40 donors after nephrectomy. The study applied the Satisfaction With Life Scale (SWLS), the Situation Assessment Questionnaire, the Health Behaviors Survey, and our own questionnaire. The mean observation period was 65.6 months. RESULTS: There was a trend toward better life satisfaction in living kidney donors compared to Polish adults. Donor life satisfaction was significantly lower when the recipient was dead than when the recipient was alive. Most donors perceived the kidney donation as a challenge in cognitive judgment. The mean score of the Health Behaviors Survey was not significantly different than in the general population in Poland. The mean pain score after donation was 3.2 in a 5-item scale (1 = severe pain, 5 = mild pain). The mean time of return to work was 3.5 months. No donors regretted their decisions about kidney donation. CONCLUSION: Living kidney donation in Poland has a positive impact on donors' quality of life. Among living kidney donors, the sense of danger concerning the risk of donation depends on the degree of the relationship with the recipient.

Relationships Between Social Attitudes Toward Deceased Organ Donation and the Donation Rates in Poland, a Country With an Opting-out System.

BACKGROUND: Monitoring of attitudes toward deceased donation gives the general view of the acceptance of this treatment but does not allow for precise prediction of single person's behavior. Consistency of actions and attitudes has many determinants, personal and situational. The idea of this study was to assess and compare relationships between behaviors and attitudes toward postmortem organ donation in single districts and between larger regions of the country (west and east). METHODS: Indicators calculated for the years 1996-2014 included the number of potential deceased donors (per million population [pmp]/y), the number of objections registered in the refusal registry (pmp), and the number and percentage of family refusals to donation. To assess relationships between variables, statistical and descriptive analyses were used. RESULTS: There were 10,731 potential donor referrals: 10 times more in the most active than in the least active province. Potential donor referrals from the western region were almost twice as high (18.3 pmp/y) as from the east (10.1). In 1,045 cases (9.7%), organs were not used owing to objections of the relatives; this index differed in each province up to 7-fold, but was almost the same in western and eastern regions. Total number of objections listed in the Refusal Registry was 28,725 (748 pmp). This index was different in each district up to 4-fold, but was not distinctly different in west and east regions. No distinct correlation (Pearson test) was found among the 3 assessed variables. CONCLUSIONS: Donation in Poland has much geographic differences. There is no common pattern of behavior and attitude toward donation and no correlation between these variables.

Implementation and Sustainability of European Training Program on Organ Donation in Poland: Results and the Impact on Donation Indicators.

BACKGROUND: Hospital training called ETPOD-Essentials in Organ Donation-was introduced in Poland in 31 hospitals with under-utilized potential of donation. The aim of this study was to assess the effect in hospitals included and not included in program, before and after trainings. METHODS: The number of potential and effective donors, organs used, and number (%) of family refusals were compared at 10 and in 20 months after the training and in equal periods before. RESULTS: In trained hospitals, the number of potential donors increased (17% in 10 months, 10% in 20 months); in remaining hospitals, donors increased in 5% in both periods. In hospitals included in ETPOD, the number of effective donors increased (2% and 4.5%); in the whole country, donors also increased (5.6% and 2.7%). In ETPOD hospitals, the number of utilized organs increased (14.5% and 8.5%); in the rest, the increase was 3% and 7%. In trained hospitals, family refusals increased from 6.9% to 16.2% and from 8.9% to 10.7%; in the whole country, family refusals decreased from 11.7% to 11% in the short term and increased from 9.6% to 12.1% in the long term. CONCLUSIONS: In hospitals involved in the ETPOD program, the increase in organ donation is greater than in the rest of hospitals. Distinct benefit was observed in consent to organ donation.

Central Register of Objections for Deceased Donation in Poland 1996 to 2014: The Country With an Opting-Out System.

BACKGROUND: Organ, tissue, and cell procurement from deceased donors for transplantation requires consent and authorization, documented donor's positive acceptance, or lack of objection to donation expressed while alive (consent). It also requires the fulfillment of other legal conditions required by law, such as person's legal abilities to act in this field or to obtain approval for donation (authorization). Consent to and authorization of donation from deceased donors requires regulations at the national level. Poland developed an opting-out policy with the Transplantation Act in 1996. The Central Register of Objections (CRO) was introduced on November 1, 1996. The purpose of this article is a formal analysis of all submitted objections and objection withdrawals managed by the CRO since the introduction of the registry in 1996 until the end of 2014. MATERIALS AND METHODS: All data collected by the CRO during 18 years of service was subject to analysis. The objections and withdrawals of objections are summarized in the tables, along with the age, sex, and place of residence of the registered residents. RESULTS: By December 31, 2014, a total of 29,288 records were registered, including 29,013 registered objections and 275 registered withdrawals of objections; this means that 0.075% of the country's population expressed objection to posthumous tissue and organ donation for transplantation. Legal representatives submitted 4208 declarations (15.6% of all declarations). The largest inflow of objections took place in 1997, the first full year of CRO activity. CONCLUSION: CRO is an indispensable option in a country with opt-out system as a part of organ donation authorization protocol. Number of registered objections is extremely low, in practice, this leads to a situation where the will of the deceased most often is obtained from his family.

The Model of Postgraduate Studies for Transplant Coordinators in Poland: 500 Graduates in the Years 2007-2015.

BACKGROUND: Since 2007, the Medical University of Warsaw has been organizing the Transplant Coordinators Postgraduate Studies, which are funded by the National Programme for the Development of Transplantation Medicine. The aim of the studies is to recruit medical professionals for every hospital with the potential of deceased donations. The goal of the present study was to formally evaluate the previous 16 editions of Transplant Coordinators Postgraduate Studies by assessing graduate profiles and analyzing the efficiency and sustainability of their education. METHODS: Graduate profiles were determined by gathering sociodemographic information contained in student records. Training efficiency and sustainability were defined by assessing the actual performance of the coordinators' functions in the hospital after taking the course. RESULTS: As of May 2015, the number of Transplant Coordinators Postgraduate Studies graduates totals 501. Approximately one half of the graduates (n = 248) had nursing degrees; training was also finished by 199 physicians, and 54 individuals had other medical education. The number of graduates per million population across the whole country totals 13. A total of 226 of the graduates (45%) were employed in the years 2007-2015 in hospitals as transplant coordinators; physicians (93 graduates), nurses (107 graduates) and other medical proffessionals (26 graduates). CONCLUSIONS: The academic formula of the Transplant Coordinators Postgraduate Studies funded by public sources makes it possible to educate practicing staff (physicians and nurses alike) for a nationwide system of donor hospital transplant coordinators posted in >200 hospitals and maintained by a national transplant organization.

Survey on attitudes and knowledge on the organ recovery from deceased donors in Roman Catholic nuns and priests.

UNLABELLED: Deceased donors (DD) organ recovery rate in Poland has never been satisfactory but over the years kidney transplantation from deceased donors has reached the level of 26 transplants/pmp. In 2007 due to a number of reasons, a dramatic fall of organ recovery rate from deceased donors (DD) occurred. The survey on public attitude toward organ transplantation carried out in the same year showed a large reduction of the public trust toward medical profession. Since then, the number of kidney transplantations has never come back to its level from 2006, regardless of a positive attitude toward organ transplantation. The attitude and knowledge survey was recently carried out in 100 physicians and 100 nurses employed in one large district hospital. The results of the attitude survey among the hospital staff showed that the level of knowledge among nurses corresponded to their age and the time since graduation. Younger nurses showed much more appreciation and knowledge toward recovery of organs from the deceased donors. Survey among physicians indicated some hesitation toward recognition of the brain death. In the present paper results of the survey on attitude and knowledge toward organ transplantation among nuns (98 nuns), priests (100 priests) and students (98 students) of the Theological School living in the same area are presented. Despite quite high (>60%) acceptance of the deceased donation, one third of questioned population showed lack of knowledge not only on existing legal regulations, but also of important documents issued by the Catholic Church. CONCLUSIONS: Improvement of transplantation program in Poland requires extensive educational program among various parts of the society: most importantly among physicians, nurses and priests. The Partnership for Transplantation program has been directed to achieve these goals.

Partnership for transplantation: a new initiative to increase deceased organ donation in Poland.

Despite the long-standing history of transplantation, the shortage of organs has remained its most restrictive factor. In 2010, the number of actual deceased organ donors in Poland was 13.5/million population (pmp). However, a huge difference in organ recovery rates is evident between various regions, eg, 32 pmp, in western Pomerania compared with 1-3 pmp in southern districts. A substantial number of patients who die while awaiting organ transplantations could be saved were effective programs able to overcome barriers in deceased organ donation. Such programs, eg, the European Donor Hospital Education Program, Donor Action, European Training Program on Organ Donation, United States Collaborative in Donation were introduced several years ago, but after transient improvements there has not been real progress. A new comprehensive program-Regional Partnership for Transplantation-was initiated a year ago in 4 districts of southern Poland by the Polish Union for Transplantation Medicine. The letter of intent to activate the donation program was signed by the local administration, the president of the local medical school, president of the Physician's Chamber, transplant centers, the Polish Union for Transplantation, and the Polish Transplant Coordinating Center. The plan of action included training of in-hospital coordinators, visits to all regional hospitals in company of a representative of the hospital founding body, examination of the real donation pool and the need for participation in a donation program training and education of the hospital staff in legal and organizational aspects of donation, brain death recognition, and various aspects of donor care. In addition, the program included communication skills workshops for intensive care unit physicians (with participation of 2 actors, an experienced anesthesiologist, and a psychologist), lectures for high school and university students and for hospital chaplains as well as alumni of higher seminaries. The preliminary results (after the first year) showed 40%-70% increases in activity of the local hospitals in the organ donation process.

Educational system for transplant coordinators in Poland: postgraduate studies at Warsaw Medical University; 2 years of experience.

Donor hospital transplant coordinators play crucial roles in the donation process. There are only a few coordinators in Poland, while there are about 400 hospitals with intensive care units (ICU). Coordinators must be professionals in medical sciences, clinical psychology, law, organization, management, and statistics. Coordinators acquire these skills during the Transplant Coordinators Postgraduate Studies at Warsaw Medical University which began in 2007. Lectures, seminars and exercises (99 hours, 6 weekends) are run by experts. The studies end with an examination and a diploma. The main criterion for acceptance of a candidate is employment in a key department in the donation process. The aim of studies is to educate coordinators for each hospital in the country. Until now 4 editions of the course have been completed. Among 123 graduates, 71 (60%) are employed in strategic departments of 48 hospitals. Preliminary results of graduates' activities in donor detection were compared in the periods before (2005-2006) and after the course (2007-2008). The background was the overall activity in Poland, where in 2007-2008 the activity fell to 79% of 2005-2006. This fall for hospitals with the graduates of this program was 82% versus hospitals without them (76%). Of the 48 hospitals that employed the graduates: 14 improved donation 5 were the same, in 12 in both periods showed no donations; whereas in 11 it was much lower (>20%), and in 6 lower but consistent with the national trend.

Extreme attitudes toward organ transplantation: how do supporters and opponents of this method of treatment differ in Poland?

BACKGROUND: Many medical professionals share the opinion that the negative social attitudes toward transplantation are the basic cause of the deficit of organ from deceased donors. Although public opinion polls in Poland invariably reveal overall acceptance of transplantation, it is extremely difficult to procure organs. The purpose of this study was to compare the attitudes of supporters and opponents of organ transplantation. MATERIALS AND METHODS: In social psychology, attitude is defined as a relatively stable inclination toward a positive or negative relation to a person or an object. It was assumed that positive attitudes are favorable as regards transplantation, whereas negative attitudes constitute a social obstacle to this method of treatment. The survey conducted between May and August 2002 included a representative sample of 1000 Poles over 15 years of age. The first part of the survey measured the general attitude toward transplantation on a rating scale ranging from "definitely agree" to "definitely disagree." RESULTS: We distinguished two extreme attitudes, ie, supporters and opponents. CONCLUSIONS: The attitudes of supporters were mainly cognitive, whereas the attitudes of opponents were dominated by negative emotions associated with fear of death, psychological trauma, and physical injury which led to avoidance behavior, passive resistance, and selective and biased information processing. Opponents often concealed or belittled their standpoints and were reluctant to discuss transplantation issues. Their behavior was more passive, and their familiarity with the medical and legal aspects of transplantation was relatively poor compared with supporters.

[Quality of life in children and adolescent with end-stage renal disease treated with dialysis and kidney transplantation]. / Ocena jakosci zycia dzieci i mlodziezy ze schylkowa niewydolnoscia nerek leczonych dializami i przeszczepieniem nerki.

This study investigates the quality of life of 139 patients remaining on alternative therapies for end-stage renal disease. Data from self-report questionnaires concerning physical activity, physical and social well-being, signs of depression and general assessment of situation, and "hope for future" were compared. Results indicate that self-assessment of quality of life (physical activity, physical and social well-being) among transplant patients is the best compared to both dialysis groups. These differences sustained in spite of deterioration of general health state with time. There were no differences between dialysis groups in terms of evaluated parameters. Overall results of quality of life assessment expressed by patients treated with hemodialysis seem to slightly improve during treatment.

Psychological rules of communication with relatives of a potential organ donor--the Polish experience.

Increase of number of organs for transplantation depends on the positive attitude of the general public toward cadaveric organ donation and transplantation. This attitude is shaped as the result of education performed by mass media and as a result of individual experience of various people with the health-care service. Whenever a decision on post-mortem donation of a deceased is unknown, there are his close relations who might express his will. The aim of this article is to draw attention to several problems of psychological nature, which refer to proceeding with relatives of organ donors. A course and result of talks with relatives of a potential organ donor depend on a number of factors, which are pointed out below. Within the frames of this interaction, basic rules of effective communication are presented, including message on death of a close person in case of brain stem death diagnosis. Furthermore, examples are presented of the most frequent errors of those who talk with relatives, scope of appearing difficulties and several methods to avoid and/or overcome occurring problems.