Xenotransplantation and Risks: The Opinion of Veterinary Students at Spanish Universities.

BACKGROUND: Understanding the perception of the risks associated with xenotransplant, especially among professionals who will contribute to the care of the animals, is important for xenotransplant to become a clinical reality. The objective of this study was to analyze opinions regarding the risks of organ xenotransplant among veterinary university students in Spain. METHODS: The study population was 2683 veterinary students from different courses and universities in Spain. Instrument valuation: Validated self-administered questionnaire completed anonymously (PCID-XENOTx-Ríos). Consent to collaborate in the study was requested. Variables for the study: attitude toward xenotransplant and risks (infectious, immunologic, ethical/moral, philosophical, religious, other unspecified risks). STATISTICS: descriptive analysis, Student t test, χ2 test, and Fisher exact test. RESULTS: Of the total number of respondents, 2646 students answered this question, with a completion rate of 98.6%. They considered immunologic risk 78.4% (n = 2074), infectious risk 48.6% (n = 1286), ethical/moral risk 10.7% (n = 284), philosophical risk 5.2% (n = 137), religious risk 1.5% (n = 40), and other risks 3.9% (n = 104). Significant relationships were observed between immunologic risks (P < .001), ethical/moral risks (P < .001), and other risks (P = .002). CONCLUSIONS: Despite the consideration of different types of risks, the favorable attitude toward xenotransplant among veterinary students at Spanish universities is highly prevalent, and evidence-based information campaigns on the different risks associated with xenotransplant are important.

In Vitro N-Terminal Acetylation of Bacterially Expressed Parvalbumins by N-Terminal Acetyltransferases from Escherichia coli.

Most eukaryotic proteins are N-terminally acetylated (Nt-acetylated) by specific N-terminal acetyltransferases (NATs). Although this co-/post-translational protein modification may affect different aspects of protein functioning, it is typically neglected in studies of bacterially expressed eukaryotic proteins, lacking this modification. To overcome this limitation of bacterial expression, we have probed the efficiency of recombinant Escherichia coli NATs (RimI, RimJ, and RimL) with regard to in vitro Nt-acetylation of several parvalbumins (PAs) expressed in E. coli. PA is a calcium-binding protein of vertebrates, which is sensitive to Nt-acetylation. Our analyses revealed that only metal-free PAs were prone to Nt-acetylation (up to 100%), whereas Ca2+ binding abolished this modification, thereby indicating that Ca2+-induced structural stabilization of PAs impedes their Nt-acetylation. RimJ and RimL were active towards all PAs with N-terminal serine. Their activity towards PAs beginning with alanine was PA-specific, suggesting the importance of the subsequent residues. RimI showed the least activity regardless of the PA studied. Overall, NATs from E. coli are suited for post-translational Nt-acetylation of bacterially expressed eukaryotic proteins with decreased structural stability.

A Novel Approach to Bacterial Expression and Purification of Myristoylated Forms of Neuronal Calcium Sensor Proteins.

N-terminal myristoylation is a common co-and post-translational modification of numerous eukaryotic and viral proteins, which affects their interaction with lipids and partner proteins, thereby modulating various cellular processes. Among those are neuronal calcium sensor (NCS) proteins, mediating transduction of calcium signals in a wide range of regulatory cascades, including reception, neurotransmission, neuronal growth and survival. The details of NCSs functioning are of special interest due to their involvement in the progression of ophthalmological and neurodegenerative diseases and their role in cancer. The well-established procedures for preparation of native-like myristoylated forms of recombinant NCSs via their bacterial co-expression with N-myristoyl transferase from Saccharomyces cerevisiae often yield a mixture of the myristoylated and non-myristoylated forms. Here, we report a novel approach to preparation of several NCSs, including recoverin, GCAP1, GCAP2, neurocalcin δ and NCS-1, ensuring their nearly complete N-myristoylation. The optimized bacterial expression and myristoylation of the NCSs is followed by a set of procedures for separation of their myristoylated and non-myristoylated forms using a combination of hydrophobic interaction chromatography steps. We demonstrate that the refolded and further purified myristoylated NCS-1 maintains its Са2+-binding ability and stability of tertiary structure. The developed approach is generally suited for preparation of other myristoylated proteins.

Monomeric state of S100P protein: Experimental and molecular dynamics study.

S100 proteins constitute a large subfamily of the EF-hand superfamily of calcium binding proteins. They possess one classical EF-hand Ca2+-binding domain and an atypical EF-hand domain. Most of the S100 proteins form stable symmetric homodimers. An analysis of literature data on S100 proteins showed that their physiological concentrations could be much lower than dissociation constants of their dimeric forms. It means that just monomeric forms of these proteins are important for their functioning. In the present work, thermal denaturation of apo-S100P protein monitored by intrinsic tyrosine fluorescence has been studied at various protein concentrations within the region from 0.04-10 µM. A transition from the dimeric to monomeric form results in a decrease in protein thermal stability shifting the mid-transition temperature from 85 to 75 °C. Monomeric S100P immobilized on the surface of a sensor chip of a surface plasmon resonance instrument forms calcium dependent 1 to 1 complexes with human interleukin-11 (equilibrium dissociation constant 1.2 nM). In contrast, immobilized interleukin-11 binds two molecules of dimeric S100P with dissociation constants of 32 nM and 288 nM. Since effective dissociation constant of dimeric S100P protein is very low (0.5 µM as evaluated from our data) the sensitivity of the existing physical methods does not allow carrying out a detailed study of S100P monomer properties. For this reason, we have used molecular dynamics methods to evaluate structural changes in S100P upon its transition from the dimeric to monomeric state. 80-ns molecular dynamics simulations of kinetics of formation of S100P, S100B and S100A11 monomers from the corresponding dimers have been carried out. It was found that during the transition from the homo-dimer to monomer form, the three S100 monomer structures undergo the following changes: (1) the helices in the four-helix bundles within each monomer rotate in order to shield the exposed non-polar residues; (2) almost all lost contacts at the dimer interface are substituted with equivalent and newly formed interactions inside each monomer, and new stabilizing interactions are formed; and (3) all monomers recreate functional hydrophobic cores. The results of the present study show that both dimeric and monomeric forms of S100 proteins can be functional.

Group Psychotherapy Could Improve Depression in Cirrhotic Patients on the Liver Transplant Waiting List.

BACKGROUND: It is well-known that there is a high incidence of depression in patients on the liver transplant (LT) waiting list. However, there have been few studies of psychological intervention on these patients. OBJECTIVES: To determine symptoms of depression in patients on the LT waiting list and the impact of group psychotherapy. METHODS: Study population: patients on the LT waiting list who received group psychotherapy (n = 15). CONTROL GROUP: patients who did not receive psychotherapy (n = 10). Measurement instrument: Beck's depression test, which was provided before psychotherapy was initiated and after it was completed (after 6 months). The control group was given the questionnaire at the same 2 points in time as the study group. The psychotherapeutic method consisted of discussing patients' feelings, which dealt with several matters related to transplantation. Different coping strategies were considered. RESULTS: More than half of those surveyed initially had depressive symptoms. When the second survey was administered to the study population, all the patients improved in their psychopathological assessment. When the survey was administered to the control group, a worse psychopathological assessment was obtained in all cases. CONCLUSIONS: Our data suggest an improvement in depressive symptoms in patients on the LT waiting list after receiving group psychotherapy.

Quality of Life and Group Psychological Intervention in Patients With Cirrhosis on Liver Transplant Waiting List.

BACKGROUND: The patients on the liver transplant (LT) waiting list usually present with deterioration in their quality of life. Previous studies on psychological intervention have shown how the quality of life can be improved. OBJECTIVE: To analyze preliminary results of the influence of group psychotherapy on the quality of life of patients on the LT waiting list. METHOD: Fifteen patients on the LT waiting list who accepted receiving group psychotherapy were selected. The development of each 1 of these sessions was carried out at fortnightly periods for 6 months (12 sessions). Those patients who received a transplant and those patients who did not attend more than 6 group psychotherapy sessions were excluded. The Nottingham Health Profile was used to assess the quality of life. It consists of 38 items belonging to 6 health dimensions: energy, pain, physical mobility, emotional reaction, sleep, and social isolation. The study population was given a questionnaire before starting group psychotherapy and after it was finished. RESULTS: Of the 15 patients selected from the study population, 3 patients were given a transplant before the psychotherapy had finished, and 5 patients were excluded for not having attended more than 50% of the sessions. Therefore, the study was completed on 7 patients (n = 7). Overall, a better assessment can be seen in the second questionnaire. CONCLUSIONS: Group psychotherapy might favorably influence the quality of life of patients on the LT waiting list; therefore, it might be interesting to carry out studies on a larger scale in order to confirm these results.

Presence of Pig IgG and IgM in Sera Samples From Baboons After an Orthotopic Liver Xenotransplantation.

INTRODUCTION: The immunorejection in xenotransplantation has mostly been studied from the host's immune system activation point of view and there is very little information about the graft-vs-host reaction. OBJECTIVES: To validate an enzyme-linked immunosorbent assay (ELISA) test for porcine IgM and IgG quantitation, the assessment of porcine IgG and IgM in sera samples from baboons after liver orthotopic xenotransplantation or in human plasma after xenotransfusion through pig organs, and to assess the presence of porcine immunoglobulin in a baboon after plasmapheresis to a complete change of plasma after 4 passages through pig liver. MATERIALS AND METHODS: Two commercial ELISA kits for pig IgG and IgM quantitation were evaluated for cross reactivity with samples from baboons, Rhesus monkeys, squirrel monkeys, and humans. Then, samples from 18 baboons after orthotopic liver xenotransplantation were studied for porcine IgG and IgM. To understand the phenomenon, human plasma samples after xenotransfusion 1, 2, 3, or 4 times through liver or kidney were assessed for porcine IgG presence and finally, the porcine IgG were quantified in sera samples obtained during more than 4 years from a baboon after plasmapheresis with baboon plasma after xenotransfusion 4 times through a pig liver. RESULTS: Porcine IgG and IgM were found in samples from xenotransplanted baboon during all survival. The quantity of porcine IgG in plasma after xenotransfusion correlated with the number of passages through the pig liver, and the IgG were completely cleared from the baboon 16 days after plasmapheresis and complete substitution of plasma after 4 xenotransfusions through a pig liver.

Multivariate Analysis of the Factors Affecting Attitude Toward Organ Donation Among the Ecuadorian Population Residing in Spain.

INTRODUCTION: Immigrants from Ecuador represent the largest group of Latin Americans in Spain and are, therefore, a subgroup of interest to understand their attitudes and influences in respect to organ donation and transplantation. OBJECTIVE: To analyze the attitude of nationals of Ecuador residing in Spain regarding deceased organ donation. METHODS: The study population included the Ecuadorian population residing in Spain. A sample of population older than 15 years was obtained randomly and stratified by age and sex (n=461). Attitude was assessed using a validated questionnaire on psychosocial aspects toward organ donation (PCID-DTO-Ríos). Assistance from immigration support associations in Spain was needed to advice on the location of potential respondents. RESULTS: Attitude toward cadaveric donation was favorable in 59% (n=271) of respondents, 12% (n=57) were against cadaveric donation, and 29% (n=133) were undecided. Several variables were associated with having a more favorable attitude. In the multivariate analysis, the following variables were independently associated with a more positive attitude toward organ donation: 1. level of formal education (odds ratio [OR]=6.849 [25.641-1.818]; P = .004); 2. being in favor of donating a family member's organs (OR=8.849 [20.833-3.717]; P < .001); 3. having commented at a family level about transplant (OR=3.717 [6.578-2.109]; P < .001); 4. not being concerned about the possible mutilation of the body after donation (OR=4.608 [8.547-2.487]; P < .001) and 5. knowing the attitude of one's religion toward donation (OR=7.462 [34.482-1.623]; P = .010). CONCLUSIONS: The attitude toward cadaveric organ donation among the Ecuadorian population residing in Spain is less favorable than that of the Spanish population and is determined by many different psychosocial variables.

Knowledge of the Concept of Brain Death: Is This an Obstacle in the Acceptance of Donation and Transplantation of Organs Among the Bolivian Population Residing in Spain?

INTRODUCTION: The Bolivian population is growing in Spain. The knowledge and acceptance of the concept of brain death are fundamental. OBJECTIVE: To analyze the level of understanding of the brain death concept among the population of Bolivians residing in Spain. METHODS: The study population was Bolivians living in Spain. The inclusion criteria were being older than 15 years, being born in Bolivia, and residing in Spain; participants were selected randomly from this group and stratified by age and sex. Knowledge of the concept of brain death was assessed using a validated questionnaire on psychosocial aspects toward organ donation. A group of people to be surveyed was randomly selected. Assistance from immigration support associations in Spain was needed to advise on the location of potential respondents. The survey was self-administered and completed anonymously. RESULTS: Of the 206 respondents, 27% understood brain death (BD) and believed that this was the death of an individual. Of the rest, 18% did not understand it and the remaining 55% believed it did not mean the death of a patient. Those who understood the concept of BD were more in favor of deceased donation than those who did not (52% vs 47%; P = .886). None of the sociopersonal variables analyzed is associated with knowledge of the concept of BD. A high percentage of respondents indicated fear of apparent death during organ donation. CONCLUSIONS: The majority of the Bolivian population residing in Spain does not understand the concept of BD. Contrary to most psychosocial studies, it is not associated with attitudes toward organ donation or other sociopersonal factors.

Attitude of the Citizens of Havana, Cuba, Toward Organ Donation: A Multivariate Analysis of the Psychosocial Factors Affecting Attitude.

INTRODUCTION: Because personal decisions affect the availability of organs for transplants, awareness about organ donations among the general population is fundamental. OBJECTIVE: To analyze attitudes toward organ donation among the citizens of Havana, Cuba. METHODS: The sample population was the residents of the city of Havana, Cuba. The inclusion criterion was being older than 15 years; the sample was obtained randomly and stratified by age and sex. Attitude was assessed using a validated questionnaire on psychosocial aspects of organ donation and transplant (PCID-DTO-Ríos). A random selection of people to be surveyed was carried out. RESULTS: A sample of 920 respondents was included in the study. Attitude toward cadaveric donation was favorable in 68% of respondents, while 14% were against and 18% were undecided. Several variables were associated with having a more favorable attitude. In the multivariate analysis, the following variables continue to feature as independent variables (P < .05): 1. level of studies; 2. knowledge of the concept of brain death; 3. attitude toward organ donation of a relative; 4. having discussed the issue of organ donation and transplantation with one's family; 5. the attitude of the couple toward organ donation and transplantation; 6. the religion of the respondent; 7. knowing the opinion of one's religion toward organ transplantation; 8. fear of manipulation of the body after death; and 9. acceptance of burial as a treatment of the body after the death. CONCLUSIONS: The attitude toward cadaveric organ donation among the residents of Havana is favorable and similar to that of the citizens of Spain. Improving the organ procurement system will increase donation rates given the population's awareness of the issue.

Psychosocial Factors Affecting Attitude Toward Organ Donation in Santiago, Cuba.

INTRODUCTION: Awareness about organ donation among the general population is fundamental to organ donation programs. It is important to determine the factors that influence attitudes toward organ donation within the general population in order to carry out cost-effective campaigns. OBJECTIVE: To analyze the attitude toward organ donation among Santiago, Cuba, citizens. METHODS: The study population encompassed residents in Santiago, Cuba. A sample population of residents older than 15 years was obtained randomly and stratified by age and sex. Attitude was assessed using a validated questionnaire on psychosocial aspects toward organ donation and transplant (PCID-DTO Ríos). Available census data were used. The survey was self-administered and completed anonymously. RESULTS: Of the 455 respondents, 70% of respondents are in favour of cadaveric donation, 16% are against, and 14% were undecided. Several variables were associated with having a more favorable attitude. And in the multivariate analysis, the following variables continue to feature as independent variables: 1. knowledge of the concept of brain death [OR = 2.386 (4.761-1.194); P = .014]; 2. being in favor of donating a family member's organs [OR = 3.067 (5.952-1.584); P = .001]; 3. a partner's favorable attitude [OR = 5.795 (1.477-22.731); P = .012]; 4. being an atheist/agnostic as the religious beliefs [OR = 1.845 (3.289-1.038); P = .037]; 5. not being concerned about the possible mutilation of the body after donation [OR = 7.437 (2.918-18.955); P < .001]; 6. not accepting other treatment options after death, such as inhumation [OR = 3.048 (5.714-1.626); P = .001]. CONCLUSIONS: The attitude toward cadaveric organ donation among the Santiago, Cuba population is favorable and it is associated with several psychosocial factors.

Multicenter Stratified Study From Spain About Acceptance of Living Liver Donation Among Veterinarian Students.

Veterinarians often hold decision-making positions in the public health care system, and therefore can influence public opinion about organ donation. The objective is to analyze the attitude of Spanish veterinarian students toward living liver donation (LLD) and to establish which factors have an influence on this attitude. METHODS: A sociological, interdisciplinary, multicenter, and observational study was carried out in the veterinarian students enrolled in Spain (n = 9000) (university academic year 2010-2011). A sample of 2854 students was stratified by geographic area and academic year. A validated questionnaire (PCID-DVH RIOS) was self-administered and completed anonymously. The questionnaire was applied to each academic year at compulsory sessions at randomly selected veterinary schools. Statistical analysis included t test, χ2 test, and logistic regression analysis. RESULTS: Completion rate was 94% (n = 2683); 89% (n = 2345) were in favor of related LLD, and 40% (n = 1053) supported unrelated LLD. The following variables were associated with a more favorable attitude: (1) age (P < .001), (2) sex (P < .001), (3) academic year (P < .001), (4) believing in the possibility of needing a transplant oneself in the future (P < .001), (5) attitude toward deceased donation (P < .001), (6) attitude toward living kidney donation (P < .001), (7) acceptance of a donated liver segment from a family member if one were needed (P < .001), (8) having discussed the subject with one's family (P = .009) and friends (P < .001), (9) a partner's opinion about the subject (P = .002), and (10) fear of the possible mutilation of the body after donation (P < .001). CONCLUSION: Spanish veterinary students have a favorable attitude toward LLD.

Veterinary Students' Attitude Toward Living Kidney Donation: A Multicenter Stratified Study From Spain.

Living kidney related donations (LKRD) should be promoted because of the current deficit of organs for transplantation. The objective of the study was to analyze the attitude of Spanish veterinary students toward LKRD, because they may influence public opinion in the future, and to determine the factors that condition it. METHODS: A sociological, interdisciplinary, multicenter, and observational study was carried out in the veterinary students enrolled in Spain (n = 9000) in the university academic year 2010-2011. A sample of 2815 students was stratified by geographical area and academic year. The students' attitude toward LKRD was assessed using a psychosocial validated questionnaire (PCID-DVR Rios), was self-administered, and was completed anonymously. Veterinary schools were randomly selected. The questionnaire was applied to each academic year at compulsory sessions. Statistical analysis was preformed using t test, χ2 test, and logistic regression analysis. RESULTS: The completion rate was 95% (n = 2683); 93% (n = 2504) were in favor of LKRD and 36% (n = 945) supported unrelated living kidney donation. The following variables were associated with having a more favorable attitude: (1) sex (P < .001), (2) being a student of southern universities (P = .03), (3) attitude toward deceased donation (P < .001), (4) having a father (P < .001) or a mother (P < .001) in favor of organ donation, and (5) having discussed the subject with friends (P = .03) or family (P = .02). However, only 60% would accept a kidney from a relative. CONCLUSION: Spanish veterinary students have a favorable attitude toward LKRD. However, only 60% would accept a kidney from a relative.

Impact of 2009 Pandemic H1N1 Influenza A Virus on Veterinary Students' Perception of Xenotransplantation.

The pandemic influenza virus A (H1N1) in 2009, which was initially associated with pigs (swine flu), could have had a negative influence on attitudes toward xenotransplantation (XT), particularly after the social alarm it caused. The objective of this study was to analyze the impact of this pandemic on the acceptance of XT among veterinary science students. METHODS: A control group sample was taken of students registered in the veterinary degree course (academic year 2007-2008). For the study group, the study was repeated on the same students (year 2008-2009) after the pandemic (April 2009). Pair-matching was carried out between both groups taking into account that (1) the questionnaire was anonymous but included the student's initials and (2) when the study was repeated, the students were in the next academic year. Attitude was assessed using a validated questionnaire. RESULTS: After comparing the surveys from the control group (n = 515) and study group (n = 465), 287 matched pairs were obtained. Acceptance of organ XT did not differ significantly before and after the outbreak, assuming similar results to those using human organs (89% vs 89%; P = .10) or with a greater risk than human donation (10% vs 13%; P = .37). There was no difference between the attitude toward tissue XT before and after (94% vs 93%; P = .69) and toward cell XT (97% vs 98%; P = .30); 82% (n = 236) believed that the pandemic had not changed their perception of XT, although 43% (n = 124) considered that it had negatively affected society's perception. CONCLUSION: The pandemic influenza virus A (H1N1) did not change the attitude of veterinary science students toward XT.

Are Dominicans in Favor of Xenotransplantation? A Study of the Attitude of Dominican Immigrants Residing in Spain and the United States.

Xenotransplantation carries many social and cultural implications. The immigrant population in countries with xenotransplantation programs, such as Spain and the United States, will play an important role in accepting such therapy. The objective of the study is to analyze the attitude toward xenotransplantation among the Dominican population residing in the United States and Spain. METHODS: The study population was born in the Dominican Republic and resides in the southeastern United States and Spain. A sample population older than 15 years was obtained randomly and stratified by age and sex. Attitude was assessed using a validated questionnaire on psychosocial aspects toward xenotransplantation (PCID-XENOTx-Ríos). A random selection of people to be surveyed was carried out. Assistance from immigration support associations was needed to advise on the location of potential respondents. RESULTS: A total of 123 respondents were included in the study: A sample was taken of residents of the population from the Dominican Republic residing in Florida, United States (n = 66), and in Spain (n = 57). If it was assumed that xenotransplanted organs functioned as well as human ones, 30% would be in favor. If the results were worse, only 7% would be in favor. This favorable attitude was related to the following variables (P < .05): level of education, an attitude in favor of deceased and living organ donation, and having spoken about donation and transplantation within the family. CONCLUSIONS: The attitude toward xenotransplantation among the population from the Dominican Republic who are residing in the southeastern United States and Spain is unfavorable.

Level of Acceptance of Solid Organ and Tissue Xenotransplantation Among the Bolivian Population Residing in Spain.

The Bolivian population is growing in Spain. Xenotransplantation of organs and/or tissues carries many social and cultural implications. It is important to find out the level of acceptance of xenotransplantation in immigrant populations, especially in populations where there are preclinical trials. The objective of the study is to analyze the attitude toward xenotransplantation of organs and tissues in the Bolivian population residing in Spain and the variables that influence their attitude. METHODS: We selected a sample of the Bolivian population living in Spain. A sample of the population older than 15 years was obtained randomly and stratified by age and sex. Attitude was assessed using a validated questionnaire on psychosocial aspects toward xenotransplantation (PCID-XENOTX-Ríos). RESULTS: Of the 206 respondents, 26% of respondents are in favor of xenotransplantation of organs if it was assumed that xenotransplanted organs functioned as well as human ones. If the results were worse, only 6% would be in favor. The following factors were associated with this attitude: (1) level of education (P = .008), (2) a favorable attitude toward human donation (P = .004), (3) a partner's favorable attitude toward transplantation (P < .001), and (4) a belief that one might need a transplant in the future (P = .01). The following were associated with attitude in the multivariate analysis: (1) having secondary education (odds ratio, 3.690; P = .004) and (2) a partner's favorable attitude toward transplantation (odds ratio, 6.024; P = .003). CONCLUSIONS: The attitude of Bolivian residents in Spain toward xenotransplantation is negative and is determined by educational and family factors.

Emigration From Puerto Rico to Florida: Multivariate Analysis of Factors That Condition Attitudes of the Puerto Rican Population Toward Organ Donation for Transplant.

BACKGROUND: The Puerto Rican population represents one of the largest immigration groups in Florida, and this has an impact on the organ transplant donation process. Our aim was to analyze attitudes toward organ donation among Puerto Ricans who currently reside in the state of Florida (USA). METHODS: The population screened consisted of individuals >15 years old, who were born in Puerto Rico, living in Florida, and awaiting organs for transplant. All participants completed the "PCID-DTO Rios" questionnaire. Random selection was done according to stratification. Support from immigration associations in Spain was needed for advice on the locations of potential respondents. Study participation was anonymized and self-administered. RESULTS: There were 259 respondents, 37% (n = 95) were in favor of donation, 36% (n = 93) were against donation, and 27% (n = 71) were undecided. The variables associated with these attitudes were: age (P = .017); civil status (P = .021); level of education (P < .001); previous experience with donation and transplant (P < .001); attitude toward organ donation of a relative (P < .001); carrying out pro-social activities (P < .001); discussing the issue of transplant with the family (P < .001) or couple (P < .001); attitude toward incineration (P < .001), burial (P < .001), and autopsy (P < .001); fear of mutilation after donation (P < .001); and religious beliefs (P < .001). In the multivariate study, it remained an independent variable to have discussed the issue at the family level (odds ratio = 11.627; P = .009). CONCLUSION: The Puerto Rican study population residing in Florida has an unfavorable attitude toward organ donation.

Differences in Attitudes Toward Living Kidney Donation Among Dominican Immigrants Living in Spain and the United States.

BACKGROUND: The Dominican population has a double-emigration pathway: one is to the USA, by proximity, and the other is to Spain, by sociocultural identification. Our aim was to determine attitudes toward living organ donation among Dominicans residing in Florida (USA) and Spain. METHODS: All study participants were at least 15 years old and living in either Florida (USA) or Spain, and stratified by gender and age. A questionnaire on attitudes toward living kidney donation ("PCID-LKD Ríos") was used. The support of immigrant associations in Florida and Spain was required to advise on survey locations. Data obtained were anonymized and self-administered. RESULTS: The study questionnaire was completed by 123 Dominicans, 68% of whom were in favor of living related kidney donation. There were differences (P = .004) according to the country of residence. Eighty-one percent of Spain's Dominican residents were in favor, compared with 56% of Florida's residents. Factors associated with attitude toward donation were level of education (P < .001), previous experience with organ donation (P = .006), attitude toward cadaveric organ donation (P < .001), belief in the possibility of needing a transplant in the future (P = .016), discussing the issue with one's family (P = .007), discussing the issue with husband/wife/partner (P = .002), carrying out pro-social activities (P = .029), religious beliefs (P = .001), and understanding the risk of living kidney donation (P = .046). CONCLUSION: Attitudes toward living kidney donation among immigrant Dominicans varies between Spain and the USA, with the former showing a more positive view.

Factors That Affect the Attitudes of the Bolivian Population in Spain With Regard to Organ Donation for Transplant.

BACKGROUND: The Bolivian population is an emerging Latin American immigrant group in Spain, several of whom have been transplanted or are awaiting transplant. We aimed to assess attitudes toward organ donation among Bolivians currently residing in Spain. METHOD: The population screened was born in Bolivia but living in Spain, stratified by gender and age. The appraisal tool used was a questionnaire that assesses attitudes toward organ donation for transplant ("PCID-DTO Ríos"). Support from immigration associations in Spain was needed for advice on locations of potential respondents. Survey participation was anonymized and the questionnaire was self-administered. Verbal consent was obtained before participation. RESULTS: There were 206 respondents: 49% (n = 101) in favor of donating their organs after death; 21% (n = 44) against donation; and 30% (n = 61) undecided. Their attitudes were found to be associated with level of education (P = .008), previous experience with donation and transplant (P = .011), concern regarding mutilation after donation (P = .002), knowing the attitude of their religion toward transplant (P = .001), the opinion of their partner (P < .001), and the possibility of needing a future transplant (P = .050). In the multivariate study, the main factor was having a partner in favor of organ donation (odds ratio = 16.129; P = .003). CONCLUSION: Attitudes toward organ donation among Bolivians residing in Spain are far more negative compared with rest of the Spanish population, due to various factors.

Knowledge of the Brain Death Concept Among the Population of Havana, Cuba.

BACKGROUND: One of the main reasons against organ donation is the fear of apparent death due to ignorance of the brain death concept. Our aim was to assess knowledge about and acceptance of the brain death concept among the population of Havana, Cuba. METHODS: The population screened, stratified by gender and age, included those >15 years old and living in Havana, Cuba. The appraisal tool utilized was a questionnaire on attitude toward organ donation ("PCID-DTO Ríos"). A random selection of individuals were surveyed according to the stratification. Cuba's census data were used. The participation was anonymized and self-administered. The verbal consent of participants was provided. RESULTS: There were 920 respondents: 31% (n = 282) knew the concept of brain death and accepted it; 57% (n = 529) did not; and 12% (n = 109) had a misperception, or did not accept brain death as a person's death. Those who knew and accepted the concept had a more favorable attitude toward their own organ donation after death (85% vs 61%; P < .001). The psychosocial factors related to the knowledge of brain death concept were: the gender (P = .002), to make up for speaking at a family level about the organ transplant (P < .001), the couple's opinion about the organ donation (P < .001) and the religion (P < .001). CONCLUSION: The brain death concept is not well understood in the population of Havana, Cuba.