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Transplantation is limited by the shortage of organs
available,1and many factors contribute to the
shortage. In Spain, a country with one of the highest
deceased donation rates in the world and with a coor-
dination model (the Spanish model) that minimizes
loss of donors due to lack of detection, the main reason
for loss of potential donors is refusal of their family
members to donate. Family refusal causes the loss of 1
out of every 4 or 5 potential donors.2,3 In addition to
psychosocial factors in the population,4,5 one of the bar-
riers that appears to prevent the procurement of more
transplant organs is that a considerable number of hos-
pital professionals may be opposed to organ donation.6-8
Usually, organ donation and transplantation activ-
ities have been focused on physicians, but we now
know that physicians have the most favorable attitudes
toward organ donation of all hospital personnel.8-12
Therefore, we should concentrate our efforts on other
subgroups of hospital personnel. In this respect, nurses
are fundamental in the organ donation and transplanta-
tion process.3Moreover, nurses frequently have more
direct contact with patients and for longer periods than
physicians do, which means that they have an impor-
tant effect on such patients. Therefore nurses’ attitudes
toward organ donation will affect patients and their
families as well as the general public in a decisive way
that is reinforced by nurses’ status as health care pro-
fessionals.
In this situation, it is a matter of great concern that
various studies have shown that organ donation and
transplantation generate stress among nurses and that
nurses lack information on the topic,13-16 although some
authors17 report that nurses have a very favorable attitude.
Objective
The objectives of our study were (1) to analyze the
attitude of nurses toward deceased donation in a terti-
ary Spanish hospital with various ongoing solid-organ
Attitude of nursing staff toward organ donation
in a Spanish hospital with a solid-organ
transplant program
Context—Nursing personnel are fundamental in the organ donation and transplan-
tation process, and their attitude toward donation has a decisive effect on patients,
patients’ families, and the general public.
Objective—To analyze the attitudes of nursing personnel toward donation in a
transplant hospital and the factors that determine those attitudes.
Materials and Methods—A random sample of 305 nurses in different hospital
services was taken and stratified by type of service. A validated psychosocial
questionnaire was used to evaluate attitudes toward donation. The survey was
completed anonymously and was self-administered. Student ttest, χ2test, and
logistic regression analysis were used for statistical analysis.
Results—Most respondents (63%) favored organ donation. The following variables
affected attitude: (1) having a favorable attitude toward donation of a family mem-
ber’s organs (P< .001), (2) knowing the concept of brain death (P< .001), (3) having
discussed organ donation and transplantation within the family (P= .001), (4) hav-
ing a favorable attitude toward autopsy (P= .006), (5) fearing mutilation of the body
(P< .001), (6) a partner’s attitude toward organ donation and transplantation (P< .001),
and (7) the respondent’s religion (P= .009). Multivariate analysis yielded the fol-
lowing significant factors: (1) fear of mutilation of the body (odds ratio, 9.5), (2)
partner’s attitude toward organ donation and transplantation (odds ratio, 0.2), and
(3) respondent’s religion (odds ratio, 2.7).
Conclusions—Attitudes toward organ donation among nurses are similar to atti-
tudes of the general public in Spain. Given the influence of nurses on the general
public, promotional campaigns directed at nurses are a priority. (Progress in
Transplantation. 2009;19:371-377)
Antonio Ríos Zambudio, MD,
Laura Martínez-Alarcón,
Pascual Parrilla, PhD,
Pablo Ramírez, MD
Coordinación Regional de Trasplantes
de la Comunidad Autónoma de Murcia
(AR, LMA, PR), Hospital Universitario
Virgen de la Arrixaca (AR, LMA, PP, PR),
Murcia, Spain
Corresponding author: Dr Antonio Ríos
Zambudio, Avenida de la Libertad
nº 208, Casillas 30007, Murcia, Spain
(e-mail: ARZRIOS@teleline.es)
To purchase electronic or print reprints,
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Phone (800) 809-2273 (ext 532) or
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E-mail reprints@aacn.org
371
Progress in Transplantation, Vol 19, No. 4, December 2009
transplant programs and (2) to analyze the factors that
determine such an attitude.
Materials and Methods
Study Population
The study was carried out in a Spanish tertiary
level hospital with a deceased organ transplant pro-
gram (kidney, liver, pancreas, and heart) and a living
donation program (kidney and liver). A random sam-
ple was taken of nurses from the different hospital
services. A total of 305 professionals were selected,
and the study was carried out between February and
December 2003.
Attitudinal Survey and Study Variables
Attitude was evaluated by using a survey of
multiple-choice questions that had been validated in
our geographic area.8,18,19 Contact was made with the
nursing supervisor or a nurse. This person was given
an explanation of the survey and was made responsi-
ble for the distribution and collection of questionnaires
in randomly selected work shifts. The questionnaire
was distributed at the start of the work day, when
access was available to the whole workforce, all of
whom completed the survey at the same time (com-
pleting the survey took 3-5 minutes). The survey was
anonymous and was self-administered, and the
process was coordinated by 2 health care collaborators
from the Regional Transplant Coordination Center.
Attitude toward the donation of a respondent’s own
organs was studied as a dependent variable. The fol-
lowing independent variables were studied: (1) sociop-
ersonal (age, sex, and marital status); (2) work (job
situation, and type of service in which the respondent
works); (3) knowledge about organ donation and trans-
plantation (previous experience with organ donation
and transplantation, knowledge of the concept of brain
death, a respondent’s belief in the possibility of need-
ing an organ transplant in the future); (4) social inter-
action (partner’s attitude toward organ donation and
transplantation, family discussion about organ dona-
tion and transplantation, attitude toward donation of a
family member’s organs upon death, and trust in the
health care system [a belief that medical errors are
committed]); (5) participation in prosocial voluntary
activities (attitude toward carrying out activities con-
cerning the rights and welfare of other citizens); (6)
religion (respondent’s religion, knowing the attitude of
the church toward organ donation and transplantation);
and (7) attitude toward the body (attitudes toward cre-
mation of the body, burial of the body, and autopsy;
concern about mutilation of the body after donation).
Statistical Analysis
The data were stored in a database and were ana-
lyzed by using the SPSS 11.0 statistical package (SPSS
Inc, Chicago, Illinois). Descriptive statistics were car-
ried out on each of the variables. The Student ttest
and χ2test were used to compare the different vari-
ables, together with an analysis of remainders. The
Fisher exact test was applied to contingency tables
when cells had an expected frequency less than 5.
In the multivariate study, a logistic regression
analysis was applied to the variables that had a signif-
icant relationship in the bivariate analysis. In all cases,
only Pvalues less than .05 were considered statisti-
cally significant. Finally, this study was approved as a
study of human subjects by the ethics committee at
our hospital.
Results
Attitude Toward Organ Donation
The completion rate was 95% (289 respondents
of 305 selected). With respect to donation of a respon-
dent’s own organs, 63% (n = 181) of respondents were
in favor and 37% (n = 108) were undecided or against.
Two noteworthy reasons were given for being in
favor: solidarity (61%) and reciprocity (66%). Most
respondents did not give a reason for being against (a
negative assertion, 46%), although fear of apparent
death was cited in 28% of cases. The vast majority of
respondents know that the hospital where they work is
a solid-organ transplant hospital (95%, n = 275).
Variables Determining Attitude Toward
Donation: Bivariate Analysis
An analysis of variables that influence attitude
toward organ donation shows that attitude is not related
to any of the personal variables such as a respondent’s
sex, age, or marital status (Table 1).
With reference to job variables, no relationship
was found between attitude and job contract situation
(P= .74), type of service in which health care activity
is carried out (P=.30), or whether the service is involved
in the transplant-donation process (P= .80). No differ-
ences were found related to whether the respondent
has had experience with organ transplantation or
donation (P= .27), or whether the respondent has been
involved in voluntary activities (P= .56).
A significant factor is understanding of the con-
cept of brain death. Thus, persons who do not under-
stand the concept of brain death or who are mistaken
about it have a more negative attitude toward the mat-
ter than do persons who understand the concept (51%
who do not understand are in favor of donation, 22%
who are mistaken about the concept are in favor of
donation, and 70% who understand the concept are in
favor of donation; P< .001).
A partner’s opinion on the subject also has an
influence: attitude is more favorable (83% in favor) if
the partner is in favor and more negative if the partner
is against (27%) or the partner’s opinion is unknown
Progress in Transplantation, Vol 19, No. 4, December 2009
372
Zambudio et al
Attitude of nursing staff toward organ donation
373
Progress in Transplantation, Vol 19, No. 4, December 2009
Continued
Age, mean (SD), y
Sex
Male (n = 85)
Female (n = 196)
Does not know/no answer (n = 8)
Marital status:
Single (n = 94)
Married (n = 167)
Widowed (n = 4)
Separated (n = 12)
Divorced (n = 9)
Does not know/no answer (n = 3)
Type of service
Surgical (n = 93)
Medical (n = 153)
Central (n = 40)
Does not know/no answer (n = 3)
Service directly related to organ donation and transplantation
Not related (n = 166)
Related (n = 123)
Job contract situation
Permanent (n = 181)
Temporary (n = 58)
Contracted (n = 46)
Does not know/no answer (n = 4)
Experience in donation and transplantation
No (n = 170)
Yes (n = 119)
Voluntary activities
Yes (n = 75)
No nor will I (n = 22)
No but I would like to (n = 177)
Does not know/no answer (n = 15)
Donation of organs of a family member
Yes (n = 92)
No (n = 22)
Would respect opinion (n = 165)
Does not know/no answer (n = 10)
Family discussion about donation
No (n = 66)
Yes (n = 223)
Knowledge of concept of brain death
Wrong concept (n = 9)
Concept known (n = 190)
Concept not known (n = 90)
Favorable attitude toward cremation
No (n = 141)
Yes (n = 148)
Favorable attitude toward autopsy
No (n = 185)
Yes (n = 104)
Concern about mutilation after donation
No (n = 231)
Yes (n = 25)
Does not know/no answer (n = 33)
40 (8)
32 (30)
73 (68)
3 (3)
31 (29)
65 (60)
1 (1)
3 (3)
5 (5)
3 (3)
37 (34)
59 (55)
11 (10)
1 (1)
61 (56)
47 (44)
71 (66)
22 (20)
14 (13)
1 (1)
68 (63)
40 (37)
25 (23)
11 (10)
66 (61)
6 (6)
7 (6)
21 (19)
74 (69)
6 (6)
36 (33)
72 (67)
7 (6)
57 (53)
44 (41)
55 (51)
53 (49)
80 (74)
28 (26)
68 (63)
18 (17)
22 (20)
38 (9)
53 (29)
123 (68)
5 (3)
63 (35)
102 (56)
3 (2)
9 (5)
4 (2)
0 (0)
56 (31)
94 (52)
29 (16)
2 (1)
105 (58)
76 (42)
110 (61)
36 (20)
32 (18)
3 (2)
102 (56)
79 (44)
50 (28)
11 (6)
111 (61)
9 (5)
85 (47)
1 (1)
91 (50)
4 (2)
30 (17)
151 (83)
2 (1)
133 (74)
46 (25)
86 (48)
95 (52)
105 (58)
76 (42)
163 (90)
7 (4)
11 (6)
.11
.95
.52
.30
.80
.74
.27
.56
<.001
.001
<.001
.58
.006
<.001
Table 1 Psychosocial variables that influence attitude toward deceased organ donation among hospital nursing personnel
Favorable attitude
(n = 181; 63%) P
Unfavorable attitude
(n = 108; 37%)Variable
No. (%) of nursesa
(40%, P<.001). Moreover, attitudes are more favorable
when opinions about donation have been discussed at
the family level (P=.001). Attitude toward donation is
also more favorable among those respondents who
would be prepared to donate the organs of a family
member if the decision had to be made (P< .001).
Attitudes toward donation are more favorable
among those respondents who would be prepared to
accept other options apart from burial after their death,
especially the performance of an autopsy (73% vs 57%;
P= .006). In addition, persons who are concerned about
mutilation after donation have a more negative atti-
tude (28%) than do persons who are not concerned
about that (71%, P< .001).
With respect to religious beliefs, the few respon-
dents who are non-Catholic had a more negative atti-
tude toward donation (P=.009). Finally, attitude is not
influenced by the belief that one may need a transplant
organ oneself (P= .76) or the belief that medical errors
may occur in the center (P= .56).
Variables Affecting Attitudes Toward Donation:
Multivariate Analysis
A multivariate analysis shows that 3 variables inde-
pendently influence attitude toward donation: (1) fear
of mutilation of the body: persons with no fear of muti-
lation are 9 times as likely to have a favorable attitude
toward donation (odds ratio, 9.52); (2) the opinion of
a respondent’s partner toward organ donation: respon-
dents who know that the partner is against donation
are 10 times less likely of being in favor of donation
(odds ratio, 0.20); and (3) a respondent’s religion:
Catholics are 3 times as likely as non-Catholics to have
a favorable attitude toward donation (odds ratio, 2.7).
Discussion
Only a few years after the first successes with kid-
ney transplants from deceased donors, various authors
began to study the psychosocial factors that influence
donation.20 Initially the focus was on the general pub-
lic, but later more emphasis was placed on studies of
other health care workers,6-8 given that part of the
problem with organ procurement is found within the
hospitals themselves.
Nurses are a fundamental subgroup of health care
workers who look after patients and promote health in
the population. In this respect, their attitudes toward
health matters are fundamental, so if they are against
donation, they generate a negative attitude toward dona-
tion among persons who might be exposed to such an
attitude or they at least generate distrust about the mat-
ter. Information offered by health care personnel has a
considerable influence on the general public. More-
over, the generation of a negative attitude in the general
public from comments made by health care profession-
als is very difficult to reverse, given that the source of
information holds a lot of credibility.21
In our study, attitudes toward deceased organ dona-
tion are the same as described in our general popula-
tion (63% in favor vs 63% opposed).22 This similarity
Partner’s opinion about organ donation and transplantation
Yes, in favor (n = 134)
Opinion not known (n = 59)
Yes, against (n = 22)
No partner (n = 42)
Does not know/no answer (n = 32)
Religion
Catholic (n = 233)
Other religion (n = 32)
Does not know/no answer (n = 24)
Possibility of needing a transplant for oneself
Yes (n = 102)
No (n = 3)
Doubts (n = 184)
There are medical errors
Yes (n = 60)
No (n = 14)
Occasionally (n = 129)
Doubts (n = 86)
23 (21)
36 (33)
16 (15)
17 (16)
16 (15)
76 (70)
18 (17)
14 (13)
41 (38)
1 (1)
66 (61)
25 (23)
3 (3)
47 (44)
33 (31)
111 (61)
23 (13)
6 (3)
25 (14)
16 (9)
157 (87)
14 (8)
10 (6)
61 (34)
2 (1)
118 (65)
35 (19)
11 (6)
82 (45)
53 (29)
<.001
.009
.76
.56
Table 1 Continued
Favorable attitude
(n = 181; 63%) P
Unfavorable attitude
(n = 108; 37%)Variable
No. (%) of nursesa
a Values are number (%) unless otherwise specified. Percentages may not total 100 because of rounding.
Progress in Transplantation, Vol 19, No. 4, December 2009
374
Zambudio et al
is important, given that the respondents are profes-
sionals who work in a transplant center and many have
worked with transplant patients and been involved in
the donation and transplant process. These data con-
firm what has already been found in other European
countries, where a negative attitude has been reported
and where a lot of fear and uncertainty surrounds the
topic of organ donation and transplantation.13-15,23-25 In
fact, when we analyze the studies reporting that nurses
are in favor,16,17,26 we see that most have very low ques-
tionnaire completion rates, which could cause a posi-
tive bias in the selection of the sample because persons
who are in favor tend to be more prepared to complete
the questionnaire than persons who are against or
undecided, and this fact could explain the high favor-
able attitude. For example, in the study by Molzahn,17
92% of nursing respondents are in favor, but the survey
completion rate is only 50%. Similarly, in a British
survey, de Sque et al26 report quite a favorable attitude
(78%) among nursing personnel, but the survey com-
pletion rate is very low at around 54%. All these facts
lead us to believe that the situation is similar in differ-
ent countries and hospitals and that the psychosocial
profile that influences such an attitude is affected by
the same populational factors.22
Among the factors that influence attitudes on this
topic, knowledge of the concept of brain death is very
important. This classic factor has been described in the
general population, but it is surprising to find it among
nursing personnel. Nurses work in health care centers
and have extensive training, so it is assumed that they
understand the concept of brain death.27 Yet 34% of
respondents did not understand this concept. This find-
ing is congruent with the main reason given for not
donating organs: fear of apparent death. If we are self-
critical, we can see that although we undertake cam-
paigns in the general public, in schools, and so on,28
we have not ensured that our own personnel are well-
informed and fully understand what we are doing.
Therefore, it is important to provide information about
brain death to health care professionals.29 In this respect,
some authors have already highlighted that the estab-
lishment of a protocol about the diagnosis of brain
death increases confidence in the process and reduces
uncertainty.30
Fear of manipulation of the body is another factor
that makes donation difficult.31 Thus, nurses have a more
negative attitude toward donation when they are not
prepared to have an autopsy carried out on themselves
upon death if it were necessary. Some authors6show
that, contrary to the belief that health care profession-
als are less sensitive than the general public toward the
manipulation of the body, they in fact have great dif-
ficulty in allowing action to be taken on the deceased
donor, even actions as well accepted as transplantation.
Thus, our results show that fear of manipulation of the
body not only remains an independent factor in the mul-
tivariate analysis, but has a high odds ratio (Table 2).
Previous experience with donation and transplan-
tation was not a favorable factor. However, various
authors have reported that, as in the general public,4
knowing transplant patients has a parallel in the hos-
pital setting,6and therefore it would be useful to high-
light the successful organ transplants within the
hospital and to make sure that all the professionals
know the success rates. Among nurses, this does not
seem to be a fundamental factor, because although it
is necessary to know transplant patients, it is also nec-
essary to understand the transplant process well in
order to avoid unfounded fears. Two noteworthy rea-
sons are given for being in favor of organ donation:
solidarity (61%) and reciprocity (66%).
Another significant factor, although it loses a cer-
tain amount of importance because most respondents
are Catholic, is religion. The Catholic church clearly
accepts organ donation and transplantation,32 and
Catholics are slowly becoming aware of this situation.
Thus, we can see why Catholics tend to have a more
Concern about mutilation after donation
Yes
No
Partner’s attitude toward transplantation
I don’t have a partner
In favor
I do not know it
Against
Religion
Other religion
Catholic
2.26
0.73
-1.04
-1.59
1.00
0.53
0.45
0.50
0.66
0.50
1
9.52 (3.356-27.100)
1
2.07 (0.86-4.96)
0.35 (0.13-0.93)
0.20 (0.06-0.74)
1
2.73 (1.03-7.24)
<.001
.10
.04
.02
.04
Table 2 Psychosocial variables that influence attitude toward deceased organ donation among hospital nursing personnel.
Multivariate study
Regression coefficient
(β) Standard error Variable
Odds ratio
(confidence interval) P
Attitude of nursing staff toward organ donation
375
Progress in Transplantation, Vol 19, No. 4, December 2009
favorable attitude toward donation, being nearly 3
times more in favor than are non-Catholics (odds
ratio, 2.7).
Finally, another fundamental factor is the opinion
of a respondent’s partner toward donation. A respon-
dent’s favorable attitude is related to a partner’s favor-
able attitude and vice versa, being against is related to
a partner’s negative opinion. Moreover, results of the
multivariate study indicate that if the partner is against
donation and the respondent knows the partner’s opin-
ion, the respondent is nearly 10 times less likely to be
in favor than a respondent who does not have a part-
ner (odds ratio, 0.2). In this way, we have seen that
family discussion about donation is a favorable factor:
professionals who have considered the topic of dona-
tion in their family have a more favorable attitude.
Therefore, as in the population, it seems to be beneficial
to encourage dialogue about transplantation and dona-
tion within family circles. Caballer et al33 have shown
via logistic regression analysis in the general popula-
tion that, among the social interaction variables, peo-
ple showing their opinion toward organ donation to
family members or close friends and people knowing
that their partner has a positive attitude have a positive
effect on the decision to donate.
Conclusions
To conclude, we could say that attitudes toward
deceased organ donation among hospital nurses are
the same as the attitudes described in our general pop-
ulation, and these attitudes are determined by the same
psychosocial variables that have been detected in the
general population. Therefore, campaigns to promote
organ donation among nurses are becoming a priority,
because nurses work in hospitals, where any negative
attitude could have a strong influence on the general
public. The concept of brain death is one that must be
made clear among nurses.
Raising the awareness of health care profession-
als is a fundamental aspect of the organ donation and
transplantation process,29 especially if we want to
reduce the 20% rate of refusals to donate in the Span-
ish population.3The predisposition of health care pro-
fessionals toward this treatment as well as the treatment
provided to families of patients with conditions likely
to evolve into brain death is vitally important when
donation is to be considered. What is more, nursing pro-
fessionals should know that when the condition of a
patient with severe structural brain damage changes from
critical to another condition that is compatible with
brain death, hopeful possibilities are offered to other
patients and their families who are awaiting transplant.
Nurses are becoming more and more important in
the care and promotion of health care matters in the
general public; nurses’ attitude affects public opinion,
given their position as health care professionals.34-36
One of the possible barriers preventing donation
might be the attitude of health care professionals who
are not always in favor and therefore do not create the
right social climate to encourage participation. In this
sense, nurses constitute a fundamental group within
the health care system, and their work will be impor-
tant for the promotion of this type of donation.
In addition, although these results could be repre-
sentative of all hospitals, we should take into account
the peculiarities of each hospital. For instance, a trans-
plant hospital is not the same as a hospital not so
involved with transplantation. As a general rule, not
all hospital personnel are in favor of organ donation
and transplantation. Therefore, we should encourage
education about organ donation and transplantation as
well as the concept of brain death. We believe that a
key way to prevent negative attitudes about donation
in future health care workers could be to educate uni-
versity students who are studying health science about
organ donation and transplantation.
Financial Disclosures
None reported.
References
1. Cantarovich F. Improvement in organ shortage through edu-
cation. Transplantation. 2002;73(11):1844-1846.
2. Martínez JM, López JS, Martín A, Martín MJ, Scandroglio B,
Martín JM. Organ donation and family decision-mtaking
within the spanish donation system. Soc Sci Med. 2001;53(4):
405-421.
3. Memoria de actividades ONT 2004. 1ª parte. Rev Esp Traspl.
2005;14(2):37-52.
4. Martínez JM, Martín A, López Jorge S. La opinión pública
española ante la donación y el trasplante de órganos. Med
Clin. 1995;105:401-406.
5. Conesa C, Ríos A, Ramírez P, et al. Psycho-social profile in
favour of organ donation. Transplant Proc. 2003;35(4):1276-
1281.
6. Frutos MA, Blanca MJ, Rosel J, Ruiz P, Elosegui E. Opin-
iones de profesionales sanitarios de Málaga sobre donación y
trasplante de órganos: actitudes en hospitales con y sin activi-
dad trasplantadora. Rev Esp Traspl. 1992;1:221-226.
7. Equipo de Coordinación de Trasplantes del Hospital General
de Segovia. Opiniones y actitudes del personal del Hospital
General de Segovia acerca de la extracción de órganos para
trasplante. Nefrología. 1991;11(suppl 1):57-59.
8. Ríos A, Conesa C, Ramírez P, et al. Attitude toward deceased
organ donation and transplantation among the workers in the
surgical servicies in a hospital with a transplant program.
Transplant Proc. 2005;37(9):3603-3608.
9. Gross T, Marguccio I, Martinoli S. Attitudes of hospital staff
involved in organ donation to the procedure. Transpl Int. 2000;
13(5):351-356.
10. Ríos A, Ramírez P, Martínez L, et al. Are personnel in trans-
plant hospitals in favor of cadaveric organ donation? Multi-
variate attitudinal study in a hospital with a solid organ
transplant program. Clin Transplant. 2006;20(6):743-754.
11. Zambudio AR, Conesa C, Ramirez P, et al. What is the atti-
tude of hospital transplant-related personnel toward donation?
J Heart Lung Transplant. 2006;25(8):972-976.
12. Ríos A, Conesa C, Ramírez P, et al. Redes Temáticas de
Investigación Cooperativa: Estrategias para Optimizar los
Resultados en Donación y Trasplante, Red C03/03. Ancillary
hospital personnel faced with organ donation and transplanta-
tion. Transplant Proc. 2006;38(3):858-862.
Progress in Transplantation, Vol 19, No. 4, December 2009
376
Zambudio et al
13. Collins TJ. Organ and tissue donation: a survey of nurse’s
knowledge and educational needs in an adult ITU. Intensive
Crit Care Nurs. 2005;21(4):226-233.
14. Ingram JE, Buckner EB, Rayburn AB. Critical care nurses’
attitudes and knowledge related to organ donation. Dimens
Crit Care Nurs. 2002;21(6):249-2545.
15. Naude A, Nel E, Uys H. Organ donation: attitude and knowl-
edge of nurses in South Africa. EDTNA ERCA J. 2002;28(1):
44-48, 55.
16. Ozdag N, Bal C. The nurses knowledge, awareness and accept-
ance of tissue-organ donation. EDTNA ERCA J. 2001; 27(4):
201-206.
17. Molzahn AE. Knowledge and attitudes of critical care nurses
regarding organ donation. Can J Cardiovasc Nurs. 1997;8(2):
13-18.
18. Conesa C, Ríos Zambudio A, Ramírez P, Canteras M, del Mar
Rodríguez MM, Parrilla P. Socio-personal profile of teenagers
opposed to organ donation. Nephrol Dial Transplant. 2004;
19(5):1269-1275.
19. Conesa C, Ríos A, Ramírez P, et al. Rural primary care centres
as a source of information about organ donation. Transplant
Proc. 2005;37(9):3609-3613.
20. Cleveland SE. Personality characteristics, body image and
social attitudes of organ transplant donors versus nondonors.
Psychosom Med. 1975;37(4):313-319.
21. Canteras Jordana M, Conesa C, Rios A, et al. Importancia de los
profesionales de atención primaria en la educación sanitaria de
la donación de órganos. Aten Primaria. 2004;34(10):528-533.
22. Conesa C, Ríos A, Ramírez P, Canteras M, Rodríguez MM,
Parrilla P. Estudio multivariante de los factores psicosociales
que influyen en la actitud poblacional hacia la donación de
órganos. Nefrología. 2005;25:684-697.
23. Boey KW. A cross-validation study of nurses’ attitudes and
commitment to organ donation in Hong Kong. Int J Nurs Stud.
2002;39(1):95-104.
24. Carter-Gentry D, McCurren C. Organ procurement from the
perspective of perioperative nurses. AORN J. 2004;80(3):
417-421, 424-431.
25. Regehr C, Kjerulf M, Popova SR, Baker AJ. Trauma and
tribulation: the experiences and attitudes of operating room
nurses working with organ donors. J Clin Nurs. 2004;13(4):
430-437.
26. Sque M, Payne S, Vlachonikolis I. Cadaveric donotransplan-
tation: nurses’ attitudes, knowledge and behaviour. Soc Sci
Med. 2000;50(4):541-552.
27. Pugliese MR, Degli Esposti D, Venturoli N, et al. Hospital
attitude survey on organ donation in the Emilia-Romagna
region, Italy. Transpl Int. 2001;14(6):411-419.
28. Ríos A, Conesa C, Munuera C, Pascual FJ, Fajardo D. Cam-
paña informativa sobre la donación y trasplante de órganos en
escolares. Aten Primaria. 1998;21(9):623-626.
29. Frutos MA. Concienciación para la donación. Nefrología.
1999;19:288-293.
30. Dodd-McCue D, Tartaglia A, Myer K, Kuthy S, Faulkner K.
Unintended consequences: the impact of protocol change on
critical care nurses’ perceptions of stress. Prog Transplant.
2004;14(1):61-67.
31. Sanner M. A comparison of public attitudes toward autopsy,
organ donation, and anatomic dissection. A Swedish survey.
JAMA. 1994;271(4):284-288.
32. Conesa C, Ríos A, Ramírez P, Parrilla P. Los católicos ante la
donación de órganos. Med Clin. 2004;123:397-398.
33. Caballer Miedes A, Martínez Sancho M. Variables influyentes
en la actitud hacia la donación de órganos. Psicothema. 2000;
12(suppl 2):100-102.
34. Jeffres LW, Carroll JA, Rubenking BE, Amschlinger J. Com-
munication as a predictor of willingness to donate one’s
organs: an addition to the Theory of Reasoned Action. Prog
Transplant. 2008;18(4):257-262.
35. Pelleriaux B, Roels L, Van Deynse D, Smits J, Cornu O, Del-
loye C. An analysis of critical care staff’s attitudes to donation
in a country with presumed-consent legislation. Prog Trans-
plant. 2008;18(3):173-178.
36. Pont Castellana T, Masnou Burralló N, Gràcia Gonzalo RM,
et al. Health care professionals: what do they know about
organ donation? Prog Transplant. 2008;18(2):141-145.
Attitude of nursing staff toward organ donation
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