Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)最新文献

Context: Few studies on public attitudes toward organ and tissue donation have been carried out in Asia.

Objective: To determine demographic influences on attitudes toward organ and tissue donation in Vietnam.

Design: Face-to-face interviews.

Setting: Tan Binh District, Ho Chi Minh City, Vietnam.

Participants: Random sample of adults (N = 785).

Main outcome measures: Awareness of donation and transplantation, acceptance of organ and tissue donation.

Results: 75% of respondents stated they had heard of organ or tissue donation, but only 55% were aware of organ and tissue transplantation taking place in Vietnam. Forty-eight percent of Buddhists and 27.5% of Christians had either no knowledge or incorrect knowledge about their religion's official position toward donation and transplantation. Sixty-four percent stated they would give consent for the donation of their decreased relative's tissues and organs, 66% would themselves become posthumous donors, and 21% to 22% would donate multiple organs and tissues. A significant association was found between respondents' acceptance of organ and tissue donation and their educational level, sex, occupation, and awareness of transplantation. Most respondents stated that their willingness to donate depended on whether other family members agreed. Many noted the importance of preventing commerce in organ and tissue transplantation but were in favor of providing healthcare for the donor's family or monetary incentives as a reward for donating.

Conclusion: Nearly two thirds of urban Vietnamese surveyed were willing to donate organs or tissues after death. Their willingness was related to awareness of transplantation, sex, education level, and occupation.

The high success rate of HLA-identical sibling transplants and our previous experience with steroid-free immunosuppressive regimens and cyclosporine withdrawal prompted us to evaluate the safety and efficacy of monotherapy with azathioprine in 12 HLA-identical kidney transplant recipients with a serum creatinine concentration less than 176.8 mumol/L, a 1-way stimulatory index less than 2.0 in a post-transplant mixed lymphocyte culture, and a demonstrated tolerance of a minimum azathioprine dose of 1.0 mg/kg per day without leukopenia. Eleven of 12 patients were successfully converted to azathioprine monotherapy without a significant change in serum creatinine concentration for as long as 76 months. Benefits of steroid and cyclosporine withdrawal included a significant reduction in mean systolic and diastolic blood pressure, number of blood pressure medications, total serum cholesterol, and glycohemoglobin in diabetic subjects. Our results suggest that azathioprine monotherapy is safe and effective in a select group of HLA-identical sibling transplants, but these benefits must be carefully balanced against an associated risk of precipitating acute allograft rejection.

Over-the-counter medications are becoming increasingly available to the general public. One of the issues facing clinicians working with transplant recipients is how to advise patients regarding management of symptoms associated with common ailments. Minimal literature is available to assist the transplant coordinators in this process. This article describes the usual immunosuppressants prescribed for transplant recipients and the over-the-counter medications used to manage these symptoms, and provides recommendations for over-the-counter medications with the least side effects.

Fear of mutilation is a significant barrier to organ and tissue donation. It constitutes an example of Mystical Thinking and may be seen as an exemplar of animal learning or, more specifically, as a representation of the "blood phobia." As such the fear is not amenable to conventional public education efforts. Cognitive and behavioral techniques used in treating other types of phobias should be studied as a way to remove this barrier to donation.