RESUMEN
OBJECTIVE: Past organ donation research has studied attitudes toward donation, predictors of signing donor cards, and distinguishing characteristics of donors vs. nondonors. The current study is the first to examine predictors of family members' satisfaction with the decision to consent or refuse donation of a dying loved one's organs or tissue. METHOD: This study surveyed 225 family members who had been approached to donate the organs or tissue of a dying loved one. Participants were surveyed about demographic characteristics, medical/hospital factors, previous knowledge of transplantation, the request process, religion, and characteristics of the deceased and of the recipient. Discriminant analyses were conducted to characterise four specific groups: a) donors who would donate again; b) donors who would not donate again; c) nondonors who would now donate; and d) nondonors who still would not donate. RESULTS: Three significant discriminant functions emerged discriminating donors from nondonors, those who were satisfied with their decision from those who were not, and people who would now donate from those who would not. Donation was predicated by formal education, being married, volunteerism, signing donor cards, and having personal conversations about donation. Subsequent satisfaction was predicted by comfort and confidence during the decision-making process, familiarity with medical center, and understanding of brain death. A willingness to now donate was predicted by personal discussions about donation. CONCLUSIONS: People should be encouraged not only to sign donor cards, but to have discussions with family about wishes. Individuals should be encouraged to seek the help of family and friends during the decision, and be aware of the need of social support from family and friends during and after the decision.
Asunto(s)
Actitud Frente a la Salud , Familia/psicología , Consentimiento Informado/estadística & datos numéricos , Donantes de Tejidos/psicología , Actitud Frente a la Salud/etnología , Aflicción , Muerte Encefálica , Causalidad , Distribución de Chi-Cuadrado , Comportamiento del Consumidor , Toma de Decisiones , Análisis Discriminante , Femenino , Encuestas de Atención de la Salud , Tamaño de las Instituciones de Salud , Humanos , Masculino , Persona de Mediana Edad , Modelos Psicológicos , Análisis Multivariante , Satisfacción Personal , Religión y Medicina , Donantes de Tejidos/estadística & datos numéricos , Trasplante/psicología , Estados UnidosRESUMEN
Productivity among organ procurement organizations varies widely in the US, and the pressure to determine critical success factors increases as the organ pool shrinks and managed care expands. This study compared three successful organ procurement organizations, identified commonalities among them in cost of doing business, and examined direct and indirect expenses, staffing, specialized requestor programs, and professional and public education programs. The three organ procurement organizations were chosen because of their performance in terms of donors per million population, complexity, and size. The following key indicators were compared and analyzed: annual operating budget, size and composition of staff, funds and resources invested in professional education versus public education, tissue recovery operations, results of minority initiatives, and employee compensation programs.
Asunto(s)
Eficiencia Organizacional , Obtención de Tejidos y Órganos/organización & administración , Presupuestos , Costos y Análisis de Costo , Educación en Salud , Personal de Salud/educación , Humanos , Evaluación de Programas y Proyectos de SaludAsunto(s)
Educación en Salud , Opinión Pública , Donantes de Tejidos , Obtención de Tejidos y Órganos/organización & administración , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Actitud Frente a la Salud , Niño , Etnicidad , Femenino , Humanos , Consentimiento Informado , Masculino , Persona de Mediana Edad , Medio Oeste de Estados Unidos , Encuestas y CuestionariosRESUMEN
Medicare allowable charges were compared between 21 continuous ambulatory peritoneal dialysis (CAPD) and 25 center hemodialysis (CHD) patients for the 12-month period from Sept 1982 through Aug 1983 to determine if savings from CAPD therapy were offset by higher hospitalization charges. All adult patients on a single therapy for the 12-month period who were not dialyzed or hospitalized at other institutions were included. The CAPD and CHD patient groups did not differ significantly by age, sex, or incidence of systemic disease. However, the CHD group had significantly more black patients. The primary renal disease, the incidence of diabetes mellitus, and other systemic diseases did not differ between the groups. The number of hospital admissions was similar between the two groups. However, the CHD patients tended to have a higher number of hospital days than the CAPD group (17.5 v 12.4). Although the total hospital charges tended to be higher for CHD ($16,145) than CAPD patients ($9,872), this difference was not significant. Outpatient dialysis charges were significantly less expensive for CAPD ($16,470) than CHD ($28,233). Emergency department charges were also significantly less for the CAPD group. Charges for patients with and without systemic disease were analyzed separately. In both subgroups, all charges were less for CAPD therapy; however, this difference was significant only for outpatient dialysis charges. Total charges for the 12-month period were significantly less for the CAPD group ($26,453) than for CHD ($45,586). This demonstrates that hospitalization charges did not offset the savings of home dialysis in these patients.
Asunto(s)
Instituciones de Atención Ambulatoria/economía , Honorarios y Precios , Unidades de Hemodiálisis en Hospital/economía , Unidades Hospitalarias/economía , Medicare/economía , Diálisis Peritoneal Ambulatoria Continua/economía , Diálisis Renal/economía , Femenino , Humanos , Reembolso de Seguro de Salud , Tiempo de Internación , Masculino , Persona de Mediana Edad , Missouri , Admisión del Paciente , Estados UnidosRESUMEN
A study of the incidence of treated end-stage renal disease (ESRD) secondary to diabetic nephropathy (DN) in Missouri from 1975 to 1984 documented a relative risk of treated ESRD due to DN 3.7 times higher for blacks than whites. Between 1980 and 1984, the incidence rate for treated ESRD due to DN increased by 150% for white patients and 315% for black patients. Blacks over age 50 have incidence rates of treated ESRD due to DN 4.9 times their white counterparts. Black females have the highest rate of all race/sex groups with DN. The escalating high risk of older blacks for treated ESRD due to DN mandates the development of effective community based identification and referral efforts.