Exchanging spare parts or becoming a new person? People's attitudes toward receiving and donating organs

The present study explored the public's feelings and ideas about receiving organs, and how this influenced their attitudes toward accepting a transplant themselves. Also the willingness to donate was examined in order to provide a complementary perspective. The main aim was to identify consistent attitude patterns that would include attitudes toward both receiving and donating organs and the motives behind this. Sixty-nine individuals with varying socio-demographic background, selected from samples who had responded to a questionnaire on receiving and donating organs and tissues, were interviewed in-depth. The approach to analyse the interviews was hermeneutic. Seven typical attitude patterns emerged. By an 'attitude pattern' was meant a specific set of attitudes and motives, that formed a consistent picture that was logical and psychologically meaningful. In the discussion, two different conceptions of the body were focused. One of them meant that the body was easily objectified and conceived as machine-like, and did not represent the self. This machine model paved the way for the understanding that body parts needed to be replaced by spare parts. The other conception meant that a new organ would transfer the donor's qualities, i.e. influence the identity of the recipient with regard to behaviour, appearance, and personality. This belief may be explained by 'analogy thinking' based on our everday experience of how mixed entities take on the qualities of all components. Another explanation would be a kind of magical thinking and 'the law of contagion', which is often connected to oral incorporation. The consequences of these conceptions when patients are confronted with the factual situation of a transplantation, were discussed.

People's feelings and ideas about receiving transplants of different origins--questions of life and death, identity, and nature's border

The aim of this study was to explore the public's feelings and ideas with regard to receiving transplants of different origins. Sixty-nine individuals with varying sociodemographic background, selected from samples who had responded to a questionnaire on receiving and donating organs, were interviewed in-depth. A wide variety of reactions was displayed. The feelings and ideas about receiving organs were summarized in ten categories: 1) the emergency situation; 2) the functioning of the transplant; 3) the influence of transplants on personality, behaviour, and appearance; 4) the influence of transplants on body image; 5) disgust; 6) cannibalism; 7) trespassing nature's border; 8) tradition; 9) ethical considerations; and 10) the debt of gratitude. Most individuals were willing to accept at least one organ. Animal organs were the least preferred. The hierarchy of organ preferences--with organs from a relative at the top and animal organs at the bottom was explained in terms of rational, magical, and analogy thinking. Finally, the consequences for the encounter between health care personnel and transplantation candidates were briefly discussed.

Giving and taking--to whom and from whom? People's attitudes toward transplantation of organs and tissue from different sources

The aims of the study were: 1) to describe the willingness of the public to receive material of different origins in one's own body; 2) to compare the willingness to donate and receive body material; 3) to compare the willingness to donate while alive and after death; 4) to compare the willingness to donate to a next-of-kin and unknown recipients. A random sample of 1500 inhabitants, 18 to 70 yr old, in the county of Uppsala, Sweden, were sent a questionnaire asking about their opinion on transplantation and transfusion issues. The response rate was 71%. Ninety-five percent accepted to receive blood transfusion, 89% bone-marrow transplantation, and 85% transplantation of a solid organ. Organs from living donors were preferred (77%), then organs from decreased donors (69%), then artificial organs (63%), and last animal organs (40%). More than half of those accepting transplants made exceptions for some types of organs. The youngest and those with higher education were more positive toward receiving all types of organs than the older ones and those with lower education. Women were less prepared than men to accept animal organs. Those who accepted organs from animals usually also accepted all other types of organs, and were willing to donate organs and tissue more often than those who did not accept to receive animal organs. The readiness to support a sick family member by giving bone-marrow and even a kidney was considerable, 89 and 81%, respectively. The attitudes were less positive with regard to giving blood and bone-marrow to unknown recipients, 54 and 41%, respectively. Sixty-one percent of the respondents were positive toward donating their own organs after death. Of those who were positive, 10% made exceptions for special organs that they did not want to donate, mostly heart, eyes, and brain. Individuals with higher education and young people were more often positive than those with lower education and old people regarding donation of blood and organs, and bone-marrow donation to a relative. Women were somewhat more accepting to donate while alive than males. Thirty-one percent, more often women than men, had signed a donor card and/or registered with the Swedish Organ Donation Registry. The results with regard to receiving organs and tissue are discussed in terms of two different sets of explanations, which can be seen as different sides of the same coin, and mutually strengthening the reactions. The great readiness to donate to a family member as well as the discrepancy between giving in life and after death is commented upon.

The discovery of potent and selective dopamine D4 receptor antagonists

The identification of a novel dopamine receptor subtype, referred to as the D4 receptor, which binds the atypical antipsychotic drug clozapine with high potency, has led to the initiation of a drug discovery program that aims to find novel inhibitors of this receptor subtype. A selective screening strategy was utilized, in which 4500 compounds chosen on the basis of structural similarities to known biogenic amine receptor antagonists were tested against both the D4 and D2 dopamine receptor subtypes. A potent D4-selective compound was discovered.

Synthesis, SAR and pharmacology of CP-293,019: a potent, selective dopamine D4 receptor antagonist

A series of novel, potent and selective pyrido[1,2-a]pyrazine dopamine D4 receptor antagonists are reported including CP-293,019 (D4 Ki = 3.4 nM, D2 Ki > 3,310 nM), which also inhibits apomorphine-induced hyperlocomotion in rats after oral dosing.

Selective dopamine D4 receptor antagonists reverse apomorphine-induced blockade of prepulse inhibition

Recent evidence suggests that the dopamine D4 receptor may play a role in schizophrenia, and that the atypical properties of the antipsychotic clozapine may be attributable in part to its antagonistic actions at this receptor. In the present study, clozapine and three other compounds having D4 dopamine receptor antagonist properties were examined for their effectiveness in reducing losses in prepulse inhibition (PPI) induced in rats by the dopamine receptor agonist apomorphine. Previously, activity in the PPI model has been shown to correlate highly with the antipsychotic potency of a number of neuroleptics. As previously reported, clozapine (1-5.6 mg/kg) significantly reduced apomorphine-induced PPI deficits. The three D4-selective compounds, CP-293,019 (5.6-17.8 mg/kg), U-101,387 (3-30 mg/kg) and L-745,870 (1-10 mg/kg), also significantly blocked the losses in PPI produced by apomorphine. Taken together, these results suggest that dopamine receptor antagonists with selectivity for the D4 dopamine receptor subtype may be effective in the treatment of schizophrenia, while being less likely to produce dyskinesias associated with D2 receptor antagonists.

Registered bone marrow donors' views on bodily donations

The attitudes of 463 potential bone marrow donors toward blood donation, kidney donation in life, organ donation after death, autopsy, and donation of the whole body for anatomic dissection were surveyed, using a questionnaire that had previously been employed for assessing the attitudes of the public. The response rate was 96%. Three quarters of the respondents were blood donors and recruited via the blood center. The proportion that accepted the procedures varied between 24% for anatomic dissection and 97% for autopsy. Differences were small between individuals with positive attitudes and individuals who had also actively taken steps to activate these attitudes. Compared with the public, the bone marrow donors were more positive to all kinds of bodily donations. The conclusion is that if one is prepared to give from the body in life, one is also prepared to give after death. The results may indicate less death anxiety and fear of physical injury, and less fear of chaos either with or without altruism compared to the public.

Medical students' attitudes toward autopsy. How does experience with autopsies influence opinion?

OBJECTIVE

To assess the attitudes of medical students and compare them with those of resident physicians and the public.

DESIGN

A survey of medical students during the term following their pathology course. Data from this survey were compared with data from previous studies conducted with resident physicians and the public.

SETTING

The Medical School, Uppsala University, Sweden.

PARTICIPANTS

Three cohorts of third-year medical students.

MAIN OUTCOME MEASURES

(1) Evaluation of autopsy activities, (2) attitudes toward having an autopsy performed on oneself and a relative, and (3) discomfort reactions at the thought of having an autopsy performed on oneself.

RESULTS

The 129 respondents (response rate 75%) had a high appreciation of the autopsy and 90% accepted being autopsied themselves. The majority thought the autopsies were respectfully performed, but 75% still felt uneasy when confronted with an autopsy or when contemplating one on themselves. The more discomfort felt, the less willing respondents were to be autopsied and the fewer the reasons were given for agreeing to an autopsy. The students and the public had very similar response patterns. Both groups were more positive toward their own autopsy than were the residents.

CONCLUSIONS

Immediately after a course in pathology the usefulness of autopsies stands out clearly, but it seems that this opinion subsides when students become qualified doctors and feelings of uneasiness take over. The similarities between the students and the public were striking, but there were some differences that were obviously attributable to medical training.

Evaluation of an organ-donor-card campaign in Sweden

One of the aims of this study was to evaluate an information campaign carried out in three geographical areas of Sweden in the winter of 1992-93. The campaign was intended to increase public awareness of organ donation and to increase the signing of donor cards. Another objective was to test the effects of different kinds of information. These were: A) an extensive "package" of information including training of key groups, lecturing at meetings and exhibitions, and advertisements of donor cards: B) a brochure to households including two donor cards; and C) a combination of A and B. Yet another aim was to reassess public opinion on transplantation issues, which had been surveyed before in 1987, 1988, and 1990. Random samples of the population in three campaign areas and a control sample were surveyed before and after the campaign, altogether 5600 persons. The average response rate was 69% (1992) and 68% (1993). In the two areas where the brochure had been distributed to the households, the rate of donor card holders had more than doubled (from 3% and 5% to 13% and 12%). In the two areas where the brochure had not been distributed, the rate was unchanged (5%). In the "brochure areas" also a somewhat larger number of people had informed their relatives about their decisions, compared with people in the other areas. In all campaign areas considerably more people were aware of the cards than in the control area. No attitude changes could be shown in any area.(ABSTRACT TRUNCATED AT 250 WORDS)

In perspective of the declining autopsy rate. Attitudes of the public

The autopsy rate is declining, probably due to attitude changes. However, attitudes toward the autopsy have been sparsely studied, public opinion evidently not at all. The present study has, therefore, investigated the attitudes and reactions of the public toward autopsy as a basis for a new autopsy act in Sweden. An age-stratified, random sample of 1950 individuals in Sweden was surveyed. Eighty-four percent reported acceptance of an autopsy for themselves and 80% for next of kin. However, 70% felt discomfort at the thought of autopsy. Irrespective of the attitudes, the most common source of discomfort was the thought of the dead body being cut up, followed by fear of being disrespectful of the dead person. Sociodemographic factors were only weakly correlated to attitudes. The most impressive finding was that older women were the most hesitant or negative group concerning the autopsy, both for themselves and for relatives. The low autopsy rate is evidently not connected with the public's negative attitudes. Even if discomfort reactions are general, rational factors dominate. Thus, it is up to the medical community to use this positive opinion to let the autopsy regain its role of quality guarantee.