L’attitudine degli studenti di infermieristica nei confronti della donazione di organi: un'indagine trasversale in un'università del Nord Italia.
10.54103/dn/20016




INTRODUZIONE: Nonostante la ricerca mostri una certa complessità nelle ragioni che spieghino il basso tasso di donazione di organi nella popolazione, diversi studi in letteratura suggeriscono che la partecipazione attiva di infermieri e medici abbia una forte influenza sui tassi di donazione. In particolare, le attitudini, le conoscenze, la fiducia, l'impegno e la formazione dei professionisti della salute risultano essere fattori influenti.
OBIETTIVI: Indagare le attitudini degli studenti infermieri universitari dell'Università di Brescia riguardo la donazione di organi e tessuti.
MATERIALI E METODI: È stata condotta un'indagine trasversale mediante la somministrazione della Organ Donation Attitudes Scale (ODAS).
RISULTATI: L'ODAS ha mostrato che la maggior parte degli studenti conosce qualcuno che ha donato un organo durante la propria vita o dopo la morte e oltre la metà conosce qualcuno che ha ricevuto un trapianto di organo. Tuttavia, il 63,3% degli studenti ha indicato di non aver ricevuto una formazione specifica. Gli scores totali variano da 45 a 71 con un punteggio mediano di 61. L'analisi di correlazione rivela come la formazione accademica non correla con le attitudini (p=0,37). Sapere che qualcuno ha ricevuto un trapianto correla con la disponibilità ad esprimere la volontà donativa (p=0,047) e la formazione accademica correla con la conoscenza percepita del processo di donazione (p=0,0001).
CONCLUSIONI: Lo studio ha riscontrato prevalentemente attitudini positive verso la donazione di organi e tessuti tra gli studenti infermieri universitari del campus di Cremona. Ulteriori ricerche coinvolgendo le università di infermieristica sono necessarie per sensibilizzare il pubblico e gli operatori sanitari.




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Dissertation Nursing
studenti di infermieristica
L’attitudine degli studenti di infermieristica nei confronti della donazione di organi: un'indagine trasversale in un'università del Nord Italia.
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2023-07-31
2023-08-01
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Yazdi Moghaddam H, Manzari ZS, Mohammadi E. Nurses’ Challenges in Caring for an Organ Donor Brain Dead Patient and their solution strategies: A Systematic Review. Iran J Nurs Midwifery Res. 2020 Jun 17;25(4):265–72.
Undergraduate nurses attitudes towards organ donation: a cross-sectional survey in a north Italian university.
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            ISSN: 2785-7263                                                                                                 DOI: 10.54103/dn/20016




      Undergraduate nurses attitudes towards organ donation: a
         cross-sectional survey in a north Italian university
Mattia Bozzetti1 , Martina Caraffini2, Chiara Agosti1, Ilaria Marcomini3, Roberta Pendoni1

1 IntensiveCare Unit, ASST Cremona, Cremona, Italy
2 Nursing Student at Bachelor School of Nursing, University of Brescia, Brescia, Italy
3 Bachelor School of Nursing, Crema Teaching Center, Crema, Italy
4 DAPSS, ASST Cremona




Findings:                                           ABSTRACT
The study found mainly positive attitudes;          BACKGROUND: Although research reveals that there are many complex
students who completed the survey responded
                                                    factors influencing the low organ donation rate in addition to nurses,
favorably to a proposal for an internship at
the Hospital Procurement Coordination for
                                                    literature suggests that nurses and doctors' active engagement and support
Organ and Tissue Donation.                          have a significant impact on donation rates. Donation rates can be influenced
                                                    by a variety of factors, including health professionals' attitudes, knowledge,
                                                    confidence, participation, and training.
Acknowledgments:
                                                    OBJECTIVES: To investigate the attitudes of undergraduate nursing
To all the students who took part in this
study, we would like to say thank you. This         students at the University of Brescia in the Campus of Cremona regarding
article    has     benefited    from      the       organ and tissue donation.
contributions of the educational director
of University of Brescia, course of                 MATERIALS AND METHODS: A cross-sectional survey was conducted
Cremona        who      obtained     project        by administering the Organ Donation Attitudes Scale (ODAS).
approvation and all nursing educators of
University of Brescia, course of Cremona            RESULTS: ODAS showed that most students know someone who has
who       helped     with     questionnaire         donated an organ during their lifetime or after death, and over half know
distribution. The translators of the                someone who has received an organ transplant. However, 63.3% of students
translated questionnaire and their assistance       indicated that they had not received specific training, and attitudes ranged
with this project are acknowledged by the
                                                    from 45 to 71 with a median score of 61. Bivariate correlation analysis
authors, together with COP facility: Elisa
Pizzera, Sonia Bonoli, and Alberto                  revealed that received academic training does not correlate with students'
Bonvecchio.                                         attitudes (p=.37). Knowing someone who has received a transplant correlates
                                                    with having expressed willingness to donate (p=.047), and academic training
                                                    correlates with perceived knowledge about the donation process (p=.0001).

                                                    CONCLUSIONS: The study found mainly positive attitudes toward organ
                                                    and tissue donation among nursing undergraduate students from the
                                                    Cremona campus. Further research involving nursing universities is needed
                                                    to raise awareness of organ donation among the public and healthcare
                                                    workers.


                              KEYWORDS: Organ Donation, Donors, Transplant, Attitudes, Nursing Students

        Corresponding author:                                               77                                     Submission received: 19/04/2023
        Mattia Bozzetti: mattia.bozzetti@asst-cremona.it                                                    End of Peer Review process: 29/05/2023
        Reparto di Terapia Intensiva e Rianimazione, ASST                                                                    Accepted: 29/05/2023
        Cremona, Viale Concordia 1, 26100, Cremona
                                                                                         This work is licensed under a Creative Commons
                                                                                         Attribution-NonCommercial-NoDerivatives 4.0 nternational
            ISSN: 2785-7263                                                                                                DOI: 10.54103/dn/20016




L’attitudine degli studenti di infermieristica nei confronti della donazione di
        organi: un'indagine trasversale in un'università del Nord Italia
                   1
Mattia Bozzetti        , Martina Caraffini2, Chiara Agosti1, Ilaria Marcomini3, Roberta Pendoni1
1 TerapiaIntensiva e Rianimazione, ASST Cremona, Cremona
2 Studentessapresso Corso di Laurea in Infermieristica, Università degli studi di Brescia, sede di Cremona
3 Corso di Laurea in Infermieristica, ASST Crema, Crema
4 DAPSS, ASST Cremona, Cremona




Riscontri:                                          ABSTRACT
Lo studio ha rilevato un’attitudine                 INTRODUZIONE: Diversi studi in letteratura suggeriscono che la
prevalentemente positiva; gli studenti che          partecipazione attiva di infermieri e medici ha una forte influenza sui tassi di
hanno completato l'indagine hanno risposto
favorevolmente alla proposta di un tirocinio
                                                    donazione, anche se la ricerca mostra la complessità delle ragioni per il basso
presso il Coordinamento ospedaliero per la          tasso di donazione di organi nella popolazione. In particolare, le attitudini, le
donazione di organi e tessuti.                      conoscenze, la fiducia, l'impegno e la formazione dei professionisti della salute
                                                    sono dimostrati come fattori influenti.
Ringraziamenti:
                                                    OBIETTIVI: Indagare le attitudini degli studenti infermieri universitari
I nostri ringraziamenti vanno a tutti gli           dell'Università di Brescia sede di Cremona riguardo la donazione di organi e
studenti che hanno partecipato a questo studio.     tessuti.
In particolare, vorremmo ringraziare i
coordinatori delle scuole di infermieristica che    MATERIALI E METODI: È stata condotta un'indagine trasversale
hanno aiutato a distribuire il questionario.        mediante la somministrazione della Organ Donation Attitudes Scale (ODAS).
Gli autori desiderano inoltre ringraziare i
traduttori del questionario e la loro assistenza    RISULTATI: L'ODAS ha mostrato che la maggior parte degli studenti
in questo progetto insieme a Elisa Pizzera,         conosce qualcuno che ha donato un organo durante la propria vita o dopo la
Sonia Bonoli e Alberto Bonvecchio.
                                                    morte, e oltre la metà conosce qualcuno che ha ricevuto un trapianto di
                                                    organo. Tuttavia, il 63,3% degli studenti ha indicato di non aver ricevuto una
                                                    formazione specifica. Gli scores totali variano da 45 a 71 con un punteggio
                                                    mediano di 61. L'analisi di correlazione rivela come la formazione accademica
                                                    non correla con le attitudini (p=0,37). Sapere che qualcuno ha ricevuto un
                                                    trapianto correla con la disponibilità ad esprimere la volontà donativa
                                                    (p=0,047), e la formazione accademica correla con la conoscenza percepita del
                                                    processo di donazione (p=0,0001).

                                                    CONCLUSIONI: Lo studio ha riscontrato prevalentemente attitudini
                                                    positive verso la donazione di organi e tessuti tra gli studenti infermieri
                                                    universitari del campus di Cremona. Ulteriori ricerche coinvolgendo le
                                                    università di infermieristica sono necessarie per sensibilizzare il pubblico e gli
                                                    operatori sanitari sulla donazione di organi.


                       KEYWORDS: Donazione di organi, Donatori, Trapianto, Attitudini, Studenti di infermieristica

        Corresponding author:                                               78                                    Submission received: 19/04/2023
        Mattia Bozzetti: mattia.bozzetti@asst-cremona.it                                                   End of Peer Review process: 29/05/2023
        Reparto di Terapia Intensiva e Rianimazione, ASST                                                                   Accepted: 29/05/2023
        Cremona, Viale Concordia 1, 26100, Cremona
                                                                                        This work is licensed under a Creative Commons
                                                                                        Attribution-NonCommercial-NoDerivatives 4.0 nternational
        ISSN: 2785-7263                                                                                         DOI: 10.54103/dn/20016




BACKGROUND                                                               required by law to declare their intention to donate their
                                                                         organs after passing away. Both parents must agree on the
The longstanding and nearly universal sociocultural
                                                                         choice in the case of minors (4). If a person has not made
perception of death has been radically altered by the
                                                                         a declaration, organ and tissue donation can only occur if
development       of      modern       critical    care    units,
                                                                         the closest relatives, including the parents, adult children,
cardiopulmonary resuscitation, and defibrillation in the
                                                                         non-separated spouse, and civil partner, do not disagree to
1950s and 1960s, which came into use more or less at the
                                                                         the wish of their family member (5,6). In 2021, the rate of
same time (1). Additionally, the widespread use of
                                                                         opposition was 28.6% of reports and resulted in the
mechanical ventilators to prevent respiratory arrest has
                                                                         exclusion of 730 potential donors. In Italy, from North to
altered the course of terminal neurological disease. It is
                                                                         South, many regions have contributed to this result by
now possible to artificially sustain life functions after the
                                                                         showing large improvements in opposition rates, resulting
brain stops working. Brain death was established as the
                                                                         in the lowest value recorded since 2012. In fact, in 2019,
total, permanent loss of brainstem function in 1976 by the
                                                                         the percentage had been 31.1% and in 2020, 30.2%.
Conference of Medical Royal Colleges and their Faculties
                                                                         However, the disparity between areas in the north, where
in the United Kingdom (2). Brain death was established as
                                                                         rejection rates are almost always below the national
the total, permanent loss of brainstem function in 1976 by
                                                                         average, and areas in the center-south, where rejection
the Conference of Medical Royal Colleges and their
                                                                         rates are disturbingly high and well above the Italian
Faculties in the United Kingdom (2). It also referred to the
                                                                         average, often frustrates contracting efforts. Donation
brainstem as the hub of brain activity, without which there
                                                                         levels increase, up 7.1% compared to 2020 (7). Different
is no life, and suggested improvements to apnea testing.
                                                                         factors    that       may       affect       attitudes         towards organ
The majority of nations have seen an increase in deceased
                                                                         donation are reported in the literature, and over the past
organ donors during the past ten years. This statement
                                                                         decade, understanding the variables that influence organ
included guidelines that included refinement of apnea
                                                                         and tissue donation has been the subject of research (8).
testing and pointed to the brainstem as the center of brain
                                                                         One of the most important barriers to organ donation is
function: without it, there is no life. In the last decade,
                                                                         the refusal of family members influenced by the family’s
most countries have increased the number of deceased
                                                                         cultural characteristics. Therefore, during the identification
organ donors. However, waiting lists still exist (3). All
                                                                         and reporting phases of the donation process, the active
adult people living in Italy are required by law to declare
                                                                         involvement and support of nurses and physicians for
their intention to donate their organs after passing away.
                                                                         donation constitute key factors. Donation rates can be
Both parents must agree on the choice in the case of
                                                                         influenced by a variety of factors, including a healthcare
minors (4). If a person has not made a declaration, organ
                                                                         professional's          attitude,         knowledge,             confidence,
and tissue donation can only occur if the closest relatives,
                                                                         participation, and training (9). In many countries, organ
including the parents, adult children, non-separated
                                                                         donation may not proceed sufficiently due to cultural and
spouse, and civil partner, do not disagree to the wish of
                                                                         social reasons (10). Literature has stated that educational
their family member. (4). All adult people living in Italy are
                                                                         training provides an opportunity to review one's attitude
       Corresponding author:                                        79                                 Submission received: 19/04/2023
       Mattia Bozzetti: mattia.bozzetti@asst-cremona.it                                         End of Peer Review process: 29/05/2023
       Reparto di Terapia Intensiva e Rianimazione, ASST                                                         Accepted: 29/05/2023
       Cremona, Viale Concordia 1, 26100, Cremona
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        ISSN: 2785-7263                                                                                          DOI: 10.54103/dn/20016




through the involvement of a family member. In addition,                  of 20 items measured by a 4-point Likert scale (4 =
students can also learn about the topic through bioethics                 strongly agree, 3=agree, 2=disagree, 1 = strongly disagree)
lessons with reflections on life and death. These                         based on students' salient beliefs toward becoming an
experiences were factors that positively influenced                       organ donor, by investigating attitudes and subjective
students' attitudes. Families and patients' willingness to                norms that considerably affect behavioral intention (14).
consent to donation might be favourably impacted by the                   Along with demographic questions like age, gender,
information and attitude of healthcare providers (12).                    ethnicity, and religion, the ODAS also asked respondents
Previous research has stated that nurses have a strong                    if they knew any organ donors or recipients. The ODAS is
influence on donation rates (8). Though research                          a trustworthy and accurate tool that may be used to
demonstrates that there are many other factors besides                    examine how people conceptualize organ donation. Since
nurses that contribute to the low organ donation rate such                the questionnaire has not been validated in Italian
as the inability of healthcare workers to discover possible               language, a process of linguistic pre-adaptation was used
donors or obtain permission from bereaved relatives is                    (15) so, in our study the scale showed good internal
thought to be a key contributor (11). Family decisions are                consistency (Cronbach’s α = 0.84). The questionnaire in
influenced    by    healthcare     personnel     training,   their        electronic and anonymous form, was administered through
intervention, and how well they interact and communicate                  Google Forms and then the database was exported and
with the family and caregivers while the patient is in the                analyzed with IBM SPSS V.26.
hospital. (13). In Italy, this phenomenon has been little
explored. The study conducted by Zampieron et al. (11)
showed a negative attitude towards donation on the part                   Data analysis
of students related to the lack of theoretical and practical
                                                                          The normality of the distribution was assessed through
knowledge of the topic. The studies that focused on
                                                                          Kolmogorov-Smirnov and Shapiro-Wilk tests in addition
student nurses were from European and British countries,
                                                                          to a graphical evaluation and estimation of skewness and
making it difficult to transfer the results to our context
                                                                          kurtosis. To identify correlations, bivariate correlations
because of differences in culture and health care systems.
                                                                          were then performed on the variables, using Tau-Kendall’s
The results of a preliminary literature review highlighted
                                                                          method. While qualitative variables were presented as
that few studies have addressed student nurses' attitudes
                                                                          frequencies and percentages, continuous data were
and knowledge about organ donation in the Italian
                                                                          presented as median and interquartile range. In order to
context.
                                                                          compare two groups, the continuous variables were
                                                                          obtained using the Wilcoxon-Mann-Whitney tests. The
MATERIAL AND METHODS                                                      categorical variables were compared using the χ2 test, and
Instruments                                                               multiple group comparisons were made using the Kruskal-
                                                                          Wallis test. The 5% level of statistical significance is
Attitudes were investigated through the Organ Donation
                                                                          employed.
Attitude Scale (ODAS) a multidimensional scale consisting
       Corresponding author:                                         80                                 Submission received: 19/04/2023
       Mattia Bozzetti: mattia.bozzetti@asst-cremona.it                                          End of Peer Review process: 29/05/2023
       Reparto di Terapia Intensiva e Rianimazione, ASST                                                          Accepted: 29/05/2023
       Cremona, Viale Concordia 1, 26100, Cremona
                                                                              This work is licensed under a Creative Commons
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        ISSN: 2785-7263                                                                                               DOI: 10.54103/dn/20016




Ethical considerations                                                         50% responsiveness rate. The study population was
                                                                               predominantly female (83.5%) aged 18-25 years (82%),
All participants agreed and gave their written informed
                                                                               Christian (67.1%) and Caucasian ethnicity (84.8%). The
consent. The study was approved by the board of the
                                                                               responsiveness rate was highest in first-year students
Nursing Degree Program at the University of Brescia.
                                                                               (40.5%) followed by second-year (34.2%) and third-year
                                                                               students (25.3%). No statistically significant differences
RESULTS                                                                        were found for the socio-demographic variables obtained
                                                                               by survey questions considered among the three years of
Sample consisted of 158 among first, second and third
                                                                               course, data are shown in Table 1.
year students. A total of 79 were returned thus achieving a

                                                     I year n (%)            II year n (%)         III year n (%)               p-value
               Sex              Female                     27 (84.4%)           22 (81.5%)               17 (85.0%)                  0.937
                                Male                        5 (15.6%)            5 (18.5%)                3 (15.0%)
                                Tot                                32                   27                       20
               Age              18-25 years                27 (84.4%)           23 (85.2%)                15 (75%)                   0.248
                                25-40 years                  1 (3.1%)            3 (11.1%)                  4 (20%)
                                40-60 years                 4 (12.5%)             1 (3.7%)                 1 (5.0%)
               Ethnicity        African                      3 (9.4%)            3 (11.1%)                3 (15.0%)                  0.724
                                Asiatic                      2 (6.3%)               0 (0%)                 1 (5.0%)
                                Caucasic                   27 (84.4%)           24 (88.9%)               16 (80,0%)
               Religion         Agnostic                     1 (3.1%)               0 (0%)                   0 (0%)                  0.790
                                Ateo                        8 (25.0%)            6 (22.2%)                4 (20.0%)
                                NS                           1 (3.1%)               0 (0%)                   0 (0%)
                                Christ                     19 (59.4%)           19 (70.4%)                14 (70%)
                                In doubt                     1 (3.1%)               0 (0%)                   0 (0%)
                                Islamic                      2 (6.3%)             2 (7.4%)                 1 (5.0%)
                                Sikh                           0 (0%)               0 (0%)                 1 (5.0%)

                                                       Table 1: Sociodemographic factors



Analysis of survey scores showed that most students in the                     of second-year students, and 20% of third-year students
sample know someone who has donated an organ during                            responded that they had not covered the topic in their
their lifetime (73.8%) or after death (72.5%). The 56.3%                       nursing course of study. 53.1% of first-year students say
responded that they know someone who has received an                           they have received training in their pre-college years, in
organ transplant. 63.3% (n=50) of students indicated that                      contrast to second-and third-year students who confirm
they had not received training regarding organ donation                        that they have not received education. Students' attitudes
during their college course and previous school years,                         toward organ donation, ranked by ODAS scores, ranged
respectively. Specifically, 87% of first-year students, 66.6%                  from a low of 45 to a high of 71 with a median score of 61

       Corresponding author:                                            81                                   Submission received: 19/04/2023
       Mattia Bozzetti: mattia.bozzetti@asst-cremona.it                                               End of Peer Review process: 29/05/2023
       Reparto di Terapia Intensiva e Rianimazione, ASST                                                               Accepted: 29/05/2023
       Cremona, Viale Concordia 1, 26100, Cremona
                                                                                   This work is licensed under a Creative Commons
                                                                                   Attribution-NonCommercial-NoDerivatives 4.0 nternational
       ISSN: 2785-7263                                                                                           DOI: 10.54103/dn/20016




IQR [54;64]. Median score observed in the three years was                [55;64] and III year Me = 62, IQR [54;65.5] as seen in
for I year Me= 60.5, IQR [54;65], II year Me = 61, IQR                   Figure 1.




                                                                     Year


                         Figure 1: Violin plot of students' attitudes toward organ donation ranked by ODAS scores

No statistically significant differences were observed                   academic training does not correlate with students'
between the overall scores of the three groups (p=0.66)                  attitudes toward organ donation (R=0.10, p=0.377)
and no outliers were found. The items that reported lower                although there is correlation with year of course (R=0.54,
median score were item 3 “I have knowledge about the                     p<0.0001). In addition, knowing someone who has
process of organ procurement and about the organ                         received an organ transplant correlates weakly with having
procurement system” with a difference between first,                     expressed willingness to donate (R=0.22, p=0.047) and
second (median=2) and third year (median=3); item 7 "I                   having     received        academic         training       correlates   with
have expressed my willingness to donate" reported lower                  perceived knowledge about the donation process (R=0.44,
score especially for the third year degree (Me=2.50). In                 p<0.0001), but not that in pre-academic years (R=0.162,
contrast, the items that reported higher median scores                   p=0.154). No statistically significant correlations were
were 4 and 19, respectively: "I am in favor of organ                     observed between the religion variable, gender, age and
donation" and "In general, I think organ donation is a                   nationality and the other variables considered for the study
good thing." The overall of ODAS scores are reported in                  (p>0.05).
Table 2. Through bivariate correlation analysis using Tau
Kendall’s method was found that having received

      Corresponding author:                                        82                                   Submission received: 19/04/2023
      Mattia Bozzetti: mattia.bozzetti@asst-cremona.it                                           End of Peer Review process: 29/05/2023
      Reparto di Terapia Intensiva e Rianimazione, ASST                                                           Accepted: 29/05/2023
      Cremona, Viale Concordia 1, 26100, Cremona
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       ISSN: 2785-7263                                                                                        DOI: 10.54103/dn/20016




                                       ODAS Items                                     N      Me Min Max                     IQR [first-
                                                                                                                              third]
       I believe in an afterlife                                                   79     3               1          4      2.00 3.00
       I have religious objections to organ donation                               79     4               1          4      4.00 4.00
       I am knowledgeable about organ procurement and the organ                    79     3               1          4      2.00 3.00
       procurement system
       I support organ donation                                                    79     4               3          4      4.00      4.00
       I would agree to an organ transplant, if my life were in danger             79     4               2          4      3.00      4.00
       without one
       I am willing to have organs donated after my death                          79     4               1          4      3.00      4.00
       I have signed an organ donor card or the back of my driver’s license 79            3               1          4      2.00      4.00
       I know someone who has signed an organ donor card or the back of 79                3               1          4      2.00      4.00
       his/her driver’s license
       It is important to discuss my wishes for after my death with my             79     3               2          4      3.00      4.00
       family
       I have discussed my wishes for after my death with my family                79     3               1          4      2.00      4.00
       If needed, I would receive an organ from a person of a different race 79           4               2          4      3.00      4.00
       than myself
       I would be wiling to donate my organs to a person of a different race 79           4               2          4      3.00      4.00
       than myself
       I believe that organ donation is against my religion                        79     4               1          4      2.50      4.00
       I have been taught that organ donation is against my religion               79     3               1          4      1.00      4.00
       I thing that organ donation is a safe, effective practice                   79     3               2          4      3.00      4.00
       I think that organ donation is mutilation to the body                       79     4               2          4      3.00      4.00
       I trust that doctors and hospitals use donated organs as they are           79     3               2          4      3.00      4.00
       Intended to be used
       I think that doctors would try just as hard to save my life whether or 79          4               2          4      3.00      4.00
       not I plan to be an organ donor
       In general, I think that organ donation is a good thing                     79     4               3         4 3.00 4.00
       Organ donation is consistent with my moral values and beliefs               79     4               1         4 3.00 4.00
       Total                                                                       79 61                 45        71 54.00 64.00
                                           Table 2: Organ Donation Attitude Scale scores.



DISCUSSION                                                             decide to donate, or that there simply is not an active, in-
                                                                       depth awareness of it. Any citizen over the age of eighteen
In this study, the attitudes of undergraduate nursing
                                                                       can express consent or refusal to organ and tissue
students towards organ donation were investigated via
                                                                       donation after death through one of the following
the ODAS (14)      questionnaire.       Understanding     their
                                                                       channels: at the municipal registration offices when issuing
attitudes was useful in our case, and it showed a
                                                                       or renewing their identity card, by filling out the Italian
predominantly positive attitude in agreement with the
                                                                       Association for Organ, Tissue and Cell Donation (AIDO)
literature (16–18). In general, ODAS scores did not show
                                                                       form, by signing the form at the local health authority
any particular differences between the three course years.
                                                                       (ATS) that has jurisdiction over them, by filling in the
One of the lowest median scores was the item "I
                                                                       National Transplant Card (NTC) or the blue card issued
expressed my willingness to donate" This suggests that
                                                                       by the Ministry of Health or one of the donor cards
there may not be enough clarity in Italy about how to
      Corresponding author:                                       83                                 Submission received: 19/04/2023
      Mattia Bozzetti: mattia.bozzetti@asst-cremona.it                                        End of Peer Review process: 29/05/2023
      Reparto di Terapia Intensiva e Rianimazione, ASST                                                        Accepted: 29/05/2023
      Cremona, Viale Concordia 1, 26100, Cremona
                                                                           This work is licensed under a Creative Commons
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        ISSN: 2785-7263                                                                                               DOI: 10.54103/dn/20016




distributed by the relevant associations, by writing down                   between training and students' attitudes is not strong
his/her own will on a blank sheet of paper, including date                  enough to influence each other, consistent with what
and signature. This statement must be kept with personal                    Martinez-Alarcòn et al. (20) stated. In contrast to the
records. Additionally, as our study demonstrates, attitudes                 findings of the study by Zampieron et al. (11), our analysis
may not always translate into congruent behavior. Jaccard                   of the results did not find a direct influence between poor
and Radecki (19) defined donor card signing as a required                   theoretical knowledge and negative attitude. It thus follows
but not sufficient condition for doing so. When there is a                  that improving learning is not always sufficient to alter the
strong positive attitude and no negative attitude regarding                 attitude towards donation (10).
organ donation, there is a willingness to donate organs.
                                                                            Our         experience            suggests           that         an educational
Therefore, engagement with these simple rules could add
                                                                            intervention combined with contextualization in internship
value in increasing accessions. In addition, equally higher
                                                                            settings could increase nursing students' positive attitudes
scores were found in the first, second, and third years for
                                                                            about organ donation. Patients who decline to be
the items "I think organ donation is a mutilation of the
                                                                            considered for transplantation may do so due to religious
body" and "I am willing to donate organs even if it is a
                                                                            considerations. When discussing live donation, these
person of a different ethnicity"; this suggests that negative
                                                                            concerns might be just as relevant as or even more so.
ethicaland moral beliefs have not emerged, but rather a
                                                                            There are compelling arguments to support the contention
broad uniformity of open-minded thinking toward others.
                                                                            that      religious        beliefs       affect      transplant        decisions
The educational training received during the academic
                                                                            considerably more frequently than clinicians and transplant
period has been shown to have an influence on the
                                                                            teams think. While some cultures hold that the spirit
knowledge regarding the donation process. In particular,
                                                                            moves from the donor to the recipient, others argue that
third-year students are found to be better prepared than
                                                                            ancestor agreement must be gained before a donation can
first-year students. The difference lies in the course of
                                                                            be made in order to prevent the remaining members of the
study within the University of Brescia, which stipulates
                                                                            family from ever losing their ancestral protection. Others
that notions are received during the "Critical Area" course
                                                                            emphasize the significance of certain rituals related to the
with a three-hour dedicated lesson about principles and
                                                                            grieving process and how organ donation is perceived as
definition of BD, Italian legislation, coordination and
                                                                            impeding this process (21). In our study, no statistically
procurement      of     potential    donors       and      families,
                                                                            significant correlations were observed between the religion
maintenance of vital signs awaiting explantation. ICU
                                                                            variable and the other variables considered, in contrast to
internships are only available in the third year of the
                                                                            what was stated by Poreddi et al. (17). The literature
course, there was generally a lack of direct clinical
                                                                            stresses that one of the main challenges includes the
experience with the treatment of patients awaiting
                                                                            influence of cultural background and religious beliefs on
transplants or possible donors. Furthermore, it was found
                                                                            individuals' attitudes, beliefs, and behaviors (22). A weak
that receiving academic training correlates with more
                                                                            correlation emerged between those who decide to express
knowledge about the donation process, but not with a
                                                                            their will to donate and knowing a donor. Having direct
higher total attitude score. This means that the link
       Corresponding author:                                           84                                    Submission received: 19/04/2023
       Mattia Bozzetti: mattia.bozzetti@asst-cremona.it                                               End of Peer Review process: 29/05/2023
       Reparto di Terapia Intensiva e Rianimazione, ASST                                                               Accepted: 29/05/2023
       Cremona, Viale Concordia 1, 26100, Cremona
                                                                                   This work is licensed under a Creative Commons
                                                                                   Attribution-NonCommercial-NoDerivatives 4.0 nternational
        ISSN: 2785-7263                                                                                       DOI: 10.54103/dn/20016




contact with someone who has donated could concretely                 teaching       methods          on       brain       death           and   organ
affect an increase in students' attitudes (16). Our results           transplantation need to be reconsidered. An educational
imply that individuals who have donated or received an                intervention should include background information on
organ, as well as nurses working in organ donation                    organ donation and brain death, criteria for eligibility as a
organizations, can aid in fostering positive attitudes and            potential donor, guidelines, the role of the intensive care
dispelling unfavorable attitudes and beliefs. If these                nurse, and the organ procurement organization. The
prospective registered nurses receive adequate training,              Hospital Procurement Coordination for Organ and Tissue
they could promote organ donation both directly and                   Donation (COP), born in 2022, proactively monitors
indirectly to patients and their families, as well as to other        neurolesion patients with the use of the NIT platform to
health care workers, because exposure to the organ                    follow their hospitalization and identify potential donors
donation system may improve nurses' ability to spot and               among them. The goal of this platform, which is accessed
suggest potential donors after starting a nursing career.             directly by the local procurement coordinator (CLP), is to
Additionally, greater interdisciplinary conversation might            facilitate the activation of the COP for the implementation
lead to even more favorable perceptions of organ                      of still-heart and multi-tissue donor pathways where
donation. These methods might help to address the                     hospital admission is followed by death. The CLP
ongoing issue of organ shortages for transplantation.                 stimulates and fosters the culture of organ and tissue
                                                                      donation, collaborates with the College for brain death
Limitations
                                                                      assessment, and supports whole-hearted donation of both
The present study was limited by the number of students
                                                                      organs and tissues. The facility offers staff training and
responding to the questionnaire, and the sample size may
                                                                      awareness-raising           courses         inherent            to     donation,
not be sufficient to achieve statistical power. In addition,
                                                                      collaborates with the communication facility and patient
82.5% of the respondents were women, making the
                                                                      associations, promoting moments of awareness aimed at
sample unrepresentative for both sexes. Although the
                                                                      users and the public. It collaborates with healthcare
Italian form of the questionnaire was not evaluated for
                                                                      personnel identified by the directorates of the public and
exploratory factorial analysis, a content validation was used
                                                                      private accredited health facilities that belong to the COP.
to try to reduce translation bias in the questionnaire. The
                                                                      All students who completed the survey responded
study should also be replicated with a larger sample and
                                                                      favorably to a proposal for an internship at the COP,
could involve more nursing universities to foster the
                                                                      which could provide them with a broader view of the
generalizability of results.
                                                                      procurement and donation process.

CONCLUSIONS
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       Corresponding author:                                     85                                  Submission received: 19/04/2023
       Mattia Bozzetti: mattia.bozzetti@asst-cremona.it                                       End of Peer Review process: 29/05/2023
       Reparto di Terapia Intensiva e Rianimazione, ASST                                                       Accepted: 29/05/2023
       Cremona, Viale Concordia 1, 26100, Cremona
                                                                           This work is licensed under a Creative Commons
                                                                           Attribution-NonCommercial-NoDerivatives 4.0 nternational
       ISSN: 2785-7263                                                                                         DOI: 10.54103/dn/20016




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      Corresponding author:                                       86                                  Submission received: 19/04/2023
      Mattia Bozzetti: mattia.bozzetti@asst-cremona.it                                         End of Peer Review process: 29/05/2023
      Reparto di Terapia Intensiva e Rianimazione, ASST                                                         Accepted: 29/05/2023
      Cremona, Viale Concordia 1, 26100, Cremona
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       ISSN: 2785-7263                                                                                DOI: 10.54103/dn/20016




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      Corresponding author:                                   87                             Submission received: 19/04/2023
      Mattia Bozzetti: mattia.bozzetti@asst-cremona.it                                End of Peer Review process: 29/05/2023
      Reparto di Terapia Intensiva e Rianimazione, ASST                                                Accepted: 29/05/2023
      Cremona, Viale Concordia 1, 26100, Cremona
                                                                   This work is licensed under a Creative Commons
                                                                   Attribution-NonCommercial-NoDerivatives 4.0 nternational
