Nurse Education Today 109 (2022) 105208

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Research article

The attitude towards organ donation: Differences between students of

medicine and nursing. A preliminary study at Unizkm - Catholic University
“Our Lady of Good Counsel” of Tirana
Federico Ruta a, *, Paolo Ferrara b, Stefano Terzoni b, Francesca Dal Mas c, j, Andrea Bottazzi d,
Emanuela Prendi e, f, Pranvera Dragusha e, Alessandro Delli Poggi f, g, Lorenzo Cobianchi h, i
a
General Direction, ASL BAT (Health Agency), Via Fornaci 201, 70031 Andria, Italy
b
San Paolo Bachelor School of Nursing San Paolo Teaching Hospital - ASST Santi Paolo e Carlo, Milan, Italy
c
Department of Management, Lincoln International Business School, Lincoln, United Kingdom
d
IRCCS Policlinico San Matteo Foundation, ICU 1 Department of Intensive Medicine, Pavia, Italy
e
Department of Biomedical Sciences, Faculty of Medicine, Catholic University “Our Lady of Good Counsel”, Tirana, Albania
f
Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
g
Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
h
Department of Clinical, Diagnostic and Pediatric Sciences. University of Pavia, Italy
i
IRCCS Policlinico San Matteo Foundation, General Surgery, Pavia, Italy
j
Interdepartmental Research Center "Organization and Governance of the Public Administration", University of Pavia, Pavia, Italy

A R T I C L E I N F O A B S T R A C T

Keywords: Background: A favourable attitude towards organ donation and transplantation is fundamental among health
Attitude professionals to promote consent, especially in a young healthcare system like Albania.
Medicine Objective: To analyse the differences in the attitude towards organ donation and transplantation and the influ­
Nursing
encing factors among medical doctors- and nurses-to-be.
Organ donation
Students
Methods and design: The article is based on an observational, descriptive, cross-sectional study. The population
includes medical and nursing students of the Catholic University of Good Counsel - Unizkm of Tirana, Albania.
Results: 389 out of 401 students took part in the investigation, of whom 324 enrolled in the Medicine under­
graduate program and 65 in the Nursing undergraduate program. Medical doctors-to-be showed higher aware­
ness about the issue of donation than their colleagues from Nursing, and they were more engaged in discussion
with other parties.
Conclusion: The preliminary results of our pilot study highlight the need to organise more training on the topic of
organ donation and transplantation among clinical students, especially those studying Nursing.

1. Background
Albania is a young democracy emerging from a 40-year-long dicta­
torship. During that period, Albanians were forced to face isolation,
deportations, famine, and the repression of their civil, political, and
religious rights (Seikaly et al., 2008). These circumstances led to the
least developed healthcare system in Europe. After the mid-1990s, there
have been relentless attempts to modernise Albania (Seikaly et al.,
2008). In March 2004, with the support of the European Public Health
Association (EUPHA) and the Open Society Institute (OSI), the Albanian
Forum of Public Health (AFPH) was founded, a central organisation
comprising several public health associations operating in Albania. In
this virtual forum, health policies have been discussed and reported to
the Albanian Ministry of Health (Roshi et al., 2006).
Unfortunately, Albania has a growing number of patients on the
waiting list for transplantation. In addition to creating a National Health
Service, cooperation with other countries has been fostered to develop a
transplant program in Albania. In 2008, the Italian Apulian Regional

* Corresponding author at: Via Fornaci 201, 70031 Andria, BT, Italy.
E-mail addresses: federicorutabat@gmail.com (F. Ruta), paolo.ferrara@asst-santipaolocarlo.it (P. Ferrara), stefano.terzoni@asst-santipaolocarlo.it (S. Terzoni),
fdalmas@lincoln.ac.uk (F. Dal Mas), a.bottazzi@smatteo.pv.it (A. Bottazzi), e.prendi@unizkm.al (E. Prendi), p.dragusha@unizkm.al (P. Dragusha), alessandro.
dellipoggi@uniroma1.it (A. Delli Poggi), lorenzo.cobianchi@unipv.it (L. Cobianchi).

https://doi.org/10.1016/j.nedt.2021.105208
Received 4 August 2021; Received in revised form 19 October 2021; Accepted 5 November 2021
Available online 8 November 2021
0260-6917/© 2021 Elsevier Ltd. All rights reserved.
F. Ruta et al.
Health Agency (ARES), the Italian Ministry of Health, and the Albanian
Ministry of Health launched a collaboration. One of the areas of interest
was to promote the execution of kidney transplants in Albania by
Albanian medical staff, financed with almost 2 million euros. The pro­
gram had two main objectives: to transmit the necessary know-how to
Albanian healthcare personnel and update the Albanian facilities and
equipment to the required standards for transplants (Xhani et al., 2011).
As soon as the trained team returned to Albania, they prepared the
donor-patient matches for living kidney transplantation. On March 26th,
2009, the Albanian medical team performed the first kidney transplant
with the active participation of two Italian urologists from the Univer­
sity of Bari, Italy. This collaboration has favoured the living-kidney
transplant program, leading to several operations and personnel and
patient exchanges between Italy and Albania.
One of the main issues in South-Eastern Europe is the limited
availability of organs which is partly linked to the lack of adequate
infrastructure for organ donation, the difficulty in identifying potential
donors within Intensive Care Units (ICUs), and a lack of trust and sup­
port by the population. Therefore, a social “culture of giving” was re­
ported to be absent or very limited. To build a National and functional
system for organ donation and transplantation (ODT), equipment and
infrastructures are needed, but above all, trained health professionals
are required to contribute to the creation of an effective donation and
transplantation network in Western Balkan countries (Xhani et al.,
2011).
The recent literature has underlined the role of personal knowledge,
attitudes, and behaviours as the main factors that can positively influ­
ence organ donation rates (Miller and Breakwell, 2018; Rithalia et al.,
2009a; Rithalia et al., 2009b; Ruta et al., 2021a). Therefore, the atti­
tudes and beliefs of health professionals in charge are able to signifi­
cantly impact the population’s will to donate organs (Mekahli et al.,
2009; Ruta et al., 2021a). In particular, one recent study (Morgan et al.,
2018) highlights the relevance of the involvement of a Specialist Nurse
for Organ Donation in increasing the consent rates of families. Medical
doctors and nurses represent a key group of healthcare professionals in
the care scenario, who play a vital role in the donation and trans­
plantation process. However, several studies highlighted a worrying lack
of knowledge and inadequate experience in this topic (Bener et al., 2008;
Ruta and Lusignani, 2019). Clinical students’ knowledge and their
opinions are fundamental because, as future medical doctors and nurses,
they will be able to influence the willingness of family members and
patients to express their “non-opposition” to organ and tissue donation
(Martínez-Alarcón et al., 2020).
Moreover, several studies demonstrated the effectiveness of dedi­
cated educational programs as knowledge translation tools (Ríos et al.,
2009) and facilitators (Dal Mas et al., 2020; Ruta et al., 2021b) to
improve students’ knowledge, increasing their awareness of the topic as
their outcome (Potenza et al., 2015). In the international literature,
many pieces of research state that medical students are more aware of
organ donation than nursing students and their favourable attitude is
associated with a broader awareness of the topic (Martínez-Alarcón
et al., 2020). However, the same literature argues that students are very
receptive to new knowledge related to health and organ donation, which
stands as a central prerequisite for designing new curricula and pieces of
training (Ruta et al., 2021b).
Our preliminary research is conducted with the collaboration of the
Unizkm - Catholic University “Our Lady of Good Counsel” of Tirana,
Albania. An analysis of the university’s educational program highlighted
some shortcomings of topics related to the donation of organs and tis­
sues for both the faculties of Nursing and Medicine. Specific training on
ODT is addressed exclusively for postgraduate professionals, while no
dedicated modules are scheduled for clinical undergraduates. Although
the topic may be addressed during general surgery and legal medicine
courses, the available time and content may not be enough to raise
awareness.
To our knowledge, in the literature, there are no published studies
2
Nurse Education Today 109 (2022) 105208
that evaluate the knowledge and attitudes of Nursing and Medicine
students towards ODT in Albania. The present article aims to start filling
this gap, offering food for thought to a broader investigation into
Albanian higher clinical education. Final results may be helpful to
policy-makers to review the curricula, aligning the future clinicians’
skillset to the needs of the actual scenario.
Understanding and assessing the attitude of the student population to
donate can support the design of effective awareness and information
campaigns in order to translate the proper knowledge on a very sensitive
and topical issue. Starting from a pilot case, the objective of the study is
to analyse the attitude towards organ and tissue donation of students in
both Medicine and Nursing through a survey gathered from the previous
literature. The students of the Catholic University of Good Counsel of
Tirana were surveyed using the PCID-DVH-Ríos questionnaire (Ríos
et al., 2018).
2. Material and methods
For the choice of the tool, a literature review was carried out by
evaluating previous articles that investigated the attitude towards after-
death organ donation. The selected methodology was a quantitative one
based on a questionnaire, repeating the survey used by A Ríos and col­
leagues in their study published in Transplantation Proceedings in 2018.
Consent to the replication was obtained from the authors. The PCID-
DTO RIOS questionnaire consists of 20 items with closed answers, and
it was used by the International Donor Collaborative Project with the
goal of studying the attitude towards the donation of organs and tissues
after death. The questionnaire PCID-DTO-RIOS is composed of four
factors that explain a high percentage of the attitude towards the
donation of a person’s organs after death. The original questionnaire
was designed by a multidisciplinary group of experts corresponding to
the transplant coordination, the University of Murcia (with the collab­
oration of the University of Valencia), the transplant hospital centre, and
an expert in statistics. Hence, after its design and use in different studies
and social groups (Ríos et al., 2007, 2009; Ríos et al., 2017) the survey
can be considered validated and trustable.
2.1. Data collection
The study is an observational, descriptive cross-sectional, involving a
non-representative sample of Albanian and international university
students. Students enrolled in the faculties of Medicine and Nursing at
the Catholic University of Good Counsel of Tirana were involved during
the academic year 2020/2021. The survey was employed from January
10th to February 10th, 2021, by completing an anonymous online
questionnaire delivered through the Google Form platform in English,
following the original survey.
The study was shared and approved by the Presidents of the Nursing
and Medicine courses. No ethics committee’s approval was needed, as
the investigation did not include patients’ data. The survey participants
were exclusively healthcare professionals, and participation in the sur­
vey was anonymous and voluntary. The investigators did not receive any
significant identifying information about the sample. No funds were
involved in the study. Fig. 1 reports the collection, eligibility, and se­
lection criteria following the STROBE methodology (STROBE, 2021).
2.2. Data analysis
Continuous variables have been described with mean and standard
deviation if normally distributed; if not, with median and interquartile
range. The Kolmogorov-Smirnov test was used for testing the normality
of the distribution. The chi-square test was used to compare the two
groups of students. The threshold of significance of the tests was set at
5%. The analyses were conducted with SPSS 25 Edition for MacOS.
F. Ruta et al. Nurse Education Today 109 (2022) 105208

Fig. 1. Data collection and eligibility criteria.

Source: The authors using the STROBE methodology.

3. Results
The investigation led to 389 questionnaires that were correctly
returned without missing data out of 410 total students (response rate
94.88%). Respondents were 304 women and 85 men. The median age
was 21 years (skewed distribution: Kolmogorov-Smirnov’s test p <
.0001) with no significant differences between genders (p = .06). Re­
spondents were Albanian and Italian citizens. Indeed, the Catholic
University of the Good Counsel is a private university, partnering with
Tor Vergata University, Rome, Italy. It delivers a joint degree valid in
both countries. More in detail, the students that took part in the inves­
tigation were Albanian (n = 235, 60.41%), Italian (n = 144, 37.02%),
and with Albanian and Italian double citizenship (n = 10, 2.57%). 324 of
them were enrolled in the Medicine undergraduate program (response
rate 95.29%), while 65 of them were attending the Nursing under­
graduate degree (response rate 92.86%).
3.1. Knowledge and information about organ donation and
transplantation
needing transplantation during their life. 273 (70.18%) were willing to
consent to the donation of the organs of their relatives; four more were
conditionally in favour for different reasons (quoting some of the an­
swers: “with the consent of the family,” “if it was up to me only and
beneficial I would consent,” “I would carefully evaluate the situation but
I am in favour,” and “yes, but only if the direct donor wanted it as well”).
90 students (23.14%) were not sure, two would take into consideration
the donor’s will, and 19 (4.88%) were against. Of those latter, most had
already discussed organ donation with their relatives (n = 11) and/or
friends (n = 13), and 12 had received information and/or education
about transplantation. Notwithstanding their responses, about 40% of
the participants did not know their loved ones’ opinion about trans­
plantation (41.13% mother’s, 46.53% father’s, 39.85% partner’s
opinion).
Most students believed participating in a debate on transplantation
could be helpful (n = 328, 84.32%), and 192 (49.36%) thought they had
“sufficient” or “good” information on this topic. 168 reported “some­
how” trust their general physician (43.19%), and 15 (3.86%) would not
trust the medical doctor in charge.

Very few responders (n = 46, 11.8%) knew persons who were organ
donors. One-third of the responders (n = 130, 33.4%) had never
received information and/or education about organ transplantation.
Books/magazines/newspapers and movies were named as the main
sources through which information was received, without significant
differences between nursing and medical students (p always >.05). In­
formation from all sources was mostly positive (p always >.05 when
comparing the two groups), as shown in Table 1.
Most responders (n = 222, 57.07%) were aware of the possibility of
3.2. Organ and blood donation
Most responders (n = 294, 75.6%) believed that the global demand
for organs to be transplanted was not completely fulfilled, and 240
(61.70%) were willing to donate their own organs. Still, 63 of them
(26.25%) had received neither information nor education on this sub­
ject. Of the 26 against organ donation (6.68%), 18 reported to have
received information/education. The motivations for the negative
response were (quoting the students): “the body of the person must rest

Table 1
Sources of information about organ donation.
Source Positive n (%) No information n (%) Negative n (%)

Nursing students Medical students Nursing students Medical students Nursing students Medical students

TV 39 (60.0) 198 (61.11) 22 (33.85) 112 (34.57) 4 (6.15) 14 (4.32)

Radio 8 (12.31) 41 (12.65) 53 (81.54) 267 (82.41) 4 (6.15) 16 (4.94)
Books/magazines/newspapers 51 (78.46) 253 (78.09) 12 (18.46) 68 (20.99) 2 (3.08) 3 (0.93)
Media outlets 18 (27.69) 94 (29.01) 43 (66.15) 210 (64.81) 4 (6.15) 20 (6.17)
Movies 47 (72.31) 233 (71.91) 12 (18.46) 59 (18.21) 6 (9.23) 32 (9.88)
Friends 34 (52.31) 179 (55.25) 23 (35.38) 119 (36.73) 8 (12.31) 26 (8.02)
Relatives 34 (52.31) 180 (55.56) 24 (36.92) 110 (33.95) 7 (10.77) 34 (10.49)
Campaigns 39 (60.0) 200 (61.73) 21 (32.31) 111 (34.26) 4 (6.15) 14 (4.32)
Healthcare professionals 44 (67.69) 212 (65.43) 20 (30.77) 99 (30.56) 1 (1.54) 13 (4.01)
Talks with other people 31 (47.69) 158 (48.77) 29 (44.62) 131 (40.43) 5 (7.69) 35 (10.80)

3
F. Ruta et al. Nurse Education Today 109 (2022) 105208

in peace” (53.73%), “the risk of apparent death” (3.60%), along with would, while only 40% of future nurses claimed to be in favour. Notably,
religious beliefs (2.31%) and other unspecified reasons (40.36%). Of the while future physicians showed greater interest in discussing the topic,
remaining 123, all not sure, 50.39% declared to have received infor­ most of the students, in general, declared they would be interested in
mation/education. In the overall sample, 51 responders (13.11%) were talking about donation dynamics.
“very worried” that their bodies could be defaced in case of trans­
plantation. One-fourth of the responders (n = 100, 25.70%) were blood 4. Discussion and conclusions
donors; among those who were not, only eleven (2.83%) declared to be
unwilling to become donors. Similarly, 110 (28.27%) were engaged as To date, the only form of transplantation developed in Albania is the
volunteers in non-profit organisations. donation of a living kidney. Indeed, living donation constitutes 100% of
kidney transplantations in Albania. Although the number of kidney
transplantations from living donors is increasing continuously world­
3.3. Beliefs and wills regarding the death wide, they constitute approximately 20% of all kidney transplantations
in Europe, with a large variation ranging from 13% in Austria, to 51% in
45 students (11.57%) declared that they would refuse “any manip­ The Netherlands and 82% in Turkey (European Commission, 2014).
ulation” of their own bodies after death. The majority of the in­ It is well known that related living kidney donation alone is unable to
terviewees reported their will to be buried or burnt (n = 222, 57.06%). meet the need for kidney transplantation of those on waiting lists.
39 students were willing to undergo autopsy (10.03%). The remaining Therefore, it is clear that the number of kidney transplantations in
77 (19.79%) reported “other” with no further details. No differences Albania must be increased significantly by expanding this with non-
were found comparing these results with the respondents’ opinion about related paired exchange living donation and also by implementing an
the possibility of recovering after brain death (with the following re­ efficient deceased donor kidney transplantation program and other
sponses: yes n = 105, 26.99%; no n = 146, 37.53%; do not know n = programs of transplantation. Moreover, many more organs and tissues
138, 35.48%, p = .20) or religious beliefs (p = .48). Many respondents are involved. Despite the fact that the scientific and academic commu­
(n = 180, 46.27%) were unable to describe whether their religion pro­ nities are working on novel ways to improve the supply of organs for
vided specific indications about death. transplantation without adversely harming the donor pool, these ini­
Analysing the main differences between the students enrolled in the tiatives are still a long way from being implemented in clinical practice
Medicine undergraduate course versus those studying nursing, some (Cobianchi et al., 2009; Croce et al., 2019; Hogan et al., 2012; Orlando
topics emerge. The following Table 2 depicts the items that show sta­ et al., 2013). The Albanian system should then develop knowledge and
tistically significant differences between the two groups of students. tools to keep up with the increasing medical needs of their patients.
Interesting enough, medical doctors-to-be seem more aware of the sit­ While there is still a gap in the clinical skills and experience from
uation, recognising the lack in the availability of organs. Future medical Albanian staff and technological and surgical tools and support, there is
doctors declare that they spend more time discussing the matter, either also the need to raise awareness towards the importance of donation to
with relatives or friends. More importantly, they show a more significant increase the donor pool. Dedicated campaigns and knowledge trans­
response towards the consent to donate, as 66% of them declared they lation tools (Ruta et al., 2021b) are needed. Still, actions should be
carried on to the clinicians in charge, being them medical doctors or
Table 2 nurses.
Results. This preliminary and pilot study aimed to describe and evaluate the
Item Course Answer p- knowledge and attitudes of Albanian nursing and medical students to­
enrolled
Yes N No N I do not
Value wards organ and tissue donation. Although most of the students have an
(%) (%) know adequate level of knowledge and attitudes in favour of organ and tissue
8. Do you think the Nursing 25 40 – 0.006
donation, very few of the interviewees declared to have signed the donor
needs of transplant (38.46) (61.54) card. Our yet limited sample highlights significant differences between
organs are covered? Medicine 70 254 – nursing and medical students. The responses to our questionnaire un­
(21.60) (78.40) derline how medical students generally show better knowledge and
11. Have you discussed Nursing 20 45 0.005
–
awareness. They do believe that the current availability does not
the matter of organ (30.77) (69.23)
donation and Medicine 176 148 – adequately cover the need for organs to be transplanted. This result is in
transplantation with (54.32) (45.68) line with the literature (Martínez-Alarcón et al., 2020). Following recent
your family? studies, their greater awareness of organ donation may support them
12. Have you discussed Nursing 34 31 – 0.047 developing a more favourable attitude than their colleagues from the
the matter of organ (52.31) (47.69)
Nursing faculty (Potenza et al., 2015). The results recorded from our
donation and Medicine 210 114 –
transplantation with (64.81) (35.19) sample show how medical students register a greater propensity to
your friends? donate organs. They are also more interested in talking about the topic
14. Would you donate Nursing 26 6 (9.23) 33 0.004 of donation with relatives and friends. Compared to future nurses, our
your organs? (40.00) (50.77)
interviewed medical students declare greater trust in their general
Medicine 214 16 94
(66.05) (4.94) (29.01) physician.
23. Do you think a talk Nursing 45 6 (9.23) 14 0.004 Several authors pointed out that clinical students’ awareness of
about organ donation (69.23) (21.53) organ donation is inadequate and that attitudes are lower in some
would be interesting Medicine 283 9 (2.78) 32 countries than in others. Interesting enough, in our sample, future nurses
for you? (87.35) (9.88)
show doubts about the topic. Still, they are likely to become the ones
more involved in the relationship with the patients and their relatives,
Item Course Answer p- who may be in charge of the decision (Morgan et al., 2018). For this
enrolled Value
Totally Quite N Regular No N reason, it would be desirable that future health professionals could
N (%) (%) N (%) (%) receive adequate training to know more and promote organ donation
24. Do you Nursing 8 23 29 5 0.0015 (Cantwell and Clifford, 2000). In addition, several studies demonstrated
trust your (12.31) (35.38) (44.62) (7.69) the effectiveness of educational programs on improving the subjective
family Medicine 86 145 83 10 and objective knowledge of students and how such training increased
physician? (26.54) (44.75) (25.62) (3.09)
their awareness (Ríos et al., 2009).

4
F. Ruta et al.
The knowledge gap of nursing students (Anker et al., 2009) under­
lined in our study could be easily bridged through dedicated training, as
reported by the literature. Indeed, students showed to be very receptive
to new knowledge related to ODT (Dal Mas et al., 2020). Several studies
reported satisfactory outcomes in the increase of nursing students’
knowledge after specific educational programs (Bollo et al., 2019).
Today, the portfolio of possible tools has increased. Webinars, for
example, proved to be an effective facilitator in translating knowledge
about the importance of donation and consent (Ruta et al., 2021b), even
in the “new normal” following the COVID-19 pandemic (Cobianchi
et al., 2020a; Cobianchi et al., 2020b) and its related mobility re­
strictions and social distancing requirements.
Another suggestion drawn from this preliminary study is to provide
an extension of the training programs for nursing and medical students
in order to improve the expertise of future nurses and doctors. It is
necessary to organise adequate, solid, and uniform training for clini­
cians. The use of new educational, informative, and communicative
tools might lead healthcare professionals to acquire clear information
and a positive attitude. A common strategy in the various healthcare
undergraduate and postgraduate courses would be desirable to ensure
the spread of the proper knowledge. Such topics and ways seem
particularly promising in a country like Albania, which is investing in
increasing the knowledge of its clinicians in order to build a modern
healthcare system, able to address its citizens’ medical needs.
Like all pieces of research, this study has several limitations. First, it
gathers data only from one academic institution, which is a private
university with an international attitude. Therefore, the sample is not
probabilistic. Moreover, in this pilot study, the year of the enrollment is
not taken into consideration. We may expect that students attending
their third, fourth, or fifth year may have gathered different knowledge
during their past modules. In contrast, early enrolled students may just
report their initial thoughts and impressions without being affected by
their still early clinical experience. Larger samples of clinical students
would allow comparing results among different groups. Moreover,
although the investigation was conducted in Albania, several partici­
pants were Italian or with double citizenship. This factor may have
biased some results, namely, cultural beliefs and information coming
from the Italian scenario and ongoing debate than the Albanian one. In
addition, the enquired university is catholic. Therefore, it would be
relevant to understand if the religious beliefs of the enrolled students or
the University’s culture or philosophy may have impacted the type of
information or teaching style in the subject of ODT. Although the
response rate among students was more than satisfactory, one more
limitation is linked to the more significant number of medical students in
the examined sample compared with those enrolled in Nursing. More
investigation should be conducted involving other Albanian public and
private universities to have a better picture of the situation in order to
lead to practical policies and curricula review proposals.
CRediT authorship contribution statement
Conceptualization: Federico Ruta
Methodology: Federico Ruta
Data curation: Federico Ruta; Paolo Ferrara, Stefano Terzoni, Ema­
nuela Prendi, Pranvera Dragusha
Writing - Original draft: Federico Ruta, Stefano Terzoni, Francesca
Dal Mas
Writing - Review & editing: Federico Ruta, Paolo Ferrara, Stefano
Terzoni, Francesca Dal Mas
Critical revisions: Andrea Bottazzi, Lorenzo Cobianchi, Alessandro
Delli Poggi
Proofreading: Francesca Dal Mas.
All the authors have read and approved the final version of the
manuscript.
5
Nurse Education Today 109 (2022) 105208
Declaration of interests
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
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blood_tissues_organs/events/journalist_workshops_organ_en.
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Akrawi, E., Molina, J., Fornoni, A., Mendez, A.J., Ricordi, C., Pastori, R.L.,
Pileggi, A., 2012. Beneficial effects of ischemic preconditioning on pancreas cold
preservation. Cell Transplant. 21 (7), 1349–1360. https://doi.org/10.3727/
096368911X623853.
Martínez-Alarcón, L., Ríos, A., Gutiérrez, P.R., Gómez, F.J., Cañadas-De la Fuente, G.A.,
García-Mayor, S., Sánchez, P., Peña-Amaro, M.P., Bondía, J.A., Bas-Sarmiento, P.,
González-Jiménez, E., Kaknani-Uttumchandani, S., Martí-García, C., López-Leiva, I.,
Gutierrez-Izquierdo, M.I., Gala-León, F.J., Benbunan-Bentata, B., Lupiani-
Giménez, M., López-Fernández, C., Ramírez, P., 2020. Attitudes toward organ
donation: differences between medical and nursing andalusian students. Transplant.
Proc. 52 (2), 496–499. https://doi.org/10.1016/j.transproceed.2019.12.035.
Mekahli, D., Liutkus, A., Fargue, S., Ranchin, B., Cochat, P., 2009. Survey of first-year
medical students to assess their knowledge and attitudes toward organ
transplantation and donation. Transplant. Proc. 41 (2), 634–638. https://doi.org/
10.1016/j.transproceed.2008.12.011.
Miller, C., Breakwell, R., 2018. What factors influence a family’s decision to agree to
organ donation? A critical literature review. Lond. J. Prim. Care 10 (4), 103–107.
https://doi.org/10.1080/17571472.2018.1459226.
Morgan, J., Hopkinson, C., Hudson, C., Murphy, P., Gardiner, D., McGowan, O.,
Miller, C., 2018. The rule of threes: three factors that triple the likelihood of families
overriding first person consent for organ donation in the UK. J. Intens. Care Soc. 19
(2), 101–106. https://doi.org/10.1177/1751143717738194.
Orlando, G., Soker, S., Stratta, R.J., Atala, A., 2013. Will regenerative medicine replace
transplantation? Cold Spring Harb. Perspect. Med. 3 (8) https://doi.org/10.1101/
cshperspect.a015693.
Potenza, R., Guermani, A., Peluso, M., Casciola, A., Ginosa, I., Sperlinga, R., Donadio, P.
P., 2015. Effectiveness of an education program on donation and transplant aimed at
students of the nursing degree course. Transplant. Proc. 47 (7), 2097–2101. https://
doi.org/10.1016/j.transproceed.2014.11.074.
Ríos, A., Cascales, P., Martínez, L., Sánchez, J., Jarvis, N., Parrilla, P., Ramírez, P., 2007.
Emigration from the British Isles to southeastern Spain: a study of attitudes toward
organ donation. Am. J. Transplant. 7 (8), 2020–2030. https://doi.org/10.1111/
j.1600-6143.2007.01879.x.
Ríos, A., López-Navas, A.I., De-Francisco, C., Sánchez, Á., Hernández, A.M., Ramírez, P.,
Parrilla, P., 2018. Living kidney donation questionnaire (PCID-DVR-Ríos): validation
and psychometric characteristics in a spanish-speaking population. Transplant. Proc.
50 (2), 370–373. https://doi.org/10.1016/j.transproceed.2017.11.069.
Ríos, A., Martínez-Alarcón, L., Sánchez, J., Jarvis, N., Parrilla, P., Ramírez, P., 2009.
German citizens in southeastern Spain: a study of attitude toward organ donation.
Clin. Transpl. 24 (3), 349–357. https://doi.org/10.1111/j.1399-0012.2009.01079.x.
F. Ruta et al.
Ríos, Antonio, López-Navas, A.I., García, J.A., Garrido, G., Ayala-García, M.A.,
Sebastián, M.J., Hernandez, A.M., Ramírez, P., Parrilla, P., 2017. The attitude of
latin american immigrants in Florida (USA) towards deceased organ donation - a
cross section cohort study. Transpl. Int. 30 (10), 1020–1031. https://doi.org/
10.1111/tri.12997.
Rithalia, A., McDaid, C., Suekarran, S., Myers, L., Sowden, A., 2009. BMJ 338. https://
doi.org/10.1136/bmj.a3162 (jan14 2), a3162–a3162.
Rithalia, A., McDaid, C., Suekarran, S., Norman, G., Myers, L., Sowden, A., 2009.
A systematic review of presumed consent systems for deceased organ donation.
Health Technol. Assess. 13 (26) https://doi.org/10.3310/hta13260.
Roshi, E., Burazeri, G., Bjegovic, V., Georgieva, L., Donev, D., Scintee, G., Hysa, B.,
Laaser, U., 2006. Building public health associations in the transition countries of
South-Eastern Europe: the example of Albania. Eur. J. Pub. Health 16 (3), 243–245.
https://doi.org/10.1093/eurpub/ckl017.
Ruta, F., Lusignani, M., 2019. Knowledge on the corneas donation in the adult population
in a province of Apulia region. Prof. Inferm. 72 (4), 253–259. https://doi.org/
10.7429/pi.2019.724253.
Nurse Education Today 109 (2022) 105208
Ruta, F., Musajo Somma, C., Lusignani, M., Vitobello, G., Gesualdo, L., Dal Mas, F.,
Peloso, A., Cobianchi, L., 2021. The Role of Healthcare Professionals in the Consent
Rate to Organ Donation. An Analysis of Southern Italian Hospitals. Annali
Dell’Istituto Superiore Di Sanita.
Ruta, Federico, Gallo, G., Ferrara, P., Terzoni, S., Della Monica, A., Dal Mas, F.,
Cobianchi, L., 2021. Translating knowledge about organs and tissues donation using
webinars. An exploratory study in Italy. Transplant. Proc. 53 (6), 1792–1797.
Seikaly, M.G., Barbullushi, M., Allabjeu, K., 2008. A major milestone in the history of
albanian kidney transplant. Pediatr. Transplant. 12 (4), 402–406. https://doi.org/
10.1111/j.1399-3046.2008.00916.x.
STROBE, 2021. STROBE - Strengthening the reporting of observational studies in
epidemiology. What is strobe? https://www.strobe-statement.org/.
Xhani, M., Selvaggi, F.P., Battaglia, M., Janko, A., Grandaliano, G., Schena, A.,
Lucarelli, G., Impedovo, S.V., Martino, P., Ditonno, P., 2011. The European Union
Interreg Program: Italian-Albanian experience with kidney transplants. In: Archivio
Italiano Di Urologia, Andrologia : Organo Ufficiale [Di] Societa Italiana Di Ecografia
Urologica e Nefrologica, 83(3), pp. 117–120.