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Organ transplantation remains currently limited because the demand for organs far exceeds the supply. Though organ procurement is a complex process involving social, organizational, and clinical factors, one of the most relevant limitations of organ availability is family refusal to donate organs of a deceased relative. In the past decades, a remarkable corpus of evidence about the factors conditioning relatives' consent has been generated. However, research in the field has been carried out mainly by means of merely empirical approaches, and only partial attempts have been made to integrate the existing empirical evidence within conceptual and theoretically based frameworks. Accordingly, this work articulates the proposal of an Integrated Psychosocial Model of Relatives' Organ Donation (IMROD) which offers a systematic view of the factors and psychosocial processes involved in family decision and their interrelations. Relatives' experience is conceptualized as a decision process about the possibility of vicariously performing an altruistic behavior that takes place under one of the most stressful experiences of one's lifetime and in the context of interaction with different healthcare professionals. Drawing on this, in the proposed model, the influence of the implied factors and their interrelations/interactions are structured and interpreted according to their theoretically based relation with processes like rational/heuristic decision-making, uncertainty, stress, bereavement, emotional reactions, sense of reciprocity, sense of freedom to decide, and attitudes/intentions toward one's own and the deceased's organ donation. Our model also develops a processual perspective and suggests different decisional scenarios that may be reached as a result of the combinations of the considered factors. Each of these scenarios may imply different balances between factors that enhance or hinder donation, such as different levels of uncertainty and potential decisional conflict. Throughout our work, current controversial or inconsistent results are discussed and interpreted on the basis of the relationships that are posited in the proposed model. Finally, we suggest that the structure of the relationships and interactions contained in our model can be used by future research to guide the formulation of hypotheses and the interpretation of results. In this sense, specific guidelines and research questions are also proposed.

Summary Starting with the relevance of the Spanish experience, this study analyses the population’s disposition towards organ donation after death by means of a representative survey of the adult Spanish population (N = 1206, estimated error ±2.87%, P < 0.05). Of the participants, 8.1% were declared donors, 59.3% were likely to donate, 14.5% were against donating and 18.1% did not know or did not respond; 87.3% would donate relative’s organs if the deceased favoured donation, 50.2% if the deceased’s wishes were unknown and 13.1% even if the deceased opposed donation. Among people who were favourable towards donation, the main motives expressed were the will to save other people’s lives, solidarity and knowing they might someday need a donation. The most important motives for not donating among participants who were against it were the fear of premature organ extraction, of premature pronouncement of death and of mutilation. Reticence to donate is associated with low socio‐economic and cultural level, advanced age and high religious commitment; it is also associated with a low perception of transplant efficacy, not directly knowing any transplanted people and the lack of qualified information. The results support diverse potentially effective strategies for promoting donation in the general population.

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Esta es la versión de autor del artículo publicado en: This is an author produced version of a paper published in:Clinical Transplantation 26.3 (2012): E200-E212

This cross-sectional study analyses the usage patterns of the new communication and information technologies (ICTs) and their relationship with visual discomfort and musculoskeletal diseases in an intentional sample of 1259 workers of Spanish organizations. The usage pattern with the greatest incidence of visual and muscular-skeletal disorders, especially in the wrist and neck, combines the use of laptops and desktops during long working hours. However, the group of workers primarily using mobile devices and working mostly at mobile posts does not appear to be particularly vulnerable to the musculoskeletal diseases and visual fatigue. The ratio of taking a short pause per hour and the implantation of certain technical and preventive measures is related to lower incidence of disorders in the workers as a whole. Current usage of ICTs is very complex and should be addressed using empirical analysis of the different forms of usage and their impacts on health.

AsbtractBackground: The complexity of current organizations implies a potential overload for workers. For this reason, it is of interest to study the effects that mental workload has on the performance of complex tasks in professional settings. Objective: The objective of this study is to empirically analyze the relation between the quality of decision-making, on the one hand, and the expected and real mental workload, on the other. Methods: The study uses an ex post facto prospective design with a sample of 176 professionals from a higher education organization. Expected mental workload (Pre-Task WL) and real mental workload (Post-Task WL) were measured with the unweighted NASA-Task Load Index (NASA-TLX) questionnaire; difference between real WL and expected WL (Differential WL) was also calculated; quality of decision-making was measured by means of the Decision-Making Questionnaire.Results: General quality of decision-making and Pre-Task WL relation is compatible with an inverted U pattern, with slight variations depending on the specific dimension of decision-making that is considered. There were no verifiable relations between Post-Task WL and decision-making. The subjects whose expected WL matched the real WL showed worse quality in decision-making than subjects with high or low Differential WL. Conclusions: The relations between mental workload and decision-making reveal a complex pattern, with evidence of nonlinear relations.

Background Most family members of potential organ donors experience the death of their relative in an intensive care unit. While under an emotional burden, bereaved relatives must make a decision that will affect the life of other patients. A better understanding of grief within the context of organ donation will help intensive care unit staff better support families during this process. Objectives To empirically describe the emotional reactions of potential organ donors’ family members facing a loved one’s death and analyze the relationship of these reactions to factors that occur in the process of illness and death. Methods A prospective observational study was conducted in 16 Spanish hospitals for 36 months. Data of 421 relatives of potential organ donors, collected through a previously validated instrument, included relatives’ emotional responses, deceased’s and relatives’ characteristics, circumstances of death, and behavior of health care staff. Results Unexpected deaths were linked to more intense emotional reactions and less acceptance of death than were anticipated deaths. Additional stressors, such as perception of poor treatment by hospital staff, perception of deficient medical care, and poor relationships among family members, were associated with stronger reactions. Conclusions Observation and analysis of the factors studied may help hospital staff members anticipate bereaved relatives’ emotional reactions and provide better support during the grieving process, increasing family members’ well-being and facilitating a better-informed organ donation decision.