Various authors have reported that, as in the general public, knowing transplant patients has a parallel in the hospital setting, and therefore it would be useful to highlight the successful organ transplants within the hospital and to make sure that all the professionals know the success rates. Among nurses, this does not seem to be a fundamental factor, because although it is necessary to know transplant patients, it is also necessary to understand the transplant process well in order to avoid unfounded fears. Another significant factor is religion. The Catholic Church clearly accepts organ donation and transplantation, and Catholics are slowly becoming aware of this situation. Thus, it can be seen why Catholics tend to have a more favorable attitude toward donation, being nearly 3 times more in favor than are non-Catholics (Zambudio, Martinez-Alarcon, Parrilla and Ramirez, 2009). Another basic factor is the opinion of a respondent's partner toward the idea of donation. A respondent's favorable attitude is related to a partner's favorable attitude and vice versa, being against is related to a partner's negative opinion. Results of a recent study indicated that if the partner is against donation and the respondent knows the partner's opinion, the respondent is nearly 10 times less likely to be in favor than a respondent who does not have a partner. It has been seen that family discussion about donation is a favorable factor. Health care professionals who have discussed the topic of donation within their own family have been shown to have a more favorable attitude towards it. Therefore, as in the population, it seems to be beneficial to encourage dialogue about transplantation and donation within family circles (Zambudio, Martinez-Alarcon, Parrilla and Ramirez, 2009).

The organ donation and transplantation society in the United States continues to undergo striking and sustainable change in order to obtain better performance and quality. Organ transplantation remains the only life-saving therapy available for many patients who suffer from organ failure. Despite the work of the Organ Donation and Transplant Collaborative's, and the marked increases in deceased donors early in the effort, deceased donors only rose by a total of 67 from 2006 to 2007 and the number of living donors declined during this same time period. The trend has been an increase in the use of organs from donors after cardiac death (DCD) and expanded criteria donors (ECD). There is a continuation of the Health and Human Services/Health Resources and Services Administration (HHS/HRSA) sponsored collaborative efforts currently focusing on transplant centers, and their relationships with Organ Procurement Organizations (OPOs), in order to facilitate growth and efficiency via the Transplant Growth and Management Collaborative (TGMC). With the deployment of DonorNet C. there has been a major change in the way that organs are offered and an increase in patient safety measures. Unfortunately, the goals of 75% conversion rates, 3.75 organs transplanted per donor, 10% of all donors from DCD sources and 20% growth of transplant center volume have yet to be reached across all donation service areas (DSAs) and transplant centers; however, there are DSAs that have not only met, but exceeded, these goals. There are transplant centers that have griped the changes that are necessary to increase their volume of cases, but not at the price of quality. Additionally, changes in organ preservation techniques took place this year, partly in response to expanding organ acceptance criteria and increasing numbers of ECDs and DCDs (Tuttle-Newhall, Krishnan, Levy, McBride, Orlowski and Sung, 2009).

The national transplant setting has changed in reaction to the increased regulatory oversight and new requirements for donation and transplant provider associations. Centers for Medicare & Medicaid Services (CMS) regulations for OPOs were put out in 2006 and for transplant programs in 2007. These, in addition to voluntary Joint Commission (TJC) standards and requests by payers for data, have left some programs beset by the costs of building and maintaining a necessary infrastructure of personnel for the perceived divergent and redundant requirements for documentation and data submission by separate governing and regulatory bodies (Tuttle-Newhall, Krishnan, Levy, McBride, Orlowski and Sung, 2009).

Despite donor designation legislation inmost states, which permits organ procurement organizations (OPO) to recover organs when the deceased's donation intentions have been documented, family members continue to play a prominent role in the donation decision-making process. Several studies in recent years have highlighted many factors that influence donation decisions by next-of-kin. OPO practices and the Organ Donation Breakthrough Collaborative have, in part, used findings...

In addition to these key objectives, OPOs strive to facilitate a good decision which is one that is characterized by providing families with sufficient organ donation information to make an informed choice, the family feeling comfortable with their decision and OPO and medical staff supporting the family's donation decision, whether donation consent is obtained or not. There is recognition within the OPO community that family members may confront a similar situation in the future and a negative experience now might lead to donation resistance in the future. However, despite the best efforts of OPOs, family members often must consider a donation request in a relatively short time period, and factors such as the deceased's donation intentions, existing organ donation attitudes, family disagreement, requestor characteristics and other contextual variables are related to the donation decision (Rodrigue, Cornell and Howard, 2008).
Although the demand for organ transplants continues to grow, the number of transplantable organs from the cadaveric donor pool remains relatively static. Living organ donation, that is removal and transplantation of organs, or segments thereof, which a donor can live without, has been proposed as an effective alternative source of transplantable organs. In fact, transplants performed from living donors have advantages including increased viability of donor organs, improved survival and reduced waiting times. Nonetheless, ethical dilemmas arise relating to postoperative donor morbidity and mortality. In Europe, a significant increase in living donations has occurred in recent years. Living donation represents 17% of kidney donation activity and 5% of liver transplantation. In Ireland in 2005 -- 2006, just three of 129 kidney transplants were living donor transplants. In 2006, however, the Irish government deemed development of a Living Transplant Program a service priority. Such development is set against the backdrop of a recent European Commission Communication which proposes expansion of living donation to increase organ availability. Establishment of this national program poses ethical, legal, social and psychological questions. An Irish Council for Bioethics poll in 2005 revealed that although 81% of respondents slightly or strongly agreed that living related donation should be promoted in Ireland, about half also agreed that its promotion could put undue pressure on one sibling to donate to another (Browne and Desmond, 2008).

In the early1990s, several trends in living donation began to emerge. Studies have demonstrated that long-term graft survival from living donor transplants, even with significant histo-compatibility antigen mismatching, tended to equal or exceed graft survival from optimally matched deceased donor transplants. As waiting time to receive an organ from a deceased donor continued to lengthen, increased numbers of people volunteered to be living donors to meet the needs of an individual candidate. In many instances, these potential donors were not familial relatives of the intended candidate but had some emotional relationship, such as family friends, coworkers or members of the same religious, civic, or fraternal organization. More living liver and lung donor transplants were performed, both of which entail a greater potential for significant donor complications than kidney transplants. As the Internet has grown as a major communication tool for the general public, some potential candidates and donors with no prior relationship have made online arrangements for living donation. Public solicitation has raised questions regarding of ethical propriety, equity of access and potential illegal financial relationships in solicited live organ donation (Brown, Higgins and Pruett, 2009).

Law and medicine have struggled with a fundamental tension between, the delaying the pronouncement of death until there is no chance of recovery and increasing the quantity and quality of organs for transplant by pronouncing death as soon as possible. Most cadaveric organs are recovered from donors who meet brain death criteria. There is, however, a growing imbalance between the number of brain-dead donors and the demand for organs. This movement in the transplant community to increase the supply of organs by using donors whose heart and lung functions have ceased, but who are not yet brain dead is a practice known as donation after cardiac death (DCD), which has proved controversial for a number of very obvious reasons (Harrington, 2009).

The need for transplantable organs is growing while the number of transplantable organs is not. There are many reasons that people give for not wanting to donate with the most of them stemming from…