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Article

Impact of the European–Mediterranean Postgraduate Program on Organ Donation and Transplantation (EMPODaT): A Survey Analysis at 6 Years

by
Chloe Ballesté
1,2,*,
Seow-Huey Choy
2,
Mauricio Galvao
2,3,
Brian Alvarez
2,
Carmen Blanco
2,
Joaquim Albiol
2,4,
Patricia Peralta
5,6,
David Paredes
1,2,4,
Martí Manyalich
2 and
Ricard Valero
1,2,7,8,9,*,† on behalf of The EMPODaT Consortium
1
Surgery and Surgical Specializations Department, Faculty of Medicine, University of Barcelona, 08036 Barcelona, Spain
2
Donation and Transplantation Institute (DTI), 08028 Barcelona, Spain
3
Medical School, Potiguar University, Natal 59056, Brazil
4
Donation and Transplantation Coordination Unit, Hospital Clinic, 08036 Barcelona, Spain
5
European Society of Intensive Care Medicine, 1040 Brussels, Belgium
6
CETT, Barcelona School of Tourism, Hospitality and Gastronomy, University of Barcelona, 08035 Barcelona, Spain
7
Department of Anesthesiology, Hospital Clínic de Barcelona, Universitat de Barcelona, 08036 Barcelona, Spain
8
Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
9
Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 28029 Fuencarral-El Pardo, Spain
*
Authors to whom correspondence should be addressed.
†
Collaborators/Membership of the Group/Team Name is provided in the Appendix A.
Transplantology 2025, 6(3), 26; https://doi.org/10.3390/transplantology6030026
Submission received: 7 July 2025 / Revised: 30 July 2025 / Accepted: 25 August 2025 / Published: 28 August 2025
(This article belongs to the Section Organ and Tissue Donation and Preservation)
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Abstract

Background/Objectives: To evaluate the impact of the European–Mediterranean Postgraduate Program on Organ Donation and Transplantation (EMPODaT) on organ donation and transplantation (ODT) at 6 years. Methods: EMPODaT is a Trans-European Mobility Programme for University Studies (TEMPUS) project founded by the European Commission to address ODT professionals’ shortage in Middle East/North Africa (MENA) countries through structured postgraduate education. Leading universities from Spain, Germany, Sweden, and France, and key institutions in Egypt, Lebanon, and Morocco, developed a one-year blended training program incorporating e-learning, in-person courses, and hospital traineeships. The effect of the program at 6 years was analyzed by surveying the 90 healthcare participants. Results: A total of 73.9% of respondents remained actively engaged in the field, and some assumed leadership roles (local directors 14.4%, donor coordinators 13%). Also, 65.2% of participants reported improvements in policies and practices, with notable progress in donor screening (39.1%), brain death diagnosis (30.4%), and hospital policy reforms (69.7%). The study identified barriers, such as legal (34.4%), financial (34.8%), and public/social resistance (39.1%). Training alone, without strong hospital policies, support, and government involvement, was insufficient for introducing meaningful changes in ODT. Conclusions: Key aspects for successful implementation of training programs on ODT in MENA countries should consider hospital leadership engagement, strengthen institutional collaborations, and incorporate national health authorities to enhance sustainability and drive systemic changes. Prioritizing individuals in key decision-making positions could further enhance program effectiveness.

1. Introduction

Organ shortage continues to be the main barrier in addressing global transplantation demands [1,2], and a key strategy to tackle this issue is establishing specialized organ donation units. These units should include multidisciplinary teams composed of healthcare professionals with expertise in the field. Training in organ donation is an indispensable first step for the development of these teams [3,4]. It has been shown that such training has proven effective in enhancing deceased organ donation programs [5,6]. However, assessing the long-term impact of healthcare training programs on clinical practice and professional development still remains an unmet challenge [6,7].
The European–Mediterranean Postgraduate Program on Organ Donation and Transplantation (EMPODaT) was created to modernize postgraduate education in living and deceased organ donation and transplantation (ODT) for Middle East/North Africa (MENA) countries, where there is a notable gap in specialized training. Funded by the European Commission’s Trans-European Mobility Programme for University Studies (TEMPUS) project, the project brought together universities from Spain, Germany, Sweden, and France, along with six institutions from Egypt, Lebanon, and Morocco. Through a combination of e-learning and in-person modules, EMPODaT trained 90 healthcare professionals from the beneficiary MENA countries. The program was shown to be a reproducible model for international postgraduate education, significantly boosting participants’ knowledge in ODT, as demonstrated by improvements in pre- and post-training tests [8].
Despite these promising immediate results, the long-term impact of the program on participants’ skills, professional careers, clinical practices, and ODT activity has not been evaluated. This study seeks to bridge that gap by analyzing the effects of training at 6 years after the conclusion of the EMPODaT program, aiming to determine its lasting influence on healthcare professionals and the ODT landscape in the MENA region. The study also aimed to assess the evolution of ODT activity in Egypt, Lebanon, and Morocco.

2. Materials and Methods

2.1. Design and Study Population

This was a cross-sectional survey study conducted between April 2023 and October 2024, involving all 90 healthcare professionals from six universities in Egypt, Lebanon, and Morocco, who had completed the EMPODaT program 6 years earlier. The participating universities were Cairo University and Mansoura University in Egypt, Lebanese American University Gilbert & Rose-Marie Chagoury Sch and University of Balamand in Lebanon, and Universite Hassan II–Casablanca and Universite Mohammed V-Souissi in Morocco. A detailed description of the training design and implementation of the EMPODaT program has been reported previously [8]. Briefly, in relation to the 90 postgraduates who participated in the EMPODaT program, they were evenly distributed across the six beneficiary universities, with 15 postgraduates enrolled per institution (30 per country) [8]. There were 51 men and 39 women, with a median age of 36 years. A total of 47 participants were mostly specialized in organ transplantation, 30 in organ donation, and 11 were nursing professionals, reflecting a multidisciplinary approach essential for strengthening organ donation and transplantation practices in the region. The training structure of the EMPODaT program [8] combined online modules specific to both organ donation and transplantation with local seminars, hospital traineeships, and international assessment using diverse evaluation methods, including pre- and post-tests, self-assessment activities, project work, attendance records, and workshops. This initiative provided a reproducible model for international postgraduate education in ODT, enhancing participants’ knowledge and supporting the professionalization of transplantation practices in MENA countries.
The design of the present survey study was already included in the scope of the TEMPUS program under the European Commission call for proposals by the Education, Audio–Visual and Culture Executive Agency (EACEA) as a further objective of the EMPODaT project [8].

2.2. Study Procedures

Six years after completing the EMPODaT training program, healthcare professionals were invited by one of the authors (C.B.) via personal e-mail to participate in a survey study evaluating the long-term impact of the intervention on their ODT practice. In order to ensure participation, the heads of the university departments involved in the EMPODaT program were also contacted by phone to check the current positions and institutional e-mails of potential participants. All participants provided their written informed consent prior to completing the online survey.
The study questionnaire was designed to assess various aspects potentially affected by the EMPODaT project. A web-based questionnaire consisting of 38 questions, including multiple choice, open-ended, rating-scale, and agreement-scale questions, was adapted from a larger questionnaire reported by Istrate et al. [6]. The time required to complete the questionnaire was approximately 20 min. The initial version was reviewed by four international professionals in the field of ODT, including two medical doctors, one biotechnologist, and one psychopedagogue. All minor amendments made were approved by consensus. The final study questionnaire included eight sections of demographic data (6 items), experience (7 items), institutional support (3 items), motivation (3 items), networking (4 items), policies (2 items), policies & practices (4 items), and practices (9 items). Different answer formats were used, including agreement scale (2 questions), multiple choice (26 questions), open-ended (3 questions), and rating scale (7 questions). This comprehensive design aimed to capture both quantitative and qualitative insights from participants. The detailed questionnaire is described in Tables S1 and S2 of the Supplementary Material.
The questionnaire was distributed between April 2023 and October 2024, with four rounds of extensions and reminders to enhance participation. A cover letter explaining the purpose of the study and a link to the self-administered online survey were provided, and responses were collected using Survey Monkey® software (https://www.surveymonkey.com/, accessed on 1 November 2024). Participation in the study was voluntary and unpaid, responses were anonymous, and no identifiable information was collected.
A further objective of the study was to assess the evolution of ODT activity in Egypt, Lebanon, and Morocco from 2014 to 2023, using data collected from the International Registry on Organ Donation and Transplantation (IRODaT) and the Global Observatory on Donation and Transplantation (GODT) [9,10], as well as unpublished data from the Ministry of Health and Population of Egypt (MOHP), National Organization of Organ and Tissue Donation and Transplantation of Lebanon (NOD), and the Conseil Consultatif de Transplantation d’Organes et de Tissus Humains du Maroc (CCTOTH).

2.3. Statistical Analysis

Only fully completed questionnaires were analyzed. Categorical data are expressed as frequencies and percentages, and continuous data as mean and standard deviation (SD).
The Fisher’s exact test and logistic regression were used to explore the relationship between participation in the EMPODaT program and the perceived impact in the different areas according to gender, previous experience, and hospital support. Statistical significance was set at p < 0.05. Statistical analyses were performed with the IBM Statistical Package for the Social Sciences (SPSS) version 23 for Windows (IBM Corp., Armonk, NY, USA).

3. Results

3.1. Study Participants

A total of 90 healthcare professionals who completed the course received the study questionnaire. Answers were obtained from 36 participants, representing 40% of the sample. However, only 23 (25.5%) returned fully completed questionnaires, which were included in the analysis. Their demographic characteristics are presented in Table 1. Also, most participants (52.2%) were from Egypt and held a PhD degree (91.3%). Nephrology was the most common specialty (56.5%), and 47.8% of participants had 6–10 years of previous experience in ODT. At the time of the present study, 73.9% were still actively involved in the field of ODT.

3.2. Impact of the EMPODaT Project on Healthcare Professionals

The effect of the EMPODaT training program on the most relevant aspects of the careers of participants in the study is shown in Table 2. Most respondents (78.3%) continued working in the field of ODT, and 14.4% were local directors/managers. Also, 13% achieved responsibilities as senior donor coordinators. Most of the participants (65.2%) agreed on an improvement of policies, practices, and processes in ODT. Changes in the hospital policies for improving ODT were reported by 69.7% of participants. Changes in ODT practices and processes included improvements in donor screening systems in 39.1% of cases, brain death diagnosis and organization of ODT office in 30.4% each, and donor procurement organization in 17.4%. However, 26% of participants recognized that no improvements had taken place. Also, more than half (52.2%) considered that the hospital had been “totally sensitive” or “sensitive” to the improvements that professionals would like to implement. In addition, a large percentage of participants (69.6%) had been able to train other professionals based on the strategies learned in the EMPODaT program.
EMPODaT training showed the greatest impact in hospital/organization/country in aspects such as changes in policy, donor screening system, and brain death diagnosis, which accounted for the highest percentages, and scored as “significant” in 43.5% of participants (Table 3). Organizational activities in donor procurement and ODT office were rated as “no influence” or “very little influence” by 34.8% and 30.4%, respectively.
As shown in Table 3, participants perceived that EMPODaT training had a “significant influence” on their personal experience on ODT knowledge (73.9%), motivation to work in the field of ODT (69.6%), attitudes toward ODT (60.9%), and desire to innovate in this field (60.9%). In general, less than 10% of participants considered that the EMPODaT training had “no influence” on their personal experience. Moreover, the EMPODaT training had a “no influence” or “very little influence” on promoting legislative (47.8%) and financial changes (60.9%), although the influence on medical care (52.2%), training and education (52.2%), and management (39.1%) was “significant”. The main reasons that exerted a “significant” effect discouraging participants from working in the area of ODT included difficulties in overcoming public/social attitudes toward donation (39.1%), legislation-related difficulties (34.4%), lack of resources for organ donation (34.8%), and lack of hospital support for organ donation (30.4%).
The relationships between the most relevant items of the EMPODaT questionnaire (ODT policies, processes, personal experience, improvements, and barriers to working in ODT) were analyzed in relation to gender, previous experience in ODT, and hospital support. There were significant results for the association between “improvements in ODT policies” as well as “improvements in practices or processes” in the participant’s region/country with “high hospital support” as compared to “low hospital support” (odds ratio [OR] 13.75, 95% confidence interval [CI] 1.21–156.65, p = 0.035). Perceived improvement in donor screening was inversely associated with years of experience in the field (OR 0.092, 95% CI 0.01–0.73, p = 0.024). Hospital support was a significant factor influencing improvement in management of the ODT process (OR 10.0, 95% CI 1.28–78.11, p = 0.028). No other significant relationships were found for personal experience or barriers to working in ODT.

3.3. Evolution of ODT Activities at the National Level

In relation to the evolution of ODT activities in Egypt (Figure 1), no deceased donation activity was recorded, although there was a slight increase in living donors over the first three years after the EMPODaT training program (2014–2016). This was followed by a sustained decrease, with a sharper drop in 2020 during the COVID-19 pandemic. There was some recovery in 2021, but the decreasing trend continued thereafter. Kidney transplantation showed a similar progression to that of living donation, given that kidney donors accounted for the highest percentage of transplants from living organ donation. The activity for liver transplantation remained low and stable.
In Lebanon (Figure 2), no data were available after 2020 due to the budget cuts in the national organization responsible for ODT and maintaining activity registries. There was a slight increase in deceased donors after the first year of the EMPODaT program (2015–2017), followed by a progressive decline after 2017. The same trend was observed for living donors. Similarly, kidney donation followed the same pattern as living donation, whereas the activity of liver transplantation remained consistently low.
In Morocco (Figure 3), deceased donation showed a stable, low activity with a decreasing trend since 2015. Living donation, however, increased steadily with a decline in 2020–2021 due to the effect of the COVID-19 pandemic, but in 2023 rebounded to levels attained in 2019. Also, kidney transplant activities were similar to living organ donations, whereas liver transplantation showed a stable, low activity. The overall activity in ODT corresponding to Morocco was the lowest compared with the other two countries.
In relation to Figure 2 and Figure 3 regarding transplantation activities in Lebanon and Morocco, it should be noted that sums of the columns may seem incorrect, but from each “deceased” donor, one or both kidneys could have been transplanted, and liver transplantations may include the full organ or split liver transplants; in addition, some cases of thoracic organs transplantations that have been carried out, were not included in the overall count.

4. Discussion

The EMPODaT training program has shown a long-term positive influence on healthcare professionals, particularly in knowledge retention, professional engagement/motivation, and changes in policy and clinical practices. However, systemic barriers and a lack of government institutional support remain significant obstacles for improving ODT in the MENA region. This positive impact of EMPODaT at 6 years suggests that the international training and networking characteristics of the program successfully motivated professionals to continue practicing in the ODT field, possibly due to increased confidence and a clearer career trajectory (73.9% remained actively involved in ODT, and more than 10% progressed into leadership roles). The influence on policies also indicates that professionals were trained not only in technical expertise but also in leadership and advocacy skills, which were important factors to drive local changes at their centers (65.2% of participants reported improvements in ODT policies and clinical practices). Moreover, the EMPODaT training combination of e-learning and in-person modules may have contributed to better knowledge absorption and retention of key concepts (73.9% of respondents reported a significant improvement in their ODT knowledge). The professional profile of participants in the EMPODaT program (95.6% had a PhD degree, and 48.7% reported between 6 and 10 years of clinical experience) may have contributed to high institutional support, facilitating the implementation of changes in policies and clinical practice. Also, the majority of participants were specialists in areas related to transplantation rather than to organ donation, which may be explained by a higher activity in living donor transplantation and relatively low activity in deceased donation in the participating countries. The observed persistent low ODT activity, particularly decreased donation and transplantation rates, after the EMPODaT program in the MENA countries, may partly result from broader governance and financial challenges.
Significant gaps exist in understanding how education and training translate into practical application by healthcare professionals. Education and training programs often enhance learners’ knowledge, but evidence of their direct impact on personal or professional aspects and clinical outcomes remains limited [11,12]. Assessment of the long-term outcome of ODT training activities is highly relevant, in part due to the large resources that healthcare organizations allocate to train staff in developing skills in all complex areas of ODT [13].
In relation to the response rate, 40% of participants answered the questionnaire, and 25.5% provided fully completed questionnaires. This response rate of 25.5% is notably higher than 16.1% reported by Istrate et al. [6], who investigated the perceived benefits of Transplant Procurement Management (TPM) training programs from 1991 to 2012. In our study, potential participants were contacted by e-mail and received online questionnaires, although local trainers in the six beneficiary universities were approached initially in order to ask for their support in motivating participation. To ensure the validity of the findings, only fully completed questionnaires were analyzed. In addition, the high academic level of participants with attainment of a PhD degree and the large clinical experience were further motivating factors for participation [14,15]. Interestingly, about 70% of participants had been involved in training activities directed to other professionals as a result of strategies acquired thanks to the EMPODaT program, effectively multiplying the program’s impact. This knowledge transfer is crucial for sustainability, as it ensures that ODT expertise continues to spread beyond the original trainees [16].
In terms of improvement in ODT processes and practices, donor screening, brain death determination, and organization of ODT office were the areas in which EMPODaT training showed the highest impact. Also, almost 40% of participants recognized that their hospital had been responsive to changes that they tried to implement. Over 60% of participants reported that the EMPODaT program reinforced their positive attitude and motivation to continue to work in the field. In fact, participants who were able to promote changes in management and local policies, practices, or processes were those who reported relying on hospital support. Therefore, the study highlights the importance of accurately selecting participants’ profiles based on the training objective, whether it is to increase knowledge in ODT or to gain a broader perspective that positively impacts clinical practices and organizational policies. In this respect, the involvement of key hospital managers in training activities is an indispensable strategy to ensure further changes in current practices. While training plays a crucial role, it has been shown that improvement is also influenced by factors such as staff engagement and organizational support [17,18]. In a review by Silva et al. [18], many reports attributed the successful donation programs to professional training for healthcare professionals. However, it also highlighted the importance of offering the training regularly to maintain its effectiveness. The training has also greatly influenced participants’ desire to innovate, a crucial factor in implementing new strategies, adopting creative problem-solving approaches, and adapting to enhance ODT. This aligns with the successful Spanish model, which thrives on a strong culture of research, innovation, and continuous commitment Streit et al. [19].
The EMPODaT Consortium was a multinational initiative uniting universities, hospitals, and transplant organizations from Europe and the MENA region to develop a structured postgraduate training program in ODT. MENA universities from Egypt, Lebanon, and Morocco adapted the training to regional needs. The program fostered interdisciplinary collaboration, bridging the education gap by transferring European expertise while incorporating local contexts. Despite its success, challenges such as accreditation, financial constraints, and bureaucratic barriers posed obstacles to long-term sustainability.

4.1. Limitations of the Study

Three methodological limitations of the study should be mentioned, including the low response rate, self-reported data, and scarce availability of data at the national level. However, the low questionnaire completion rate is a common drawback of online survey studies [20] that affects the generalizability of findings and may introduce response bias, as healthcare professionals who responded might have had stronger opinions or more positive experiences with the EMPODaT training. Also, the possibility of overestimating improvements in local centers and careers cannot be excluded, as the study relied on self-reported perceptions of the effect of EMPODaT rather than objective clinical or policy outcome measures. Also, it should be noted that in the three countries analyzed, Egypt, Lebanon, and Morocco, official data at national level regarding deceased and living organ donation and transplantation were limited, unstable or incomplete due to infrastructure-related organizational problems and budget cuts, which reduced the study’s ability to correlate the impact of training with actual increases in ODT rates.
Finally, it is possible that a somewhat larger number of participants could have been obtained with a shorter time interval between training and assessment of results. However, this strategy would have prevented us from analyzing the impact of the training intervention in the long term. Although some previous studies have evaluated the benefits of transplant procurement management (TPM) specialized training in professionals involved in ODT [6,21], none have evaluated the long-term impact of a more complete and extensive training program, such as EMPODaT [8]. Thus, comparisons cannot be made in the context of similar studies.

4.2. Practical Implications and Future Research

In this study, hospital support was a key factor determining whether participants could implement changes in policies and practices. The possibility of introducing meaningful changes in ODT requires the strong support of hospital policies as well as government involvement, since training alone seems to be insufficient for introducing consistent improvements in practice. Different studies have emphasized that improvements in ODT is a complex task that requires attention to multiple components beyond professional training, such as continued governmental commitment at local and national levels, high degree of collaboration and coordination of different processes and medical specialties, full understanding of challenges, efficient public awareness, adequately funded and staffed national transplant organizations, and multi-stage programs and policies at the hospital setting to increase authorization rates and to improve the entire organ donation process [3,22,23,24,25]. Therefore, the EMPODaT training program alone was not sufficient to drive positive advances when the institutional support was weak. Political, economic, and institutional instability in the MENA region during the study period may have influenced the results and activity rates obtained. Measuring institutional and policy changes based on objective parameters is a future challenge in the follow-up of training programs in ODT. Moreover, involvement of hospital managers and national/regional institutions to ensure structural changes and policy adoption should be prioritized in future training programs. Finally, a more selective approach in choosing participants, especially considering those in key decision-making roles, may maximize the impact of training programs in line with the EMPODaT project. In addition to improving the selection of the target group of participants, different strategies have been proposed to increase the response rates, particularly sequential mixed-mode administration methods (e.g., mail and telephone follow-up) [26,27] or the use of e-mail pre-notification, e-mail invitation, and reminders in web surveys [28]. In the present study, however, participants were initially contacted by e-mail with a personal invitation. Additionally, telephone contact was made with the heads of the university departments involved in the EMPODaT program to check the institutional e-mails of participants. Four rounds of extensions and reminders were included in our strategy to enhance participation.

5. Conclusions

The long-term positive influence of the EMPODaT training program is reflected by the high retention of trained professionals in the ODT field, knowledge dissemination to other healthcare workers, demonstrated improvements in policies and practices, and the career advancement of participants into leadership roles. The study confirms that while training enhances individual knowledge, organizational support is critical for the maintenance of long-term beneficial effects. However, the impact of the EMPODaT training program on ODT activities may have been affected by the influence of other factors unrelated to the effects of training. In the three MENA countries included in the study, organizational inefficiencies, structural weaknesses in their healthcare systems, financial constraints, and healthcare policies could have been important factors involved in decreased organ donation and slowing down ODT activities.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/transplantology6030026/s1. Table S1: Items of the EMPODaT questionnaire; Table S2: Summary of the areas and types of answers of the EMPODaT questionnaire.

Author Contributions

C.B. (Chloe Balleste) was the principal investigator, designed and performed the study, collected data, analyzed data, and wrote the paper. R.V. supervised and coordinated the study and revised the draft for intellectual content. S.-H.C., M.G., B.A., C.B. (Carmen Blanco), J.A., and M.M. contributed to data collection and analysis. The remaining authors coordinated the implementation of the study at local universities. All authors have seen and approved the final draft. The authors declined the use of artificial intelligence, language models, machine learning, or similar technologies to create content or assist with writing or editing of the manuscript. All authors have read and agreed to the published version of the manuscript.

Funding

TEMPUS program of the European Commission.

Institutional Review Board Statement

According to Spanish legislation, specifically the Royal Decree 1090/2015 of 4 December, which regulates clinical trials with medicinal products, the Ethics Committees for Research with Medicinal Products, and the Spanish Registry of Clinical Trials, survey-based studies that do not involve any intervention and in which data are collected anonymously do not require Ethics Committee approval.

Informed Consent Statement

Informed consent was obtained from all professionals who participated in the survey.

Data Availability Statement

Study data are available from the corresponding author upon reasonable request.

Acknowledgments

The authors thank Marta Pulido for editing the manuscript and for editorial assistance.

Conflicts of Interest

The authors declare no conflicts of interest.

Abbreviations

The following abbreviations are used in this manuscript:
EMPODaTEuropean–Mediterranean Postgraduate Program on Organ Donation and Transplantation
CCTOTHConseil Consultatif de Transplantation d’Organes et de Tissus Humains du Maroc
CIConfidence interval
EACEAEducation, Audio–Visual and Culture Executive Agency
GODTGlobal Observatory on Donation and Transplantation
IRODaTInternational Registry on Organ Donation and Transplantation
MENAMiddle East/North Africa
MOHPMinistry of Health and Population of Egypt
NODNational Organization of Organ and Tissue Donation and Transplantation of Lebanon
ODTOrgan Donation and Transplantation
OROdds Ratio
SDStandard Deviation
SPSSStatistical Package for the Social Sciences
TPMTransplant Procurement Management

Appendix A

The EMPODaT Consortium: (members by institution in alphabetical order): Cairo University, Cairo, Egypt: Sayed Akl, Hesham Badawy, Rashad Barsoum, Ayman Dessouky, Wahid Doss, Hussein El-Fishawe, Rizk Elgalley, Manar Elkholy, Ahmed El-Shaarawy, Moustafa Elshazli, Maher Fawzy, Tarek Fayad, Hany Hafez, May Hassaballah, Adel Hosny, Karim Hosny, Mai Mehrez, Tarek Mohsen, Ahmed Mokhtar, Ahmed Ali Morsy, Ashraf Adel Mosharafa, Safinaz Othman, Ismail Rady Saad, Mohamed Said and Maysa Shawqy; Mansoura University, Mansoura, Egypt: Mohamed Abdelwahab, Ahmed Akl, Wafaa Albhaey, Mohamed Adel Bakr†, Essam Abu Bieh, Tarek El Diasty, Mohamed El Saadany, Ahmed Halawa, Ahmed Ibrahim Kamal Abdelkader, Ayman Maher, Ahmed Mansour, Mohamed Nasr Mibed, Ayman Refaea, Rasha Refaie, Hussein Sheashaa†, Ahmed Shokeir; Balamand University, El-Koura, Lebanon: Fadi Abou Jaoude, Maroun Abou Jaoude, Sola Aoun Bahous, Imad Hajj, Walid Faraj, Najat Fares, Boutros Ghanem, Najat Joubran, Georges S. Juvelekian, Maha Khachab, Kamil Nassar, Joe Nohra, Naji Riachi, Antoine Stephane and Farida Younan; Lebanese American University Gilbert & Rose-Marie Chagoury SCH (LAU), Beirut, Lebanon: Fayez Abilama, Fadi Abou Jaoude, Maroun Abou Jaoude, Reshdi Ahdab, Wissam Faour, Walid Faraj, Boutros Ghanem, Georges S. Juvelekian, Hala Kilani, Marwan Masri, Naji Riachi, Antoine Stephane†, Farida Younan and Nazih Youssef; Hassan II University of Casablanca, Casablanca, Morocco: Abderrahim Aït Mhamed, Lahoucine Barrou, Mohammed Benghanem Gharbi, Nisrine Bennani, Siham Bennani, Elisabeth Cassuto Farid Chehab, Abdelaziz Chlilek, Mohamed El Hassane Gharbi, Chafik El Kettani El Hamidi, Rachida Habbal, Malika Khabtou, Daniel Maroudy, Ghislaine Medkouri, Fathi Meziane, Benyounès Ramdani, Hicham Sbaï, Kenza Soulami, Nadia Tahiri Jouti and Mohamed Zamd; Mohammed V University of Rabat, Rabat, Morocco: Zaitouna Al Hamany, Rabia Bayahia, Abdelkader Belkouchi, Amine Benkabbou, Taoufik Dakka, Soukaina Doukkali, Mohamed El Hassane Gharbi, Ahmed Elhijri, Malika Essakalli, Mamoun Faroudy, Abdellatif Koutani, Mohamed Laaroussi, Said Moughil, Naima Ouzeddoun and Hakima Rou; University of Lund, Lund, Sweden: Peter Desatnik and Ehab Rafael; University Côte d’Azur, Nice, France: Patrick Jambou, Jean-François Velly and Jean-Philippe Verhoye; University Hospital Freiburg, Freiburg, Germany: Klaus Michael Lücking, Przemyslaw Pisarski and Patrick Samson-Himmelstjerna; Donation and Transplantation Institute, Barcelona, Spain: Javier Aguirrezabalaga, Estephan Arredondo Cordova, Chloe Ballesté Delpierre, María Paula Gómez Gómez, Melania Istrate, Martí Manyalich Vidal, Gloria Páez, Patricia Peralta Lasso, Aneta Toncheva, Ricard Valero Castell and Juan Villar Gallardo; and University of Barcelona, Barcelona, Spain: Chloe Ballesté Delpierre, Ricardo Casaroli Marano, Melania Istrate, Martí Manyalich Vidal, David Paredes Zapata, Vicente Jose Torregrosa Prats and Ricard Valero Castell.

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Transplantology 06 00026 g001
Figure 1. Evolution of transplantation activities per million population (pmp), including living donors and kidney and liver transplants, from 2014 to 2023 in Egypt. No activity in deceased donors was recorded.
Figure 1. Evolution of transplantation activities per million population (pmp), including living donors and kidney and liver transplants, from 2014 to 2023 in Egypt. No activity in deceased donors was recorded.
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Transplantology 06 00026 g002
Figure 2. Evolution of transplantation activities per million population (pmp), including deceased donors, living donors, and kidney and liver transplants, from 2014 to 2020 in Lebanon (data after 2020 was not available).
Figure 2. Evolution of transplantation activities per million population (pmp), including deceased donors, living donors, and kidney and liver transplants, from 2014 to 2020 in Lebanon (data after 2020 was not available).
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Transplantology 06 00026 g003
Figure 3. Evolution of transplantation activities per million population (pmp), including deceased donors, living donors, and kidney and liver transplants, from 2014 to 2023 in Morocco (y-axis scale ranges from 0 to 1.8 pmp).
Figure 3. Evolution of transplantation activities per million population (pmp), including deceased donors, living donors, and kidney and liver transplants, from 2014 to 2023 in Morocco (y-axis scale ranges from 0 to 1.8 pmp).
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Table 1. Demographic characteristics of 23 participants.
Table 1. Demographic characteristics of 23 participants.
CharacteristicsN (%)
Gender
     Male12 (52.2)
     Female11 (47.8)
Country of residence
     Egypt12 (52.2)
     Lebanon5 (21.7)
     Morocco6 (26.1)
Highest level of education
     Undergraduate2 (8.7)
     PhD21 (91.3)
Specialty
     Nephrology13 (56.5)
     Intensive care medicine/ Anesthesiology3 (13.0)
     Hepatology2 (8.6)
     Abdominal surgery1 (4.3)
     Immunology1 (4.3)
     Thoracic surgery1 (4.3)
     Ophthalmology1 (4.3)
     Urology1 (4.3)
Experience in ODT prior to the EMPODaT training program
     0–5 years6 (26.1)
     6–10 years11 (47.8)
     11–15 years3 (13.0)
     16–20 years2 (8.7)
     More than 20 years1 (4.3)
Active in ODT
     No6 (26.1)
     Yes17 (73.9)
ODT: organ donation and transplantation.
Table 2. Professional and institutional improvements following the EMPODaT training.
Table 2. Professional and institutional improvements following the EMPODaT training.
QuestionsN (%)
Q10: What roles have you held since receiving EMPODaT training?
   None related to ODT2 (8.7)
   Healthcare professionals related to ODT18 (78.3)
   Junior donor coordinator1 (4.3)
   Senior donor coordinator3 (13)
   Local director/manager in ODT4 (14.4)
Q16: Have you achieved any improvements in organ donation and transplantation policies in your region or country?
   Yes15 (65.2)
   No8 (34.8)
Q17: What kind of improvements have been achieved in terms of organ donation and transplantation policy?
   Changes in hospital16 (69.7)
   Changes in regional5 (21.7)
   Changes in national4 (17.4)
   None6 (26)
Q18: Have you achieved any improvements in organ donation and transplantation practices or processes in your region or country?
   Yes15 (65.2)
   No8 (34.8)
Q19: What kind of improvements have been achieved in terms of organ donation and transplantation practices or processes?
   Donor screening system9 (39.1)
   Brain death diagnosis7 (30.4)
   Donor maintenance3 (13)
   Family interview for donation3 (13)
   Donor procurement organization4 (17.4)
   Organization of ODT office7 (30.4)
   Setting up laws and rules of ODT1 (4.3)
   None6 (26)
Q28: To what extent has your hospital, organization, or country been responsive to changes that you or others in your training group have tried to implement?
   Totally sensitive3 (13)
   Sensitive9 (39.1)
   Neither sensitive nor insensitive5 (21.7)
   Insensitive4 (17.4)
Q29: Have you trained other professionals using the techniques you learned in the EMPODaT training?
   Yes16 (69.6)
   No7 (30.4)
ODT: organ donation and transplantation.
Table 3. Perceived impact of EMPODaT program on personal and hospital-related aspects.
Table 3. Perceived impact of EMPODaT program on personal and hospital-related aspects.
QuestionsDegree of Perceived Impact, N (%)
No InfluenceVery LittleModerateSignificant
Q20: Assess the degree to which you believe the EMPODaT training has impacted each of the following aspects in your hospital/organization/country
   Changes in policy4 (17.4)2 (8.7)7 (30.4)10 (43.5)
   Donor screening system3 (13.0)4 (17.4)6 (26.1)10 (43.5)
   Brain death diagnosis4 (17.4)3 (13.0)6 (26.1)10 (43.5)
   Donor maintenance4 (17.4)5 (21.7)6 (26.1)8 (34.8)
   Family interview for donation4 (17.4)5 (21.7)6 (26.1)8 (34.8)
   Donor procurement organization6 (26.1)2 (8.7)8 (34.8)7 (30.4)
   Organization of the ODT office6 (26.1)1 (4.3)10 (43.5)6 (26.1)
Q23: Rate the extent to which you believe the EMPODaT training has influenced your personal experience
   Respect from peers-2 (8.7)10 (43.5)11 (47.8)
   Advantages in career advancement2 (8.7)4 (17.4)9 (39.1)8 (34.8)
   Technical skills for ODT-3 (13.0)9 (39.1)11 (47.8)
   Networking skills-1 (4.3)5 (21.7)17 (73.9)
   Attitude towards ODT1 (4.3)5 (21.7)9 (39.1)8 (34.8)
   Motivation to work in the field of ODT-2 (8.7)7 (30.4)14 (60.9)
   Opportunities for collaboration in ODT1 (4.3)1 (4.3)5 (21.7)16 (69.6)
   Ability to change ODT practices1 (4.3)6 (26.1)7 (30.4)9 (39.1)
   Ability to change ODT policies2 (8.7)3 (13.0)9 (39.1)9 (39.1)
   Desire to innovate in the field of ODT4 (17.4)5 (21.7)5 (21.7)9 (39.1)
   Communication skills related to ODT1 (4.3)2 (8.7)6 (26.1)14 (60.9)
Q27: In what areas do you feel the EMPODaT training has helped you to influence improvement or change in the ODT process?
   Medical care-3 (13.0)8 (34.8)12 (52.2)
   Training and education-2 (8.7)9 (39.1)12 (52.2)
   Communication with family-4 (17.4)11 (47.8)8 (34.8)
   Research and development3 (13.0)5 (21.7)11 (47.8)4 (17.4)
   Legislative changes7 (30.4)4 (17.4)7 (30.4)5 (21.7)
   Financial changes6 (26.1)8 (34.8)5 (21.7)4 (17.4)
   Management3 (13.0)6 (26.1)5 (21.7)9 (39.1)
Q38: How the following reasons have discouraged you from working in the area of ODT?
   The legislation in my country makes organ donation too difficult6 (26.1)5 (21.7)4 (17.4)8 (34.8)
   Development of other areas of interest3 (13.0)7 (30.4)8 (34.8)5 (21.7)
   Public attitudes toward donation are too difficult to overcome2 (8.7)7 (30.4)5 (21.7)9 (39.1)
   Lack of hospital support for organ donation4 (17.4)8 (34.8)4 (17.4)7 (30.4)
   Lack of resources for organ donation3 (13.0)9 (39.1)3 (13.0)8 (34.8)
   Religious barriers make donation impossible5 (21.7)4 (17.4)9 (39.1)5 (21.7)
   Others19 (82.6)2 (8.7)-2 (8.7)
ODT: organ donation and transplantation.
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MDPI and ACS Style

Ballesté, C.; Choy, S.-H.; Galvao, M.; Alvarez, B.; Blanco, C.; Albiol, J.; Peralta, P.; Paredes, D.; Manyalich, M.; Valero, R., on behalf of The EMPODaT Consortium. Impact of the European–Mediterranean Postgraduate Program on Organ Donation and Transplantation (EMPODaT): A Survey Analysis at 6 Years. Transplantology 2025, 6, 26. https://doi.org/10.3390/transplantology6030026

AMA Style

Ballesté C, Choy S-H, Galvao M, Alvarez B, Blanco C, Albiol J, Peralta P, Paredes D, Manyalich M, Valero R on behalf of The EMPODaT Consortium. Impact of the European–Mediterranean Postgraduate Program on Organ Donation and Transplantation (EMPODaT): A Survey Analysis at 6 Years. Transplantology. 2025; 6(3):26. https://doi.org/10.3390/transplantology6030026

Chicago/Turabian Style

Ballesté, Chloe, Seow-Huey Choy, Mauricio Galvao, Brian Alvarez, Carmen Blanco, Joaquim Albiol, Patricia Peralta, David Paredes, Martí Manyalich, and Ricard Valero on behalf of The EMPODaT Consortium. 2025. "Impact of the European–Mediterranean Postgraduate Program on Organ Donation and Transplantation (EMPODaT): A Survey Analysis at 6 Years" Transplantology 6, no. 3: 26. https://doi.org/10.3390/transplantology6030026

APA Style

Ballesté, C., Choy, S.-H., Galvao, M., Alvarez, B., Blanco, C., Albiol, J., Peralta, P., Paredes, D., Manyalich, M., & Valero, R., on behalf of The EMPODaT Consortium. (2025). Impact of the European–Mediterranean Postgraduate Program on Organ Donation and Transplantation (EMPODaT): A Survey Analysis at 6 Years. Transplantology, 6(3), 26. https://doi.org/10.3390/transplantology6030026

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