1 Murcia Region Transplant Coordination Centre, Ronda de Levante no. 11, 30008, 2 Primary Health Centre Fortuna, Gerencia de Atención Primaria I, Carretera de Abanilla s/n, 30620 and 3 Transplant Unit, Hospital Universitario Virgen de la Arrixaca, El Palmar, 30120, Murcia, Spain
Correspondence and offprint requests to: Dr Antonio Ríos Zambudio, Avenida de la Libertad no. 208, Casillas, 30007, Murcia, Spain. Email: ARZRIOS{at}teleline.es
![]() |
Abstract |
---|
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
---|
Materials and methods. An opinion poll was used to study a random sample in two geographical areas (urban and rural). Assessment was made of attitudes towards donation of one's own organs as a living donor to an unknown person, as a living donor to a relative and/or close acquaintance and, as a cadaveric donor, and of the different psycho-social variables that may influence this attitude.
Results. In the urban setting, 60% had a favourable response towards cadaveric donation; 29% were in favour of living kidney donation to an unknown person, a percentage which increased to 89% for donation to a relative or a friend. These rates were lower for liver (21 and 74%, respectively). When asked if they would accept an organ donated by a relative or a friend, 67% would accept a kidney and 60% a liver. Attitude towards living donation to an unknown person is more positive among those in favour of cadaveric donation and those who have had previous experience of donation. With respect to level of education, university students are more undecided about living donation to an unknown person than the other groups. In terms of attitude towards donation to relatives and/or friends, there is also the influence of social factors (sex, marital status). However, if the living donation is intended for oneself, there is no variable with which to associate this attitude. In the rural setting, 56% of the respondents refused to complete the survey due to fear of living donation. No statistical study was conducted due to the bias of the rural sample.
Conclusions. There is great fear and ignorance of living donation among the rural population, and uncertainties in the urban population, although attitudes are more positive towards living donation to relatives and/or friends than towards cadaveric donation. These positive attitudes towards living donation are very strongly related to attitudes towards cadaveric donation, previous experience of donation and level of education.
Keywords: attitude; information; living donation to an unknown person; living donation to a relative and/or friend; organ donation
![]() |
Introduction |
---|
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
---|
Although the Spanish population shows a predisposition towards cadaveric solid-organ donation [1], living donation is not well documented among the public. There may be a certain fear surrounding the idea, as it may be perceived as the therapeutic mutilation of a healthy person and it may be conditioned by various ethical issues [4]. This is important, as it could negatively influence cadaveric donation and transplantation; public attitude plays a major role in this therapy, because without donation there is no transplant.
The aim of this study is two-fold: (i) to determine the attitude of the population towards living donation for transplantation in comparison with cadaveric donation; and (ii) to analyse various epidemiological and psycho-social factors which may influence this attitude.
![]() |
Materials and methods |
---|
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
---|
Survey
Opinion on this therapy was assessed by an 18-item survey on living donation (Appendix 1). This survey was based on validated surveys about cadaveric [1,5] and living organ donation in Spain [6]. Most of the questions were multiple-choice and included the most commonly expected possible answers and a final option left blank for respondents to answer as they wished. The survey was distributed by health experts from the Regional Transplant Coordination Centre: these pollsters were the same in both settings and their function was to clarify any conceptual doubts the respondents might have had. The survey was completed anonymously by the respondents themselves and handed back to the interviewer in a sealed envelope.
|
Description of the sample
The rate of response to the survey was 77.5% (n = 310), with 63% of females (n = 195). The mean respondent age was 40±18 years. As regards marital status, 57% (n = 176) were married and 37% (n = 114) single. With regard to level of education, 53% (n = 164) had a primary education or below, 29% (n = 91) had experienced secondary education, 9% (27%) undertaken higher education, and the rest did not respond to the question. It is important to note that 51% (n = 157) had had previous experience of organ donation and/or transplantation through a relative or acquaintance.
As far as geographical setting was concerned, in the urban setting, 245 of the 250 completed the survey (2% non-response rate), whereas in the rural setting only 65 of the 150 completed the survey (44%). The remaining 56% of the respondents in the rural setting refused to complete the survey due to fear of living donation.
The mean age of the respondents in the urban setting was 41±19 years, and 62% were females (n = 152). Fifty-six percent were married (n = 136), 53% (n = 129) had undergone primary education or below, and 50% (n = 122) had had previous experience of organ donation and/or transplantation. The mean age of the respondents in the rural setting was 36±16 years, with a majority of females (66%; n = 43). Sixty-two percent (n = 40) were married, 54% (n = 35) had undergone primary education or below, and 54% (n = 35) had had previous experience in the matter.
Statistics
A descriptive statistical study was carried out on each of the variables, with application of the Student t-test, the 2 test complemented with analysis of residues, and the Fisher test if necessary. Differences were considered significant for levels of P < 0.05.
In view of the major difference in survey completion in the two geographical settings, an independent analysis was performed of both groups to avoid bias in the analysis.
![]() |
Results |
---|
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
---|
Attitude towards living organ donation
In the case of living kidney donation to an unknown person, 29% (n = 70) are in favour, 20% (n = 48) against and 51% (n = 127) undecided. If the donation were to a relative and/or friend, the percentage in favour rises to 89% (n = 217), with 1% opposed (n = 3) and 10% undecided (n = 25). When respondents are asked if they would accept a kidney donated by a relative and/or friend, the percentage of positive responses is 67% (n = 164), with 11% opposed (n = 28) and 22% undecided (n = 53). Attitude towards living kidney donation to an unknown person is significantly more positive among those in favour of cadaveric donation (P<0.0005) and those with previous experience of donation and/or transplantation (P = 0.017). University students are more undecided about living kidney donation to an unknown person than the rest of the population studied (P = 0.039) (Table 1). If we analyse this attitude in the case of living donation to a relative and/or friend, it is seen that besides attitude towards cadaveric donation (P = 0.0005), opinion is also influenced by marital status (P = 0.001) and sex (P = 0.001) (Table 1). However, when living donation is considered for oneself, these variables do not influence this attitude (Table 1).
|
|
|
Attitude towards cadaveric donation
With regard to the attitude towards cadaveric donation of those answering the survey, only 49% (n = 32) are in favour, 33% (n = 21) against and 18% (n = 12) undecided. The most frequent reasons given in favour of donation are solidarity (89%) and reciprocity (76%), and against donation are fear of corpse mutilation (47%) and flat refusal (21%). If the donation were from a relative and/or friend, the favourable opinion drops to 43% (n = 28), with 37% (n = 24) opposed and 20% (n = 13) undecided (Table 4).
|
Comparison of attitude towards living vs cadaveric donation
No statistical study was done due to the bias of the sample, as a 56% negative attitude would have to be added to these data corresponding to those refusing to complete the survey out of fear. If we took into account this 56%, favourable opinion towards living donation to an unknown person would be only 20% for kidney (46% in the rural sample) and only 15% for liver (34% in the rural sample).
![]() |
Discussion |
---|
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
---|
It must be remembered that living donation has caused a good deal of controversy in a number of countries, particularly regarding the subject of financial incentives for people to donate organs and the creation of a possible black market for living donor organs [13]. These controversies, and many others [4], have led most countries to consider legislation that clearly regulates living organ donation and transplantation [14]. This legislation in Spain is very strict, and living donation is evaluated case by case, requiring assessment by the hospital ethics committee and a judge [8].
There are few studies among the population on public attitudes towards living donation. Generally they are studies confined to the donor's family environment [15]. A Swedish study by Karrfelt et al. [16] analyses the psychological and ethical repercussions in parents donating a kidney to their own children aged under 16 years. The authors observe that donation does not represent an ethical or psychological obstacle for the donor parents, but rather it improves their self-esteem and emotional relationship with the recipient child.
Recently, Spital [17] in a populational study of 1009 Americans showed that a large percentage of the population (76%) are in favour of living donation, not only to relatives but also to non-relatives (24%), similar to the percentages in our urban setting. As in our study, the favourable attitude towards living donation to an unknown person affects a quarter of the respondents, data which have also been observed recently by Landolt et al. [18] in the Canadian population.
Worth noting among our results is the fear posed by the possibility of living donation in the rural setting, leading the selected population to refuse to participate in the survey. There may be several factors behind this fear, but possibly those with the greatest influence are widespread ignorance of the subject and the negative news and controversies that may be broadcast in the media, such as organ trafficking [19]. This, at the right time with a suitable explanation given by a health professional, leads respondents to accept this type of donation, which would have otherwise been rejected, as is clear from our study. Therefore, health education campaigns are necessary in these areas, where the work of primary health care professionals may be fundamental [20].
In the urban setting, living donation is seen differently, depending on the origin of the organ and on the recipient. Generally, living donation to an unknown person generates a great deal of indecision. However, when the donation is considered for a direct relative and/or friend, the percentages in favour rise sharply. Living donation to an unknown person is accepted less than cadaveric donation, whereas when donation is to a relative and/or friend, the attitude of the population becomes more favourable than for cadaveric donation. Likewise, the percentages in favour of living donation increase when respondents are asked to regard themselves as potential recipients of an organ, with 67% in favour for kidney and 60% for liver.
The percentages in favour of living donation are higher for kidney than for liver, possibly due to the fact that the kidney is a double organ and donation thereof causes less anxiety and fear than that of a single organ such as the liver, although these differences are only significant when the donation is related. The remarkably small difference between attitudes towards kidney and liver donation is probably due to lack of information about this aspect.
When analysing the variables that influence attitude towards living organ donationof both the kidney and liverwe observe situation-dependent variations. In the case of living donation to an unknown person, we see that the main factors in favour of this attitude are level of education, previous experience of organ donation and/or transplantation, and being in favour of cadaveric donation (Tables 1 and 2). However, when donation is to a relative and/or friend, to save their lives, then other types of emotional and social factors come into play, such as marital status, married people being more in favour of donation, and female sex (Tables 1 and 2). It seems logical that when it is a loved one, attitudes are influenced not only by factors of awareness but also by emotional factors.
Finally, it is worth noting that there are no variables influencing attitude towards living donation when it is considered for oneself as the recipient, especially in the case of liver (Table 2). The subject's own life is unconsciously given priority over any previously manifested beliefs and attitudes towards donation. This is not new to those of us working in the field of transplantation. We all have patients who at one time or another have declared themselves opposed to organ donation and transplantation but, when the time comes for them to need an organ, have radically changed their attitude in favour. In human behaviour, the survival instinct is usually stronger than most of the beliefs we have.
In conclusion, there is major fear and ignorance of living donation among the rural population, and in the urban setting there are doubts and uncertainties, although when living donation is to a relative and/or acquaintance then attitudes in favour are greater than for cadaveric donation. This attitude towards living donation is very much linked to attitudes towards cadaveric donation, previous experience of donation and level of education. Health education campaigns are necessary, especially in the rural setting, to promote living donation.
Conflict of interest statement. None declared.
![]() |
References |
---|
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
---|
|