Living anonymous kidney donation: what does the public think?

BACKGROUND: Health professionals are increasingly turning to living organ donation to augment cadaveric donation. Although living donation is currently performed with donors who are either genetically or emotionally related to the recipient, a 1997 British Columbia Transplant Society survey indicated that 32% of BC residents would be willing to donate a kidney, while alive, to a stranger (unpublished data). The goal of this study is to tap the public pulse about the living anonymous donor (LAD) by replicating and expanding the 1997 findings. METHODS: Five hundred BC residents completed a telephone survey including demographic information, questions about their organ donation behaviors and attitudes, and their willingness to donate a kidney, while alive, to particular individuals (child, spouse, parent, relative, friend, and stranger). To improve the methodological rigor of the 1997 study, an informed condition was added in the current study where participants learned about living donation before being asked about their willingness to donate. RESULTS: There were no differences among the 1997 results and the two conditions in the 2000 survey. Twenty-eight percent of participants in the uninformed condition and 29% of participants in the informed condition indicated that they would be willing to be LADs. LADs were more likely than self-reported non-donors to have registered as cadaveric donors and to endorse attitudes that were congruent with wanting to donate to a stranger. CONCLUSIONS: This study replicates the 1997 findings and increases confidence that a significant minority of British Columbians support living anonymous donation and that some would consider becoming LADs themselves.     

Attitudes toward organ donation among waitlisted transplant patients: results of a cross‐sectional survey

Organ shortage remains a major barrier to transplantation. While many efforts have focused on educating the general population regarding donation, few studies have examined knowledge regarding donation and donor registration rates among waitlisted candidates. We aimed to determine waitlisted patients' willingness to donate, elucidate attitudes surrounding organ allocation, and identify barriers to donation. A cross‐sectional survey was distributed to assess demographics, knowledge regarding organ donation, and attitudes regarding the allocation process. Responses from 225 of 579 (39%) waitlisted patients were collected. Seventy‐one respondents (32%) were registered donors, while 64 patients (28%) noted no interest in participating in donation. A total of 19% of respondents felt their medical treatment would change by being a donor, while 86 patients (38%) felt their condition precluded them from donation. Forty patients (18%) felt they should be prioritized on the waitlist if they agreed to donate. A minority of patients (28%) reported discussion of organ donation with their physician. Waitlisted candidates constitute a population of willing, although often unregistered, organ donors. Moreover, many endorse misconceptions regarding the allocation process and their donation eligibility. In a population for which transplantation is not always possible, education is needed regarding organ donation among waitlisted patients, as this may enhance donation rates.     

Routine Referral by Urologists Increase Opportunities for Corneal Donation

Background

The levels of corneal donation are insufficient to meet the demand for corneal transplantation in Japan. To overcome this problem, we started to routinely mention the possibility of corneal donation to the families of patients who died in our hospital's Urology Department in February 2008. In this study, we evaluated the effectiveness of this approach.

The public's willingness to discuss their preference for organ donation with family members

We sought to assess the public's willingness to discuss their preference for organ donation with family members and to identify factors associated with willingness to discuss donation. We categorized individuals (N = 4365) with a preference for donation according to their willingness to discuss donation and used ordinal logistic regression analysis to identify factors related to their level of willingness. About half of those who want to donate have discussed this with a family member. Others were at various stages with respect to their commitment to discuss donation. Those in the more committed stages were more likely than others to have signed an organ donor card, to have seen information about organ donation, to be male, to be white or Hispanic, to know about donation issues, and to be comfortable with the idea of their own death. The decision to donate is ultimately made by family members of a suitable candidate for donation, yet nearly half of those who wish to donate have not made their wishes known. Interventions targeted to individuals at different stages of commitment are needed so that more family members can respond in accordance with their loved one's wishes.     

Determinants of willingness to donate living related and cadaveric organs: identifying opportunities for intervention

BACKGROUND: Although low rates of cadaveric organ donation have been attributed to potential cadaveric donors' concerns regarding their religious beliefs and mistrust of the health care system, it is unclear whether similar concerns are important to potential living related donors. It is also not known which factors might be most responsible for low rates of cadaveric and living related donation among the general public. METHODS: We conducted a cross-sectional study of households in Maryland, using a standardized telephone questionnaire, to assess factors associated with willingness to donate cadaveric and living related organs. We compared factors (demographic, cultural, attitudinal, and clinical) related to willingness to donate cadaveric organs with factors related to willingness to donate living related organs. In multivariate analyses, we assessed the independent relation of factors to willingness to donate cadaveric and living related organs, and we assessed the relative importance of these factors in explaining variation in the general public's willingness to donate. RESULTS: Of 385 participants (84% of randomized homes), 254 (66%) were extremely willing to donate to a sibling but only 179 (47%) had designated themselves a cadaveric donor on their drivers' licenses. In bivariate analysis, older age, comorbid conditions, mistrust in hospitals, and concerns about discrimination in hospitals were statistically significantly associated with less willingness to donate living related organs, although African-Americans, older age, lower education, lack of insurance, unemployment, comorbid conditions, and religion/spirituality were associated with less willingness to donate cadaveric organs. After adjusting for potential confounders, only mistrust in hospitals and concerns about discrimination remained strongly and independently associated with 50 to 60% less odds of willingness to donate living related organs [[relative odds [95% confidence intervals (CI)]: 0.4 (0.2-0.7) to 0.5 (0.3-1.0) and 0.4 (0.2-0.9), respectively]] although presence of dependents was associated with 70% higher odds of willingness to donate living related organs [relative odds (95% CI): 1.7 (1.0-3.0)]. In contrast, older age, employment status, religion/spirituality, and mistrust in hospitals were associated with 50 to 90% less odds of willingness to donate living related organs cadaveric organs [relative odds (95% CI): 0.3 (0.1-0.8), 0.4(0.2-0.8), 0.1 (0.1- 0.5) to 0.5 (0.2-0.9), and 0.3 (0.2-0.6), respectively]. Mistrust in hospitals and concerns about the surgical donation procedure contributed most to the variation in willingness to be a living related donor, although race contributed most to the variation in willingness to be a cadaveric donor. CONCLUSIONS: Many factors affect the general public's willingness to donate organs, but their relative contribution is different for living related versus cadaveric donation. Efforts to improve organ donation rates should be directed toward factors that are most important in explaining the existing variation in willingness to donate.     

Knowledge,attitudes, practices and behaviors regarding deceased organ donation and transplantation in Malaysia’s multi‐ethnic society: a baseline study

Wong LP. Knowledge, attitudes, practices and behaviors regarding deceased organ donation and transplantation in Malaysia’s multi‐ethnic society: a baseline study.
Clin Transplant 2011: 25: E22–E31. © 2010 John Wiley & Sons A/S. Abstract: Background: Malaysia’s organ and tissue donation rates are among the lowest in the world. The study aims to explore the knowledge, attitudes, practices and behaviors regarding deceased organ donation and transplantation in the diverse ethnic communities in the state of Selangor, Malaysia. Methods: A cross‐sectional, population‐based, computer‐assisted telephone interview exploring multi‐ethnic participants’ knowledge, attitudes, practices and behavioral on deceased organ donation and transplantation was conducted from February to April 2009. Results: Although only 5.5% of the total participants (N = 1174) reported that they have registered to be organ donor, a further 35.2% of those who have not register for organ donation indicated willingness to donate their own. Significant socio‐demographic disparities with respect to knowledge and attitudes scores were observed. In particular, Malays (20.7%) indicated lower willingness to donate organs compared to the Chinese (36.6%) and Indians (51.4%) (p < 0.001). In multivariate logistic regression analysis, willingness to donate one’s own organ was associated with knowledge score (odds ratio [OR] = 1.17, 95% confidence interval [CI] = 1.13–1.22), attitude score (OR = 1.17, 95% CI = 1.05–1.31), secondary school education (OR = 1.46, 95% CI = 1.05–2.02), and Malay ethnicity (OR = 0.18, 95% CI = 0.03–0.94). Conclusion: Findings assist organ donation and transplantation organizations to reach out the diverse socio‐demographic and ethnic communities with cultural‐specific information about organ donation.     

Potential yield of imminent death kidney donation

About 99 000 people are waiting for a kidney in the United States, and many will die waiting. The concept of “imminent death” donation, a type of living donation, has been gaining attention among physicians, patients, and ethicists. We estimated the number of potential imminent death kidney donors at the University of Wisconsin Hospital and Clinics by assessing the number of annual deaths in individuals with normal kidney function. Based on a previous survey suggesting that one‐third of patients might be willing to donate at imminent death, we estimate that between 76 and 396 people in the state of Wisconsin would be medically eligible and willing to donate each year at the time of imminent death. We extrapolated these numbers to all transplant centers in the United States, estimating that between 5925 and 31 097 people might be eligible and willing to donate each year. Our results suggest that allowing donation at imminent death and including discussions about organ donation in end‐of‐life planning could substantially reduce the nation's kidney waiting list while providing many more donors the opportunity to give this gift.     

The process of organ donation and its effect on consent

OBJECTIVE: To identify those factors that enhance or inhibit organ donation in order to provide data to help policy makers, hospital administrators and transplantation professionals make informed choices about how to modify the donor system and to structure 'best practice' interventions. SUMMARY OF BACKGROUND DATA: Legislative efforts to increase donation rates have not been successful. An emphasis on process is needed to help explain this. METHODS: The study was conducted using a stratified random sample of 23 hospitals in the Pittsburgh and Minneapolis/St Paul standard statistical metropolitan areas. Each week, the medical charts of all in-patient and emergency room patient deaths at each hospital were reviewed using a standardized review protocol to determine eligibility for organ, tissue, and cornea donation. A total of 10,681 patient charts were reviewed over a 4-yr period. Eight hundred and twenty-eight cases out of 1,723 eligible cases were selected for inclusion in the study. Data were collected on 827 of these cases. All health care providers (HCPs) who spoke with the family after the patient's death or discussed donation with the family were interviewed. RESULTS: Of the 10,681 patient charts reviewed, 16.5% were eligible to donate either organs, tissues, or corneas, and 87.0% of donor-eligible patients' families were approached and asked to donate. Consent rates were 23.5% for corneas, 34.5% for tissues, and 46.5% for organ donation. Multiple logistic regression demonstrated that the best and strongest predictor of donation decisions was the family's initial response to the donation request, as reported by the HCP. Three initial response groups are examined and compared. Those families who expressed an initially favorable reaction were most likely to agree to donation. Furthermore, discussion patterns differed by initial reaction group, with families who expressed initial indecision about donation sharing more characteristics with families who were not favorable than those who were favorable. More detailed information was provided to the favorable families, as compared to the other two groups, concerning the effect of donation on funeral arrangements and costs. Families who were favorable were also more likely to meet with an organ procurement organization representative than were other families. The strongest predictor of a family's unfavorable response to a donation request was the belief that the patient would have been against donation. A number of other variables, including HCP attitudes, also had an impact on the family's decision to donate. CONCLUSIONS: A number of discussion and HCP characteristics are associated with a family's willingness to consent to organ donation. Further study is needed to determine if interventions based on the characteristics identified in this study will increase consent to donation.     

Coverage of the organ donation process on Grey’s Anatomy: the story of Denny Duquette

Abstract: This investigation examined the impact of Grey’s Anatomy viewing on a host of organ donation‐related variables: organ donation beliefs and attitudes and a willingness to discuss organ donation with family. Following exposure to a storyline in which two myths were presented: (i) the rich and famous can buy their way to the top of organ waiting lists (purchase myth) and (ii) friends and family of medical professionals receive organ transplants quicker than other individuals (relationship myth), results revealed that loyal viewers of Grey’s Anatomy are less likely to believe the purchase myth compared to non‐viewers. No difference emerged between these two groups with respect to the relationship myth. Additionally, loyal viewers were more likely to talk about their willingness to donate organs than non‐viewers. Results are discussed with an emphasis on how Grey’s Anatomy portrayals can impact perceptions and action tendencies related to organ donation.     

Organ donation: a cross-sectional survey of the knowledge and personal views of Turkish health care professionals

Health care professionals (HCPs) represent a key element in the cadaveric organ donation process. This cross-sectional survey assessed HCPs' knowledge, attitudes, and behavior related to cadaveric organ donation and transplantation. One thousand one hundred eighty-four HCPs were randomly selected from various units of five health care institutions located in three major Turkish cities. Each individual completed a questionnaire. The ages ranged between 18 and 63 years. By examining the tendency to organ procurement, 78.6% of the physicians and 69.5% of the nurses stated that establishing brain death during ventilator support is the optimum condition. The results indicated good overall knowledge of the criteria for brain death. Physicians displayed significantly better understanding of the criteria for brain death and optimal conditions for organ procurement. While physicians have significantly better knowledge about kidney transplantation, there was no difference for liver transplantation. Compared to nurses, doctors had significantly better knowledge of which organs can be used in the current transplantation process. Although 44.2% claimed they were willing to donate their organs, only 17.9% actually carried a legal donation card. The rate of willingness to donate was significantly higher among doctors than nurses. Physicians have significantly better knowledge about legal aspects of organ donation and transplantation. Overall, the survey revealed that lack of knowledge has a negative impact on people's attitudes toward organ donation even among health care professionals. Improvements must be made to develop a nationwide Donor Hospital Education Program that will provide training concerning transplantation and organ donation.     

Vascularized Composite Allograft Donation and Transplantation: A Survey of Public Attitudes in the United States

Vascularized composite allograft (VCA) transplantation has emerged as a groundbreaking surgical intervention to return identity and function following traumatic injury, congenital deformity, or disfigurement. While public attitudes toward traditional organ/tissue donation are favorable, little is known about attitudes toward VCA donation and transplantation. A survey was conducted of 1485 U.S. residents in August 2016 to assess VCA donation attitudes. Participants also completed the Revised Health Care System Distrust Scale. Most respondents were willing to donate hands/forearms (67.4%) and legs (66.8%), and almost half (48.0%) were willing to donate the face. Three‐quarters (74.4%) of women were willing to donate the uterus; 54.4% of men were willing to donate the penis. VCA donation willingness was more likely among whites and Hispanics (p < 0.001), registered organ/tissue donors (p < 0.001), and those with less health care system distrust (p < 0.001) and media exposure to VCA transplantation (p = 0.003). Many who opposed VCA donation expressed concerns about psychological discomfort, mutilation, identity loss, and the reaction of others to seeing familiar body parts on a stranger. Attitudes toward VCA donation are favorable overall, despite limited exposure to VCA messaging and confusion about how VCA donation occurs. These findings may help guide the development and implementation of VCA public education campaigns.     

The decision to donate: a model of decision making among individuals and families

Fifty years ago, the first successful kidney transplantation was performed. Since then significant advances in transplantation have been made. Unfortunately, the number of people needing transplants far surpasses the number willing to donate. The literature addresses a plethora of variables influencing whether individuals will become donors themselves or whether family members will donate a loved one's organs. However, to date, no model has examined similarities and differences in the processes by which individuals and families go about making decisions to donate their own or another's organs. In this article, individual and family donation decisions are discussed using Janis' 5-stage model of decision making. We suggest that the weighty nature of donation decisions levels the playing field for decisions made for self and for others. Although the specifics (eg, micro-level) may vary slightly, the processes by which people go about deciding to donate their own organs or those of another individual are similar (eg, macro-level).     

Influence of Empathy,Beliefs, Attitudes,and Demographic Variables on Willingness to Donate Organs

Background

As organ transplantation has become a more routine medical procedure, there has been a growing interest in studying people's attitudes and knowledge concerning organ donation. Trait empathy and self-interest influence different pro-social behaviors to a great extent; still, their role in the promotion of organ donation registration and willingness to donate organs remains unclear. However, people with higher levels of empathy report more altruistic beliefs. We assessed the influence of empathy, beliefs, and demographic variables on willingness to donate organs.

Methods

We included 191 subjects (135 female, 56 male) aged 16–61 years (mean, 26.86 ± 12.88), who participated in educational meetings concerning organ donation. The group was composed of students, teachers, and nurses. Survey tools included the Individual Questionnaire: Study of Attitudes Towards Transplantation, consisting of 26 closed-ended questions (with the consent of the Krakow Statistical Office) and the Empathy Scale by Mehrabian and Epstein.

Results

Of the respondents, 97.4% accept transplantation from living donors, 95.8% accept deceased donations, and 78.5% agree with posthumous life-saving organ donation. The majority of respondents (73%) achieved an average level of empathy, and 20.4% of respondents exhibited considerably higher empathy levels. There was a significant difference between the respondents' sex and their agreement to make a life-saving organ donation. Differences were found among the groups, the attitudes and willingness to donate organs, and between the level of empathy and agreement/consent for organ donation.

Conclusions

Our findings show that the group in general has favorable beliefs about transplantation and declares a willingness to make a posthumous organ donation. These beliefs vary based on demographic variables. Education about organ and tissue donation a has a positive impact on donation and transplantation rates.     

Living kidney donors – a prospective study of quality of life before and after kidney donation

Although the safety of living kidney donation has been well established, prospective studies examining the physical and psychosocial aspects of the donor's quality of life are still scarce. Thus, the purpose of this prospective work was to assess the quality of life of 50 consecutive donors before and after kidney transplantation. All donors were asked to respond to both a donor questionnaire and the short‐form 36‐item health survey (SF‐36). Interviews were individually conducted before, three months after, and over one yr after transplantation. Donation was considered a positive experience by all patients and had no impact on any physical or psychosocial aspect of the donor's life. Improved self‐esteem and better quality of life after donation were reported in 52% of the cases. All donors would donate again and encouraged donation. SF‐36 data indicated improvement in post‐donation mental and physical scores among living donors closely related to recipient. Overall, most donors had a positive experience, felt no changes in quality of life, experienced enhanced self‐esteem, would donate again, and recommended donation.     

The Relationship Between Verified Organ Donor Designation and Patient Demographic and Medical Characteristics

Previous studies on the correlates of organ donation consent have focused on self‐reported willingness to donate and on self‐reported medical suitability to donate. However, these may be subject to social desirability bias and inaccurate assessments of medical suitability. The authors sought to overcome these limitations by directly verifying donor designation on driver's licenses and by abstracting comorbid conditions from electronic health records. Using a cross‐sectional study design, they reviewed the health records of 2070 randomly selected primary care patients at a large urban safety‐net medical system to obtain demographic and medical characteristics. They also examined driver's licenses that were scanned into electronic health records as part of the patient registration process for donor designation. Overall, 943 (46%) patients were designated as a donor on their driver's license. On multivariate analysis, donor designation was positively associated with age 35–54 years, female sex, nonblack race, speaking English or Spanish, being employed, having private insurance, having an income >$45 000, and having fewer comorbid conditions. These demographic and medical characteristics resulted in patient subgroups with donor designation rates ranging from 21% to 75%. In conclusion, patient characteristics are strongly related to verified donor designation. Further work should tailor organ donation efforts to specific subgroups.     

Should people who donate a kidney to a stranger be permitted to choose their recipients? Views of the United States public

BACKGROUND: Several transplant centers have begun to accept kidneys donated by altruistic living strangers. Many of these centers insist that such donations be nondirected, meaning that the donors may not choose their recipients. On the other hand, some authors have argued that anonymous donors should be allowed to select their recipients. This study was designed to explore public attitudes toward this issue. METHODS: Two telephone surveys of US adults, each including more than 1000 participants, were conducted. The first asked about the general acceptability of allowing altruistic strangers to direct donations, the willingness to donate a kidney to a stranger, and the impact of permitting directed donation on willingness to give. The second survey asked about the acceptability of directed donation to members of specific groups. RESULTS: About one quarter of the respondents said they would donate a kidney to a stranger for free, and the vast majority of them would donate even if they could not choose their recipients. Two thirds would not allow anonymous kidney donors to direct their gifts to a member of a specific racial or religious group, but three quarters would support kidney donations directed to children.CONCLUSIONS: These data support the current policy of several transplant centers that people who wish to donate a kidney to a stranger are not permitted to choose their recipients on the basis of membership in a racial or religious group. On the other hand, theoretical considerations and the results of this study suggest that people who wish to donate a kidney only to an unknown child should be permitted to do so.     

The reasons families donate organs for transplantation: implications for policy and practice

BACKGROUND: The objective of this study is to examine the reasoning behind donation decisions of donor-eligible patients' next-of-kin. Cases were identified through chart review at hospitals in Ohio and Pennsylvania. Family decision makers of donor-eligible patients (N = 420) were interviewed to understand decisions regarding organ donation. METHODS: Responses to inquiries regarding donation decisions were recorded verbatim and then categorized into major themes. Patterns of reasons to donate or not were examined to identify trends. Logistic regression was employed to explore the associations between decision-maker characteristics and donation decision. RESULTS: Most families gave more than one reason for their decision. Respondents who chose to donate most frequently mentioned altruistic reasons for their decision (78%). However, this response was almost never provided as a single reason. Seventy-five percent of families attributed the decision to the patient's explicit communication of a desire to donate. The belief that the patient did not want to donate was cited by 51% of families who did not donate; 36% of these families cited this as the sole reason for not donating. Concerns about disfigurement and feelings of emotional exhaustion also played a significant role. CONCLUSIONS: Reasons to donate or not are complex. Altruism, although important, does not seem to be sufficient to motivate organ donation. Knowing patient's preferences was a stronger influence overall. Moreover, certain reasons were highly correlated with each other. Supportive emotional care for the family and reassurance and information about the donation process are indicated as important issues to address to encourage donation.     

Knowledge of Kidney Donation Among Care Givers in Two Tertiary Hospitals in Southwest Nigeria

One of the major challenges of kidney transplantation is shortage of kidney donors. Care givers (CGs) are potential kidney donors, but the majority of them are unwilling to donate due to inadequate knowledge on kidney donation. This study evaluated the knowledge of kidney donation and its determinants among CGs in two tertiary hospitals in Southwest Nigeria. This was a cross‐sectional study that was carried out in the Kidney Care Centre (KCC), Ondo and Babcock University Teaching Hospital (BUTH), Ilishan‐Remo using a self‐administered pretested questionnaire that assessed knowledge of kidney donation and its determinants. Pvalue of <0.05 was taken as significant. A total of 244 respondents participated in the study. The majority were below 40 years, married, and female. The proportion of respondents with adequate knowledge of kidney donation was 63.4%. More respondents from BUTH compared to KCC had adequate knowledge of kidney donation (80% vs. 46.7%, P ≤ 0.001). Similarly, the mean knowledge score was higher in respondents from BUTH (P ≤ 0.001). Factors that determined knowledge of kidney donation were female gender (AOR: 3.43, 95% CI: 1.25–9.40, P = 0.02) and social class (AOR: 1.22, 95% CI: 0.50–2.95, P ≤ 0.001). There was positive correlation between knowledge of kidney donation among the respondents from both hospitals and their willingness to donate kidneys (r = 0.439, P ≤ 0.001). Knowledge of kidney donation was better among BUTH's respondents. Gender and social class were predictors of knowledge of kidney donation. Improving knowledge of kidney donation may improve willingness to donate among the public.     

Organ donation: a population-based study

OBJECTIVE: Through a population-based study, it was identified the prevalence of people's willingness to donate their own organs and from their relatives, evaluating associated factors in an adult population. It was also identified their understanding of cerebral death. METHODOLOGY: Cross-sectional study, with people aged 20 yr or older in the urban area of Pelotas, State of Rio Grande do Sul, Brazil. The instrument used was a structured questionnaire, filled out in individual interviews. Chi-squared and linear trend test were used in the bivariated analysis. Multivariated analysis was conducted according to a hierarchical classification model using Poisson regression. It was considered meaningful the value for p < or = 0.05 two-sided. RESULTS: Amid 3159 participants, the prevalence to donate organs was 52%, amongst which 58% had expressed such willingness to a relative. Most respondents (80.1%) would authorize the donation of relative's organs who had previously declared their willingness to do so. When the subject had not been discussed, only a third of the total number of people interviewed would authorize the donation of a relative's organ. After adjustment to confusing factors, higher willingness was characterized among the youngest, the higher educated and those belonging to families with income over 10 minimum wages. The Evangelical and Jehovah's Witnesses practitioners showed to be less prone to donate. CONCLUSION: According to the study, when the peoples had not enough information regarding family member's donation wishes the rate of willingness to donate organs is lower. Sociodemographic characteristics influence the rate of public willingness to donate organs and campaigns educational should be directed to improve rates of donation the organs.     

Public attitudes toward kidney donation by friends and altruistic strangers in the United States

BACKGROUND: A severe shortage of organs is one of the major barriers facing transplantation today. One promising approach to this serious problem is to increase the use of genetically unrelated living kidney donors. Because of excellent results and favorable ethical considerations, spousal donation has become a widely accepted practice in the United States. The majority of U.S. transplant centers are now also willing to consider friends as donors, but they seem to be less comfortable about this donor source and most centers are opposed to using strangers. This study was designed to see what the public thinks about these issues. METHODS: A telephone survey of 1009 randomly selected adults living in the U.S. was conducted by the Gallup Organization. The survey asked about the acceptability of kidney donation by close friends and altruistic strangers and the willingness of respondents to make such donations themselves. RESULTS: Over 90% of respondents believe that kidney donation by close friends is acceptable and 80% feel the same way about kidney donation by altruistic strangers. Most respondents (76%) would probably donate a kidney to a close friend with renal failure and 24% said they would even donate a kidney to a stranger for free. CONCLUSION: It seems that the vast majority of American adults believe that living kidney donation by friends and altruistic strangers is an acceptable practice and many would consider making such donations themselves. When considered along with excellent results and favorable ethical arguments, these data suggest that kidney donation by friends and altruistic strangers should be considered as acceptable as is donation by spouses.