Living-donor kidney transplantation

The number of living donations is increasing in Europe and especially in Germany. The reasons seem to be a continuous shortage of cadaveric organs, better results after living related and living unrelated donation, and a high willingness in the population to donate. Various legal prerequisites have to be fulfilled in different countries. In general, careful donor evaluation is necessary to avoid excessive risk in the donor. Nephrectomy for transplantation can be performed via various approaches; microinvasive surgical techniques have been introduced, but are not yet established. Immunosuppression in living related donation is no different from that in cadaveric transplantations. In conclusion, living donation seems to be an adequate alternative to cadaveric donation. Moreover, results are twice as good as cadaveric donation with regard to long-term function. Received: 25 October 1999 Accepted: 27 October 1999     

Patients' willingness to talk to others about living kidney donation

BACKGROUND: Living donor kidney transplantation has several advantages for patients with end-stage renal disease. However, many patients are reluctant to pursue this treatment option, preferring instead to wait for a deceased donor organ. OBJECTIVE: To examine predictors of patients' willingness to talk to others about living kidney donation. METHODS: One hundred thirty-two adult patients awaiting kidney transplantation who were enrolled in a randomized trial examining the effectiveness of education on rates of live donor kidney transplantation completed a baseline rating of their willingness to talk to others about living kidney donation. Also, patients completed measures of knowledge and concerns about living donation and a rating of perceived health. RESULTS: Slightly more than half the patients (56.1%) had low willingness to talk to others about living donation. The following variables were associated with higher willingness to talk to others: white race (odds ratio, 3.31; confidence interval, 1.7-7.4), college education (odds ratio, 3.43, confidence interval, 2.0-5.6), fewer concerns about living donor kidney transplantation (odds ratio, 0.31; confidence interval, 0.2-0.6), and less favorable perceptions of their current health status (odds ratio, 4.31; confidence interval, 2.6-7.6). CONCLUSION: White race, more education, less concern about living donor kidney transplantation, and poorer perceived health are associated with greater willingness to talk to others about living kidney donation. These findings have important implications for educating patients about living donor kidney transplantation.     

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.     

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.     

Factors Associated With the Willingness of Clinical Health Care Professionals for Living Organ Donation

Understanding the attitudes and willingness in regard to living organ donation of health care professionals is important for clinical practice and needs to be addressed. Thus, the objective of this study was to examine willingness and its influencing factors in regard to living organ donation in clinical health care professionals.

The General Public''s Concerns about Clinical Risk in Live Kidney Donation

Difficulty in attracting live kidney donors may be related to fears regarding both the surgical procedure for kidney harvesting and future failure of the remaining kidney. We conducted a cross-sectional study of households in Maryland to identify public disincentives to living related kidney donation. In multivariate analyses, we assessed the independent effects of several factors on willingness to donate a kidney to a sibling. We also assessed thresholds for factors above which persons would not donate a kidney. Of 385 participants, 66% were extremely willing to donate to a sibling. After adjustment, those who considered the length of a hospital stay, out-of-pocket expenses, size and appearance of a scar, the time it takes to get to the transplant center, and the donor risk of developing kidney failure very important had 50-60% less odds of being extremely willing to donate. Median acceptable levels for risk of complications, hospital stay, compensated and uncompensated time from work, time requiring pain medications, and out-of-pocket expenses were greater than levels from clinical evidence regarding both laparoscopic and open nephrectomy. Unrealistic concerns among the general public regarding live donation may serve as potential disincentives to donation. Efforts to educate the public regarding live donation might help assuage fears and attract those who may not otherwise donate.     

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.     

Socio-personal factors influencing public attitude towards living donation in south-eastern Spain.

OBJECTIVES: Our aim was to determine public attitudes towards living donation compared with cadaveric donation, and to analyse psycho-social factors that may influence this attitude. 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.     

Attitude,Willingness, and Associated Factors in Organ Donation Among Health Professionals in Gondar,Northwest Ethiopia

BackgroundOrgan transplantation is considered one of the greatest advances of modern science, and it has given many patients a renewed lease on life. The demand for organs far exceeds the supply. Health professionals are fundamental in the process of organ procurement.ObjectiveTo assess the attitude, willingness, and associated factors in organ donation among health professionals of Gondar, Ethiopia.MethodsOur cross-sectional study was conducted among 382 randomly selected health professionals in Gondar using a self-administered questionnaire. Multivariable logistic regression analysis was applied to analyze the data.ResultsAmong health professionals, 79.1% had favorable attitude toward organ donation and 74.6% were willing to donate their organs. After adjusting for covariates, the odds of having a favorable attitude about organ donation were 3.2 and 11.9 times higher in the professions of laboratory technologists and medical doctors, respectively. By keeping all other variables constant, attitude was found to be positively associated with awareness (adjusted odds ratio [aOR] 12.74, 95% confidence interval [CI] 3.71-43.8) and being a member of the Red Cross Association (aOR 5.24, 95% CI 1.46-18.96). Willingness was positively associated with awareness (aOR 6.25, 95% CI 2.0-19.53), a member of the Red Cross Association (aOR 5.09, 95% CI 1.5-17.22), a laboratory technologist (aOR 3.57, 95% CI 1.37-9.29), and a medical doctor (aOR 6.52, 95 % CI 1.93-22.01).ConclusionsThe main findings indicated that the majority of health professionals in Gondar had a favorable attitude toward organ donation and were willing to donate their organs in times of need.     

Knowledge and willingness toward living organ donation: a survey of three universities in Changsha, Hunan Province, China

BACKGROUND: This study was conducted to clarify the knowledge and attitudes of Chinese university students regarding living organ donation and analyze the determinants impacting their decisions. METHODS: A questionnaire was delivered to college students chosen by random assignment. The data was analyzed by Statistics Package for Social Science (SPSS) software. RESULTS: Of 434 participants, 49.8% indicated they would be willing to be living organ donors, 58.4% believed living organ donation could ease the organ shortage, 48.2% thought that the recovery rate of recipients of living organ donors transplants was equal to or even better than deceased donation, 62.4% designated relatives as their most probable recipients, 48.0% argued that partial compensation was an effective method to increase live organ donation, and 53.7% wished to donate through transplantation centers. According to univariate analysis, attitudes regarding the value of life, relationship between body integrity and health as well as body integrity and conventional culture were factors that impacted on an individual's decision. Students' knowledge of the value of living organ transplantation and their economic background were considered to be determinants of individual willingness. Furthermore, the operation's impact on quality of life and postoperative complications were additional concerns. Multivariate analysis indicated that other factors influencing students' willingness to donate included attitudes toward the relationship between body integrity and health, beliefs regarding body integrity and conventional culture, value of living donor organ transplantation, economic background of students, and anxiety about the impact on postoperative complications. CONCLUSIONS: Numerous students were willing to participate in living organ donation. At the same time, social education and advertisements for living organ donation were far from adequate, having little or no influence on the decision-making process.     

Specific Unwillingness to Donate Eyes: The Impact of Disfigurement,Knowledge and Procurement on Corneal Donation

Although willingness, attitudes and beliefs surrounding solid‐organ donation have been extensively investigated, much less is known about corneal donation. Despite evidence that a substantial number of families who agree to multiorgan donation also specifically refuse corneal donation, it is unclear why this occurs and what can be done to increase rates of corneal donation. We conducted a survey of 371 Australian adults regarding their views on corneal donation. Although willingness to donate corneas generally reflected a person's willingness to donate all of one's organs, unwillingness to donate corneas appeared to be due to other factors. Specifically, decisions not to donate appear to be driven by a range of concerns surrounding disfigurement. The survey also provides eye banks with reassurance about the acceptability of whole globe procurement, and recognition that research into blindness is a highly valued part of corneal donation. Finally, the survey identifies that many individuals see benefit in having their family engaged in the decision‐making process, suggesting that decisions about donation are more complex than a simple appeal to the autonomy of the deceased.     

Deceased Donor Organs: What Can Be Done to Raise Donation Rates Using Evidence From Malaysia?

Organ donation rates have continued to fall seriously short of needs worldwide, with the lowest rates recorded among developing economies. This study seeks to analyze evidence from a developing economy to explore the usefulness of social psychological theory to solve the problem. The study deployed a large survey (n = 10 412) using a convenience sampling procedure targeted at increasing the number of Malaysians registered with the Ministry of Health, Malaysia who are willing to donate organs upon death. Structural equation modeling was deployed to estimate simultaneously the relative influence of cognitive and noncognitive variables on willingness to donate deceased organs. The cognitive factors of donation perception, socioeconomic status and financial incentives, and the noncognitive factors of demography and fear showed a high statistically significant (1%) relationship with willingness to donate organs after death. While financial incentives were significant, cash rewards showed the least impact. Donation perception showed the highest impact, which shows that the development of effective pedagogic programs with simultaneous improvements to the quality of services provided by medical personnel engaged in retrieving and transplanting deceased donor organs can help raise organ donation rates.     

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.     

The influence of socio-demographic factors, treatment perceptions and attitudes to living donation on willingness to consider living kidney donor among kidney transplant candidates.

BACKGROUND: Living donor, compared with cadaveric donor kidney transplantation, is associated with prolonged graft survival and increased life expectancy for patients with end-stage renal disease (ESRD). However, access to living donor transplantation remains variable. Our objective was to further our understanding of the factors associated with the willingness to consider living donor kidney transplant (LDKTx). METHODS: All patients from two tertiary care hospitals being assessed for a LDKTx (n = 81), and a random sample of patients on the waiting list for a cadaveric kidney transplant (CDKTx, n = 133) were invited to participate. A mail survey assessed participants' socio-demographic characteristics, and perceptions of dialysis, CDKTx and LDKTx. Multivariable logistic regression was used to assess the influence of these factors on willingness to consider LDKTx. RESULTS: Adjusting for patient age, employment status and number of close relatives, willingness to consider an LDKTx was independently associated with a lower perceived risk of peri-operative complications to the donor (adjusted OR 3.59, P = 0.02), the perception that the recipient would live longer following living donor transplantation (adjusted OR 4.34, P = 0.003) and greater perceived appropriateness of asking a family member to donate a kidney (adjusted OR 5.06, P = 0.007). CONCLUSION: Among the ESRD patients studied, adjusting for key factors that may be associated with access to LDKTx, perceptions about risks to the donor and benefits to the recipient were independently associated with a willingness to consider LDKTx as a treatment option. Provision of standardized comprehensible information about all treatment options to patients with ESRD may improve acceptance rates for living donor transplantation.     

Attitude of hospital personnel faced with living liver donation in a Spanish center with a living donor liver transplant program.

In Spain, despite its high rate of cadaveric donation, death while on the liver transplant waiting list is high. For this reason, living liver donation is being encouraged despite of the risk of morbidity for the donor. The objective of this study was to analyze attitudes toward living liver donation among hospital personnel in a hospital with a recently authorized living donor liver transplantation program. A random sample was taken and was stratified by type of service and job category (n = 1,262). Attitude was evaluated by means of a validated psychosocial questionnaire. The questionnaire was completed anonymously and was self-administered. Statistical analysis included the Student t test, the chi(2) test, and logistical regression analysis. The questionnaire completion rate was 93% (n = 1,168). Only 15% (n = 170) of respondents were in favor of living liver donation if it were unrelated. An additional 65% (n = 766) were in favor if this donation, but only for relatives. Of the rest, 9% (n = 107) did not agree with living liver donation, and the remaining 11% (n = 125) were undecided. The variables related to this attitude were age (P = 0.044); job category (P = 0.002); type of service (according to whether it is related to organ donation and transplantation) (P = 0.044); participation in prosocial activities (P = 0.026); attitude toward cadaveric organ donation (P <0.001); attitude of a respondent's partner toward organ donation (P = 0.010); a respondent's belief that in the future, he or she may need a transplant (P < 0.001); and a willingness to receive a donated living liver organ if one were needed (P < 0.001). There is also a close relationship between attitude toward living kidney donation and living liver donation (P < 0.001). In the multivariate analysis, the only common independent variable from the bivariate analysis was a willingness to receive a living donor liver transplant if one were needed (odds ratio = 9.3). Attitude toward living liver donation among hospital personnel in a hospital with a solid organ transplant program is favorable and is affected by factors related to cadaveric donation, altruistic activity, and feelings of reciprocity. Physicians and the youngest hospital workers are those who are most in favor, which leads us to think that there is a promising future for living liver transplantation, which is essential given the cadaveric organ deficit and the high mortality rate while on the waiting list.     

Potential living kidney donors' health education use and comfort with donation

CONTEXT: Much living kidney donation research focuses on actual donors rather than all donors who are evaluated by the transplant center. OBJECTIVE: To determine (1) what concerns and benefits potential donors saw possible from donation, (2) how they educated themselves before contacting the transplant center, and (3) who were the most comfortable donors. DESIGN: A telephone survey of 91 potential donors before transplant evaluation. SETTING: Barnes-Jewish Hospital Transplant Center in St Louis, Mo. MAIN OUTCOME MEASURES: Willingness and comfort donating, key concerns and perceived benefits to donation, hours of transplant-related education. RESULTS: On a 7-point scale, potential donors were very willing (mean=6.65, SD=0.95) and comfortable (mean=6.31, SD= 1.12) donating. They were most concerned that their recipients would die if they could not donate, the evaluation and surgery would be anxiety provoking or painful, and they did not understand what donation would require. Donors previously spent an average of 6 hours reading health resources and 32 hours discussing donation. Using logistic regression, those donors with 0 to 4 concerns (odds ratio=7.1, 95% confidence interval [CI], 2.2-23.16), more than 5 benefits (odds ratio=3.7, 95% CI, 1.2-11.0), and who were family members (odds ratio=4.7, 95% CI, 1.4-15.8) were more likely to be extremely comfortable donating compared to others. CONCLUSIONS: Before evaluation, most potential donors are willing to donate because they think that it is important to improve the health of a loved one. Their knowledge of donation varies and they need clear information about medical testing and support coping with any negative donation outcomes.     

Cornea recipients: are their opinions and attitudes toward organ donation different from those of the general population?

BACKGROUND: Cornea transplantation provides a second chance for people with poor visual function. Unfortunately, there is a major shortage of donor cornea tissue. The purpose of this study was to evaluate the attitudes and willingness to donate organs among cornea transplant recipients. METHODS: Sixty-eight patients who underwent cornea transplantation between January 2002 and May 2003 were asked to complete a questionnaire dealing with their attitudes toward cornea and organ donation, and willingness to donate an organ. RESULTS: Religion was a contributing factor for a negative decision to donate organs. Only 29% of participants, most of whom were nonreligious were carrying a signed donation card. Fifty-eight percent of the patients knew that the cornea graft is derived from a deceased person; most of these patients were of European or American origin. Seventy-three percent knew that donation requires the agreement of a family member. Age, gender, marital status, and education were not significantly associated with attitude toward donation. CONCLUSION: Stronger efforts are needed by transplant coordinators, physicians, and nurses to improve the education and knowledge of patients and their families about the basic aspects of transplantation. Greater public awareness may increase the willingness to donate organs.     

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.     

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.