- Email: [email protected]
Multivariate Analysis of Factors That Influence the Attitude of the Ecuadorian Population Resident in Spain Toward Living-Related Kidney Donation
Multivariate Analysis of Factors That Influence the Attitude of the Ecuadorian Population Resident in Spain Toward Living-Related Kidney Donation A. Ríosa,b,c,*, A.I. López-Navasa,d, Á. Sáncheza, M.A. Ayalaa,e, G. Garridof, M.J. Sebastiána,g, J. Flores-Medinad, L. Martinez-Alarcona,c, G. Ramisa,h, A.M. Hernándezi, P. Ramíreza,b,c, and P. Parrillaa,b,c a Proyecto Colaborativo Internacional Donante (International Collaborative Donor Project), Murcia, Spain; bDepartment of Surgery, Pediatrics, Obstetrics, and Gynecology, University of Murcia, Murcia, Spain; cTransplant Unit, Surgery Service, IMIBeHospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain; dDepartment of Psychology, Catholic University of Murcia, Murcia, Spain; eHospital Regional de Alta Especialidad del Bajío, León, Guanajuato, Mexico; fOrganización Nacional de Trasplantes, Madrid, Spain; g Coordinación de Trasplantes. UMAE Hospital de Especialidades No. 25 IMSS, Monterrey, México; hDepartment of Animal Production, Faculty of Veterinary Medicine, University of Murcia, Murcia, España; and iEndocrinology and Nutrition Service, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
ABSTRACT Background. The Ecuadorian population is the largest Latin-American immigrant group in Spain. Currently, several Ecuadorians have received transplants or are awaiting transplants in Spain. The aim of this work was to analyze the attitude toward living kidney donation among the Ecuadorian population residing in Spain. Methods. The population screened were born in Ecuador, residing in Spain, and >15 years old, stratified by gender and age, and appraised with the use of the questionnaire on attitude toward organ donation for transplantation “PCID-DVR-Ríos.” Support from immigration associations in Spain was used to advise on the location of potential respondents. The completion was anonymous and self-administered. Verbal consent was obtained. Statistics included Student t test, c2, Fisher exact test, and logistic regression analysis. Results. A total of 461 respondents were included: 80% (n ¼ 367) were in favor of livingrelated kidney donation (for a relative or close friend). This attitude was associated with psychosocial variables that persisted in the multivariate study: 1) female gender (odds ratio [OR], 3.086; P ¼ .001); 2) considering oneself a potential kidney receptor in the future (OR, 16.949; P ¼ .002); 3) economic incentive in the donation (OR, 100; P ¼ .004); and 4) knowing the attitude of their religion toward transplantation (OR, 32.258; P < .001). Conclusions. Living-related donation is accepted among the Ecuadorian population residing in Spain and is associated with sociopersonal and religious factors.
T
HE ECUADORIAN population is the most numerous Latin American immigrant group in Spain. Currently, several Ecuadorians have received transplants or are awaiting transplantation in Spain. Therefore, their involvement in donation is important, and thus the importance of knowing their predisposition to donate. Even in Spain, for example, where there is one of the highest rates of deceased donation, this type of donation is insufficient [1]. To reduce
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the deficit, living donation is being encouraged, given that it is an ethically acceptable therapeutic option owing to the low level of risk for the donor and the good clinical results
*Address correspondence to Dr Antonio Ríos Zambudio, Avenida de la Libertad n 208, Casillas, 30007 Murcia, Spain. E-mail: [email protected] or [email protected] ª 2017 Elsevier Inc. All rights reserved. 230 Park Avenue, New York, NY 10169
Transplantation Proceedings, 50, 366e369 (2018)
ECUADORIAN POPULATION IN SPAIN AND LRKD
achieved. However, despite an ongoing living donor program in most Spanish transplant centers and most health care professionals being in favor, currently this type of donation is very limited [1]. In addition, it has been seen that Spanish patients on the transplant wait list are unwilling to accept an organ from a family member because they believe that they will be able to obtain a deceased organ and thus avoid the mutilation of a loved one [2]. The objective of the present study was to analyze the attitude of the population of Ecuador immigrants in Spain toward living kidney donation (LKD) for transplantation. METHODS Population Screened The screened population were born in Ecuador and reside in Spain. To find out about the population with these characteristics, the last census of inhabitants from our community was used as a reference where there is a record of the legal population. In addition, there is a percentage of population of these nationalities that are not legal, and to estimate this number, several immigration associations were consulted to estimate the size of this group. Therefore, to the 216,474 Ecuadorian residents with legal documentation in Spain, we added those estimated by the associations, resulting in a total of 513,000 Ecuadorians living in Spain. The sample population was >15 years old and stratified by age and gender.
Appraisal Tool Attitude was assessed with the use of a validated questionnaire of attitude toward living kidney donation, the PCIDeDVR-Ríos (Proyecto Colaborativo Internacional Donante sobre Donación de Vivo Renal developed by Dr Ríos) [2e8]. This questionnaire included items distributed in 3 subscales of factors, and it was validated in the Spanish population, showing a total of explained variance of 63.203% and a Cronbach alpha reliability coefficient of 0.834.
Fieldwork Research A random selection of people to survey was based on stratification. Immigration associations in Spain advised on the location of potential respondents. The completion was anonymous and selfadministered. Verbal consent was requested to assist in the study.
Statistics Student t test, c2, Fisher exact test, and logistic regression analysis were applied.
RESULTS Attitude Toward Living Kidney Donation
A total of 461 respondents were included in the study: 80% (n ¼ 367) were in favor of living-related kidney donation (for a family member or close friend). This attitude was associated with different psychosocial variables. In the different groups of analyzed variables, statistically relevant results were observed. Among the sociopersonal variables, gender and marital status were significant, with women (84% vs 74%; P ¼ .007) and those who are married (84% vs 68%; P ¼ .021) having a more favorable attitude
367
toward LKD. Among the variables in knowledge and attitude toward organ donation and transplantation, the relationship between attitude toward LKD and attitude toward cadaveric organ donation (84% vs 73%; P ¼ .004) and having considered the possibility of needing a transplant compared with those who have not considered this option (92% vs 54%; P < .001) stood out. Regarding social variables, the favorable opinion of one’s partner toward donation and organ transplantation influenced attitudes toward LKD of the respondents compared with those who did not know the position of their partners (95% vs 80%; P ¼ .003). In religious variables, the fact that the respondent knew of the attitude in favor of their religion influenced the favorable attitude toward LKD (91% vs 58%; P < .001). Finally, among the body-related variables, those who were not concerned about the possible mutilation of the body after donation had a more favorable attitude toward LKD than those who were concerned about such treatment of the body (84% vs 72%; P ¼ .047) (Table 1). Multivariate Analysis
Persisting as independent variables were being female (OR, 2.427; P ¼ .006), favorable opinion of partner toward donation and transplantation (OR, 4.524; P ¼ .007), having considered the possibility of needing a transplant in the future (OR, 8.064; P ¼ .006), and knowing the favorable opinion of the religion one professes (OR, 16.666; P ¼ .001) (Table 1). DISCUSSION
There is currently a growing tendency toward LKD [1]. However, in Spain, owing to several factors, but mainly because of the great development in deceased donation, living donation is minimal. The persistently high number of kidney patients awaiting kidney transplants is making living donation a necessity, especially if we take into account the low risk from surgery in healthy donors and that the results are better than in deceased donation [9]. This situation is different from the position in countries where the organ donation rates are lower than the Spanish ones [1]. For instance, in most Latin American countries, the kidney transplant rate is sustained by living donation [10]. This complex situation is forcing us to search for those recipients who could be most in favor of living kidney donation [2]. Among these are patients who were not born in Spain [6e8]. Our data show that this is a population group with a favorable attitude toward living-related donation, with 80% in favor. Analysis of the factors affecting attitude toward LKD revealed a notable relationship with family influence: those respondents who had discussed the subject of organ donation with their partners were more in favor [3e8]. That is why it is important to discuss the subject of organ donation within the family, a fundamental fact in deceased donation, and, as we can see, important in living donation as well [11,12]. Another important factor is that the respondents’ religious activity did not affect attitude, but being aware of
368
RÍOS, LÓPEZ-NAVAS, SÁNCHEZ ET AL Table 1. Variables Affecting Attitude Toward Related Living Donation Bivariate Analysis In Favor (n ¼ 367; 80%)
Variable
Sociopersonal variables Age (32 8 y) e Gender Female Marriage status Married Children e Level of studies e Knowledge about and attitude toward organ donation and transplantation variables Personal experience with donation or transplantation e Attitude about cadaver organ donation In favor Possibility of needing a transplant in the future Yes Social interaction and prosocial behavior variables Discussed with family e Opinion of partner In favor Engages in prosocial behavior e Religious variables Professed religion e Knowledge of one’s religions’ attitude about transplantation In favor Attitude toward the body variables Preocupación por la mutilación tras la donación No Aceptación de la incineración e Valoración del riesgo de la donación de vivo e
Not in Favor (n ¼ 94; 20%)
e Male Separated/divorced/single e e e Against No e Don’t know e e Against Si e e
P Value
.385 .007 .021 .418 .633 .969 .004 <.001 .806 .003 .858 .215 <.001 .047 .442 .064
Multivariate Analysis Variable
Regression coefficient (b)
Gender Men (n ¼ 194) Women (n ¼ 267) Partner opinion about donation Not known (n ¼ 207) In favor (n ¼ 125) I have not got couple (n ¼ 65) Against (n ¼ 25) Possibility of needing a transplant in the future No (n ¼ 11) Yes (n ¼ 172) I don’t know (n ¼ 278) Knowing religion’s opinion Against (n ¼ 17) In favor (n ¼ 124) I don’t know it (n ¼ 285)
Standard Error
Odds Ratio (Confidence Interval)
P Value
0.886
0.325
1 2.427 (4.587e1.283)
.006
1.510 0.152 0.647
0.558 0.449 0.713
1 4.524 (13.513e1.517) 1.164 (2.808e0.482) 1.908 (7.751e0.471)
.007 .735 .365
2.084 1.247
0.756 0.705
1 8.064 (35.714e1.824) 3.484 (13.888e0.874)
.006 .077
2.814 1.252
0.831 0.668
1 16.666 (83.333e3.278) 3.496 (12.987e0.943)
.001 .061
the view of one’s religion toward organ donation and transplantation was important. This matters when it is time to promote living donation activity. In addition, taking advantage of the fact that contact is currently being made with religious authorities to promote deceased donation, this would be a beneficial promotional option. Moreover, this is an independent factor affecting attitude toward LKD to the extent that when a respondent believes that his or her religion is against it, their attitude is very negative about the matter, and if he or she believes that their religion has a positive view, his or her attitude is very positive [11e13]. In conclusion, we can say that living-related donation is very well accepted among the Ecuadorian population
resident in Spain and is associated with sociopersonal and religious factors.
REFERENCES [1] Council of Europe. International Figures on Donation and Transplantation 2015. Newsl Transplant 2016;16(21). [2] Martínez L, Ríos A, Conesa C, Alcaraz J, González MJ, Ramírez P, Parrilla P. Attitude of kidney patients on the transplant waiting list toward related living donation. Reason for the scarce development of living donation in Spain. Clin Transplant 2006;20: 719e24. [3] Ríos A, Ramírez P, del Mar Rodríguez M, Martínez L, Montoya MJ, Lucas D, et al. Attitude of ancillary personnel faced
ECUADORIAN POPULATION IN SPAIN AND LRKD with living kidney donation in a hospital with a living donor kidney transplant program. Transplantation 2007;83:336e40. [4] Ríos A, Ramírez P, Martínez L, García JA, Montoya MJ, Lucas D, Parrilla P. Attitude of personnel in hospital cadaveric organ transplanterelated units faced with living kidney donation in a hospital with a living kidney donor transplantation program. Nephron Clin Pract 2008;108:c75e82. [5] Ríos A, López-Navas A, Ayala-García MA, Sebastián MJ, Abdo-Cuza A, Martínez-Alarcón L, et al. A multicenter study in Spanish, Mexican and Cuban hospitals of attitude toward living kidney donation. Ann Transplant 2014;19:96e103. [6] Ríos A, Martinez L, Sánchez J, Jarvis N, Guzmán D, Parrilla P, Ramírez P. Factors that influence the attitude of East European residents in Spain toward living kidney donation. Transpl Int 2009;22:707e16. [7] Ríos A, López-Navas A, Martínez-Alarcón L, Sánchez J, Ramírez P, Parrilla P. Latin-Americans in Spain and their attitude toward living kidney donation. Clin Transplant 2015;29: 1054e62.
369 [8] Ríos A, Martínez-Alarcón L, Sánchez J, Jarvis N, Garcia JA, Rodríguez JM, et al. The quest for favourable subgroups to encourage living kidney donation in Spain. An attitudinal study among British and Irish citizens resident in southeastern Spain. Nephrol Dial Transplant 2008;23:1720e7. [9] Segev DL, Muzaale AD, Caffo BS, Mehta SH, Singer AL, Taranto SE, et al. Perioperative mortality and long-term survival following live kidney donation. JAMA 2010;303:959e66. [10] RedeConsejo Iberoamericano de Donación y Trasplante. Trasplante en Iberoamérica. Newsletter 2016;10(1). [11] Ríos A, López-Navas A, García JA, Garrido G, Ayala MA, Sebastián MJ, et al. The attitude of Latin American immigrants resident in Florida (USA) toward deceased organ donation. Transpl Int 2017;30:1020e31. [12] Ríos A, López A, López A, Gómez F, Iriarte J, Herruzo R, et al. A multicentre and stratified study of the attitude of medical students toward organ donation in Spain. Ethn Health 2017;30:1e19. [13] Ríos A. International Collaborative Donor Project. Cir Esp 2018;96:69e75.
ABSTRACT Background. The Ecuadorian population is the largest Latin-American immigrant group in Spain. Currently, several Ecuadorians have received transplants or are awaiting transplants in Spain. The aim of this work was to analyze the attitude toward living kidney donation among the Ecuadorian population residing in Spain. Methods. The population screened were born in Ecuador, residing in Spain, and >15 years old, stratified by gender and age, and appraised with the use of the questionnaire on attitude toward organ donation for transplantation “PCID-DVR-Ríos.” Support from immigration associations in Spain was used to advise on the location of potential respondents. The completion was anonymous and self-administered. Verbal consent was obtained. Statistics included Student t test, c2, Fisher exact test, and logistic regression analysis. Results. A total of 461 respondents were included: 80% (n ¼ 367) were in favor of livingrelated kidney donation (for a relative or close friend). This attitude was associated with psychosocial variables that persisted in the multivariate study: 1) female gender (odds ratio [OR], 3.086; P ¼ .001); 2) considering oneself a potential kidney receptor in the future (OR, 16.949; P ¼ .002); 3) economic incentive in the donation (OR, 100; P ¼ .004); and 4) knowing the attitude of their religion toward transplantation (OR, 32.258; P < .001). Conclusions. Living-related donation is accepted among the Ecuadorian population residing in Spain and is associated with sociopersonal and religious factors.
T
HE ECUADORIAN population is the most numerous Latin American immigrant group in Spain. Currently, several Ecuadorians have received transplants or are awaiting transplantation in Spain. Therefore, their involvement in donation is important, and thus the importance of knowing their predisposition to donate. Even in Spain, for example, where there is one of the highest rates of deceased donation, this type of donation is insufficient [1]. To reduce
0041-1345/18 https://doi.org/10.1016/j.transproceed.2017.11.067
366
the deficit, living donation is being encouraged, given that it is an ethically acceptable therapeutic option owing to the low level of risk for the donor and the good clinical results
*Address correspondence to Dr Antonio Ríos Zambudio, Avenida de la Libertad n 208, Casillas, 30007 Murcia, Spain. E-mail: [email protected] or [email protected] ª 2017 Elsevier Inc. All rights reserved. 230 Park Avenue, New York, NY 10169
Transplantation Proceedings, 50, 366e369 (2018)
ECUADORIAN POPULATION IN SPAIN AND LRKD
achieved. However, despite an ongoing living donor program in most Spanish transplant centers and most health care professionals being in favor, currently this type of donation is very limited [1]. In addition, it has been seen that Spanish patients on the transplant wait list are unwilling to accept an organ from a family member because they believe that they will be able to obtain a deceased organ and thus avoid the mutilation of a loved one [2]. The objective of the present study was to analyze the attitude of the population of Ecuador immigrants in Spain toward living kidney donation (LKD) for transplantation. METHODS Population Screened The screened population were born in Ecuador and reside in Spain. To find out about the population with these characteristics, the last census of inhabitants from our community was used as a reference where there is a record of the legal population. In addition, there is a percentage of population of these nationalities that are not legal, and to estimate this number, several immigration associations were consulted to estimate the size of this group. Therefore, to the 216,474 Ecuadorian residents with legal documentation in Spain, we added those estimated by the associations, resulting in a total of 513,000 Ecuadorians living in Spain. The sample population was >15 years old and stratified by age and gender.
Appraisal Tool Attitude was assessed with the use of a validated questionnaire of attitude toward living kidney donation, the PCIDeDVR-Ríos (Proyecto Colaborativo Internacional Donante sobre Donación de Vivo Renal developed by Dr Ríos) [2e8]. This questionnaire included items distributed in 3 subscales of factors, and it was validated in the Spanish population, showing a total of explained variance of 63.203% and a Cronbach alpha reliability coefficient of 0.834.
Fieldwork Research A random selection of people to survey was based on stratification. Immigration associations in Spain advised on the location of potential respondents. The completion was anonymous and selfadministered. Verbal consent was requested to assist in the study.
Statistics Student t test, c2, Fisher exact test, and logistic regression analysis were applied.
RESULTS Attitude Toward Living Kidney Donation
A total of 461 respondents were included in the study: 80% (n ¼ 367) were in favor of living-related kidney donation (for a family member or close friend). This attitude was associated with different psychosocial variables. In the different groups of analyzed variables, statistically relevant results were observed. Among the sociopersonal variables, gender and marital status were significant, with women (84% vs 74%; P ¼ .007) and those who are married (84% vs 68%; P ¼ .021) having a more favorable attitude
367
toward LKD. Among the variables in knowledge and attitude toward organ donation and transplantation, the relationship between attitude toward LKD and attitude toward cadaveric organ donation (84% vs 73%; P ¼ .004) and having considered the possibility of needing a transplant compared with those who have not considered this option (92% vs 54%; P < .001) stood out. Regarding social variables, the favorable opinion of one’s partner toward donation and organ transplantation influenced attitudes toward LKD of the respondents compared with those who did not know the position of their partners (95% vs 80%; P ¼ .003). In religious variables, the fact that the respondent knew of the attitude in favor of their religion influenced the favorable attitude toward LKD (91% vs 58%; P < .001). Finally, among the body-related variables, those who were not concerned about the possible mutilation of the body after donation had a more favorable attitude toward LKD than those who were concerned about such treatment of the body (84% vs 72%; P ¼ .047) (Table 1). Multivariate Analysis
Persisting as independent variables were being female (OR, 2.427; P ¼ .006), favorable opinion of partner toward donation and transplantation (OR, 4.524; P ¼ .007), having considered the possibility of needing a transplant in the future (OR, 8.064; P ¼ .006), and knowing the favorable opinion of the religion one professes (OR, 16.666; P ¼ .001) (Table 1). DISCUSSION
There is currently a growing tendency toward LKD [1]. However, in Spain, owing to several factors, but mainly because of the great development in deceased donation, living donation is minimal. The persistently high number of kidney patients awaiting kidney transplants is making living donation a necessity, especially if we take into account the low risk from surgery in healthy donors and that the results are better than in deceased donation [9]. This situation is different from the position in countries where the organ donation rates are lower than the Spanish ones [1]. For instance, in most Latin American countries, the kidney transplant rate is sustained by living donation [10]. This complex situation is forcing us to search for those recipients who could be most in favor of living kidney donation [2]. Among these are patients who were not born in Spain [6e8]. Our data show that this is a population group with a favorable attitude toward living-related donation, with 80% in favor. Analysis of the factors affecting attitude toward LKD revealed a notable relationship with family influence: those respondents who had discussed the subject of organ donation with their partners were more in favor [3e8]. That is why it is important to discuss the subject of organ donation within the family, a fundamental fact in deceased donation, and, as we can see, important in living donation as well [11,12]. Another important factor is that the respondents’ religious activity did not affect attitude, but being aware of
368
RÍOS, LÓPEZ-NAVAS, SÁNCHEZ ET AL Table 1. Variables Affecting Attitude Toward Related Living Donation Bivariate Analysis In Favor (n ¼ 367; 80%)
Variable
Sociopersonal variables Age (32 8 y) e Gender Female Marriage status Married Children e Level of studies e Knowledge about and attitude toward organ donation and transplantation variables Personal experience with donation or transplantation e Attitude about cadaver organ donation In favor Possibility of needing a transplant in the future Yes Social interaction and prosocial behavior variables Discussed with family e Opinion of partner In favor Engages in prosocial behavior e Religious variables Professed religion e Knowledge of one’s religions’ attitude about transplantation In favor Attitude toward the body variables Preocupación por la mutilación tras la donación No Aceptación de la incineración e Valoración del riesgo de la donación de vivo e
Not in Favor (n ¼ 94; 20%)
e Male Separated/divorced/single e e e Against No e Don’t know e e Against Si e e
P Value
.385 .007 .021 .418 .633 .969 .004 <.001 .806 .003 .858 .215 <.001 .047 .442 .064
Multivariate Analysis Variable
Regression coefficient (b)
Gender Men (n ¼ 194) Women (n ¼ 267) Partner opinion about donation Not known (n ¼ 207) In favor (n ¼ 125) I have not got couple (n ¼ 65) Against (n ¼ 25) Possibility of needing a transplant in the future No (n ¼ 11) Yes (n ¼ 172) I don’t know (n ¼ 278) Knowing religion’s opinion Against (n ¼ 17) In favor (n ¼ 124) I don’t know it (n ¼ 285)
Standard Error
Odds Ratio (Confidence Interval)
P Value
0.886
0.325
1 2.427 (4.587e1.283)
.006
1.510 0.152 0.647
0.558 0.449 0.713
1 4.524 (13.513e1.517) 1.164 (2.808e0.482) 1.908 (7.751e0.471)
.007 .735 .365
2.084 1.247
0.756 0.705
1 8.064 (35.714e1.824) 3.484 (13.888e0.874)
.006 .077
2.814 1.252
0.831 0.668
1 16.666 (83.333e3.278) 3.496 (12.987e0.943)
.001 .061
the view of one’s religion toward organ donation and transplantation was important. This matters when it is time to promote living donation activity. In addition, taking advantage of the fact that contact is currently being made with religious authorities to promote deceased donation, this would be a beneficial promotional option. Moreover, this is an independent factor affecting attitude toward LKD to the extent that when a respondent believes that his or her religion is against it, their attitude is very negative about the matter, and if he or she believes that their religion has a positive view, his or her attitude is very positive [11e13]. In conclusion, we can say that living-related donation is very well accepted among the Ecuadorian population
resident in Spain and is associated with sociopersonal and religious factors.
REFERENCES [1] Council of Europe. International Figures on Donation and Transplantation 2015. Newsl Transplant 2016;16(21). [2] Martínez L, Ríos A, Conesa C, Alcaraz J, González MJ, Ramírez P, Parrilla P. Attitude of kidney patients on the transplant waiting list toward related living donation. Reason for the scarce development of living donation in Spain. Clin Transplant 2006;20: 719e24. [3] Ríos A, Ramírez P, del Mar Rodríguez M, Martínez L, Montoya MJ, Lucas D, et al. Attitude of ancillary personnel faced
ECUADORIAN POPULATION IN SPAIN AND LRKD with living kidney donation in a hospital with a living donor kidney transplant program. Transplantation 2007;83:336e40. [4] Ríos A, Ramírez P, Martínez L, García JA, Montoya MJ, Lucas D, Parrilla P. Attitude of personnel in hospital cadaveric organ transplanterelated units faced with living kidney donation in a hospital with a living kidney donor transplantation program. Nephron Clin Pract 2008;108:c75e82. [5] Ríos A, López-Navas A, Ayala-García MA, Sebastián MJ, Abdo-Cuza A, Martínez-Alarcón L, et al. A multicenter study in Spanish, Mexican and Cuban hospitals of attitude toward living kidney donation. Ann Transplant 2014;19:96e103. [6] Ríos A, Martinez L, Sánchez J, Jarvis N, Guzmán D, Parrilla P, Ramírez P. Factors that influence the attitude of East European residents in Spain toward living kidney donation. Transpl Int 2009;22:707e16. [7] Ríos A, López-Navas A, Martínez-Alarcón L, Sánchez J, Ramírez P, Parrilla P. Latin-Americans in Spain and their attitude toward living kidney donation. Clin Transplant 2015;29: 1054e62.
369 [8] Ríos A, Martínez-Alarcón L, Sánchez J, Jarvis N, Garcia JA, Rodríguez JM, et al. The quest for favourable subgroups to encourage living kidney donation in Spain. An attitudinal study among British and Irish citizens resident in southeastern Spain. Nephrol Dial Transplant 2008;23:1720e7. [9] Segev DL, Muzaale AD, Caffo BS, Mehta SH, Singer AL, Taranto SE, et al. Perioperative mortality and long-term survival following live kidney donation. JAMA 2010;303:959e66. [10] RedeConsejo Iberoamericano de Donación y Trasplante. Trasplante en Iberoamérica. Newsletter 2016;10(1). [11] Ríos A, López-Navas A, García JA, Garrido G, Ayala MA, Sebastián MJ, et al. The attitude of Latin American immigrants resident in Florida (USA) toward deceased organ donation. Transpl Int 2017;30:1020e31. [12] Ríos A, López A, López A, Gómez F, Iriarte J, Herruzo R, et al. A multicentre and stratified study of the attitude of medical students toward organ donation in Spain. Ethn Health 2017;30:1e19. [13] Ríos A. International Collaborative Donor Project. Cir Esp 2018;96:69e75.