- Email: [email protected]
Attitudes Toward Living Donation in the Bolivian Population Residing in Spain
Attitudes Toward Living Donation in the Bolivian Population Residing in Spain A. Riosa,*, A. Lopez-Navasa,b,c, P. Fernández-Olivaresc, L. Martinez-Alarcóna,b,d,e, M. Miklaa,f,g, G. Ramish, P. Ramireza,b,d,e, and P. Parrillab,d a International Collaborative Donor Project (“Projecto Collaborativo Internacional Donor”); bDepartment of Surgery, Paediatrics, Obstetrics and Gynaecology, University of Murcia; cDepartment of Psychology, Catholic University San Antonio, UCAM; dTransplant Unit, Surgery Service, IMIB - Clinical Hospital Universitario Virgen de la Arrixaca; eRegional Transplant Centre, Department of Health and Consumer Affairs in the Region of Murcia; fDepartment of Nursing, University of Murcia; gGeneral Hospital Universitario Reina Sofía; and h Faculty of Veterinary, University of Murcia, Murcia, Spain
ABSTRACT Introduction. Living donation is increasingly necessary to address the shortage of organs for transplantation. Analyzing attitudes and influences toward living donation is essential. This study sought to analyze the attitude toward living donation in the population of Bolivians residing in Spain, and the variables that influence their attitude. Material and Methods. We selected a sample of Bolivians living in Spain. Respondents were selected using a stratified sampling by age and sex. We used a validated questionnaire of psychosocial aspects (the questionnaire of Proyecto Colaborativo Internacional Donante about Living Kidney Donation [Donación de Vivo Renal in Spanish]), which is selfadministered and anonymous. The Student t test, c2, and Fisher tests, as well as logistic regression analysis, were used to analyze the gathered data. Results. Of all respondents (n ¼ 206), 83% (n ¼ 170) were in favor of living-related donation, and 32% (n ¼ 66) were in favor of living-unrelated donation. The rest, 8.5% (n ¼ 18) were not in favor of living donation and 8.5% (n ¼ 18) were undecided. Acceptance of the living donation was associated with the religious beliefs of the respondent (P ¼ .014), with no worry about the scars that may remain after the donation (P ¼ .016), and with the risk evaluation of living donation (P ¼ .029). On multivariate analysis, the most important variable was the risk associated with living donation (odds ratio, 6.329; 95% CI, 30.303e1.328; P ¼ .021). Conclusions. Attitudes toward living donation among the Bolivian population residing in Spain is favorable, and represents a group that may be encouraged to become donors.
O
RGAN DONATION FROM dead donors is insufficient to obtain optimal rates of transplants. Even in Spain, which has the highest rates of cadaveric donation, this source of organs is inadequate to meet the need [1]. One way to cover this deficit is to expand living donation; it is an ethically acceptable therapeutic optiondit is of low risk to the donor and has good clinical outcomes [2]. In both Europe and America, the notable increase in the immigrant population is creating a new social and demographic reality. In Spain, the population from Latin American is growing progressively given its similarities in culture, religion, and language, which facilitates their integration into society. Bolivian immigrants
represent a significant population in Spain. If we take into account that, in Spain, kidney donation focuses mainly on living donation, given the limited development of cadaveric donation [1], it is possible that this population will be in favor of living-related kidney donation, and therefore may be a group that the health care system can encourage to participate in living kidney donation. The aim of this study was to determine the attitude of the Bolivian population residing in *Address correspondence to Antonio Ríos Zambudio, Avenida de la Libertad n 208, Casillas, 30007, Murcia, Spain. E-mail: [email protected]
ª 2015 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
0041-1345/15 http://dx.doi.org/10.1016/j.transproceed.2015.10.011
Transplantation Proceedings, 47, 2597e2599 (2015)
2597
2598
Spain toward living donation and to analyze the variables that influence this attitude. MATERIAL AND METHODS Study Population We selected a sample of residents of the Bolivian population resident in Spain (n ¼ 206), stratified by age and sex.
Opinion Survey and Study Variables Attitude was assessed using a validated questionnaire of attitude toward Living Organ Donation and Transplantation [3e5] (the “PCID e DVR Rios: Questionnaire of Proyecto Colaborativo Internacional Donante about Living Kidney Donation [Donación de Vivo Renal in Spanish], which was developed by Ríos). This questionnaire includes questions on 3 subscales, validated in the Spanish population, presenting a total of 63.005% explained variance and reliability coefficient Cronbach’s alpha of 0.778. It was selfadministered and completed anonymously. The dependent variables analyzed were attitude toward related living donation.
Statistical Analysis We conducted a descriptive statistical analysis using the Student t test, c2 test, and logistic regression analysis.
RESULTS Attitude Toward Living Donation
Of the total of 206 respondents, 83% (n ¼ 170) were in favor of living-related donation and 32% (n ¼ 66) if it was unrelated. Of the rest, the 8.5% (n ¼ 18) were not in favor and 8.5% (n ¼ 18) were undecided. Factors Affecting Attitude Toward Living-Related Donation
Attitude toward the living donation was not associated with age (P ¼ .462), sex (P ¼ .549), marital status (P ¼ .834), having offspring (P ¼ .361), educational level (P ¼ .342) or with the having had personal experience with organ donation and transplantation (P ¼ .480), attitude toward cadaveric organ donation (P ¼ .180), and believing that the possibility of needing a transplant to oneself (P ¼ .116), or with having established a dialog at the family level on the topic of organ donation and transplantation (P ¼ .099), partner opinion toward organ donation and transplantation (P ¼ .460), and the realization of altruistic activities social by respondent (P ¼ .510). Religious factors did not influence respondent in attitude (P ¼ .694); however, there was objectively a more favorable attitude among those whose know that their religion has a favorable attitude toward organ donation. Thus, 94% of respondents who are religious and consider their religion as favorable toward donation favor donation, compared with 73% among those who believe their religion is against donation and 76% among those who are unaware the position of his or her religious belief (P ¼ .014). In terms of variables related to the attitude toward the body, there was a more favorable attitude among those for whom possible scars after donation are not a major concern (90% vs 67%; P ¼ .016). Those who believe
RIOS, LOPEZ-NAVAS, FERNÁNDEZ-OLIVARES ET AL
that living donation has little risk are more likely to be in favor of living donation compared with those who believe that it has a high risk (93% vs. 74%; P ¼ .029). On multivariate analysis, the most important variable is the consideration of risk for the donor living donation (odds ratio, 6.329; 95% CI, 30.303e1.328; P ¼ .021; Table 1). DISCUSSION
Given the shortage of organs for transplants, there is an increasing trend toward living donation, especially kidney [6]. However, in Spain the living donation rate has not experienced the increase that one might expect. There are several reasons, one of them is the great development of the cadaveric donation [1], and another is the idiosyncrasy of the Spanish patients on the waiting list. One of the main obstacles to this type of donation are the recipients themselves, who are accustomed to hear of the high rates of cadaveric donation, and refuse to accept a living donation from a family because they consider it a “mutilation,” when they could get it from a cadaveric donor [7]. In other countries, especially with rates of cadaveric donation lower than in Spain, this situation in totally different and rates for living donation are relatively high [1]. Thus, in most Latin American countries, kidney transplants are based on living donation. Therefore, it is important to look for groups of recipients who are more open to living donation [7]; in Spain, a target population is nonnative patients [4], including those of Latin American origin. Our data show that the Bolivian population is a subgroup favorable toward the living-related donation. Moreover, >30% are also in favor of living-unrelated kidney donation. Acceptance of living donation was greater than that described in Anglo-Saxons areas [8]. As noted in this study, in large part acceptance is a result of education; most respondents consider donation to carry little or no risk to health the donor’s health. In addition, the success of living donation is enhanced by the biologic relationship of the donor and recipient. In this population group, in which we analyzed factors that determine attitude toward living donation, there was not an objective relationship with cadaveric donation, a factor that normally has been described at the population level as a factor contributing to such an attitude [9e13]. Fear of mutilation or scarring after donation influenced negatively attitudes toward living donation. In this regard, it was Table 1. Multivariate Analysis of the Variables That Influence Attitude Toward Living Donation Among Bolivian Citizens Resident in Spain Assessment of the Risk of Living Donation
Much (n ¼ 57) Some (n ¼ 70) No (n ¼ 24) Doubts the risk (n ¼ 41)
Regression Standard Coefficient (b) Error
1.096 0.486 1.844
0.515 0.641 0.796
Odds Ratio (CI)
P
1 2.994 (8.196e1.091) .033 1.626 (5.714e0.463) .448 6.329 (30.303e1.328) .021
BOLIVIAN POPULATION RESIDING IN SPAIN
noted that currently in most centers renal extraction is performed laparoscopically with minimal scars and early discharge, which could reduce this concern. In conclusion, Bolivian people residing in Spain regard living organ donation favorably; therefore, patients awaiting transplantation who are from Bolivia are a groups receptive to living kidney donation. REFERENCES [1] Council of Europe. Internacional figures on donation and transplantation 2013. Newsletter Transplant 2014;19:1. [2] Sanner MA. The donation process of living kidney donors. Nephrol Dial Transplant 2005;20:1707e17. [3] Ríos A, Ramírez P, Rodríguez MM, et al. Attitude of ancillary personnel faced with living kidney donation in a hospital with a living donor kidney transplant program. Transplantation 2007;83: 336e40. [4] Ríos A, Martínez-Alarcón L, Sánchez J. 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. [5] Ríos A, Martinez L, Sánchez J, et al. Factors that influence the attitude of East European residents in Spain toward living kidney donation. Transplant Int 2009;22:707e16.
2599 [6] Davis CL. Living kidney donors: current state of affairs. Adv Chronic Kidney Dis 2009;16:242e9. [7] Martínez-Alarcón L, Ríos A, Conesa C, et al. Attitude of kidney patients on the transplant waiting list toward related living donation. A reason for the scarce development of living donation in Spain. Clin Transplant 2006;20:719e24. [8] Spital A. Public attitudes toward kidney donation by friends and altruistic strangers in the United States. Transplantation 2001;71:1061e4. [9] Ríos A, López-Navas A, Ayala-García MA, et al. Estudio multicéntrico hispano-latinoamericano de actitud hacia la donación de órganos entre profesionales de centros sanitarios hospitalarios. Cir Esp 2014;92:393e403. [10] Ríos A, Martínez L, Sánchez J, et al. German citizens in south-eastern Spain: a study of attitude toward organ donation. Clin Transplant 2010;24:349e57. [11] Ríos A, López A, Navalón JC, et al. The Latin-American population in Spain and organ donation. Attitude toward deceased organ donation and organ donation rates. Transplant Int 2015;28:437e47. [12] Ríos A, López A, Ayala MA, et al. Level of awareness of personnel in hospital services related to the donation process: a Spanish and Latin-American multicenter study. J Heart Lung Transplant 2012;31:850e7. [13] Ríos A, Cascales P, Martínez L, et al. Emigration from the British Isles to south-eastern Spain: a study of attitudes toward organ donation. Am J Transplant 2007;7:2020e30.
ABSTRACT Introduction. Living donation is increasingly necessary to address the shortage of organs for transplantation. Analyzing attitudes and influences toward living donation is essential. This study sought to analyze the attitude toward living donation in the population of Bolivians residing in Spain, and the variables that influence their attitude. Material and Methods. We selected a sample of Bolivians living in Spain. Respondents were selected using a stratified sampling by age and sex. We used a validated questionnaire of psychosocial aspects (the questionnaire of Proyecto Colaborativo Internacional Donante about Living Kidney Donation [Donación de Vivo Renal in Spanish]), which is selfadministered and anonymous. The Student t test, c2, and Fisher tests, as well as logistic regression analysis, were used to analyze the gathered data. Results. Of all respondents (n ¼ 206), 83% (n ¼ 170) were in favor of living-related donation, and 32% (n ¼ 66) were in favor of living-unrelated donation. The rest, 8.5% (n ¼ 18) were not in favor of living donation and 8.5% (n ¼ 18) were undecided. Acceptance of the living donation was associated with the religious beliefs of the respondent (P ¼ .014), with no worry about the scars that may remain after the donation (P ¼ .016), and with the risk evaluation of living donation (P ¼ .029). On multivariate analysis, the most important variable was the risk associated with living donation (odds ratio, 6.329; 95% CI, 30.303e1.328; P ¼ .021). Conclusions. Attitudes toward living donation among the Bolivian population residing in Spain is favorable, and represents a group that may be encouraged to become donors.
O
RGAN DONATION FROM dead donors is insufficient to obtain optimal rates of transplants. Even in Spain, which has the highest rates of cadaveric donation, this source of organs is inadequate to meet the need [1]. One way to cover this deficit is to expand living donation; it is an ethically acceptable therapeutic optiondit is of low risk to the donor and has good clinical outcomes [2]. In both Europe and America, the notable increase in the immigrant population is creating a new social and demographic reality. In Spain, the population from Latin American is growing progressively given its similarities in culture, religion, and language, which facilitates their integration into society. Bolivian immigrants
represent a significant population in Spain. If we take into account that, in Spain, kidney donation focuses mainly on living donation, given the limited development of cadaveric donation [1], it is possible that this population will be in favor of living-related kidney donation, and therefore may be a group that the health care system can encourage to participate in living kidney donation. The aim of this study was to determine the attitude of the Bolivian population residing in *Address correspondence to Antonio Ríos Zambudio, Avenida de la Libertad n 208, Casillas, 30007, Murcia, Spain. E-mail: [email protected]
ª 2015 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
0041-1345/15 http://dx.doi.org/10.1016/j.transproceed.2015.10.011
Transplantation Proceedings, 47, 2597e2599 (2015)
2597
2598
Spain toward living donation and to analyze the variables that influence this attitude. MATERIAL AND METHODS Study Population We selected a sample of residents of the Bolivian population resident in Spain (n ¼ 206), stratified by age and sex.
Opinion Survey and Study Variables Attitude was assessed using a validated questionnaire of attitude toward Living Organ Donation and Transplantation [3e5] (the “PCID e DVR Rios: Questionnaire of Proyecto Colaborativo Internacional Donante about Living Kidney Donation [Donación de Vivo Renal in Spanish], which was developed by Ríos). This questionnaire includes questions on 3 subscales, validated in the Spanish population, presenting a total of 63.005% explained variance and reliability coefficient Cronbach’s alpha of 0.778. It was selfadministered and completed anonymously. The dependent variables analyzed were attitude toward related living donation.
Statistical Analysis We conducted a descriptive statistical analysis using the Student t test, c2 test, and logistic regression analysis.
RESULTS Attitude Toward Living Donation
Of the total of 206 respondents, 83% (n ¼ 170) were in favor of living-related donation and 32% (n ¼ 66) if it was unrelated. Of the rest, the 8.5% (n ¼ 18) were not in favor and 8.5% (n ¼ 18) were undecided. Factors Affecting Attitude Toward Living-Related Donation
Attitude toward the living donation was not associated with age (P ¼ .462), sex (P ¼ .549), marital status (P ¼ .834), having offspring (P ¼ .361), educational level (P ¼ .342) or with the having had personal experience with organ donation and transplantation (P ¼ .480), attitude toward cadaveric organ donation (P ¼ .180), and believing that the possibility of needing a transplant to oneself (P ¼ .116), or with having established a dialog at the family level on the topic of organ donation and transplantation (P ¼ .099), partner opinion toward organ donation and transplantation (P ¼ .460), and the realization of altruistic activities social by respondent (P ¼ .510). Religious factors did not influence respondent in attitude (P ¼ .694); however, there was objectively a more favorable attitude among those whose know that their religion has a favorable attitude toward organ donation. Thus, 94% of respondents who are religious and consider their religion as favorable toward donation favor donation, compared with 73% among those who believe their religion is against donation and 76% among those who are unaware the position of his or her religious belief (P ¼ .014). In terms of variables related to the attitude toward the body, there was a more favorable attitude among those for whom possible scars after donation are not a major concern (90% vs 67%; P ¼ .016). Those who believe
RIOS, LOPEZ-NAVAS, FERNÁNDEZ-OLIVARES ET AL
that living donation has little risk are more likely to be in favor of living donation compared with those who believe that it has a high risk (93% vs. 74%; P ¼ .029). On multivariate analysis, the most important variable is the consideration of risk for the donor living donation (odds ratio, 6.329; 95% CI, 30.303e1.328; P ¼ .021; Table 1). DISCUSSION
Given the shortage of organs for transplants, there is an increasing trend toward living donation, especially kidney [6]. However, in Spain the living donation rate has not experienced the increase that one might expect. There are several reasons, one of them is the great development of the cadaveric donation [1], and another is the idiosyncrasy of the Spanish patients on the waiting list. One of the main obstacles to this type of donation are the recipients themselves, who are accustomed to hear of the high rates of cadaveric donation, and refuse to accept a living donation from a family because they consider it a “mutilation,” when they could get it from a cadaveric donor [7]. In other countries, especially with rates of cadaveric donation lower than in Spain, this situation in totally different and rates for living donation are relatively high [1]. Thus, in most Latin American countries, kidney transplants are based on living donation. Therefore, it is important to look for groups of recipients who are more open to living donation [7]; in Spain, a target population is nonnative patients [4], including those of Latin American origin. Our data show that the Bolivian population is a subgroup favorable toward the living-related donation. Moreover, >30% are also in favor of living-unrelated kidney donation. Acceptance of living donation was greater than that described in Anglo-Saxons areas [8]. As noted in this study, in large part acceptance is a result of education; most respondents consider donation to carry little or no risk to health the donor’s health. In addition, the success of living donation is enhanced by the biologic relationship of the donor and recipient. In this population group, in which we analyzed factors that determine attitude toward living donation, there was not an objective relationship with cadaveric donation, a factor that normally has been described at the population level as a factor contributing to such an attitude [9e13]. Fear of mutilation or scarring after donation influenced negatively attitudes toward living donation. In this regard, it was Table 1. Multivariate Analysis of the Variables That Influence Attitude Toward Living Donation Among Bolivian Citizens Resident in Spain Assessment of the Risk of Living Donation
Much (n ¼ 57) Some (n ¼ 70) No (n ¼ 24) Doubts the risk (n ¼ 41)
Regression Standard Coefficient (b) Error
1.096 0.486 1.844
0.515 0.641 0.796
Odds Ratio (CI)
P
1 2.994 (8.196e1.091) .033 1.626 (5.714e0.463) .448 6.329 (30.303e1.328) .021
BOLIVIAN POPULATION RESIDING IN SPAIN
noted that currently in most centers renal extraction is performed laparoscopically with minimal scars and early discharge, which could reduce this concern. In conclusion, Bolivian people residing in Spain regard living organ donation favorably; therefore, patients awaiting transplantation who are from Bolivia are a groups receptive to living kidney donation. REFERENCES [1] Council of Europe. Internacional figures on donation and transplantation 2013. Newsletter Transplant 2014;19:1. [2] Sanner MA. The donation process of living kidney donors. Nephrol Dial Transplant 2005;20:1707e17. [3] Ríos A, Ramírez P, Rodríguez MM, et al. Attitude of ancillary personnel faced with living kidney donation in a hospital with a living donor kidney transplant program. Transplantation 2007;83: 336e40. [4] Ríos A, Martínez-Alarcón L, Sánchez J. 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. [5] Ríos A, Martinez L, Sánchez J, et al. Factors that influence the attitude of East European residents in Spain toward living kidney donation. Transplant Int 2009;22:707e16.
2599 [6] Davis CL. Living kidney donors: current state of affairs. Adv Chronic Kidney Dis 2009;16:242e9. [7] Martínez-Alarcón L, Ríos A, Conesa C, et al. Attitude of kidney patients on the transplant waiting list toward related living donation. A reason for the scarce development of living donation in Spain. Clin Transplant 2006;20:719e24. [8] Spital A. Public attitudes toward kidney donation by friends and altruistic strangers in the United States. Transplantation 2001;71:1061e4. [9] Ríos A, López-Navas A, Ayala-García MA, et al. Estudio multicéntrico hispano-latinoamericano de actitud hacia la donación de órganos entre profesionales de centros sanitarios hospitalarios. Cir Esp 2014;92:393e403. [10] Ríos A, Martínez L, Sánchez J, et al. German citizens in south-eastern Spain: a study of attitude toward organ donation. Clin Transplant 2010;24:349e57. [11] Ríos A, López A, Navalón JC, et al. The Latin-American population in Spain and organ donation. Attitude toward deceased organ donation and organ donation rates. Transplant Int 2015;28:437e47. [12] Ríos A, López A, Ayala MA, et al. Level of awareness of personnel in hospital services related to the donation process: a Spanish and Latin-American multicenter study. J Heart Lung Transplant 2012;31:850e7. [13] Ríos A, Cascales P, Martínez L, et al. Emigration from the British Isles to south-eastern Spain: a study of attitudes toward organ donation. Am J Transplant 2007;7:2020e30.