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Detection of targets for organ donation in Turkey
Detection of Targets for Organ Donation in Turkey N. Kec¸ecioglu, M. Tuncer, M. Sarikaya, G. Su¨leymanlar, F. Ersoy, M. Akaydin, and G. Yakupoglu
I
N TURKEY, positive public attitudes toward organ donation show increasing trends. This is due to both the growing number of candidates awaiting transplantation and improvement in graft and patient survival rates.1 Organ shortage, especially in developing countries, is one of the most critical problems faced by transplantation teams. Attitudes toward organ donation are affected by many factors such as education, socioeconomic status, culture, and religion. Motivation and education of the population is very important in countries like Turkey, where cadaveric transplantation is low.2 The aim of this study was to determine the weak points in our efforts and to detect the targets that would improve the rate of consent for organ donation.
SUBJECTS AND METHODS Six hundred ninety-five normal individuals (338 women, 357 men) who were admitted to Akdeniz University (Transplantation, Education, Research, and Application Center) for organ donation between October 1997 and April 1998 were included in the study. All were given a questionnaire to complete. The questionnaire required information regarding: 1. Age, gender, educational and marital status, and employment. 2. Reasons for organ donation. 3. Knowledge about organ transplantation. 4. Ways in which they gathered information regarding organ and tissue donation during their lives. 5. Ways in which they gathered information regarding how and where they could donate their organs. The answers to the questionnaires were registered in a data bank and all statistical analyses assessed using SPSS software. Categoric values were analyzed with chi-square test. P ⬍ .05 was considered significant.
RESULTS
Donor gender distribution was similar (48.6% women, 51.2% men, P ⫽ .791). Marital status was as follows: 6% widowed; 57.7% married; and 36.3% single. Educational status was proportional to organ donation. Education of donors was 43.7% university, 33.4% high school, 10.2% secondary school, 11.8% primary school, and 0.9% uneducated (Fig 1). Donor professions included 30.5% self-employed, 17.4% health-care personnel, 14.8% official, 13.7% housewives, 6.5% retired, and 5% students. Only 5.9% knew the number of organs that could be transplanted, and 8.1% knew of a patient who was waiting for an organ. Most donors
Fig 1.
Educational status of donors.
obtained information about transplantation from the media (51.4%), 24.6% during their education, and 0.6% held no information about transplantation (Fig 2). Most donors (82.2%) indicated that they decided to donate their organs to help humanity and 0.7% decided to donate their organs due to religious reasons.
Fig 2.
Information sources for organ donation.
From the Akdeniz University Transplantation Education, Research, and Application Center, Antalya, Turkey (N.K., G.N.); Akdeniz University Medical School, Department of Medicine, Antalya, Turkey (M.T., M.S., F.E.); and Akdeniz University Medical School, Department of General Surgery, Transplantation Education, Research, and Application Center, Antalya, Turkey (M.A., G.Y.). Address reprint requests to Dr Nilgu¨n Kec¸ecioglu, Akdeniz University Hospital, Transplantation Education, Research and Application Center, Arapsuyu, 07070 Antalya, Turkey. E-mail: [email protected].
© 1999 by Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010
0041-1345/99/$–see front matter PII S0041-1345(99)00828-3
Transplantation Proceedings, 31, 3373–3374 (1999)
3373
3374
DISCUSSION
In Turkey the first living related kidney transplantation was performed in 1975.2 The first cadaver donor kidney transplantation was performed 3 years later with an organ supplied by the Eurotransplant Foundation. After enactment of the law concerned with harvesting, storing, and transplanting organs and tissues, the first domestic cadaveric kidney transplantation was performed in 1979. In spite of the improvements in the graft and patient survival rates, the number of cadaveric organ transplants has not reached the desired level and the number of patients on the waiting list is increasing rapidly.3 Shortage of cadaveric organs for transplantation is a global problem.4. We believe that education and motivation of the population about organ transplantation and donation is as important as the legislative efforts involving harvesting, storing, and transplanting of organs and tissues; development of organized professional teams; and national and international coordination. In one study, public attitudes toward organ donation were investigated by survey in a Turkish community.5 The investigators suggested that the main reasons for refusal of organs donation are deficits in knowledge about transplantation and misinformation regarding organ donation. Similarly, in our study we found that most people who agreed to donate their organs are well educated. Results show that only 0.9% of were uneducated and only 0.6% had no information about transplantation. Our results also show that the population is not well informed about organ and
KEC¸ECIOGLU, TUNCER, SARIKAYA ET AL
tissue transplantation, and proper emphasis on the subject has not been presented in educational programs. In this respect, media and campaigns seem to be more effective than education in our population. In some studies, it has been suggested that Islamic opinion is strongly in favor of organ donation6; however, surveys in our country have shown that one of the main reason for refusal to donate organs is religious beliefs.5 Similarly, in this study, only 0.7% of subjects decided to donate their organs due to religious beliefs. In summary, our results show that the most important target must be to increase the educational status of the population. Education about organ transplantation must begin in primary school and our target group must be the students. Media and campaigns are important and powerful tools for motivating and informing the population about organ donation.
REFERENCES 1. Haberal M, Bilgin N, Arslan G, et al: Transplant Proc 30:683, 1998 2. Haberal M, Karakayali H, Bilgin N, et al: Transplant Proc 28:408, 1996 3. Light JA, Kowalski WO, Ritchie WO, et al: Transplant Proc 28:16, 1996 4. Evans RW, Orions CE, Ascher NL: JAMA 267:239, 1992 5. Bilgel H, Bilgel N, Okan N, et al: Transplant Int 4:243, 1991 6. Daar AS: Transplant Proc 23:2505, 1991
I
N TURKEY, positive public attitudes toward organ donation show increasing trends. This is due to both the growing number of candidates awaiting transplantation and improvement in graft and patient survival rates.1 Organ shortage, especially in developing countries, is one of the most critical problems faced by transplantation teams. Attitudes toward organ donation are affected by many factors such as education, socioeconomic status, culture, and religion. Motivation and education of the population is very important in countries like Turkey, where cadaveric transplantation is low.2 The aim of this study was to determine the weak points in our efforts and to detect the targets that would improve the rate of consent for organ donation.
SUBJECTS AND METHODS Six hundred ninety-five normal individuals (338 women, 357 men) who were admitted to Akdeniz University (Transplantation, Education, Research, and Application Center) for organ donation between October 1997 and April 1998 were included in the study. All were given a questionnaire to complete. The questionnaire required information regarding: 1. Age, gender, educational and marital status, and employment. 2. Reasons for organ donation. 3. Knowledge about organ transplantation. 4. Ways in which they gathered information regarding organ and tissue donation during their lives. 5. Ways in which they gathered information regarding how and where they could donate their organs. The answers to the questionnaires were registered in a data bank and all statistical analyses assessed using SPSS software. Categoric values were analyzed with chi-square test. P ⬍ .05 was considered significant.
RESULTS
Donor gender distribution was similar (48.6% women, 51.2% men, P ⫽ .791). Marital status was as follows: 6% widowed; 57.7% married; and 36.3% single. Educational status was proportional to organ donation. Education of donors was 43.7% university, 33.4% high school, 10.2% secondary school, 11.8% primary school, and 0.9% uneducated (Fig 1). Donor professions included 30.5% self-employed, 17.4% health-care personnel, 14.8% official, 13.7% housewives, 6.5% retired, and 5% students. Only 5.9% knew the number of organs that could be transplanted, and 8.1% knew of a patient who was waiting for an organ. Most donors
Fig 1.
Educational status of donors.
obtained information about transplantation from the media (51.4%), 24.6% during their education, and 0.6% held no information about transplantation (Fig 2). Most donors (82.2%) indicated that they decided to donate their organs to help humanity and 0.7% decided to donate their organs due to religious reasons.
Fig 2.
Information sources for organ donation.
From the Akdeniz University Transplantation Education, Research, and Application Center, Antalya, Turkey (N.K., G.N.); Akdeniz University Medical School, Department of Medicine, Antalya, Turkey (M.T., M.S., F.E.); and Akdeniz University Medical School, Department of General Surgery, Transplantation Education, Research, and Application Center, Antalya, Turkey (M.A., G.Y.). Address reprint requests to Dr Nilgu¨n Kec¸ecioglu, Akdeniz University Hospital, Transplantation Education, Research and Application Center, Arapsuyu, 07070 Antalya, Turkey. E-mail: [email protected].
© 1999 by Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010
0041-1345/99/$–see front matter PII S0041-1345(99)00828-3
Transplantation Proceedings, 31, 3373–3374 (1999)
3373
3374
DISCUSSION
In Turkey the first living related kidney transplantation was performed in 1975.2 The first cadaver donor kidney transplantation was performed 3 years later with an organ supplied by the Eurotransplant Foundation. After enactment of the law concerned with harvesting, storing, and transplanting organs and tissues, the first domestic cadaveric kidney transplantation was performed in 1979. In spite of the improvements in the graft and patient survival rates, the number of cadaveric organ transplants has not reached the desired level and the number of patients on the waiting list is increasing rapidly.3 Shortage of cadaveric organs for transplantation is a global problem.4. We believe that education and motivation of the population about organ transplantation and donation is as important as the legislative efforts involving harvesting, storing, and transplanting of organs and tissues; development of organized professional teams; and national and international coordination. In one study, public attitudes toward organ donation were investigated by survey in a Turkish community.5 The investigators suggested that the main reasons for refusal of organs donation are deficits in knowledge about transplantation and misinformation regarding organ donation. Similarly, in our study we found that most people who agreed to donate their organs are well educated. Results show that only 0.9% of were uneducated and only 0.6% had no information about transplantation. Our results also show that the population is not well informed about organ and
KEC¸ECIOGLU, TUNCER, SARIKAYA ET AL
tissue transplantation, and proper emphasis on the subject has not been presented in educational programs. In this respect, media and campaigns seem to be more effective than education in our population. In some studies, it has been suggested that Islamic opinion is strongly in favor of organ donation6; however, surveys in our country have shown that one of the main reason for refusal to donate organs is religious beliefs.5 Similarly, in this study, only 0.7% of subjects decided to donate their organs due to religious beliefs. In summary, our results show that the most important target must be to increase the educational status of the population. Education about organ transplantation must begin in primary school and our target group must be the students. Media and campaigns are important and powerful tools for motivating and informing the population about organ donation.
REFERENCES 1. Haberal M, Bilgin N, Arslan G, et al: Transplant Proc 30:683, 1998 2. Haberal M, Karakayali H, Bilgin N, et al: Transplant Proc 28:408, 1996 3. Light JA, Kowalski WO, Ritchie WO, et al: Transplant Proc 28:16, 1996 4. Evans RW, Orions CE, Ascher NL: JAMA 267:239, 1992 5. Bilgel H, Bilgel N, Okan N, et al: Transplant Int 4:243, 1991 6. Daar AS: Transplant Proc 23:2505, 1991