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Evaluation of Attitudes Toward Living Organ Donation: A Multicenter Study of Compulsory Secondary School Education Teachers
Evaluation of Attitudes Toward Living Organ Donation: A Multicenter Study of Compulsory Secondary School Education Teachers A. Ríos, B. Febrero, L. Martínez-Alarcón, A. López-Navas, J. Sánchez, D. Guzmán, P. Ramírez, and P. Parrilla ABSTRACT Background. There is a considerable transplant organ deficit. To offset the organ shortage, living donation is being encouraged. Young persons form a sector of the population in whom early awareness is important to encourage favorable attitudes toward donation. Teachers play important roles in education and in generating attitudes. Purpose. We analyzed the attitudes of secondary school teachers toward living organ donation and sought to determine the psychosocial variables that affect these attitudes. Materials and methods. We randomly selected Teachers from 10 secondary schools in southeastern Spain. Their attitudes toward living donation were evaluated using a validated questionnaire, which was self-administered anonymously. The statistical tests were Student t test and the 2 test. Results. Regarding living kidney donation, 92% of teachers were in favor of related donation, decreasing to 16% when it was not from a related individual. In contrast, regarding related donations, 7% were not in favor, and 1% undecided. Teachers who had discussed the matter with their family and friends had more favorable attitudes (P ⬍ .05). In the case of living liver donations, 91% were in favor of related donation (falling to 20% if not related), 7% were not in favor, and 2% had doubts. Attitudes were more favorable among women, teachers with children, and those who had discussed the matter with their family and friends (P ⬍ .05). Conclusions. Teachers had favorable attitudes toward living related kidney or liver donation. Their students would receive positive information when they request relevant information. rgan transplantation is becoming more effective, offering an increasingly better quality of life.1 It is being limited only by the shortage of available organs.2 Increasing the number of transplantable organs requires action on many levels, both organizational and social.3,5 In addition, living donation is being encouraged, given that it is an ethically acceptable therapeutic option, owing to the low risk for the donor and its good clinical results, though the situation in living kidney donation differs from that of living liver donation.6,8 In this respect, young people constitute a sector of the population in whom awareness at an early age is important to encourage favorable attitudes and increase long-term donation rates. Teachers play an important part in the education of these young persons, consequently being important in the generation of their attitudes. The present study had the following objectives: 1) to analyze the attitudes of teachers of compulsory secondary education (CSE)
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in Spain toward living organ donation; and 2) to determine the psychosocial variables affecting these attitudes.
MATERIALS AND METHODS Study Population During the 2005–2006 academic year we studied a random representative sample (n ⫽ 327) of the population in the teaching sector in southeastern Spain, specifically secondary school teachers working in 90 state schools. Among these, we randomly selected 10 schools. From the Servicio de Cirugía General, Hospital Universitario Virgen de la Arrixaca, Murcia. Address reprint requests to Antonio Ríos Zambudio, Avd. de la Libertad 208, Casillas, 30007 Murcia, Spain. E-mail: ARZRIOS@ teleline.es
0041-1345/10/$–see front matter doi:10.1016/j.transproceed.2010.05.076
© 2010 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
3106
Transplantation Proceedings, 42, 3106 –3108 (2010)
HIGH SCHOOL TEACHERS’ ATTITUDES TOWARD LIVING ORGAN DONATION
Instrument for Measuring Attitude and Study Variables A meeting was set up in each school to present the study project. Once accepted, surveys were distributed in a general session to teachers in the selected schools. The instrument used to measure attitudes had 40 questions divided into categories, involving an exclusive or a multiple response option, based on surveys previously validated in the local area.8,13 This questionnaire was selfadministered and completed anonymously. The process was supervised by collaborators from the regional transplant team. The dependent variable was attitude toward the donation of one’s own kidney and liver organs while alive. The following independent variables were taken into account to determine the profile of the teacher: 1) sociopersonal factors; 2) general information; 3) knowledge about organ donation; 4) social interaction; 5) prosocial behavior; 6) religion; and 7) attitude toward the body after their own or a close family member’s death.
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women (95% vs 87%; P ⫽ .037) and among teachers with children (94% vs 84%; P ⫽ .005). No association was found with having a previous experience with the process, participation in prosocial activities, or religious variables. Twothirds (65%; n ⫽ 173) of teachers had discussed the question of organ donation and transplantation with their families. A more favorable attitude was found among those who had spoken with their family about the matter compared with those who had not (67% vs 16%; P ⫽ .005). A similar situation was seen when the subject had been discussed among friends, which had occurred in 63% (n ⫽ 168) of cases, where it was associated with a more favorable attitude compared with those who had not spoken with friends about the matter (66% vs 31%; P ⫽ .006). DISCUSSION
Statistical Analysis Data were analyzed with the SPSS statistical package (version 15.0). Descriptive statistical analysis used Student t test and 2 test complemented by an analysis of remainders.
RESULTS Attitude Toward Living Kidney Donation
Of the teachers interviewed, 92% (n ⫽ 244) were in favor of related living kidney donation and 16% (n ⫽ 43) in favor of unrelated kidney donation. Only 7% (n ⫽ 20) were against related living kidney donation, and 1% (n ⫽ 2) were undecided. In the case of being prepared to receive a living donated kidney if needed, 60% (n ⫽ 163) would accept one, 13% (n ⫽ 35) would not, and 27% (n ⫽ 73) were undecided. After analyzing attitudes toward living kidney donation, no relevant differences were found in sociopersonal factors, previous experience with the process, participation in prosocial activities, or religious factors. Two-thirds (65%; n ⫽ 172) of teachers had spoken about donation with their families. A more favorable attitude was noted among those who had talked about the subject with their family compared with those who had not done so (95% vs 80%; P ⫽ .002). Similarly, discussing the subject of donation with friends, which had occurred in 62% (n ⫽ 166) of cases, was associated with a more favorable attitude compared with those who had not (95% vs 86%; P ⫽ .03). A close association was noted between positive attitudes toward living kidney and toward living liver donation (P ⬍ .001). Attitude Toward Living Liver Donation
Most teachers (91%; n ⫽ 243) were in favor of related living liver donation, with the figure decreasing to 20% (n ⫽ 54) if it was not a related donor. Only 7% (n ⫽ 19) were not in favor of related living liver donation, and 2% (n ⫽ 5) had doubts. Some teachers (62%; n ⫽ 167) would accept a related living liver donation, whereas 11% (n ⫽ 31) would not, and 27% were undecided (n ⫽ 72). After analyzing the variables affecting attitudes toward living liver donation, no differences were noted according to age or marital status. However, more favorable attitudes were observed among
More than 90% of teaching personnel in secondary schools had positive attitudes toward living related donation for both kidney and liver transplantation. This was higher than the level observed in the general public9,14,15 and among most health care professionals.11,13,16,17 This observation is of great relevance given that teachers are an important source of information for students and that they may also influence their students. One of the roles played by the teacher is to act as an intermediary between pupils and the acquisition of information requested by the children. The favorable attitudes of this population group regarding both living kidney and living liver donation could have a considerable effect on the students, which could be positive for the future attitudes of young people. Regarding living unrelated donation, a favorable attitude ranged between 16% and 20%, findings that were similar to those described for the general public9,15 and among Spanish health care professionals.11–13 Despite the clear difference between kidney donation, which involves a low risk of morbidity and better transplant results compared with liver donation,18 a favorable attitude toward living related donation was similar for both kidney and liver donation. We observed few psychosocial variables that affected attitudes toward living related donation. It is clear that emotional factors had the main influence on attitudes toward this type of donation. If, on the other hand, we compare attitudes toward living donation with those toward deceased donation, they were higher in the former setting. Thus, a favorable attitude toward living donation was ⬎90% when the donation was related versus 75% for deceased donations.4,7,10 In conclusion, the attitudes of teachers toward living related organ donation, both kidney and liver, are important in the education of students, to provide positive information to a request for relevant information. REFERENCES 1. Mejías D, Ramírez P, Ríos A, et al: Recurrence of alcoholism and quality of life in patients with alcoholic cirrhosis following liver transplantation. Transplant Proc 31:2472, 1999
3108 2. Cantarovich F, Heguilén R, Filho MA, et al: An international opinion poll of well-educated people regarding awareness and feelings about organ donation for transplantation. Transpl Int 20:512, 2007 3. Conesa C, Ríos A, Ramírez P, et al: Estudio multivariante de los factores psicosociales que influyen en la actitud poblacional hacia la donación de órganos. Nefrología 25:684, 2005 4. Ríos A, Ramírez P, Martínez L, et al: Are personnel in transplant hospitals in favor of cadaveric organ donation? Multivariate attitudinal study in a hospital with a solid organ transplant program. Clin Transplant 20:743, 2006 5. Ríos A, Conesa C, Ramírez P, et al: What is the attitude of hospital personnel in transplant related services towards donation? J Heart Lung Transpl 25:972, 2006 6. Ratner LE, Rana A, Ratner ER, et al: The altruistic unbalanced paired kidney exchange: proof of concept and survey of potential donor and recipient attitudes. Transplantation 89:15, 2010 7. Mjøen G, Øyen O, Holdaas H, et al: Morbidity and mortality in 1022 consecutive living donor nephrectomies: benefits of a living donor registry. Transplantation 88:1273, 2009 8. Ríos A, Martínez-Alarcón L, Sánchez J, 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 23:1720, 2008 9. Conesa C, Ríos A, Ramírez P, et al: Socio-personal factors influencing public attitude towards living donation in south-eastern Spain. Nephrol Dial Transplant 19:2874, 2004 10. Conesa C, Ríos A, Ramírez P, et al: Attitude of primary care nurses toward living kidney donation. Transplant Proc 37:3626, 2005
RÍOS, FEBRERO, MARTÍNEZ-ALARCÓN ET AL 11. Ríos A, Ramírez P, Rodríguez MM, et al: Personnel in cadaveric organ transplant-related hospital units faced with living liver donation: an attitudinal study in a Spanish hospital with a cadaveric and living liver transplant programme. Liver Int 27:687, 2007 12. Ríos A, Ramírez P, Rodríguez MM, et al: Attitude of hospital personnel faced with living liver donation in a Spanish center with a living donor liver transplant program. Liver Transpl 13:1049, 2007 13. 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 83:36, 2007 14. 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 20:719, 2006 15. Martínez-Alarcón L, Ríos A, López MJ, et al: The attitude of future journalists toward living donation. Transplant Proc 41:2055, 2009 16. Ríos A, Ramírez P, Galindo PJ, et al: Primary health care personnel faced with cadaveric organ donation: a multicenter study in south-eastern Spain. Clin Transplant 22:657, 2008 17. Ríos A, Conesa C, Ramírez P, et al: Attitude toward deceased organ donation and transplantation among the workers in the surgical servicies in a hospital with a transplant program. Transplant Proc 37:3603, 2005 18. Parrilla P, Ramírez P, Ríos A: Manual sobre donación y trasplante de órganos. Arán Ed Cap 77:828, 2008
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in Spain toward living organ donation; and 2) to determine the psychosocial variables affecting these attitudes.
MATERIALS AND METHODS Study Population During the 2005–2006 academic year we studied a random representative sample (n ⫽ 327) of the population in the teaching sector in southeastern Spain, specifically secondary school teachers working in 90 state schools. Among these, we randomly selected 10 schools. From the Servicio de Cirugía General, Hospital Universitario Virgen de la Arrixaca, Murcia. Address reprint requests to Antonio Ríos Zambudio, Avd. de la Libertad 208, Casillas, 30007 Murcia, Spain. E-mail: ARZRIOS@ teleline.es
0041-1345/10/$–see front matter doi:10.1016/j.transproceed.2010.05.076
© 2010 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
3106
Transplantation Proceedings, 42, 3106 –3108 (2010)
HIGH SCHOOL TEACHERS’ ATTITUDES TOWARD LIVING ORGAN DONATION
Instrument for Measuring Attitude and Study Variables A meeting was set up in each school to present the study project. Once accepted, surveys were distributed in a general session to teachers in the selected schools. The instrument used to measure attitudes had 40 questions divided into categories, involving an exclusive or a multiple response option, based on surveys previously validated in the local area.8,13 This questionnaire was selfadministered and completed anonymously. The process was supervised by collaborators from the regional transplant team. The dependent variable was attitude toward the donation of one’s own kidney and liver organs while alive. The following independent variables were taken into account to determine the profile of the teacher: 1) sociopersonal factors; 2) general information; 3) knowledge about organ donation; 4) social interaction; 5) prosocial behavior; 6) religion; and 7) attitude toward the body after their own or a close family member’s death.
3107
women (95% vs 87%; P ⫽ .037) and among teachers with children (94% vs 84%; P ⫽ .005). No association was found with having a previous experience with the process, participation in prosocial activities, or religious variables. Twothirds (65%; n ⫽ 173) of teachers had discussed the question of organ donation and transplantation with their families. A more favorable attitude was found among those who had spoken with their family about the matter compared with those who had not (67% vs 16%; P ⫽ .005). A similar situation was seen when the subject had been discussed among friends, which had occurred in 63% (n ⫽ 168) of cases, where it was associated with a more favorable attitude compared with those who had not spoken with friends about the matter (66% vs 31%; P ⫽ .006). DISCUSSION
Statistical Analysis Data were analyzed with the SPSS statistical package (version 15.0). Descriptive statistical analysis used Student t test and 2 test complemented by an analysis of remainders.
RESULTS Attitude Toward Living Kidney Donation
Of the teachers interviewed, 92% (n ⫽ 244) were in favor of related living kidney donation and 16% (n ⫽ 43) in favor of unrelated kidney donation. Only 7% (n ⫽ 20) were against related living kidney donation, and 1% (n ⫽ 2) were undecided. In the case of being prepared to receive a living donated kidney if needed, 60% (n ⫽ 163) would accept one, 13% (n ⫽ 35) would not, and 27% (n ⫽ 73) were undecided. After analyzing attitudes toward living kidney donation, no relevant differences were found in sociopersonal factors, previous experience with the process, participation in prosocial activities, or religious factors. Two-thirds (65%; n ⫽ 172) of teachers had spoken about donation with their families. A more favorable attitude was noted among those who had talked about the subject with their family compared with those who had not done so (95% vs 80%; P ⫽ .002). Similarly, discussing the subject of donation with friends, which had occurred in 62% (n ⫽ 166) of cases, was associated with a more favorable attitude compared with those who had not (95% vs 86%; P ⫽ .03). A close association was noted between positive attitudes toward living kidney and toward living liver donation (P ⬍ .001). Attitude Toward Living Liver Donation
Most teachers (91%; n ⫽ 243) were in favor of related living liver donation, with the figure decreasing to 20% (n ⫽ 54) if it was not a related donor. Only 7% (n ⫽ 19) were not in favor of related living liver donation, and 2% (n ⫽ 5) had doubts. Some teachers (62%; n ⫽ 167) would accept a related living liver donation, whereas 11% (n ⫽ 31) would not, and 27% were undecided (n ⫽ 72). After analyzing the variables affecting attitudes toward living liver donation, no differences were noted according to age or marital status. However, more favorable attitudes were observed among
More than 90% of teaching personnel in secondary schools had positive attitudes toward living related donation for both kidney and liver transplantation. This was higher than the level observed in the general public9,14,15 and among most health care professionals.11,13,16,17 This observation is of great relevance given that teachers are an important source of information for students and that they may also influence their students. One of the roles played by the teacher is to act as an intermediary between pupils and the acquisition of information requested by the children. The favorable attitudes of this population group regarding both living kidney and living liver donation could have a considerable effect on the students, which could be positive for the future attitudes of young people. Regarding living unrelated donation, a favorable attitude ranged between 16% and 20%, findings that were similar to those described for the general public9,15 and among Spanish health care professionals.11–13 Despite the clear difference between kidney donation, which involves a low risk of morbidity and better transplant results compared with liver donation,18 a favorable attitude toward living related donation was similar for both kidney and liver donation. We observed few psychosocial variables that affected attitudes toward living related donation. It is clear that emotional factors had the main influence on attitudes toward this type of donation. If, on the other hand, we compare attitudes toward living donation with those toward deceased donation, they were higher in the former setting. Thus, a favorable attitude toward living donation was ⬎90% when the donation was related versus 75% for deceased donations.4,7,10 In conclusion, the attitudes of teachers toward living related organ donation, both kidney and liver, are important in the education of students, to provide positive information to a request for relevant information. REFERENCES 1. Mejías D, Ramírez P, Ríos A, et al: Recurrence of alcoholism and quality of life in patients with alcoholic cirrhosis following liver transplantation. Transplant Proc 31:2472, 1999
3108 2. Cantarovich F, Heguilén R, Filho MA, et al: An international opinion poll of well-educated people regarding awareness and feelings about organ donation for transplantation. Transpl Int 20:512, 2007 3. Conesa C, Ríos A, Ramírez P, et al: Estudio multivariante de los factores psicosociales que influyen en la actitud poblacional hacia la donación de órganos. Nefrología 25:684, 2005 4. Ríos A, Ramírez P, Martínez L, et al: Are personnel in transplant hospitals in favor of cadaveric organ donation? Multivariate attitudinal study in a hospital with a solid organ transplant program. Clin Transplant 20:743, 2006 5. Ríos A, Conesa C, Ramírez P, et al: What is the attitude of hospital personnel in transplant related services towards donation? J Heart Lung Transpl 25:972, 2006 6. Ratner LE, Rana A, Ratner ER, et al: The altruistic unbalanced paired kidney exchange: proof of concept and survey of potential donor and recipient attitudes. Transplantation 89:15, 2010 7. Mjøen G, Øyen O, Holdaas H, et al: Morbidity and mortality in 1022 consecutive living donor nephrectomies: benefits of a living donor registry. Transplantation 88:1273, 2009 8. Ríos A, Martínez-Alarcón L, Sánchez J, 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 23:1720, 2008 9. Conesa C, Ríos A, Ramírez P, et al: Socio-personal factors influencing public attitude towards living donation in south-eastern Spain. Nephrol Dial Transplant 19:2874, 2004 10. Conesa C, Ríos A, Ramírez P, et al: Attitude of primary care nurses toward living kidney donation. Transplant Proc 37:3626, 2005
RÍOS, FEBRERO, MARTÍNEZ-ALARCÓN ET AL 11. Ríos A, Ramírez P, Rodríguez MM, et al: Personnel in cadaveric organ transplant-related hospital units faced with living liver donation: an attitudinal study in a Spanish hospital with a cadaveric and living liver transplant programme. Liver Int 27:687, 2007 12. Ríos A, Ramírez P, Rodríguez MM, et al: Attitude of hospital personnel faced with living liver donation in a Spanish center with a living donor liver transplant program. Liver Transpl 13:1049, 2007 13. 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 83:36, 2007 14. 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 20:719, 2006 15. Martínez-Alarcón L, Ríos A, López MJ, et al: The attitude of future journalists toward living donation. Transplant Proc 41:2055, 2009 16. Ríos A, Ramírez P, Galindo PJ, et al: Primary health care personnel faced with cadaveric organ donation: a multicenter study in south-eastern Spain. Clin Transplant 22:657, 2008 17. Ríos A, Conesa C, Ramírez P, et al: Attitude toward deceased organ donation and transplantation among the workers in the surgical servicies in a hospital with a transplant program. Transplant Proc 37:3603, 2005 18. Parrilla P, Ramírez P, Ríos A: Manual sobre donación y trasplante de órganos. Arán Ed Cap 77:828, 2008