Attitudes Toward Live and Postmortem Kidney Donation: A Survey of Chinese Medical Students
Objectives: As the gap between supply and demand for donor organs is increasing, we sought to clarify the knowledge and attitudes regarding living-organ donation among Chinese medical students and analyze their incentives and influencing factors.
Materials and Methods: Data were collected from Chinese medical students using a standardized questionnaire.
Results: Of 320 surveyed participants, 261 participants (81.6%) said they would consider donating their live kidney organ, and 262 participants (81.9%) were willing to donate posthumously. Although 177 participants (55.7%) confirmed current regulations on posthumous organ donation, only 85 participants (26.7%) could correctly identify the regulations on live organ donation in China. Gender differences were not significantly associated with willingness to donate a kidney, whereas religion and socioeconomic status of the respondents were significantly associated with willingness to donate a live or posthumous kidney.
Conclusions: Among well-informed, young, healthy, and economically well-off Chinese male and female medical students, most were willing to be live kidney donors. Religion and socioeconomic status may affect the decision-making process for organ disposition.
Key words: Altruistic donation, Medical ethics, Organ donation, China
As transplant techniques and immunosuppressants advance, treating end-stage renal disease has improved.1,2 However, the gap between supply and demand of donor organs continues to widen. In China, more than 1 million patients are on the wait list for transplants, but only about 100 000 (10%) can receive a transplant annually. Most organ sources are from deceased donors, dependent upon the willingness of donation.3 Conversely, the sale of kidneys is prohibited in China and consequently, live kidney donation has been encouraged.4
With respect to the public in general, there is a lack of understanding of the meaning of “brain death,” and fear of surgery is disadvantageous to organ donation.5 Therefore, the attitudes of health care personnel toward organ donation are important for successful implementation of organ transplants. Previous studies have shown that health care workers are willing to be live-kidney donors.6 Apart from professional medical knowledge, many factors (eg, attitudes toward the value of life, body integrity, filial piety, and conventional culture) could affect an individual’s decision. In China, traditional Chinese culture, socioeconomic status, and “feudal superstitions” have hampered deceased- or living-donor organ donation.7 To effectively expand the pool of available kidneys, it is important that we explore the attitudes and willingness of living-kidney donation among the Chinese population. Identifying barriers to living donation allows us to take effective measures to educate potential donors. To address this issue, we conducted a survey study among Chinese medical students using a standardized questionnaire.
Materials and Methods
The survey was performed at Zhejiang University, Zhejiang Chinese Medical University, Hangzhou Teachers College, and their affiliated hospitals in Hangzhou City, where male and female medical students had clinical internships. The participants were young, well-educated, familiar with medical information, and healthy enough to be potential donors. The study was approved by the Ethical Review Committee of the institute, and all protocols conformed with the ethical guidelines of the 1975 Helsinki Declaration. Informed written consent was obtained from all subjects.
A 34-item standardized questionnaire was designed to survey the sociodemographic information, attitudes, and willingness of Chinese medical students regarding kidney donation. To examine the attitudes of men and women, the study population was subgrouped. The response rate was 93%.
The questionnaire was anonymously distributed to participants, and they were asked about (1) social/personal factors (eg, age, sex, marital status, having children, family income, and political status); (2) knowledge regarding organ donation and transplant (eg, previous experience of organ donation and transplant, knowledge about brain death, and a respondent’s belief that he or she might require a transplant in the future); (3) religious factors (eg, a respondent’s religion, and knowledge of the respondent’s religion regarding organ donation and transplant); (4) willingness to receive live- or deceased-donor kidney; (5) willingness to donate a kidney to a lover or a stranger; and (6) willingness to donate a living or posthumous kidney.
Of 320 surveyed participants, 137 were men (42.8%) and 140 (44%) were the only child in the family. Of all respondents, 111 participants (34.9%) were religious at different degrees (Table 1). A commensurate proportion of a low socioeconomic status (44.2%) and middle or high socioeconomic (43.1%) was observed. Of those responding, 177 participants (55.7%) confirmed that they knew the current regulations in China on posthumous organ donation, but only 85 participants (26.7%) could correctly identify the regulations on living-organ donation (Table 2).
Of 320 surveyed participants, 255 (79.9%) would prefer living-kidney for transplant, whereas only 37 participants (11.6%) could accept a kidney graft from a deceased donor. And 261 participants (81.6%) said they would consider donating their kidney while alive, and 262 participants (81.9%) would be willing to be posthumous donors (Table 2).
Although more women were willing to donate a living or posthumous kidney to a stranger (living, 18.7% vs 14.7%; posthumous, 69.2% vs 64.7%), no significant differences were found (Table 3), implying that gender was not associated with willingness to donate a living kidney.
A significant correlation between religion and willingness to donate a posthumous kidney to a stranger (P = .0054), as well as a statistically significant correlation between religion and willingness to donate a kidney to a loved one or a stranger was seen (P = .0207) (Table 4). This indicates that religious respondents have a significantly higher willingness to donate a posthumous kidney to a stranger or to a loved one or a stranger. Of the respondents, 178 (55.6%) were not the only child in the family. Additionally, medical students of low economic status were more willing to donate a kidney to a loved one compared with those of middle or high economic status (87.5% vs 79.9%); this was only marginally significant (χ2=2.895; P = .0888) (Table 5).
In our pilot cross-sectional study, the low rate of correctly identifying current regulations regarding organ donation among medical students reflects their lack of knowledge about legal facts of organ donation. Theoretically, these health care providers should have good knowledge of organ donation because they would be the primary intermediators in establishing a relationship between a potential donor and recipient. Their attitudes regarding organ donation also would influence a potential donor’s consent.
Although factors including younger age and a quality education may favor receptiveness to organ donation,7 our finding that a high rate of willingness was observed exceeded our initial expectation. However, in China, the rate of actual organ donation is lower, implying a gap between the individual’s attitude and behavior. Our preliminary data reflect the prima facie willingness and attitudes of medical students. Further study on the willingness to donate a kidney is important in practice.
In China low socioeconomic status was a predictor of a disposition to live kidney donation, as evidenced by a higher rate of willingness to donate among respondents from low-income families (Table 5). Similarly, this strong relation between socioeconomic background and willingness to donate a posthumous organ previously has been reported.8 In Spain, those surveyed participants with low socioeconomic level and high religious commitment were less likely to donate.9 Therefore, the reason should be investigated as to why low socioeconomic status Chinese medical students are inclined to altruistically donate an organ.
It is well-known that most religions may influence organ donation, although the attitudes including favor or opposition are not well-defined.10,11 With respect to certain religions, their beliefs are contrary to donation.12 The awareness of health care principle and the significance of organ donation should be notified to the followers by the religious authorities. Therefore, it is valuable to study the relation between religion and organ donation. Our findings revealed that among Chinese medical students, Buddhism and the Christian church are the primary religions (85.6%). A significant correlation was observed between religion and willingness to donate a posthumous kidney to a stranger (P = .0054) or to donate a kidney to a loved one or a stranger (P = .0207). This finding is different from published data from Western countries.10 As a multidimensional construct, the effect of religion on the willingness to donate an organ depends on how the construct is measured.12 Therefore, further in-depth research is required.
Although a kidney can be transplanted between the sexes, gender disparity in organ donation has been observed consistently. The characteristics of maternity force women to take more responsibilities for families. Women are more willing to donate their organs and to undergo the risks of surgery.13,14 However, most respondents (91.9%) in our study were unmarried and might have less experience in taking family responsibilities. Our present findings did not show any statistical differences in willingness of living or posthumous kidney donation among medical students.
Taken together, our findings show that well-informed, young, healthy, and socially well-off Chinese male/female medical students are mostly willing to be living kidney donors. Religion and socioeconomic status, rather than gender, may be important in the decision-making process for organ disposition.
Volume : 12
From the 1Hospital Administration Office, Second Affiliated
Hospital of School of Medicine, Zhejiang University, Hangzhou City, People's
Republic of China; the 2Department of Public Health, Charité
University Medicine, Campus Virchow, Berlin, Germany; and the 3Institute
of Biomedical Ethics, University of Zurich, Switzerland
Table 1. Demographic Data of the Patients
Table 2. Awareness of Legality of Living/Posthumous Organ Donation
Table 3. Attitudes of Female and Male Toward Organ Donation
Table 4. Attitudes of Religious and Nonreligious Respondents Toward Organ Donation
Table 5. Attitudes of Respondents With Different Economic Background Toward
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