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National Program Toward Improving Renal Health: Advancingrgan Donation Awareness

.D.B. Uriarte, M.L. Amarillo, R.S. Ampil, M.N.T. Manauis, the Philippine Information Agency,

.A. Danguilan, and E.T. Ona

ABSTRACT

Background. Despite the national advocacy campaign for kidney transplantation fromdeceased donors in the Philippines 96% of kidneys transplanted into 721 kidney transplantsfrom 1999 to 2001 came from living donors. A national survey on the knowledge, attitudes andperceptions of Filipinos on organ donation in 2001 showed factors that disadvantageddeceased organ donation to be poor understanding of “brain death,” religion, and fear of theoperation. These concerns were addressed and another survey was conducted in 2005.Objectives. To compare knowledge, attitudes, and perceptions of Filipinos on organdonation between 2001 and 2005, and compare the number of kidney transplants fromdeceased donors between 2001 until 2008.Methods. Two surveys in 15 regions of the Philippines were conducted using multistagesampling. Using a structured questionnaire there were 2000 respondents in 2001, and 2140in 2005. Analysis was performed using chi-square analysis.Results. The majority of respondents knew about kidney donation. Between 2001 and2005, there was increased awareness that transplants came from both living and deceaseddonors (37% to 41%) and a decline in those believing transplants came only from deceaseddonors (14% to 9%). Willingness to become a living (59% to 87%) or a deceased donor(35% to 49%) increased. The increase in transplantation from deceased donors from anaverage of 10 per year from 1999 to 2001 to 31 per year from 2006 to 2008.Conclusion. Increased awareness about kidney donation among Filipinos, improvedconsent to become an organ donor, and an increase in kidney transplantation from

deceased donors occurred from 2001 to 2008.

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EALTH STATISTICS show that renal diseases areamong the top ten causes of mortality in the Philip-

ines.1 Compared with other modalities of renal replace-ent therapy, transplantation clearly improves the quality

f life of patients with chronic kidney disease and confers aurvival benefit.2 With the continuous increase in number ofidney transplants in the Philippines (about 24% per year),idneys from living donors have remained the primaryonor source since 2000 (Table 1).The Renal Disease Control Program (REDCOP) of theational Kidney and Transplant Institute (NKTI) and thehilippine Information Agency, performed a nationwideurvey in 2001 to determine the knowledge, attitudes andractices of Filipinos on organ donation and to improve the

eceased donor advocacy program. A second survey in I

2010 by Elsevier Inc. All rights reserved.60 Park Avenue South, New York, NY 10010-1710

ransplantation Proceedings, 42, 121–123 (2010)

005, by the Institute of Clinical Epidemiology, Nationalnstitutes of Health, likewise examined whether the na-ional advocacy campaign on organ donation was effectiveo increase acceptance of deceased organ donation. The

From the Renal Disease Control Program (R.D.B.U., M.L.A.),ational Kidney and Transplant Institute; the Department oflinical Epidemiology, College of Medicine, University of thehilippines Manila; the Department of Adult Nephrology (R.S.A.,.A.D.), National Kidney and Transplant Institute; the Humanrgan Preservation Effort (M.N.T.M.), National Kidney and Trans-lant Institute; and the Department of Organ Transplantation

E.T.O.), National Kidney and Transplant Institute, Philippines.Address reprint requests to Romina A. Danguilan, MD, Depart-ent of Adult Nephrology, National Kidney and Transplant

nstitute, Philippines. E-mail: dromina@ymail.com

0041-1345/10/$–see front matterdoi:10.1016/j.transproceed.2009.11.025

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122 URIARTE, AMARILLO, AMPIL ET AL

dvocacy campaign included tri-media coverage, seminarso educate the general population as well as medical andon-medical professionals concerning kidney disease, trans-lantation, and organ donation. Herein we have comparedhe results of the 2 surveys and the number of transplantsrom deceased donors from 2001 to 2008.

ETHODS

wo nationwide surveys were conducted in 15 regions of thehilippines using multistage sampling. All regions in the Philip-ines were included with at least 2 cities or provinces selected astudy sites, except for 1 region that has peace and order problems.sing a face-to-face structured questionnaire. There were 2000

espondents interviewed in 2001, and 2140 in 2005. To select theespondents, the barangays of each province were grouped accord-ng to the National Statistics Coordination Board’s rural/urbanlassification of barangays, and from this list, sample barangaysere randomly chosen with probability proportional to its esti-ated size. A subsample of 7–12 households was randomly selected

rom each barangay through systematic sampling. We obtained aisting of all eligible household members aged 18–65 years in eachousehold and the sample respondent was chosen using Kishables.

The studies were approved by the Institutional Review Boardnd are in accordance with the Declaration of Helsinki. Analysissed tests for single proportion and chi square analyses. Theumber of transplants from deceased donors was obtained fromhe Philippine Renal Disease Registry.

ESULTS

he majority of respondents in both surveys were females;1% and 63%, respectively, and 23% were housewives.early half of them were between the ages of 18 and 35

ears; 69%–73% were married, and close to 90% werehristian. Educational attainment was high with �5%nschooled. Monthly income was �USD$212.00 for about0% of respondents.The majority of the respondents to both surveys knew

hat kidney donation could be performed in the Philippines.etween 2001 and 2005, there was increased awareness that

ransplants came from both living and deceased donors37%–41%) and a decline in those believing that trans-

Table 1. Number of New Kidney Transplants According toDonor Source

YearNumber of Transplants

From Living DonorsNumber of TransplantsFrom Deceased Donors

008 468 30007 483 29006 374 36005 598 13004 413 15003 413 7002 296 10001 253 6000 250 17999 189 6

lants came only from deceased donors (14%– 9%). There

as increased willingness to become a living (64%–87%) ordeceased donor (16%–78%).Impediments to donation in the first survey included a

ack of knowledge about which organs could be donated byliving and/or deceased donor, poor understanding of the

oncept of brain death, as respondents equated brain deatho cardiac death. Although most perceived that their reli-ion favored organ donation, those who disagreed believedhat it was bad to replace what God had given to a person.inally, respondents had fears about the process of donorephrectomy and its post-operative effects. There was a fearf causing pain, mutilation or disfigurement to the donor.In 2001, the consent for donation positively correlated

ith single civil status, higher educational attainment (highchool, college graduate, and vocational course graduates),nd higher monthly income (�USD$212 a month; Table 2).

The Philippine Renal Disease Registry reported an in-rease in transplantation from deceased donors, averaging0 per year from 1999 to 2001, 11 per year from 2002 to005, and 31 per year from 2006 to 2008 (Table 1).

ISCUSSION

lthough it has been established that organ donation isruly a gift of life,3 it is paradoxical that the public whoecognize that transplantation is an effective therapy do notxhibit an overwhelming willingness to donate their organsr those of a family member.4,5 The public are enthusiasticbout the idea of saving lives through transplantation butay not be comfortable with the idea of donation itself.6

ecause a major problem facing clinical transplantation ishe lack of deceased donor organs, successful strategieseed to be developed to increase the likelihood that familyembers will donate their loved one’s organs. A wide-

pread approach involves influencing the public’s decision-aking regarding organ donation.7

This is the first national survey looking at how Filipinosegard and support organ donation. From the first survey,he advocacy campaign was improved to educate the pop-lation about the types of transplantable organs, which

Table 2. Factors Affecting Willingness to Donate an Organ inthe 2001 Survey

Factor n Willing to Donate (%) P

arital status .004Single 501 68Married 1371 63Separated 20 60Widower 104 50

ducational attainment .01Grade school 168 55High school 469 63College 489 67Vocational 76 72onthly household Income .035�USD$212.00 807 60�USD$212.00 518 70

Variable income 39 51

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IMPROVING RENAL HEALTH 123

rgans could come from living, deceased or both types ofonors, the position of various religions on organ donation,nd a careful explanation of the process of donor retrieval,tressing that for deceased donors, no pain is felt with theperation. The concept of brain death is a more difficultubject, and still defined incorrectly in the 2005 survey.learly, the delineation of brain death and cardiac deatheeds careful explanation.There was an increase in the knowledge and willingness

o donate between 2001 and 2005, both as a living donornd as a deceased donor. Although the total number ofidney transplants from deceased donors continues toncrease, it still comprises only 7%.

The profile of people willing to become organ donors haseen established in the literature. Those who have signedonor cards were most likely young, educated, with a higherocioeconomic status.8,9 This profile was consistent with oururvey where a significant correlation was found betweenncreased consent to donation and being single, educated,nd earning a higher monthly income (P � .05; Table 2).

There is an indication that women are more likely to beilling to donate.8 Since the majority of respondents in both

urveys in our study were women, this may have beeneflected by the high consent rates.

Many persons have not seriously thought about organonation. This indicates a great need for education so thathose who are uncertain and unwilling to donate canecome willing donors through education. Discussion onhe meaning of brain death and exposure to successfulecipients may turn skeptics into believers.8,10 Mass mediand current advocacy campaigns have raised awarenessbout the need for organ donors. In the United States, thetrategy developed by the volunteer advertising agency,erry and Ketchum Advertising, New York, had a 3-armpproach: (1) educate the target by creating awareness ofhe pressing need for organ and tissue donation; (2) moti-ate the target to make a decision regarding organ andissue donation; and (3) inform the target of the importancef making their wishes known to a family member. Theyreated the phrase “Share your Life . . . Share your Deci-ion” with a corresponding logo in their campaign.5

Local agencies like the REDCOP and the Human Organ

reservation Effort of the NKTI, an office dedicated to

AT

romoting organ donation, should continue to strengthenheir educational campaigns and network with other agen-ies such as the Department of Education and Culture, toarry the information to more sectors of society, such astudents and teachers, since they are the most likely toonate.In conclusion, there was increased awareness among

ilipinos about kidney donation and increased consentates to become an organ donor, either living or deceased,etween 2001 and 2005. Being single, more educated, andaving higher income positively correlated with consent foronation. There was an increase in kidney transplantationrom deceased donors from 2001 to 2008.

EFERENCES

1. Ten leading causes of mortality. Philippine Health Statistics005 of the Department of Health.2. Philippine Renal Disease Registry: PRDR Annual Report.

hilippine Society of Nephrology and Renal Disease Controlrogram, National Kidney and Transplant Institute, Department ofealth, 20093. Klassen AC, Klassen DK: Who are the donors in organ

onation? The family’s perspective in mandated choice. Ann Interned 125:70, 19964. Manninen DL, Evans RW: Public attitudes and behavior

egarding organ donation. JAMA 253:3111, 19855. Wolf JS, Servino EM, Nathan HN: National strategy to

evelop public acceptance of organ and tissue donation. Transplantroc 29:1477, 19976. Smirnoff LA, Arnold RM, Caplan AL, et al: Public policy

overning organ and tissue procurement in the United States,esults from the National Organ and Tissue Procurement Study. 1

uly 1995. Volume 123 Issue 1. Pages 10–17.7. Guadagnoli E, Christiansen CL, DeJong W, et al: The

ublic’s willingness to discuss their preference for organ donationith family members. Clinical Transplant 13:342, 19998. Morgan S, Miller JK: Communicating About Gifts of Life:

he Effect of Knowledge, Attitudes, and Altruism on Behavior andehavioral Intentions Regarding Organ Donation. J Applied Com-unication Research 30:163, 20029. Pham H, Spigner C: Knowledge and opinions about organ

onation and transplantation among Vietnamese Americans ineattle, Washington: a pilot study. Clin Transplant 18:707, 200410. Joun P Coonan PR, LeGrande ME: Attitudes of Korean-

mericans in and around NY City toward organ transplantation.ransplant Proc 29:3751, 1997