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Attitudes and Behavior Toward Organ Donation in Greece

E. Georgiadou, N. Sounidakis, E. Mouloudi, P. Giaglis, T. Giasnetsova, K. Marmanidou,and N. Gritsi-Gerogianni

ABSTRACT

Introduction. During the two last decades remarkable progress has been made amongtransplantations in Greece. However, organ donation remains a controversial issue.Purpose. To explore and determine factors associated with differences in willingness todonate organs among Greeks.Methods. We administered a survey to 2263 adults living in the region of Thessaloniki.We studied the incidence of registered donors, their awareness on the subject of braindeath and organ donation, their willingness to donate and factors that influence donationof their own and their relatives organs, as well as their feelings about such a decision.Results. The respondents knew the significance of brain death and organ donation; 3.8%were already registered to be donors. Nearly half of them (48.3%) wanted to become adonor and 49.1% would donate organs of their relatives; 55.7% were afraid of theprocedure of organ removal to and 58.3% would feel guilt about gifting the organs of arelative. Women were more prone to become donors (odds ratio 1.95) and parents weremore likely to be registered as donors (odds ratio 1.84). About 63.7% of OrthodoxChristians wished to become donors. Professional and educational levels were notobserved to influence attitudes.Conclusions. Despite knowledge and willingness regarding organ donation, only a small

percentage of Greeks are actually registered to be donors.

DESPITE DRAMATIC ADVANCES in transplanta-tion over the last decades, thousands of people still

succumb a waiting an organ. The history of transplantationin Greece over 20 years includes the first kidney transplan-tation in 1985. The foundation of the national transplantorganization in 1999 boosted the number of transplanta-tions over the following years. The utilization of possibledonors in Greek intensive care units (ICUs) reached 64.5%in 2008.1 However, little is known about the attitudes and

ehavior of Greeks toward organ donation. This surveyought to record the knowledge and attitudes of the Greekopulation toward transplantation and organ donation. Itlso explored the relationship between gender, religion,ducation, occupation, and willingness to donate, seeking todentify populations that might be more likely to becomergan donors.

MATERIALS AND METHODS

The survey included 2263 adults who were residents of the city of

Thessaloniki. We excluded people younger than 18 years old,

0041-1345/12/$–see front matterhttp://dx.doi.org/10.1016/j.transproceed.2012.09.017

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health personnel, patients, and their relatives from the study. Toensure respondents privacy the study was voluntary and anonymousand there were no consent forms. Data collection lasted 6 months;all survey procedures were approved by our scientific committee.

People were informed about the survey by doctors and nursesworking in the ICU, the questionnaires were available uponrequest. We sought to gather information in three categories:knowledge and opinion regarding brain death and donation as wellas population demographics (Table 1).

Answers were recorded in a binary mode (yes/no); subjects whodid not answer a question were considered to be “not responders”for that question. Only completed answers were included in thestatistical analysis. Chi-square tests were used for categoricaldemographic variables. Univariate and multivariate logistic regres-sion analysis models assessed the relationships between gender,age, occupation, and willingness to donate. A two-tailed P value ofless than .05 was considered statistically significant. We also

From the Intensive Care Unit, University Hospital “Hippokra-tio,” Thessaloniki, Greece.

Address reprint requests to Eleni Mouloudi, MD, 85 Mantineas

Street, Thessaloniki, Greece 54248. E-mail: elmoulou@yahoo.gr

© 2012 by Elsevier Inc. All rights reserved.360 Park Avenue South, New York, NY 10010-1710

Transplantation Proceedings, 44, 2698–2701 (2012)

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ATTITUDES TOWARD DONATION IN GREECE 2699

calculated odds ratios (OR) and confidence intervals (CI). Descrip-tive and comparative analyses were performed using the StatisticalPackage for the Social Sciences (SPSS version 14, SPSS Inc, USA).

RESULTS

Of the 2300 people offered the survey, 2263 (98.4%)responded. A sample of the questionnaire and the percent-age of those who answered positively to the questions arepresented in Table 1 The study population characteristicsre shown in Table 2 All participants, regardless of genderr age, displayed a high level of knowledge of brain death89.7%), organ transplantation (97.7%) and their impor-ance (94.8%). Yet only 3.8% (86/2263) of responders werelready officially registered as donors before the survey.ifty-six of 86 (65.1%) were married (OR 1.8) and 5462.8%) had children (OR 1.8). Among the entire studyopulation, people under 30 years old were more likely toe registered as donors. Other factors seemed to have little

nfluence on the attitudes of those already registered asonors (Table 3).There were 1087 (48.03%) responders who expressed a

illingness to donate. Women (OR 1.95), people under 30ears old (OR 2.4), and parents (OR 1.2) were more proneo desire donation (table 4). Among Orthodox Christians3.7% would like to be organ donors.Almost half of the participants (49.1%) agreed to donate

he organs of their relatives. Approximately 1261 (55.7%)ould feel guilty about such a decision (46.6% in the groupf Orthodox Christians) and 58.3% expressed a fear abouthe procedure of organ removal.

Nearly all of the subjects cited more than one source ofnformation that influenced their attitude. The media70.6%) seemed to play the major role providing informa-

Table 1. The Structure of the Questionnaire Regarding OrganDonation and the Percentage of Positive Answers

Demographic dataAge______________________Sex (male/female)Occupation_________________Family status (married/single)Children (yes/no)Religion______________________Questionaire (% yes)1. Do you know what we call “brain death”? (89.7)2. Do you know what organ donation is? (99.7)3. Are you a registered organ donor? (3.7)4. Would you like to be an organ donor? (48.3)5. Do you think that organ donation can save lives? (94.8)6. Would you donate organs of a relative of yours? (49.1)7. Does the procedure of organ removal afraid you? (55.7)8. Would you feel guilt after the organ removal of a relative for

organ transplantation? (58.3)Your information about transplantation and organ donation comes

from: media/magazines/health personnel/otherThank you very much for your collaboration.I.C.U., “Hippokratio” General Hospital, Thessaloniki

ion about organ donation and transplantation, while mag-

zines (46.2%) and health personnel (33.6%) affected re-pondents behavior to a lesser extent.

DISCUSSION

Solid organ transplantation has rapidly developed into thetherapy of choice for end-stage organ failure.2 The expan-ion of its use has resulted in a large shortage of organupply. The current system is unable to meet the increasingemands; steps must be taken to augment the availability ofrgan for transplantation.3

The medicolegal criter for of brain death in Greece arestrict. The number of deceased donors per million popula-tion (dpmp) is among the lowest in the European Union(5.8–8.9), while Spain reaches 34.2 dpmp and the UnitedStates 26.2 dpmp.4,5 Moreover, registered donors are only0.83% of the total population while in the United Kingdom,

Table 2. Sample Population Characteristics

Total %

SexMen 1189 52.54Women 1066 47.10Not responders 8 0.36

Age range 18–83 years mean 36.4 years oldAge

�30 838 37.0330–40 637 28.1440–50 370 16.3550–60 227 10.0360–70 97 4.2970–80 49 2.16�80 12 0.53Not responders 33 1.47

Family statusMarried 1235 54.57Single 1011 44.68Not responders 17 0.75Parents 1132 50

OccupationPrivate sector employees 579 25.59Freelance 479 21.17Students 304 13.43Public sector 202 8.92University education 177 7.82Retired 135 5.97Household 88 3.89Catholic nuns 40 1.77Unemployed 33 1.45Farmers 29 1.29Not responders 197 8.70

ReligionOrthodox Christians 1580 69.81Protestants 234 10.34Catholics 224 9.90Jews 14 0.61Muslims 10 0.44Others—atheists 25 1.10

Not responders 176 7.80

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2700 GEORGIADOU, SOUNIDAKIS, MOULOUDI ET AL

it reaches 25%.6 In contrast, the waiting list includes 880atients number that is growing.1

The literature describes age, sex, religiosity, and lowconsent rate to affect the decisions of the general popula-tion to donate organs.6–12 Medical mistrust, ethnic differ-ences, and religious taboos seem to influence behaviortoward organ donation.7

Although a great part of our study population seemed tobe aware of brain death, organ donation and transplanta-tion; only 3.8% of the participants were registered donors.The majority of the willing cohort were people youngerthan 30 years old, married, and those with children.

A great deal of the published literature on willingness toagree to organ donation has focused primarily on demo-graphic predictors. Previous findings have indicated thatyounger rather than older people are more likely to bewilling to be potential donors, that women are more likelyto be willing, and that higher education and income wereassociated with donor willingness.10,11,13,14 Among our sam-ple, women and younger people were more likely to donatethan men or older people. Yet, higher education did notseem to influence peoples’ attitude toward organ donation.

Most of the religions worldwide favor organ transplanta-tion, highlighting the important role of religious institutionsin helping people to make the donation decision.5–21 TheGreek Orthodox Church does not object to procedures thatcontribute to the restoration of health, as long as donor’sfree will is respected.22 The present study revealed that63.7% of Greek Orthodox citizens would like to be regis-tered as donors. Among this cohort most Protestant andCatholic responders were financial immigrants from third-world countries. Thus, bias other than religion may affecttheir responses. Also, the sample size of Muslims and Jewswas too small to provide any stable reliable data.

Among our population sample 59.5% feared organ re-moval while 57.2% would have guilt if he or she gaveconsent to donate a loved one’s organs.

Finally, information about transplantation comes mostlyfrom the media (70.6%) and to a lesser degree from healthpersonnel, relatives, or friends. The latter may imply that a

Table 3. Factors That Influence Registered Donors

Factors OR 95% CI P Value

Sex (female/male) 1.022 0.664–1.574 .921Age groups (ys)

�30/30–40 1.283 0.432–1.404 .406�30/40–50 2.631 0.212–0.678 .001�30/50–60 1.119 0.362–2.207 .807�30/60–70 1.724 0.197–1.706 .323�30/70–80 3.623 0.092–0.832 .022�30/�80 LITTLE

SAMPLEccupation 0.962 0.878–1.054 .405amily statusMarried 1.549 0.986–2.453 .058Parents 1.848 1.168–2.925 .009

OR, odds ratio; CI, confidence interval.

ore active support for organ donation by religious andtate institution positively affect the future of transplanta-ions in Greece; but all these factors need further evalua-ion.2,6,23

ACKNOWLEDGMENTS

We thank Mr Efstratio Xatzixiro, General Coordinator of theGreek national transplant organization for the data regardingorgan donation and transplantation in Greece.

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Table 4. Factors Affecting Willingness to Donate Organs

Factors OR 95% CI P Value

Sex (female/male) 1.95 0.430–0.607 .0001Age group (y)

�30/30–40 1.575 1.274–1.946 .0001�30/40–50 2.217 0.344–0.592 .0001�30/50–60 1.472 0.493–0.935 .018�30/60–70 2.380 0.260–0.678 .0001�30/70–80 2.252 0.233–0.849 .014�30/�80 LITLLE

SAMPLEOccupation 1.035 0.930–1.002 .064Family status

Married 1.090 0.919–1.292 .325Parents 1.203 1.014–1.426 .034

OR, odds ratio; CI, confidence interval.

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ATTITUDES TOWARD DONATION IN GREECE 2701

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and policy on organ donation: a comparison between two urbantrauma centers in developed nations. J Trauma 54:995, 2003