00000ctm a22000001a 4500 UP-1685523046125372808 Buklod 20230503092606.0 a r |||| u| ta 071031s xx d r |||| u| (iLib)UPMNL-00000051577 LG 995 2004 E6 C75 Crisostomo, Arlene Cabotaje- Kidney donation & transplantation attitudes, beliefs & intention to donate & receive among family members, caregivers or watchers of hemodialysis patients Arlene F. Cabotaje-Crisostomo. xix, 179 leaves. Vita Thesis (MS Clinical Epidemiology)-- University of the Philippines, Manila RATIONALE: Chronic kidney disease stage V, also known as End Stage Renal Disease is the tenth leading cause of mortality in the Philippines. The accepted best modality of treatment is kidney transplantation. However, a shortage of donors exists. A nationwide local survey on organ donation by the Renal Disease Program among the general population in the year 2000 revealed a 64 percent willingness to be an organ donor. However, in reality there is a great difficulty in convincing people to donate an organ and this reported willingness to donate is not clinically evident. It was recommended that people with higher propensity to be organ donors be prioritized and be considered as a primary target population for organ donation. No study has been done to determine their attitudes, beliefs, and behavioral intention to donate and receive a kidney. OBJECTIVES: To determine the attitudes and beliefs of family members, caregivers, or watchers of hemodialysis patients toward kidney donation and transplantation; and to determine the association between socio-demographic factors and behavioral intentions to donate and receive a kidney using a locally validated questionnaire. DESIGN: Cross-sectional study in two phases, developed and validation of the questionnaire and survey proper. SETTING: Private Outpatient hemodialysis clinic Quezon City, Metro Manila, Philippines. METHODS: The first phase involved a survey of out patient hemodialysis units in Quezon City and Manila, interviews of priests and imams, and the development and validation of the questionnaires with 40 respondents. In the second phase, 200 family members, caregivers, or watchers of hemodialysis patients were asked to complete the self-administered developed in Phase I. SAMPLING: In Phase II, respondents were recruited consecutively as their patients came in for hemodialysis. If the patient had more than one companion or watcher, the respondent was chosen as follows: family member was preferred over the caregiver or the caregiver over the watcher. And for family members, the following order was used: siblings preferred over the children, the children over the parents, the parents over cousins, cousins over uncles/aunts, uncles/aunts over nephews/nieces, nephews/nieces over the spouse. STATISTICAL ANALYSIS: The actual number of patients and percentage of patients for each religion were reported in Phase I. For Phase II, the socio-demographic profile of the subjects was described. Independent T-Test was used to compare the mean attitudes and beliefs of the participants between categorical binary factors. For qualitative factors having more than two categories, one-way Analysis of Variance (ANOVA) was used. For the quantitative factors such as age, duration of care, and annual household income, simple linear regression was used. Results of the above analysis were examined and factors to be included in the multiple linear regression analysis were determined. Multiple regression analysis was done to determine the patients' characteristics that are associated to one's tendency to donate or receive a kidney. All tests were don at a = 0.05, two-tailed. RESULTS: The final questionnaire had two scenarios. In scenario I, the respondent was asked if he/she would be willing to donate a kidney to his/her parent, sibling, child, or blood relative given the condition that his/her patient was fit to undergo the transplantation. In the second scenario, the respondent was asked to pretend that he/she had the end stage renal disease and needed the kidney transplant. There were 200 respondents for the final questionnaire, with mean age of 40.9 and a standard deviation of 14.2 years with a range of 18-75 years old; 68.5 percent were females; 62.5 percent were married; 75.5 were Roman Catholics. Majority of respondents (81.5%) were nuclear family members, and 50 percent were possible living related donors. Mean duration of care of patients was 28.7 and standard deviation of 34.0 months; 53.5 percent have had no job for more than six months; 55.5 percent had college or post-graduate education; and two-thirds earned less than Php139,000.00 a year. Majority (94.5% in Scenario I and 91.5% in Scenario II) believed that kidney transplantation gives life and is not a form of organ mutilation (84.5% in Scenario I and 81.7% in Scenario II). There was a remarkable degree of uncertainty regarding complications that may arise with the kidney donation and transplantation. Most of them believed that a kidney from a living related donor was better as compared with one from a living non-related donor or cadaver donor. More than half agreed that according to their religion, organ donation was a great service one can do; and were willing to donate a parent, sibling, child or blood relative. But fear of the surgical procedure made most of the respondents refuse to have a kidney transplant if the need to do so arises. Univariate analysis identified gender, civil status, involvement in one's religion, the relationship between the respondent and patient, kind and employment, education, influence the willingness to donate a kidney. While gender, the relationship between the respondent and patient, education, and annual household income were significant determinants in the willingness to receive a kidney. Multiple linear regression analysis revealed that the behavioral intention to donate a parent, sibling, child or blood relative was associated with: (1) religion, involvement in one's religion, relation to the patient, and sex. Such that a respondent who is a female (compared to male) and a Muslim compared to a Roman Catholic, has minimal involvement in his religion (member or attendee vs. leader), and has no blood relation with the patient (care giver vs. nuclear family member), is less likely to donate a kidney to a parent, sibling, child, or blood relative. While the behavioral intention to receive a kidney was associated with relation to the patient, involvement in one's religion, and education. If the respondent had no blood relation with the patient or had a lesser degree of consanguinity with the patient (care giver, watcher, or extended family member vs. nuclear family member), and was less involved in his or her religion (member vs. leader), that respondent was less likely to accept a kidney. But a higher level of education (college or post graduate level compared to an elementary level) gave a tendency for one to be willing to undergo a kidney transplant. CONCLUSION: Our study showed that The Roman Catholic church and Islam were in favor of kidney donation and transplantation. Both religions were against the sale of organs and having brokers interfere with organ donation arrangements. The respondents generally believe that kidney transplantation would benefit their patients and was not a form of organ mutilation. Most of them (70.5%) were willing to donate their kidney to a parent, sibling, child, or blood relative. Their preference was as a living related donor in 70.5 percent and cadaver donor in 54.5 percent. Furthermore, multiple linear regression analysis showed that there was less of a tendency to donate a kidney for a parent, sibling, or child when: (1) there was not blood relation between the respondent and the patient (care giver vs. nuclear family member); (2) less involvement in one's religion (member vs. leader). But, there was a greater tendency to be willing to undergo a kidney transplant if one had a higher level of education (college or post graduate vs. elementary education). However, there was widespread uncertainty regarding kidney donation and transplantation. New strategies have to be don to clarity issues, and encourage kidney donation and transplantation. Kidney Transplantation. UPMNL MED LG 995 2004 E6 C75 Thesis