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Saudi Journal of Kidney Diseases and Transplantation
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RENAL DATA FROM ASIA - AFRICA  
Year : 2016  |  Volume : 27  |  Issue : 1  |  Page : 118-124
Knowledge, attitudes and beliefs of first-degree relatives of patients with chronic kidney disease toward kidney donation in Nigeria


1 Department of Medicine, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
2 Department of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria

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Date of Web Publication15-Jan-2016
 

   Abstract 

In most parts of Sub-Saharan Africa, kidney transplant programs are dependent on the willingness of relatives of patients with kidney failure to donate kidneys. This study assessed the attitudes of relatives of patients with chronic kidney disease (CKD) toward kidney donation. This was a cross-sectional survey of relatives of patients with CKD attending the nephrology service of our hospital. The respondents' socio-demographic characteristics and knowledge and beliefs about kidney transplantation, as well as their willingness to donate a kidney, were assessed using a self-administered questionnaire. There were 161 respondents who returned completed questionnaires; the mean age of the respondents was 34.8 ± 12.6 years and 52.2% of them were female. About 85.1% of the respondents were aware that kidney transplantation was a treatment option for end-stage renal failure, while 70% of them believed that kidney transplantation resulted in an improvement in the quality of life of these patients. However, 25.5% of the respondents believed that kidney donors were at risk of developing kidney failure in the future. Overall, 77.6% of the respondents were willing to donate a kidney, especially if the affected individual was their offspring. The majority of the respondents were willing to donate a kidney to a relative with CKD.

How to cite this article:
Bello BT, Raji YR. Knowledge, attitudes and beliefs of first-degree relatives of patients with chronic kidney disease toward kidney donation in Nigeria. Saudi J Kidney Dis Transpl 2016;27:118-24

How to cite this URL:
Bello BT, Raji YR. Knowledge, attitudes and beliefs of first-degree relatives of patients with chronic kidney disease toward kidney donation in Nigeria. Saudi J Kidney Dis Transpl [serial online] 2016 [cited 2019 Nov 20];27:118-24. Available from: http://www.sjkdt.org/text.asp?2016/27/1/118/174141

   Introduction Top


The incidence of end-stage renal disease (ESRD) worldwide is rising and kidney transplantation remains the best treatment option for it. [1],[2],[3],[4] However, donor kidneys for transplantation are scarce. The use of deceased donor kidneys has significantly increased the number of transplanted patients in countries where this practice is being carried out. In Sub-Saharan Africa, kidney transplantation is available in only a few countries, the donors most often being relatives of the recipient. [5],[6]

Kidney transplantation has been available in Nigeria for about 13 years; however, all the transplanted kidneys were from living donors because the enabling legal and ethical frameworks for the practice of deceased kidney donation are non-existent. [7],[8],[9],[10]

Because the willingness to donate a kidney is to some extent dependent on the knowledge, attitude and cultural values of the potential kidney donors, [11] assessing these characteristic in first-degree relatives (FDRs) of patients with chronic kidney disease (CKD) may reveal information about the likelihood that this group of individuals would be willing to donate their kidneys.

The aim of this study was to assess the knowledge, attitude and awareness of the relatives of patients with ESRD and their willingness to serve as kidney donors in our population.


   Subjects and Methods Top


This was a cross-sectional, descriptive survey of FDRs of patients with CKD who were attending the adult nephrology outpatient service of our teaching hospital located in Lagos, South-west Nigeria. Individuals were recruited into the study if they were parents, siblings or off-spring of patients with CKD, were 18 years of age or older and consented to participate in the study. The study protocol was approved by the health research and ethics committee of the hospital.

Information was obtained from the study participants using a structured questionnaire. The questionnaire was designed to retrieve information regarding the socio-demographic characteristics, level of education, knowledge about kidney transplantation and source of this knowledge as well as willingness to donate a kidney. It was pre-tested on 20 patients with hypertension who were attending the general out-patient clinic of our hospital to ensure reproducibility of the responses.

The study was carried out over a six-month period. During the first month, the names, ages and contact phone numbers of relatives of patients with CKD were retrieved from a database. This database had been generated as part of an earlier study investigating the prevalence of albuminuria and reduced glomerular filtration rate in FDRs of patients with CKD. Over the next one month, the relatives were contacted twice via phone. During the first contact, the nature and aims of the study were discussed, they were informed that their responses would be confidential and they were assured that refusal to participate in the study would in no way affect the quality of care for their relatives. They were then given a twoweek period to decide whether they would be willing to participate in the study. Two weeks after the initial contact, they were contacted again by phone. During this contact, they were asked specifically if they would be willing to participate in the study. Individuals who consented to participate in the study were then asked if they would prefer to receive the study questionnaire by electronic mail or surface mail or would want to physically visit the hospital to complete the study questionnaire.

Over the subsequent month, the study questionnaires were sent out to the consenting relatives and the completed questionnaires were returned to the researchers not later than three months after they were sent out. Questionnaires not received by this time were excluded from the data analysis.


   Statistical analysis Top


Data obtained from the study participants were analyzed using the Epi Info statistical software version 3.5.3. Continuous variables were presented as means and standard deviations while categorical variables were presented as proportions.


   Results Top


Two hundred and seventy relatives were contacted about participation in the study. Of these, 210 (77.8%) participants consented to participate in the study and were sent questionnaires. Of the questionnaires sent, 161 questionnaires were returned as at the time of the deadline of the study, resulting in a response rate of 76.7%. The mean age of the respondents was 34.8 ± 3 years, with an age range of 18-80 years, and 84 (52.2%) of the respondents were female. The majority of the respondents were offspring of patients with CKD. [Figure 1] shows the highest level of formal education attained by the respondents.
Figure 1: Highest level of formal education attained by the study respondents.

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[Table 1] shows the response of the study participants to specific questions about kidney transplantation. Television and radio programs as well as newspaper articles were the most common sources of information about kidney transplant for the respondents, with >50% of the respondents receiving their information about kidney transplantation via the mass media compared with 32.3% who received the information from a healthcare practitioner [Figure 2].
Figure 2: Source of respondents' information about kidney transplantation.

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Table 1: Response of the study participants to specific questions about kidney transplantation.

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Overall, 125 (77.6%) of the respondents were willing to donate a kidney to someone with kidney failure. [Figure 3] shows the willingness of the respondents to donate a kidney to different groups of individuals. Respondents were far more likely to be willing to donate a kidney to a FDR or spouse with kidney failure than they were to a non-relative; 75.2% of them were willing to donate to an offspring versus 24.8% willing to donate to a nonrelative.
Figure 3: Willingness of the respondents to donate a kidney to different groups of individuals.

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   Discussion Top


The FDRs of patients with CKD who participated in this study were young with a mean age of 34.8 years and >60% of them were highly educated, having attained at least a tertiary level education. Nearly half of them were adult children of patients with CKD. Overall, there was a slight female preponderance among the respondents; however, this female preponderance was much more marked among respondents who were parents of patients with CKD. More than two-thirds of respondents in this group were women.

The majority (85.1%) of the study participants had some knowledge about kidney transplantation. However, only 11.8% of the respondents knew anyone who had received a kidney transplant, and an even smaller proportion (7.5%) knew anyone who had donated a kidney. Most of the respondents believed that having a kidney transplant improved the quality of life of patients with kidney failure, but only 40% saw it as a cure for kidney failure. About two-thirds of the respondents were of the opinion that kidney transplants were too expensive and out of the reach of the majority of Nigerians. This view is most likely traceable to the fact that not only is renal care in Nigeria expensive, but patients have to pay out-of-pocket for care. [12],[13]

Despite having at least one FDR with CKD who was attending a specialist nephrology clinic, the source of information about kidney transplantation in more than half of the respondents in this study were mass media outlets, with only about one-third having been informed about kidney transplantation by a healthcare provider. This finding is in contrast to that reported by Lennerling et al, [14] who studied 207 potential kidney donors undergoing evaluation for kidney donation in Norway and Sweden and found that physicians were the dominant source of information about kidney donation for the potential kidney donors they surveyed. Our finding may be a reflection of two different factors. There is a gross shortage of specialists in Nigeria, resulting in many of the specialist clinics being overcrowded with patients and leaving very little room for communication with patients and their relatives. Added to this is the fact that the study population is made up of young, well-educated adults who are likely to have access to the Internet and social media networks, which are a ready avenue for information on most topics.

Surprisingly, although kidney transplant surgeries have been carried out in Nigeria for over 13 years, [15] less than half of the respondents were aware that this procedure was being carried out within the country. This poor state of knowledge about the availability of kidney transplantation in Nigeria is likely to be responsible, at least in part, for the exceptionally high rates of transplant tourism among Nigerian patients. [16] It is also an indictment of both the kidney transplant community and the mass media in Nigeria as they appear not to have done enough to spread awareness about the availability of kidney transplant surgery within the country.

Almost all of the respondents were aware that the kidneys transplanted into patients with kidney failure were sourced from other individuals. Most of the respondents were aware that kidneys for transplantation could be sourced from FDRs of patients with kidney failure. However, only about 11% of the respondents were aware that kidneys could be sourced from deceased donors, a fact that is most likely a reflection of deceased kidney donation not being practiced in the country. Of particular interest is the fact that about half of all the respondents felt that kidneys for transplantation could also be sourced from commercial donors. This finding suggests that the FDRs of patients with CKD may be open to procurement of donor kidneys, and is similar to that reported by Al-Saeid et al, [17] who found that more than half of all physicians and emergency room technicians surveyed in their study believed that kidneys could be bought and sold in the state of Qatar. This apparently widespread belief in the commercialization of kidney donation has been linked on the one hand to the gross shortage of donor kidneys and on the other hand to the unregulated growth in transplant tourism worldwide. [18],[19] Chugh and Jha [20] in fact were of the opinion that some form of commercial transaction is involved in most living unrelated renal transplants carried out in developing countries.

About 25% of the respondents in our study were of the opinion that donating a kidney would increase their risk of developing kidney failure in the future. Although this finding is similar to that reported by Joan et al [21] who in a survey of Australian nephrologists and trainees found that 25% of the respondents were of the opinion that kidney donors were at an increased risk of developing ESRD, there is a need to improve public awareness about the overall safety of kidney donation as documented extensively in the medical literature. [22],[23],[24],[25]

Overall, more than three-quarters of the respondents who participated in this study were willing to donate a kidney to an affected relative. This finding is similar to that reported by Agaba et al, [26] who documented that 75.6% of the Nigerian healthcare professionals surveyed in Jos were willing to be living kidney donors. The figures from both studies are however significantly higher than those reported by Aghanwa et al, [27] who found that 62% of health workers, 52.1% of the patients' relatives and 27.1% of rural dwellers in Ile-Ife, Nigeria, expressed willingness to donate a kidney. The difference may be explained by the increasing awareness of kidney transplantation as a lifesaving treatment modality in the general population. Aghanwa's study was carried out between 1996 and 1998, a time when kidney transplantation was not even available in Nigeria.

Among respondents who participated in this study, willingness to donate a kidney to a relative varied based on the relationship to that family member. Respondents were willing to donate to their offspring, sibling, mother, spouse and father in decreasing order. This finding is similar to that reported by both Aghanwa et al [27] from Nigeria and Boulware et al [28] from the USA. The most common reasons given by the respondents in this study for their willingness to donate a kidney to a relative was affection and a sense of responsibility toward the relative. Yang et al [11] had documented previously that the willingness to donate kidneys by the relatives was largely determined by how close the potential donor felt they were to the recipients, and Lennerling et at [14] reported that the potential kidney donors in their study expressed much more concern for the recipient than for themselves.

We conclude that the FDRs of CKD patients, who participated in this study, have an aboveaverage knowledge about kidney transplantation. The majority of them were willing to donate a kidney to their relatives with CKD. The willingness to donate a kidney varies with the relationship between the patient and the FDR.

Conflict of Interest: None declared.

 
   References Top

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Wiedebusch S, Reiermann S, Steinke C, et al. Quality of life, coping, and mental health status after living kidney donation. Transplant Proc 2009;41:1483-8.  Back to cited text no. 24
    
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Correspondence Address:
Babawale T Bello
Department of Medicine, College of Medicine, University of Lagos, Idi-Araba, Lagos
Nigeria
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DOI: 10.4103/1319-2442.174141

PMID: 26787577

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