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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2021  |  Volume : 32  |  Issue : 1  |  Page : 268-270
Altruistic Attitudes among the Relatives of Patients with Chronic Kidney Disease: A Cross-sectional Study


1 Department of Nephrology, Iqraa International Hospital and Research Center, Kozhikode, Kerala, India
2 Department of Psychiatry, Iqraa International Hospital and Research Center, Calicut, Kerala, India

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Date of Web Publication16-Jun-2021
 

How to cite this article:
Hafeeq B, Uvais N A, Aziz F. Altruistic Attitudes among the Relatives of Patients with Chronic Kidney Disease: A Cross-sectional Study. Saudi J Kidney Dis Transpl 2021;32:268-70

How to cite this URL:
Hafeeq B, Uvais N A, Aziz F. Altruistic Attitudes among the Relatives of Patients with Chronic Kidney Disease: A Cross-sectional Study. Saudi J Kidney Dis Transpl [serial online] 2021 [cited 2021 Dec 8];32:268-70. Available from: https://www.sjkdt.org/text.asp?2021/32/1/268/318538


To the Editor,

The growth of chronic kidney disease (CKD) has become a profound public health problem, especially for developing countries like India. Due to steady increase in the incidence of risk factors, such as diabetes among younger Indians, the prevalence of CKD is expected to rise further as diabetes accounts for 40%–60% case of end-stage renal disease (ESRD).[1] Patients with stage 5 CKD require renal replacement therapy - chronic hemodialysis, peritoneal dialysis, or kidney transplantation. The prevalence of ESRD requiring transplantation in India is estimated to be between 151 and 232 per million population, and around 220,000 people require kidney transplantation in India.[2] A major barrier to kidney transplantation is the scarcity of organs. Current Indian law permits both living kidney transplantation and transplantation from deceased donation. The published data indicate that approximately 7500 kidney transplantations are performed at 250 kidney-transplant centers in India; out of these, 90% come from living donors.[2] Countries around the world are working to increase kidney donation as it is a significantly better treatment option for patients with CKD when compared to dialysis, in terms of better clinical outcome and cost-effectiveness.[3] However, due to the ever-increasing demand for a kidney transplant and a relatively static supply of organs, the gap between the number of patients wanting a kidney and the number of available organs is widening.

In India, like most other countries, kidney donation is limited to “altruistic” donors, and the law prohibits the donors from receiving anything of material value in exchange for giving a kidney. Altruistic acts are defined as acts of goodwill for the well-being of others, without any selfish intent.[4] Altruism is exercised in several medical contexts, especially in organ donation. Organ donation is an ultimate example of altruistic acts where the contribution by the society is simply paramount in its deliverance as organs can only come from the members of the society.[5] However, recent publications supported by surveys argued for a regulated system of incentives for donation that can have the potential to increase both living and deceased donation while eliminating the harms of unregulated markets.[3] They also argued to recognize realistically the multiple and over-lapping motives that underlie donation within and outside of families other than “altruism” such as a sense of obligation, a need to be accepted or valued by family and friends, or even an easily identifiable secondary gain.[3]

To the best of our knowledge, there are no studies exploring the altruistic behavior among the relatives (the potential kidney donors) of patients with CKD. This study was conducted with the objective of assessing altruistic attitudes among the close relatives of patients with CKD in India and determining the socio-demographic factors which influence altruism.

The study was conducted in a tertiary care hospital in Calicut city, Kerala, after obtaining permission from ethical committee of the institution. The hospital has a full-fledged nephrology department with facilities for dialysis and kidney transplantation. The study was approved by the institutional ethics committee of the hospital.

The altruistic behavior among the relatives of patients with CKD was assessed by the Altruism Personality Scale.[6] The Altruism Personality Scale has 20 items on which respondents are required to rate the frequency with which they engage in certain altruistic behaviors. One item that is not relevant in the Indian context was removed, namely “I have helped a stranger’s car out of the snow.”

The study instrument also contained questions related to sociodemographic details of the participants such as age, gender, religion, education, habitat, and relationship with the CKD patient. The final number of questions in the questionnaire was 25.

The study topic was introduced to the relatives of patients with CKD and informed consent was obtained from everybody who agreed to participate. The participants were then handed the study questionnaire, which was to be answered using a pen and paper format, and a trained social worker helped those who had difficulty in understanding the questionnaire. The data were entered in an MS Excel Spreadsheet and analyzed using GraphPad Prism version 7 for Windows (GraphPad Software, La Jolla California USA, www.graphpad.com).

We approached 100 relatives of patients with CKD and received 94 responses. The age of the respondents ranges from 22 to 87 years, with a mean age of 44.04 years. Fifty-one respondents were females. Sixty-four respondents were Muslims, and rest were Hindus. Forty-six respondents received less than 10 years of formal education, 30 respondents completed 12 years of formal education, and 18 respondents completed 15 years of formal education. Thirty-one respondents were wife of CKD patients, followed by children (25), husband (15), parents (11), siblings (4), and others (8). The mean altruism score of the sample was 59.18 (standard deviation: 12.25). The age of the sample was found to be positively correlated with the altruism score (P <0.0001). The results showed no association between gender, religion, educational level, and relationship with CKD patients with altruism score [Table 1].
Table 1: Factors influencing altruistic behaviors.

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We explored the altruism level of relatives of patients with CKD and its association with demographic factors. We found that the mean altruism score of the studied population was above the neutral score of 47.5, which indicates that the relatives of the patients with CKD were generally altruistic in nature, and this has clinical and policy implications. Recently, there have been debates over the desirability of material incentives offered as a supplement to live organ donation to promote kidney donation to meet the demand gap. However, our study results indicate that in a society where family and social bonds are strong, altruistic kidney donation should be promoted over any other modes of donation as relatives are generally altruistic in their approach. Moreover, studies have also shown that altruism is more signi-ficantly related to the willingness of individuals to donate a kidney only for immediate family and close friends where material expectations are usually nil.[7] Another recent study explored the factors influencing an individual’s stated altruistic sentiments by measuring the willing-ness to sacrifice own health for another person’s health. The study found that individuals are more altruistic toward young children and altruism tends to be lowest toward those who are more socially distant.[8] Individuals demonstrate greater degrees of both health and wealth altruism toward members of their immediate family than other groups, which supports the theory of kinship altruism.

In conclusion, altruistic kidney donation should be promoted in developing communities like India where kinship altruism could be high. Our study results highlight that relatives of patients with CKD are generally altruistic in nature and kinship altruism should be utilized to promote organ donation in our population.

Conflict of interest: None declared.



 
   References Top

1.
Rajapurkar MM, John GT, Kirpalani AL, et al. What do we know about chronic kidney disease in India: First report of the Indian CKD registry. BMC Nephrol 2012;13:10.  Back to cited text no. 1
    
2.
Shroff S. Current trends in kidney transplantation in India. Indian J Urol 2016;32:173-4.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Working Group on Incentives for Living Donation; Matas AJ, Satel S, Munn S, et al. Incentives for organ donation: Proposed standards for an internationally acceptable system. Am J Transplant 2012;12:306-12.  Back to cited text no. 3
    
4.
Steinberg D. Altruism in medicine: Its definition, nature, and dilemmas. Camb Q Healthc Ethics 2010;19:249-57.  Back to cited text no. 4
    
5.
AlHejaili W, Almalik F, Albrahim L, Alkhaldi F, AlHejaili A, Al Sayyari A. Scores of awareness and altruism in organ transplantation among Saudi health colleges students-impact of gender, year of study, and field of specialization. Saudi J Kidney Dis Transpl 2018;29:1028-34.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Rushton JP, Chrisjohn RD, Fekken GC. The altruistic personality and the self-report altruism scale. Pers Individ Differ 1981;2:293-302.  Back to cited text no. 6
    
7.
Long MC, Krause E. Altruism by age and social proximity. PLoS One 2017;12: e0180411.  Back to cited text no. 7
    
8.
Humphries HL, Conrad BK, Berry R, Reed S, Jennings C. Framing the gift of life: An empirical examination of altruism, social distance and material incentives in non-directed kidney donor motivation. J Nephrol Soc Work 2009;31:20-7.  Back to cited text no. 8
    

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Correspondence Address:
N A Uvais
Department of Psychiatry, Iqraa International Hospital and Research Center, Calicut, Kerala
India
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DOI: 10.4103/1319-2442.318538

PMID: 34145145

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