© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Clin Transplant 2014: 28: 149–151 DOI: 10.1111/ctr.12307

Clinical Transplantation

Letter to the Editor

Physicians’ attitude toward organ donation and transplantation in the USA The public views organ donation favorably, with 60–90% of survey responders expressing a willingness to be an organ donor (1, 2). However, this positive attitude translates to nationwide donation rate of less than 40% (3). There is a paucity of literature addressing organ donation from a provider viewpoint. We conducted a survey to find out the percentage of physicians who were registered organ donors and the attitude of physicians in the USA toward a one possible non-monetary incentivized system to increase organ donation pool. A multidisciplinary panel of gastroenterology fellows and transplant hepatologists developed a 19-question electronic survey. Content validation and survey methodology were completed utilizing literature review, item generation, and small and large group discussions. The survey questions were piloted with a focus group of 15 physicians at three different institutions for face and content validity, feasibility and to ensure that all content domains were covered. This included evaluation on relevance and readability of each item, revision of existing items, and additions to the survey as needed. An electronic invitation to participate in the electronic survey was sent to 4000 residency and fellowship program directors in the USA. The anonymous survey was run through Google Documents© and included questions characterizing demographics, awareness of organ shortage, respondent organ donation status, and attitude toward assigning a higher priority to organ donors should they require liver transplantation in the future and reasons for opting against organ donation. The survey (Supplement 1) can be accessed through the following website https://docs.google. com/spreadsheet/viewform?formkey=dC1PMGtq Vk00d0JuWWhlWENMTmszZkE6MA. A total of 724 physicians in different specialties and subspecialties representing a broad sample of trainees and attending physicians at institutions across the nation participated. Eighteen physicians were excluded due to missing

donor status. Around 86% of responders were aware about organ shortage problem and its consequences. The estimated number of participating physicians in the USA is around 878,194 physicians (4). Thus, the calculated confidence interval is 3.65% (95% confidence level). Chi-square and Student’s t-test were used to examine differences between those respondents registered as donors (n = 539 physicians, 76.3%) and those who were registered as non-donors (n = 167 physicians, 23.7%). Table 1 summarizes the demographics and characteristics of the participants as well as attitude toward assigning a higher priority to organ donors should they require liver transplantation in the future. There were no differences between the two groups with regard to age, gender, specialty, level of training, location of practice, and involvement in the care of liver transplant recipients having liver disease or having a close relative or friend with liver disease. Respondents who were identified as donors were more significantly aware about issues related to organ shortage and its consequences (87.8% vs. 80.1%, p < 0.03). The most common reasons for declining to register as organ donor included the following: religious purposes, followed by concerns about resultant poor medical care should a donor require medical care, rejecting the idea of surgical intervention following death as well as beliefs that the current organ allocation system is unfair. Among industrial countries, Israel’s organ donation has been one of the lowest. This led to introduce a new measurements including The Organ Transplantation Law in 2008. One component of the law included granting prioritization in organ allocation to those who registered as organ donors. As a consequence, the number of new registered donor has increased. Furthermore, there was a significant increase in the number of deceased organ donors. The organ donation rate

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Letter to the Editor Table 1. Demographics and characteristics of respondents and attitude toward assigning extra MELD score for donors should they require liver transplantation. Confidence interval is 3.65% (95% confidence level)

Mean age (yr) Males Females Trainees Attending physicians Primary care physicians and Medical specialists Surgeons and Surgical Specialists Location of practice Midwest West Northeast South Have liver disease Have a friend or close relative with liver disease Provide routinely care for patients with liver transplantation or who require liver transplantation Results Support assigning extra MELD score for donors should they require liver transplantation Neutral about assigning extra MELD score for donors should they require liver transplantation Do not support assigning extra MELD score for donors should they require liver transplantation

Donors (%) (n = 539)

Non-donors (%) (n = 167)

p Value

41.2 55.7 44.3 39.5 60.3 83.1

41.6 64.1 35.9 44.9 55.1 83.2

0.90 0.06 0.06 0.22 0.23 0.97

16.9

16.8

0.97

31.3 19 25.8 23.9 1.5 12.6

33.6 13.1 30.7 22.6 3.6 15

0.62 0.11 0.26 0.76 0.07 0.17

18.2

15

0.33

Authors’ contributions

AAA and AQM designed the study and analyzed the data. AAA and AAJ wrote the manuscript. AAA and WH critically reviewed the manuscript. Amer A. Alkhatiba, Angela Q. Maldonadob,c, Ala Abdel Jalild and William Hutsone a

37.7

28.5

0.03

10.2

16.4

0.03

52.2

55.2

0.50

increased from 7.8 to 11.4 donors per million population (5). We acknowledge the limitation of this study. The response rate was difficult to calculate for several reasons. There were technical difficulties accessing the survey from a cohort of institutions because of their Internet firewall. There were also instructions to forward to survey to colleagues

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who did not initially receive the original request resulting in completion of the survey by physicians and trainees who were not accounted for. Although a response rate of 60% or greater would be optimal, information gleaned from survey studies with less than optimal response rates continue to yield valuable information (6, 7). Organ donation awareness continues to challenge modern society, and this survey study has provided some insight into physicians’ perceptions of organ donation as well as their opinions on one possible non-monetary incentivized system. Innovative ideas are needed to bring the issue of organ donation to the forefront to begin to eliminate the gap between organ supply and demand as well as to educate both the public and healthcare population.

Division of Gastroenterology and Hepatology, Cancer Treatment Centers of America, Tulsa, OK, b Department of Pharmacotherapy, Washington State University, Washington, DC, cKidney Transplant Program, Providence Sacred Heart Medical Center & Children’s Hospital, Spokane, WA, d Department of Internal Medicine, McLeod Regional Medical Center, Florence, SC and eDivision of Gastroenterology and Hepatology, Department of Medicine, Medical School, University of Maryland Medical Center, Baltimore, MD, USA e-mail: [email protected]

References 1. EVERS S, FAREWELL VT, HALLORAN PF. Public awareness of organ donation. CMAJ 1988: 138: 37. 2. SANNER MA. Giving and taking–to whom and from whom? People’s attitudes toward transplantation of organs and tissue from different sources. Clin Transplant 1998: 12: 530. 3. LAI M. Do we need to change our national organ donation policy? Hepatology 2010: 51: 1479. 4. YOUNG A, CHAUDHRY HJ, THOMAS JV, DUGAN M. A census of actively licensed physicians in the United States, 2012. J Med Reg 2013: 99: 11. 5. LAVEE J, ASHKENAZI T, STOLER A, COHEN J, BEYAR R. Preliminary marked increase in the national organ donation rate in Israel following implementation of a new organ transplantation law. Am J Transplant 2013: 13: 780.

Letter to the Editor 6. HOLBROOK A, KROSNICK J, PFENT A. The causes and consequences of response rates in surveys by the news media and government contractor survey research firms N.C.T. In: LEPKOWSKI JM, BRICK JM, DE LEEUW ED, JAPEC L, LAVRAKAS PJ, LINK MW, SANGSTER RL eds. Advances in

Telephone Survey Methodology, New York: Wiley, 2007:499. 7. CURTIN R, PRESSER S, SINGER E. The effects of response rate changes on the index of consumer sentiment. Public Opin Q 2000: 64: 413.

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Physicians' attitude toward organ donation and transplantation in the USA.

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