Willingness of caregivers to donate a kidney to a patient with end-stage renal disease: Findings from four dialysis providing health facilities in Uganda

Examining kidney donation in Nigeria: a mixed methods study of family members' knowledge, perceptions, information needs and decision-making

BACKGROUND

A major challenge of transplantation is the unavailability of organs. For a successful transplantation process, awareness and negative attitudes among potential donors need to be sought for and addressed. Our objective was to examine the knowledge, perception and information needs of family members of patients with chronic kidney disease (CKD) in Nigeria and factors associated with their likelihood to decide to donate a kidney.

METHODS

This was a convergent parallel mixed method study that obtained information from family members of patients with CKD in Nigeria. Ordinal logistic regression was used to determine factors associated with the likelihood of donation. Thematic analysis was used for the qualitative analysis.

RESULTS

Three hundred and six respondents with a mean age of 41.2 ± 12.9 years participated in the quantitative survey. About 30% of participants were not familiar with the concept of kidney donation; 63% had never sought information about kidney donation; about 75% felt inadequately informed about the risks, benefits, and requirements of kidney donation. About 26% of participants were unlikely to consider donating a kidney to a family member with CKD. The majority expressed medical risk (47%) as their primary concern with donation. The age group of respondents (OR 0.48, 95% CI 0.239-0.967, P = 0.04), parent/child relationship, (OR 2.42, 95%CI 1.198-4.886, P = 0.01), awareness of the suitable medical factors for donation (OR 2.07, 95%CI 1.127-3.796, P = 0.02), and provision of support or counsel to donors (OR 3.89, 95%CI 1.576-9.638, P = 0.003), were independently associated with decisions to donate. The qualitative analysis identified personal, socio-cultural, religious and psychological factors that could influence willingness to donate.

CONCLUSION

This study identified factors that influenced donations and brought to the fore the need to adequately educate and provide support for potential kidney donors.

CLINICAL TRIAL NUMBER

Not applicable.

Support for whole-body donation among educational staff in Southwestern Ugandan medical educational schools

BACKGROUND

The teaching of anatomy from early days of medical education relied on the use of cadaver; hence, the present study assessed the support for whole-body donation among academic staff.

METHODS

This is a cross-sectional study conducted from January to March 2024 in Southwestern Ugandan medical educational schools among 160 academic staff. Ethical approval was obtained and structured questionnaires were distributed to study participants in the selected Medical Educational Schools.

RESULTS

Among the 160 sampled academic staff, only 16 % and 18 % supported the donation of their whole-body and the bodies of their relatives/friends for anatomical education respectively. The reason put forward for respondents support for whole-body donation were contribution to medical science (88.5 %) and learnt from someone's body (53.8 %). The fear of misuse of their body (42.5 %), cultural (53.7 %) and religious (44.8 %) belief were the reasons for non-support for whole-body donation among the study participants.

CONCLUSION

This study concluded that support for whole-body donation among academic staff was low; reasons for non-support were fear of misuse of body, religious and cultural beliefs; hence, we recommend the need for massive desensitization of the public aimed at building confidence on whole-body donation in the community.

Biliary atresia in Uganda: Current ethical challenges and advancement of public policy

Biliary atresia is a progressive cholangiopathy in neonates, which often results in liver failure. In high-income countries, initial treatment requires prompt diagnosis followed by Kasai portoenterostomy. For those with a late diagnosis, or those in whom Kasai portoenterostomy fails, liver transplantation is the only lifesaving treatment. Unfortunately, in low- and middle-income countries, timely diagnosis is a challenge and liver transplantation is rarely accessible. Here, we discuss the ethical dilemmas surrounding treatment of babies with biliary atresia in Uganda. Issues that require careful consideration include: risk of catastrophic health expenditure to families, ethical dilemmas of transplant tourism, medical risks of maintaining the transplant in a low-resourced health system, and difficult decisions encountered by the surgeon caring for these patients. Four distinct models of the patient-physician relationship are applied to biliary atresia in Uganda. These models describe differences in patient and physician roles, and patient values and autonomy. Solid organ transplantation is a rapidly evolving segment of healthcare in Uganda and ongoing policy advancements may shift ethical considerations in the future.