Socio-economic factors are the main factors affecting organ donation

Dear Editor,

We were delighted to come across the high-quality research article by Martino et al.¹ entitled “Attitude and knowledge of medical students toward donation after circulatory death.” The study aimed to investigate and analyze the acceptance of organ donation in Brazil. Martino et al. conducted a survey among medical students at a public university in Brazil, utilizing a questionnaire comprising 26 goals and Likert scale questions. The results revealed that a majority of participants were familiar with the concept of brain death, and the acceptance of postmortem donation was significantly higher than that of living donation. These intriguing findings and valuable results have captured our interest. However, upon further reading and investigation, we believe that the conclusions reached by Martino et al. warrant additional exploration and research. We are enthusiastic about contributing to the ongoing debate and eagerly anticipate hearing from the authors.

First and foremost, it is important to note that the authors of the study did not conduct a multi-center survey. The sample solely consisted of medical students from a public university in Brazil. By drawing conclusions based on a single center, the study deviated from the principles of a multi-center approach. It is well established that relying on a single sample source can significantly diminish the reliability of conclusions. There are various potential confounding factors that can influence medical students’ perceptions of organ donation, both living and postmortem. These factors may include the geographic environment, household income, cultural influences, regional policies, etc. Moreover, these factors can often interplay with one another. Additionally, differences in educational levels among various universities can contribute to distinct cognitive perspectives among students. Students attending higher-level universities may display a higher acceptance of organ donation, whereas those attending lower-level universities may exhibit relatively lower acceptance rates². Therefore, it is strongly recommended that the authors supplement their study with multi-center surveys to enhance the reliability of the data.

Furthermore, we observed that the authors compared the willingness of Chinese students to donate kidneys to their relatives while alive with that of Brazilian medical students. However, it is important to acknowledge that the comparability between these two groups is relatively low due to the profound influence of Confucianism and culture in China. Chinese students are often influenced by family ethics and humanistic values, which may contribute to their increased willingness to donate organs to their relatives. Additionally, the authors mentioned the proportion of liver donation. It is worth noting that the liver has the remarkable ability to regenerate fully with just 30% of its original mass. As individuals with medical education are likely to be aware of this fact, they may exhibit greater acceptance of liver donations, whether in vivo or posthumously.

Finally, it is worth noting that the author highlights a distinction between Eastern and Western countries regarding organ donations. According to the authors, Eastern countries, particularly China and Japan, heavily influenced by Confucianism, face difficulties in accepting living donations compared to postmortem donations. This is due to the emphasis on filial piety in Confucian culture, where the preservation of one’s body, including hair and skin given by parents, is considered paramount: “My body, including hair and skin, which is given by parents, shouldn’t be damaged. This is the basic principle of filial piety.” Filial piety holds great significance in these countries³. On the contrary, some scholars⁴,⁵ argue that socioeconomic factors, rather than religious beliefs or other considerations, are the primary barriers to organ donation in Western countries.

CONSENT FOR PUBLICATION

All other authors have read the manuscript and have agreed to submit it in its current form for consideration for publication in the Revista da Associacao Medica Brasileira.

REFERENCES

• ^1.
  Martino RB, Guidotte DV, Waisberg DR, Santos AGD, Cassenote AJF, Arantes RM, et al. Attitude and knowledge of medical students toward donation after circulatory death. Rev Assoc Med Bras (1992). 2021;67(4):602-6. https://doi.org/10.1590/1806-9282.20210012
  » https://doi.org/10.1590/1806-9282.20210012
• ^2.
  Bracher M, Madi-Segwagwe BC, Winstanley E, Gillan H, Long-Sutehall T. Family refusal of eye tissue donation from potential solid organ donors: a retrospective analysis of summary and free-text data from the UK National Health Service Blood and Transplant Services (NHS-BT) National Referral Centre (1 April 2014 to 31 March 2017). BMJ Open. 2021;11(9):e045250. https://doi.org/10.1136/bmjopen-2020-045250
  » https://doi.org/10.1136/bmjopen-2020-045250
• ^3.
  Jones DG, Nie JB. Does confucianism allow for body donation?. Anat Sci Educ. 2018;11(5):525-31. https://doi.org/10.1002/ase.1771
  » https://doi.org/10.1002/ase.1771
• ^4.
  Gill J, Dong J, Rose C, Johnston O, Landsberg D, Gill J. The effect of race and income on living kidney donation in the United States. J Am Soc Nephrol. 2013;24(11):1872-9. https://doi.org/10.1681/ASN.2013010049
  » https://doi.org/10.1681/ASN.2013010049
• ^5.
  Leonardis F, Gitto L, Favi E, Oliva A, Angelico R, Mitterhofer A, et al. A Keynesian perspective on the health economics of kidney transplantation would strengthen the value of the whole organ donation and transplantation service. Front Public Health. 2023;11:1120210. https://doi.org/10.3389/fpubh.2023.1120210
  » https://doi.org/10.3389/fpubh.2023.1120210

• Funding: none.

Publication Dates

• Publication in this collection
  09 Oct 2023
• Date of issue
  2023

History

• Received
  22 July 2023
• Accepted
  24 July 2023