Teenagers' point of view on living donor kidney transplantation: Cinderella or princess?

UNLABELLED: Living kidney donation is an important clinical option, encountering different fortunes in the world. AIM: To analyse the opinions of a large subset of older teenagers attending high school (7999 students, median age 18) on different aspects of living kidney transplantation. METHODS: Analysis of semistructured questionnaires submitted within an educational campaign on dialysis and transplantation in the high schools of Torino and its county (about 2,000,000 inhabitants). RESULTS: Over 90% of the students had already heard of transplantation, mainly via television (88.4% county, 84.5% city). 80% would donate a kidney to a family member (3.5% wouldn't, 16.5% uncertain); answers were correlated with sex (females more than males p<0.0001), school type (istituti tecnici versus licei p=0.007), interest (yes versus other p<0.0001). A lower percent of individuals would receive a kidney (58.4% county, 59.4% city), only 10% would ask for donation. Over 40% of students consider legally buying a kidney a patient's right, only 26.6% would discourage this choice. The answers were correlated with the reverse pattern as for non-mercenary donation with type of school (licei more than istituti tecnici: p<0.0001), sex (males versus females p<0.0001), interest (not versus yes: p=0.002). CONCLUSIONS: Teenagers are favourable towards all forms of living kidney donation. The lower prevalence of positive answers on acceptance versus donation suggests that fears of endangering the donor's health may be one of the causes for a low living donation rate in our setting. The mixed answers on mercenary donation suggest discussing this complex issue in future educational programs.

Efficacy of an educational programme for secondary school students on opinions on renal transplantation and organ donation: a randomized controlled trial.

CONTEXT: Organ shortage for transplantation is a crucial problem; educational interventions may increase donations and decrease opposition. OBJECTIVE: To test the efficacy of an educational programme on opinions on organ transplantation and kidney donation. DESIGN AND PARTICIPANTS: Cluster Randomized Controlled Trial: eight intervention and eight control schools were randomly selected from the 33 public schools that agreed to participate. Targets: students in the last 2 years of secondary school (17-18 years); seven schools per group completed the study. EDUCATIONAL PROGRAMME: INTERVENTION: first questionnaire (anonymous); 2 h lesson in each class; 2 h general session with patients and experts; second questionnaire. CONTROL: questionnaires. MAIN OUTCOME MEASURES: Differences between questionnaires (comparative analysis); interest; satisfaction with the programme; (cross-sectional analysis). RESULTS: 1776 first, 1467 second questionnaires were retrieved. Living kidney donation: at baseline 78.8% of students would donate a kidney to a relative/friend in need. The answers were unaffected by type of school but depended on sex (females more prone to donate, P<0.001); the answers did not change after the lessons. Cadaveric kidney donation: baseline opinions were mixed (intervention schools: 31.5% yes, 33.7% no, 34.8% uncertain), depending on type of school (classical-scientific high schools more positive than technical institutes, P<0.001), sex (males more prone to donate, P<0.001). Answers on living and cadaveric donation were correlated (P<0.001). The educational intervention increased favourable (31.5 to 42.9%) and uncertain (34.8 to 41.1%) opinions and decreased negative ones (33.7 to 16%) (P<0.001). CONCLUSIONS: Educational interventions are effective in increasing interest and improving opinions about cadaveric organ donation.

Lost to follow-up: the bottleneck of early referral to renal units?

BACKGROUND: Early referral is a major goal in chronic kidney diseases; however, loss to follow-up, potentially limiting its advantages, has never been studied. MATERIAL/METHODS: In order to assess the prevalence and causes of loss to follow-up, a telephone inquiry was performed in a renal outpatient unit, mainly dedicated to early referral of diabetic patients. Patients were considered to be in follow-up if there was at least one check-up in the period February 2001-February 2002, and lost to follow-up if the last check-up had occurred in the previous year. The reasons for loss to follow-up were related to typical clinical-biochemical parameters to define a "drop-out profile". RESULTS: 195 patients were on follow-up: median creatinine 1.4 mg/dL, age 64, 76.9% diabetics. 81 patients were lost to follow-up: creatinine 1.4 mg/dL, age 70, 73.8% diabetics. A telephone number was available in 87.6% of the cases; 25 were not found, 7 had died, 24 were non-compliant, 1 was bed-ridden, 12 had changed care unit, 2 had started dialysis. Renal care was shorter in those lost to follow-up; among the latter, serum creatinine and age were significantly lower in non-compliant patients. A logistic regression model confirmed the significance of lower serum creatinine at last check-up in non-compliant patients (p=0.018). CONCLUSIONS: Loss to follow-up is a problem in nephrology; lack of awareness probably causes the higher drop-out rate at lower creatinine levels. The initial period of care may be crucial for long-term compliance. Further studies are needed to tailor organizational and educational interventions.