Transplantology in the Małopolska voivodship.

Analysis of results from a pilot project conducted by the Statistical Office in Krakow.

Anna Jasiówka

Centre for Health Statistics

Statistical Office in Krakow

Table of contents

Transplantation definition

Legislation systems

Transplantation problems

Organ donation activity in Poland and Małopolska voivodship in 2010

Pilot project in Małopolska voivodship conducted by the Statistical Office in Krakow

Transplantation

removal of organs, tissues and cells of the human body in order to save or prolong life of person with end stage of particular organ incapacity

organs from 1 donor can save up to 8 people

2 organ donor types◦ deceased donor – a person who has recently died ◦ living donor – adult relatives, partner or close

friends with emotional investment

Legislation systems

2 main systems◦ „Opt in” – anyone who has given consent is a donor

(ex. Germany, Greece)◦ „Opt out” – anyone who has not refused is a donor

(ex. Austria, Belgium, Poland, Spain, Sweden)

lack of correlation between the legislative system and the rate of donation

Transplantation problems (1)

insufficient number of donors (organs)

insufficient information flow among health care units

improper care over potential donor – destruction of organs

long time period between operation on donor and succeeding operation on recipient

Transplantation problems (2)

improper coordination of transplantation activities

post transplantation infections

rejection of transplanted organs

financial limitations

complicated administrative procedures

Organ donation activity in Poland and Małopolska voivodship in 2010

Poland Małopolska

Number of deceased organ donors 509 13

Number of deceased organ donors per million of population (pmp)

13,3 3,9

Number of deceased multi-organ donors 240 7

Rate of deceased multi-organ donors 47% 53,8%

Number of transplants 1376 28

* From deceased donors 1306 28

* From living donors 70 0

Number of recipients 1347 28

Source: Polish Transplant Coordinating Centre – Annual Report 2011

Deceased organ donors in 2010

12,8

14,8

4,5

20

19,2

3,9

9,4

13

3,3

17,5

15,5

12,6

7,7

15,7

26,2

27,6

below 1 855 0501 855 051 - 2 699 3962 699 397 - 3 543 7413 543 742 - 4 388 087over 4 388 088

Number of deceased donors per 1 mln of population

Number of inhabitants

Number of deceased organ donors per 1 million of population

Voivodship 2005 2006 2007 2008 2009 2010

Dolnośląskie 18,9 12,5 6,5 10,6 9,7 12,8

Kujawsko-pomorskie 16,4 13,5 12,6 11,7 13,3 14,8

Lubelskie 16,4 9,6 4,6 4,6 5,5 4,5

Lubuskie 5,9 7,9 8,0 8,0 9,0 20,0

Łódzkie 19,2 11,2 7,0 9,4 10,4 19,2

Małopolskie 4,0 3,1 0,9 0,6 1,5 3,9

Mazowieckie 16,8 12,8 8,7 10,5 8,3 9,4

Opolskie 18,7 23,8 12,5 15,4 4,0 13,0

Podkarpackie 1,9 0,5 0,9 2,4 1,9 3,3

Podlaskie 10,7 20,0 7,6 7,6 15,8 17,5

Pomorskie 14,7 14,2 13,1 13,6 15,9 15,5

Śląskie 11,2 9,6 8,6 8,2 7,8 12,6

Świętokrzyskie 2,3 1,6 0,8 4,7 7,8 7,7

Warmińsko-mazurskie 19,6 21,7 12,6 14,1 14,3 15,7

Wielkopolskie 17,0 24,0 16,9 25,5 24,1 26,2

Zachodniopomorskie 38,8 34,3 31,9 40,8 34,7 27,6Source: Polish Transplant Coordinating Centre – Annual Report 2011

Pilot project in Małopolska voivodship

conducted by the Statistical Office in Krakow

Project design

Aim: identification of attitudes towards transplantation by examination of knowledge, willingness to donate organs for transplantation purposes, opinions on organ procurement and experience with respect to organ donation

Tool: a standardized questionnaire developed for the purpose of the project on the basis of empirical and theoretical literature in the field as well as previous studies

Sample: 938 Malopolska voivodships’ inhabitants aged 18 years of age

Method of analysis data: bivariate analysis using Chi-square test, the significance level p<0,05

Project conducted in January 2011 by interviewers from the Statistical Office in Krakow

Project characteristics

Completeness: 82,5% (774 people out of 938 to whom questionnaire was dedicated)

Main reasons of non participation in the project:◦ Refusal to take part in the project ◦ Temporary absence in residence place ◦ Influence of disease or/ and age

General characteristics of respondents:◦ Age: mean age 45 years +/- SD 17,3 years◦ Gender: men 46,8%, women 53,2%◦ Residence place: rural area 58%, urban area 42%◦ Education: below secondary 49,7%, secondary 32,7%,

higher 17,6%

Acceptance of transplantation procedures

Percentage of respondents who accept transplantation from living donors

Age group: 18-29 (89%), 30-41 (91%), 42-53 (85%), 54-65 (82%), 65+ (68%)

Residence place: urban area (87%), rural area (82%)

Percentage of respondents who accept transplantation from deceased donors

Education: below secondary (81%), secondary (88%), higher (93%)

Residence place: urban area (89%), rural area (83%)

Percentage of respondents who consider that doctors follow medical standards while making a death

statement

Education: below secondary (49%), secondary (62%), higher (68%)

Residence place: urban area (61%), rural area (54%)

Respondents’ opinion about

Respondents’ knowledge about

Percentage of respondents who know definition of human death

Age group: 18-29 (61%), 30-41(60%), 42-53 (62%), 54-65 (51%), 65+(38%)

Education: below secondary (47%), secondary (62%), higher (68%)

Residence place: urban area (65%), rural area (49%)

Percentage of respondents who have knowledge about organ donor card

Age group: 18-29 (91%), 30-41 (89%), 42-53 (91%), 54-65 (77%), 65+(67%)

Education: below secondary (78%), secondary (89%), higher (96%)

Residence place:urban area (90%), rural area (81%)

definition of human death

Respondents’ conversations with relatives, friends

Percentage of respondents who talk with their relatives, friends about organ donation

Consent for the extraction of respondnets organs (living donor): yes (43%), no (15%), do not know (25%)

Consent for the extraction of respondents organs after death: yes (41%), no (18%), do not know (14%)

Respondents’ decision with regards to relative’s organs donation depending on knowledge of the

relative’s wish

Important decision factors

Important decision factors

Summary (1)

In Małopolska voivodship, there is one of the lowest indicator of deceased organ donors per one million of population - in 2010 it was 3,9. In comparison the indicator for Poland was 13,3

Małopolska inhabitants have positive attitudes towards transplantation and organ procurement

Low educated iinhabitants of rural areas have insufficient knowledge about transplantation and organ procurement

Most of the Małopolska inhabitants have heard about organ donor card

Majority of respondents have not talked with relatives and friends about their wishes with respect to organ procurement

Summary (2)

Knowledge about relative wish with respect to organ procurement has significant impact on the decisions made by families to give consent for the extraction of relatives’ organs

Solidarity is one of the most important factors determining declared consent for the extraction of respondent’s as well as relatives’ organs

Thank you for the attention