ORGAN DONATION AND ALLOCATION II

T. Kee¹, V. Joshi², K.V.D. Erf², W.L. Chow², T.S. Swah³, P. Goh³, G. Tan³, S. Yeo³, R. Tan³, C. Lim¹, J. Lim¹, C.M. Chan^1
1Renal Medicine, Singapore General Hospital, Singapore/SINGAPORE, ², Singhealth Centre for Health Services Research, Singapore/SINGAPORE, ³Head Office, Singhealth Polyclinics, Singapore/SINGAPORE

Body: Introduction: The Human Organ Transplant Act (HOTA) in Singapore allows for the removal of heart, liver, kidneys and corneas for the purpose of transplantation, from Singaporean citizens or permanent residents (PRs) who died in hospital. This is provided that they (1) were at least 21 years old, (2) did not opt out from HOTA during life and (3) were of sound mind. Singapore is also the only country that includes Muslims in a presumed consent law. All Singaporeans citizens and PRs who turn 21 years of age will receive a letter from the Ministry of Health (MOH) to inform them about HOTA and the option to opt out. The MOH also informs the general public twice a year on HOTA through the media in the 4 official languages of Singapore. A cross-sectional survey of the Singapore public was performed to determine awareness of HOTA and whether it was positively related to altruistic behavior. Methods: The study population consisted of 1384 of 1520 individuals (91% response rate) who visited 3 government primary care medical centres and completed a self-administered questionnaire. This questionnaire consisted of 34 questions to collect data on demographic characteristics, baseline knowledge of chronic kidney disease, attitudes and perceptions on living kidney donor transplantation and awareness of HOTA. Two questions were asked to assess respondents' awareness of HOTA (AWA) and the option to opt out (OPT). Another two questions were asked to assess knowledge on which organs were recoverable (ORG) and who was included under HOTA (INC). Another 2 questions were asked to determine participation in altruistic behavior. Results: The mean age of respondents was 48.8±15 years. Majority were Chinese (71.8%), men (50.3%) and received high school or lesser education (73.4%). These characteristics were comparable to those seen in the general Singapore population. For AWA, 32.8% and 46.5% reported being ' familiar ' and ' somewhat familiar ' of HOTA. Correct responses was seen in 68%, 57.2% and 43.5% for OPT, ORG and INC respectively. Multivariate logistic regression analysis revealed positive predictors were income more than SD$2000/month (for AWA and OPT), higher than high school education (for AWA, ORG and OPT) and Islam religion (for AWA and INC) (all p<0.05). Age > 60 years and chronic illness were other positive predictors for AWA and INC respectively (p<0.05). For altruistic behavior, 26.1% and 30.4% have donated blood or performed voluntary charity work. Univariate regression analysis showed an association of such altruistic behavior to familiarity with HOTA (OR=1.15; p<0.001) and the association persisted after adjusting for demographic characteristics (OR=1.13; p<0.001). Conclusions: This survey revealed that 79.3% of respondents were aware of HOTA but the knowledge levels for specific aspects of HOTA was lower. Other public measures such as inclusion of HOTA in the education curriculum of Singapore schools, road-shows in suburbia and putting the option to opt out during processing of identity cards or driving licenses may increase awareness and knowledge levels on HOTA.

Disclosure: All authors have declared no conflicts of interest.