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 PolandMałopolska Number of deceased organ donors50913 Number of deceased organ donors per million of population (pmp) 13,33,9 Number of deceased multi-organ donors2407 Rate of deceased multi-organ donors47%53,8% Number of transplants * From deceased donors * From living donors700 Number of recipients Source: Polish Transplant Coordinating Centre – Annual Report 2011

Deceased organ donors in 2010

Number of deceased organ donors per 1 million of population Voivodship Dolnośląskie18,912,56,510,69,712,8 Kujawsko-pomorskie16,413,512,611,713,314,8 Lubelskie16,49,64,6 5,54,5 Lubuskie5,97,98,0 9,020,0 Łódzkie19,211,27,09,410,419,2 Małopolskie4,03,10,90,61,53,9 Mazowieckie16,812,88,710,58,39,4 Opolskie18,723,812,515,44,013,0 Podkarpackie1,90,50,92,41,93,3 Podlaskie10,720,07,6 15,817,5 Pomorskie14,714,213,113,615,915,5 Śląskie11,29,68,68,27,812,6 Świętokrzyskie2,31,60,84,77,87,7 Warmińsko-mazurskie19,621,712,614,114,315,7 Wielkopolskie17,024,016,925,524,126,2 Zachodniopomorskie38,834,331,940,834,727,6 Source: Polish Transplant Coordinating Centre – Annual Report 2011

Pilot project in Małopolska voivodship 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: (89%), (91%), (85%), (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: (61%), 30-41(60%), (62%), (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: (91%), (89%), (91%), (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

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

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