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Mamven M, Adejumo OA, Edeki IR, Oyedepo DS, Ngoka SC, Ummate I, Abdu A, Tuko MT, Adeyeye LA, Loskurima U, Fasaanu A, Madu NC, Angbazo D. Perspectives of relatives of patients with end-stage kidney disease on kidney sources, commercial kidney donation, and barriers to living kidney donation in Nigeria: a qualitative study. J Nephrol 2024:10.1007/s40620-024-02019-1. [PMID: 39012427 DOI: 10.1007/s40620-024-02019-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/22/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Kidney transplantation is the best mode of kidney replacement therapy. However, the shortage of organ donations has been a major challenge globally. Relatives of patients with end-stage kidney disease (ESKD) are potential kidney donors. We explored their perspectives about kidney donation, kidney commercialisation, and barriers to kidney donation. METHODS In-depth interviews were conducted among 28 relatives of ESKD patients across the six geopolitical zones and Federal Capital Territory of Nigeria. The interview focused on potential sources of kidney donors, kidney commercialisation and barriers to kidney donation. ATLAS.ti version 9.0.22.0 was used for data analysis. RESULTS Mean age of the study participants was 41.57 ± 14.55 years; 54% were females, 60.7% were married, 93% had tertiary education and 75% were first degree relatives of ESKD patients. There were 7 themes and 28 subthemes generated in this study. The potential sources of kidney donors identified by the study participants included commercial, hospital, family and non-family member donors. While some opined that a family member is the best choice as a kidney donor, others preferred a commercial donor. The majority of those interviewed do not believe that it is wrong to purchase a kidney, and would be willing to do so. Identified factors that promote kidney commercialisation were unwillingness of a family member to donate, having the financial capacity to purchase a kidney, non-fitness of family members to donate. Identified barriers to kidney donation were age, poor health status, polygamy, perceived poor expertise of the medical team, perceived risk of the procedure, parental influence and religious beliefs. CONCLUSIONS The majority of participants lacked correct information about kidney donation. Implementation of educational program policies and laws regulating and reinforcing ethical principles of kidney donation and transplantation should be ensured.
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Affiliation(s)
- Manmak Mamven
- Department of Internal Medicine, University of Abuja, Gwagwalada, Abuja, Nigeria
| | | | - Imuetinyan Rashida Edeki
- Department of Internal Medicine, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Dapo Sunday Oyedepo
- Department of Internal Medicine, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | | | - Ibrahim Ummate
- Department of Internal Medicine, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Alhaji Abdu
- Department of Internal Medicine, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Bauchi State, Nigeria
| | - Moses Tari Tuko
- Department of Internal Medicine, Federal Medical Centre, Birnin Kebbi, Kebbi State, Nigeria
| | | | - Umar Loskurima
- Department of Internal Medicine, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Ayodeji Fasaanu
- Department of Internal Medicine, Afe Babalola University Teaching Hospital, Ado Ekiti, Ekiti State, Nigeria
| | - Nwokedi Chinedu Madu
- Department of Internal Medicine, University of Abuja, Gwagwalada, Abuja, Nigeria
| | - Dorcas Angbazo
- National Assembly Health Service Directorate, Abuja, Nigeria
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Transplant: The Success of Renal Transplant Programs. Semin Nephrol 2023; 42:151312. [PMID: 36931206 DOI: 10.1016/j.semnephrol.2023.151312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
In the absence of malignancy or other severe comorbidity, kidney transplantation offers better survival rates and quality of life than dialysis. Despite this survival advantage, many lower- and upper-middle-income countries do not offer adequate kidney transplant services. This is particularly troubling because end-stage kidney disease often is more common in these countries than in high-income countries and overall is less costly in the life of a patient. We describe the contrasting levels of provision of kidney transplantation in Mexico, India, Nigeria, Ghana, and Zimbabwe, and kidney transplant services for children in Africa.
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Bunori H, Izudi J, Alege JB, Bajunirwe F. Willingness of caregivers to donate a kidney to a patient with end-stage renal disease: Findings from four dialysis providing health facilities in Uganda. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000287. [PMID: 36962211 PMCID: PMC10021730 DOI: 10.1371/journal.pgph.0000287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/23/2022] [Indexed: 11/19/2022]
Abstract
Most patients with end-stage renal disease (ESRD) benefit from a kidney transplant but there is limited information from developing countries like Uganda about the willingness of caregivers for patients with end-stage kidney disease to donate a kidney. In this cross-sectional study, we examined the magnitude and factors associated with the willingness of caregivers to donate a kidney to their patient with ESRD in Kampala, Uganda. The study was conducted at four health facilities that provide kidney dialysis in Kampala, Uganda. We used a structured questionnaire to interview caregivers for patients with ESRD. Caregivers who reported they would consider donating a kidney to a patient with ESRD were considered willing and the rest as unwilling. We summarized data using descriptive statistics and used an adjusted prevalence risk ratio (aPRR) from a generalized linear model to establish factors independently associated with willingness to donate.We enrolled 125 participants with a mean age of 32.3±9.8 years and found 68 (54.4%) participants were willing to donate a kidney for transplant. Willingness to donate a kidney was more likely among older caregivers namely those aged 25-34 years (aPRR, 1.15; 95% CI, 1.01-1.31) and ≥35 years (aPRR 1.16; 95% CI, 1.05-1.29) compared to those aged 18-24 years, females compared to males (aPRR, 1.30; 95% CI, 1.19-1.42), those with a positive attitude towards organ donation (aPRR, 1.24; 95% CI, 1.13-1.36), and when organ kidney donation was permissible by the participant's religious faith (aPRR, 1.11; 95% CI, 1.01-1.22). Conversely, willingness to donate a kidney was less likely when the family did not approve of kidney donation (aPRR, 0.80; 95% CI, 0.71-0.90). We concluded that more than half of caregivers to patients with ESRD are willing to donate a kidney for transplant. To improve the willingness of caregivers to patients with ESRD in donating a kidney, the social, religious, and personal barriers to kidney donation may need to be addressed.
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Affiliation(s)
- Hope Bunori
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda
| | - Jonathan Izudi
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - John Bosco Alege
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
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Boima V, Amissah-Arthur MB, Yorke E, Dey D, Fiagbe D, Yawson AE, Nonvignon J, Mate-Kole CC. Determinants of willingness to accept kidney transplantation among chronic kidney disease patients in Ghana. BMC Nephrol 2021; 22:129. [PMID: 33849488 PMCID: PMC8045236 DOI: 10.1186/s12882-021-02335-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 04/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The burden of chronic kidney disease in Africa is three to four times higher compared to high-income countries and the cost of treatment is beyond the reach of most affected persons. The best treatment for end stage renal disease is kidney transplantation which is not available in most African countries. As kidney transplantation surgery is emerging in Ghana, this study assessed factors which could influence the willingness of patients with chronic kidney disease to accept it as a mode of treatment. METHODS This cross-sectional survey was carried out among patients with chronic kidney disease in Korle-Bu Teaching Hospital. A consecutive sampling method was used to recruit consenting patients. A structured questionnaire and standardized research instruments were used to obtain information on demographic, socio-economic characteristics, knowledge about transplantation, perception of transplantation, religiosity and spirituality. Logistic regression model was used to assess the determinants of willingness to accept a kidney transplant. RESULTS 342 CKD patients participated in the study of which 56.7% (n = 194) were male. The mean age of the participants was 50.24 ± 17.08 years. The proportion of participants who were willing to accept a kidney transplant was 67.3% (95%CI: 62.0-72.2%). The factors which influenced participants' willingness to accept this treatment included; willingness to attend a class on kidney transplantation (p < 0.016), willingness to donate a kidney if they had the chance (p < 0.005), perception that a living person could donate a kidney (p < 0.001) and perceived improvement in quality of life after transplantation (p < 0.005). The barriers for accepting kidney transplantation were anticipated complications of transplant surgery and financial constraints. CONCLUSION More than two-thirds of CKD patients were willing to accept a kidney transplant and this is influenced by multiple factors. Government health agencies must consider full or partial coverage of kidney transplantation through the existing national health insurance scheme. Further, efficient educational programmes are required to improve both patients' and physicians' knowledge on the importance of kidney transplantation in the management of end stage renal disease in Ghana.
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Affiliation(s)
- V Boima
- Department of Medicine and Therapeutics, College of Health Sciences, University of Ghana Medical School, University of Ghana, P. O. Box 4236, Korle-Bu, Accra, Ghana.
| | - M B Amissah-Arthur
- Department of Medicine and Therapeutics, College of Health Sciences, University of Ghana Medical School, University of Ghana, P. O. Box 4236, Korle-Bu, Accra, Ghana
| | - E Yorke
- Department of Medicine and Therapeutics, College of Health Sciences, University of Ghana Medical School, University of Ghana, P. O. Box 4236, Korle-Bu, Accra, Ghana
| | - D Dey
- Department of Medicine and Therapeutics, College of Health Sciences, University of Ghana Medical School, University of Ghana, P. O. Box 4236, Korle-Bu, Accra, Ghana
| | - Delali Fiagbe
- Department of Psychiatry, College of Health Sciences and Center for ageing studies, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - A E Yawson
- Department of Medicine and Therapeutics, College of Health Sciences, University of Ghana Medical School, University of Ghana, P. O. Box 4236, Korle-Bu, Accra, Ghana.,Departments of Biostatistics, College of Health Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - J Nonvignon
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - C C Mate-Kole
- Department of Medicine and Therapeutics, College of Health Sciences, University of Ghana Medical School, University of Ghana, P. O. Box 4236, Korle-Bu, Accra, Ghana.,Department of Psychology, College of Humanities, University of Ghana, Legon, Ghana
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Mojapelo MR, Maboe KA. Knowledge, attitude and barriers to kidney donation in Limpopo province, South Africa. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Boima V, Agyabeng K, Ganu V, Dey D, Yorke E, Amissah-Arthur MB, Wilson AA, Yawson AE, Mate-Kole CC, Nonvignon J. Willingness to pay for kidney transplantation among chronic kidney disease patients in Ghana. PLoS One 2020; 15:e0244437. [PMID: 33378327 PMCID: PMC7773273 DOI: 10.1371/journal.pone.0244437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/09/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Kidney transplantation is the preferred treatment for patients with end stage renal disease. However, it is largely unavailable in many sub-Sahara African countries including Ghana. In Ghana, treatment for end stage renal disease including transplantation, is usually financed out-of-pocket. As efforts continue to be made to expand the kidney transplantation programme in Ghana, it remains unclear whether patients with Chronic Kidney Disease (CKD) would be willing to pay for a kidney transplant. AIM The aim of the study was to assess CKD patients' willingness to pay for kidney transplantation as a treatment option for end stage renal disease in Ghana. METHODS A facility based cross-sectional study conducted at the Renal Outpatient clinic and Dialysis Unit of Korle-Bu Teaching Hospital among 342 CKD patients 18 years and above including those receiving haemodialysis. A consecutive sampling approach was used to recruit patients. Structured questionnaires were administered to obtain information on demographic, socio-economic, knowledge about transplant, perception of transplantation and willingness to pay for transplant. In addition, the INSPIRIT questionnaire was used to assess patients' level of religiosity and spirituality. Contingent valuation method (CVM) method was used to assess willingness to pay (WTP) for kidney transplantation. Logistic regression model was used to determine the significant predictors of WTP. RESULTS The average age of respondents was 50.2 ± 17.1 years with most (56.7% (194/342) being male. Overall, 90 out of the 342 study participants (26.3%, 95%CI: 21.7-31.3%) were willing to pay for a kidney transplant at the current going price (≥ $ 17,550) or more. The median amount participants were willing to pay below the current price was $986 (IQR: $197 -$1972). Among those willing to accept (67.3%, 230/342), 29.1% (67/230) were willing to pay for kidney transplant at the prevailing price. Wealth quintile, social support in terms of number of family friends one could talk to about personal issues and number of family members one can call on for help were the only factors identified to be significantly predictive of willingness to pay (p-value < 0.05). CONCLUSION The overall willingness to pay for kidney transplant is low among chronic kidney disease patients attending Korle-Bu Teaching Hospital. Patients with higher socio-economic status and those with more family members one can call on for help were more likely to pay for kidney transplantation. The study's findings give policy makers an understanding of CKD patients circumstances regarding affordability of the medical management of CKD including kidney transplantation. This can help develop pricing models to attain an ideal poise between a cost effective but sustainable kidney transplant programme and improve patient access to this ultimate treatment option.
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Affiliation(s)
- V. Boima
- Department of Medicine and Therapeutics University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
- * E-mail: ,
| | - K. Agyabeng
- Departments of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - V. Ganu
- Department of Medicine and therapeutics, Korle-Bu Teaching Hospital, Accra, Ghana
| | - D. Dey
- Department of Medicine and Therapeutics University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - E. Yorke
- Department of Medicine and Therapeutics University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - M. B. Amissah-Arthur
- Department of Medicine and Therapeutics University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - A. A. Wilson
- Departemnt of Public Health, Greater Accra regional Hospital, Ghana Health Service, Accra, Ghana
| | - A. E. Yawson
- Departments of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - C. C. Mate-Kole
- Department of Medicine and Therapeutics University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
- Department of Psychology/Center for ageing studies, College of Humanities, University of Ghana, Legon, Ghana
| | - J. Nonvignon
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
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Knowledge and Willingness to Donate Kidneys for Transplantation in Ghana: A Cross-Sectional Survey. Transplant Proc 2020; 52:2883-2889. [DOI: 10.1016/j.transproceed.2020.02.165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/23/2020] [Indexed: 12/11/2022]
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