Baseline characteristics of the respondents
In total, 1,000 participants completed the survey, and their baseline characteristics are summarized in Table 1. The median age of the study participants was 47±15.2 years, and 491 (49.1%) were men. Of the respondents, 88.9% lived in metropolitan or small-medium-sized cities, and 57.9% graduated from college or beyond. Overall, 71.3% had not been diagnosed with any chronic disease. The most significant number of respondents were non-religious (46.7%), followed by Christians (24.6%), Buddhists (15.9%), and Catholics (11.9%).
The survey was conducted with the same questions after exposing the description provided to the donor during transplantation consultations to check whether there were any changes in the responses. After reading the explanation regarding kidney transplants, 83.8% of respondents answered that they fully understood living donor kidney transplantation. Of those who answered an open-ended question asking if they had any further questions, 6.4% of participants were curious about the side effects after donation, and 4.4% asked about the reward and social support for donors.
Awareness and perceptions of live donor kidney transplantation
In the initial survey, 811 (81.1%) respondents were aware of living kidney donation. In a question regarding their level of awareness of live donor kidney transplantation, more than half of the participants replied that they knew very well (4.6%) or to a certain extent (52.9%), while the other 42.5% said that they did not know well or had only heard of it (Figure 1). Regarding the safety of kidney donation, 31.9% of the participants thought it was relatively safe, and 22.3% thought it was unsafe (Figure 2A). Many survey participants considered that kidney donation would affect donors’ long-term health (82.6%, Figure 2B).
Interestingly, the participants tended to perceive live kidney donation as safer after reading a detailed description of living donor transplantation compared with their initial response (Figure 2A). Similarly, the proportion of respondents that believed kidney donation may not affect donors’ health was increased, although the majority still worried about the adverse effect on the overall health status after kidney donation (Figure 2B).
Individual willingness to donate a kidney
When asked if they were willing to donate their kidneys, 511 (51.1%) answered positively. The distribution of religion, marital status, and chronic disease status did not differ significantly depending on the willingness to donate a kidney (Table 2). When multiple choices were allowed, participants wanted to donate their kidneys in the order of their offspring (86.3%), spouse (85.5%), sibling (80.2%), parent (75.9%), a close friend (31.9%), relative (19.0%), and others (6.8%).
Among the 511 participants willing to donate a kidney, the most common reason to donate a kidney was philanthropic causes, including self-satisfaction after saving someone they love (69.7%) and promoting the recipient’s health (67.7%). Only 19% of them considered kidney donation to have no possible adverse health effects (Figure 3A).
Among the 136 participants who were not willing to donate a kidney, the most common reasons for reluctance to donate a kidney were possible complications driven by surgical procedures and hospitalization that were never needed for their own sake in substance. They reported fear of adverse physical complications after nephrectomy (69.1%) and long-term adverse medical outcomes (54.4%). Additionally, 33.8% of the respondents answered that they were afraid of affecting their economic status after the donation (Figure 3B). There was no statistically significant difference in the willingness to donate kidneys after providing detailed explanations regarding kidney transplantation (P=0.076).
Opinions on social support for living kidney donors
Initially, most participants were more likely to agree that the government should provide social and economic support to living kidney donors (yes, 73.2%; no, 8.3%; unsure, 18.5% of the total 1,000 participants). When asked what kind of support should be provided to the donors by allowing duplicate responses, the results were in the following order: support for nephrectomy and hospitalization expenses (74.2%), support of hospital expenses for follow-up monitoring of renal function after donor nephrectomy (70.1%), justification of sick leave within a certain period after donor nephrectomy (66.0%), support for kidney-related tests of national health examination after donor nephrectomy (64.5%), and support for salary during a leave of work (55.7%). Finally, 73.2% of the respondents agreed that there was a need for socioeconomic support for living kidney donors, which increased to 81.3% after reading the explanation of donor nephrectomy and possible short-term and long-term complications (Figure 4A; P<0.001, McNemar's test).
Opinions related to discrimination after live kidney donation
In a survey on the possibility of social disadvantages due to donations, 253 (25.3%) of the participants thought they would be discriminated against or disadvantaged at work after donation, and the main reason for discrimination is sick leave that living donors might not need. In total, 536 (53.6%) respondents answered that there would be no disadvantages before reading the description regarding live kidney donations. The proportion of respondents who answered “there will be disadvantages” significantly increased from 25.3% to 29.2% when comparing before and after exposure to the description (Figure 4B).