Participant characteristics by willingness to accept kidney transplantation
In all 342 patients participated in the study of which 56.7% (n = 194) were males. The average age of the participants was 50.24 ± 17.08 years. The proportion of patients who would like to undergo kidney transplant was 67.3% (95%CI: 62.0–72.2%) while 18.4% were not willing to accept, and 14.3% were indecisive (Don't Know/Not sure) about accepting kidney transplantation. About 40% of the participants had completed tertiary education and 43.0% were employed. In all, 29.0% were on dialysis and the proportion of dialysis patients who were willing to undergo kidney transplant was about 12.0% higher than those who were not on dialysis (75.8% vs 63.8%, p = 0.028). The proportion of patients with some form of medical insurance who would like to undergo kidney transplant was 17% more than those without (69.3% vs 52.4%, p = 0.028) – Table 1.
Table 1
Participant characteristics by willingness to accept kidney transplantation
|
Willing to undergo kidney transplant
|
|
No(%)
|
Yes(%)
|
Total(%c)
|
p-value
|
Sex
|
|
|
|
0.129
|
Male
|
57 (29.38)
|
137 (70.62)
|
194 (56.73)
|
|
Female
|
55 (37.16)
|
93 (62.84)
|
148 (43.27)
|
|
Current Age (years)
|
|
|
|
|
Mean ± SD
|
51.86 ± 18.07
|
49.45 ± 16.56
|
50.24 ± 17.08
|
0.233
|
< 40 years
|
27 (30.34)
|
62 (69.66)
|
89 (26.02)
|
0.470
|
40–59 years
|
44 (30.77)
|
99 (69.23)
|
143 (41.81)
|
|
>=60 years
|
41 (37.27)
|
69 (62.73)
|
110 (32.16)
|
|
Current Marital Status
|
|
|
|
0.187
|
Married
|
60 (30.93)
|
134 (69.07)
|
194 (56.73)
|
|
Single
|
27 (33.33)
|
54 (66.67)
|
81 (23.68)
|
|
Widowed
|
20 (45.45)
|
24 (54.55)
|
44 (12.87)
|
|
Divorced
|
5 (21.74)
|
18 (78.26)
|
23 (6.73)
|
|
Religion
|
|
|
|
0.427
|
Christian
|
99 (31.73)
|
213 (68.27)
|
312 (91.23)
|
|
Muslim
|
11 (44)
|
14 (56)
|
25 (7.31)
|
|
Non-denominational
|
2 (40)
|
3 (60)
|
5 (1.46)
|
|
Educational Level
|
|
|
|
0.052
|
No formal education
|
10 (52.63)
|
9 (47.37)
|
19 (5.56)
|
|
Primary/JHS
|
42 (38.53)
|
67 (61.47)
|
109 (31.87)
|
|
Senior high School/Vo
|
19 (25)
|
57 (75)
|
76 (22.22)
|
|
Tertiary education
|
41 (29.71)
|
97 (70.29)
|
138 (40.35)
|
|
Employment Status
|
|
|
|
0.359
|
Unemployed
|
41 (35.65)
|
74 (64.35)
|
115 (33.63)
|
|
Employed
|
42 (28.57)
|
105 (71.43)
|
147 (42.98)
|
|
Retired
|
29 (36.25)
|
51 (63.75)
|
80 (23.39)
|
|
Wealth quintile
|
|
|
|
0.205
|
1st quintile
|
29 (42.03)
|
40 (57.97)
|
69 (20.18)
|
|
2nd quintile
|
20 (28.99)
|
49 (71.01)
|
69 (20.18)
|
|
3rd quintile
|
25 (36.23)
|
44 (63.77)
|
69 (20.18)
|
|
4th quintile
|
22 (32.35)
|
46 (67.65)
|
68 (19.88)
|
|
5th quintile
|
16 (23.88)
|
51 (76.12)
|
67 (19.59)
|
|
Social Support
|
|
|
|
0.385
|
Low
|
40 (35.09)
|
74 (64.91)
|
114 (33.33)
|
|
Medium
|
32 (27.83)
|
83 (72.17)
|
115 (33.63)
|
|
High
|
40 (35.4)
|
73 (64.6)
|
113 (33.04)
|
|
Dialysis
|
|
|
|
0.032*
|
Yes
|
24 (24.24)
|
75 (75.76)
|
99 (28.95)
|
|
No
|
88 (36.21)
|
155 (63.79)
|
243 (71.05)
|
|
CKD stage
|
|
|
|
0.086
|
stage 3
|
8 (25.81)
|
23 (74.19)
|
31 (9.06)
|
|
stage 4
|
29 (46.03)
|
34 (53.97)
|
63 (18.42)
|
|
stage 5
|
11 (33.33)
|
22 (66.67)
|
33 (9.65)
|
|
End stage on dialysis
|
64 (29.77)
|
151 (70.23)
|
215 (62.87)
|
|
Has valid health insurance
|
|
|
|
0.028*
|
Yes
|
92 (30.67)
|
208 (69.33)
|
300 (87.72)
|
|
No
|
20 (47.62)
|
22 (52.38)
|
42 (12.28)
|
|
Preferred source of kidney
|
|
|
< 0.001***
|
Deceased Kidney
|
3 (50.00)
|
3 (50.00)
|
6 (1.75)
|
|
Living Kidney
|
28 (20.29)
|
110 (79.71)
|
138 (40.35)
|
|
N/A- I don't want a kidney
|
32 (94.12)
|
2 (5.88)
|
34 (9.94)
|
|
No preference
|
49 (29.88)
|
115 (70.12)
|
164 (47.95)
|
|
Other regular Income
|
|
|
|
0.101
|
Yes
|
2 (13.33)
|
13 (86.67)
|
15 (4.39)
|
|
No
|
110 (33.64)
|
217 (66.36)
|
327 (95.61)
|
|
*p < 0.05, **p < 0.01, ***p < 0.001, N = frequency; %§ represent row percentages, %Ꝭ represent column percentages; p-values obtained from chi-square\Fishers’ exact tests of association. |
Barriers to kidney transplant among participants unwilling to accept kidney transplantation
Among 63 participants who emphatically said no to accepting kidney transplantation, item response rates for questionnaire assessing perceived barriers to willingness to accept kidney transplantation was 100%. The respondents gave the following reasons as unimportant when deciding not to accept a kidney transplant- distrust for physicians (87.3%), need for more time to think and learn about it (76.2%), religious concerns (65.08%), concern about having somebody’s organ in their body (71.43%). Further, pain and fear of surgery was not an important reason for accepting kidney transplant in 47.6% of participants. Complications from transplant was very important to 39.7% of patients but unimportant to 38.1% of patients in deciding their unwillingness to accept a kidney transplant. Although financial constraint was not important to 49.2% of patients in their unwillingness to accept a kidney transplant it was very important for 30.2% of them (Table 2).
Knowledge and attitude/views towards transplantation and kidney donation
Most of the participants (68.7%) reported to have previously heard about kidney transplant (Table 3).
Table 3
Patient knowledge, attitude and perception by willingness to accept kidney transplantation
|
Willing to accept kidney transplantation
|
|
No
|
Yes
|
Total
|
p-value
|
|
N(%§)
|
N(%§)
|
N(%Ꝭ)
|
|
Heard about kidney transplant (Prior knowledge)
|
|
|
|
< 0.001***
|
Yes
|
67 (26.38)
|
187 (73.62)
|
254(74.27)
|
|
No
|
44 (53.01)
|
39 (46.99)
|
83(24.27)
|
|
Don't Know/Not sure
|
1 (20)
|
4 (80)
|
5(1.46)
|
|
Physician discussed transplant with patient
|
|
|
|
0.032*
|
Yes
|
24 (24.24)
|
75 (75.76)
|
99(28.95)
|
|
No
|
88 (36.21)
|
155 (63.79)
|
243(71.05)
|
|
Ever referred for transplant
evaluation
|
|
|
|
0.936
|
Yes
|
12 (30.77)
|
27 (69.23)
|
39(11.40)
|
|
No
|
99 (33.00)
|
201 (67.00)
|
300(87.72)
|
|
Know/Not sure
|
1 (33.33)
|
2 (66.67)
|
3(0.88)
|
|
Self-reported knowledge
on kidney transplant
|
|
|
|
0.131
|
Below average
|
64 (37.87)
|
105 (62.13)
|
169(49.42)
|
|
Average
|
39 (27.27)
|
104 (72.73)
|
143(41.81)
|
|
Above average
|
9 (30)
|
21 (70)
|
30(8.77)
|
|
Aware of transplant centers in Ghana
|
|
|
|
0.187
|
Yes
|
18 (24)
|
57 (76)
|
75(21.93)
|
|
No
|
91 (35.27)
|
167 (64.73)
|
258(75.44)
|
|
Don’t Know/Not sure
|
3 (33.33)
|
6 (66.67)
|
9(2.63)
|
|
Feel need to know more about Kidney transplant
|
|
|
|
< 0.001***
|
Yes
|
58 (22.92)
|
195 (77.08)
|
253(73.98)
|
|
No
|
46 (61.33)
|
29 (38.67)
|
75(21.93)
|
|
Don't Know/Not sure
|
8 (57.14)
|
6 (42.86)
|
14(4.09)
|
|
Willing to attend a class
about kidney transplant
|
|
|
|
< 0.001***
|
Yes
|
57 (21.84)
|
204 (78.16)
|
261(76.32)
|
|
No
|
42 (66.67)
|
21 (33.33)
|
63(18.42)
|
|
Don’t Know/Not sure
|
13 (72.22)
|
5 (27.78)
|
18(5.26)
|
|
Know the level of kidney function when a transplant can be done
|
|
|
|
0.944
|
the kidney function
|
1 (33.33)
|
2 (66.67)
|
3(0.88)
|
|
after a patient
|
4 (28.57)
|
10 (71.43)
|
14(4.09)
|
|
I don't know
|
107 (32.92)
|
218 (67.08)
|
325(95.03)
|
|
Willing to donate kidneys
|
|
|
< 0.001***
|
Yes
|
38 (17.76)
|
176 (82.24)
|
214(62.57)
|
|
No
|
48 (66.67)
|
24 (33.33)
|
72(21.05)
|
|
Not sure
|
26 (46.43)
|
30 (53.57)
|
56(16.37)
|
|
Can a living person donate kidney
|
|
|
< 0.001***
|
Yes
|
61 (21.94)
|
217 (78.06)
|
278(81.29)
|
|
No
|
7 (77.78)
|
2 (22.22)
|
9(2.63)
|
|
Not sure
|
44 (80)
|
11 (20)
|
55(16.08)
|
|
Perception of quality of life after
kidney transplant
|
|
|
|
< 0.001***
|
Incorrect
|
47 (60.26)
|
31 (39.74)
|
78(22.81)
|
|
Correct(improve quality of life)
|
65 (24.62)
|
199 (75.38)
|
264(77.19)
|
|
Would you ask for a kidney
donation
|
|
|
|
< 0.001***
|
Yes
|
61 (22.18)
|
214 (77.82)
|
275 (80.41)
|
|
No
|
51 (76.15)
|
16 (23.88)
|
67 (19.59)
|
|
*p < 0.05, **p < 0.01, ***p < 0.001, N = frequency; %§ represent row percentages, %Ꝭ represent column percentages; p-values obtained from chi-square\Fishers’ exact tests of association. |
Twenty-nine percent of the total participants discussed kidney transplantation as an alternative to dialysis with their physician with 9.1% of the participants having ever been referred for kidney transplant evaluation. About nine out of every ten participants rated their knowledge about kidney transplantation as “below average” or “average”. Approximately one-third of the participants were unaware of any transplant centers in Ghana. In addition, about two-thirds of them feel they need to know more about kidney transplant (73.98%).
The proportion of participants who were willing to donate kidney if they had chance was 62.6% and most (81.3%) of the participants knew that a living person could donate a kidney. Majority (80.4%) of the participants reported that they would ask for a kidney donation if there is the need to.
The likelihood of willingness accept a kidney transplant was associated with the following factors; participants who had heard about kidney transplant, had discussed transplant with Physician, feel they need to know more about kidney transplant, willing to attend a class, willingness to donate kidneys, knew a living person can donate kidney, and those who would ask for a kidney donation were significantly associated with willingness to undergo kidney transplantation. (p < 0.05) (Table 3).
Predictors of patients’ willingness to accept kidney transplantation
The multiple binary logistic regression model revealed that willingness to attend a class about kidney transplant, willingness to donate kidneys, perception that a living person can a donate kidney, perception of quality of life after kidney transplant and whether one would ask for a kidney donation as the significantly predictive factors of patients willingness to undergo kidney transplant (p < 0.05). From the model, patients who were unwilling or Don't Know/Not sure of attending a class about kidney transplant had 91% (aOR: 0.09, 95% CI: 0.01–0.63)and 98% (aOR: 0.02, 95%CI: 0.001–0.37) reduced odds of accepting to undergo kidney transplant compared to those who were willing to attend the class respectively. Similarly, patients who were not willing or not sure of donating kidney had 71% (aOR: 0.29, 95%CI:0.13–0.64) and 62% (aOR: 0.38, 95% CI: 0.16–0.91) lower odds of accepting kidney transplant compared to those who were willing to donate kidney if they had the chance respectively. Again, not Knowing/Not sure and not believing that a living person can donate a kidney was associated with 90% % (aOR: 0.10 95%CI: 0.04–0.27)) and 89% (aOR: 0.11, 95%CI: 0.02–0.76) lower odds of accepting to undergo kidney transplant compared to those who believe a living person can donate kidney respectively. Having the Perception of improvement in quality of life after kidney transplant was associated with about 3 times higher odds of accepting to undergo kidney transplant compared to those who perceived contrary to that (aOR: 3.11, 95%CI: 1.42–6.78). Patients who indicated that they would be able to ask someone if they need a kidney transplant had about 6 times higher odds of accepting to undergo kidney transplant compared to those who cannot (aOR: 5.82, 95%CI: 2.53–13.43) - Table 4.
Table 4
Determining factors of patients’ willingness to accept kidney transplant
|
Sensitivity Analysis
|
|
Logistic regression
|
Penalized maximum likelihood logistic regression
|
Poisson regression
|
|
aOR (95% CI)
|
P-value
|
aOR (95% CI)
|
P-value
|
aIRR (95% CI)
|
P-value
|
Heard about kidney transplant (Prior knowledge)
|
|
0.891
|
|
0.948
|
|
0.962
|
Yes
|
1
|
|
1
|
|
1
|
|
No
|
0.93(0.38–2.28)
|
|
0.93(0.4–2.16)
|
|
0.95(0.66–1.39)
|
|
Don't Know/Not sure
|
1.81(0.12–27.37)
|
|
1.36(0.13–14.23)
|
|
1.06(0.35–3.22)
|
|
Physician discussed transplant with patient,
|
|
0.809
|
|
0.801
|
|
0.912
|
Yes
|
1
|
|
1
|
|
1
|
|
No
|
1.1(0.51–2.36)
|
|
1.1(0.53–2.26)
|
|
1.02(0.75–1.38)
|
|
Feel need to know more about Kidney transplant
|
|
0.456
|
|
0.614
|
|
0.840
|
Yes
|
1
|
|
1
|
|
1
|
|
No
|
3.18(0.44–22.98)
|
|
2.32(0.38–14.05)
|
|
1.19(0.61–2.33)
|
|
Don't Know/Not sure
|
6.19(0.18–214.6)
|
|
3.69(0.14–96.66)
|
|
1.19(0.36–3.97)
|
|
Willing to attend a class about kidney transplant
|
|
0.016*
|
|
0.034*
|
|
0.100
|
Yes
|
1
|
|
1
|
|
1
|
|
No
|
0.09(0.01–0.63)
|
|
0.13(0.02–0.77)
|
|
0.58(0.27–1.24)
|
|
Don't Know/Not sure
|
0.02(0.001–0.37)
|
|
0.03(0.001–0.59)
|
|
0.4(0.11–1.37)
|
|
Willingness to donate kidneys,
|
|
0.004**
|
|
0.005**
|
|
0.264
|
Yes
|
1
|
|
1
|
|
1
|
|
No
|
0.29(0.13–0.64)
|
|
0.32(0.15–0.68)
|
|
0.7(0.45–1.11)
|
|
Not sure
|
0.38(0.16–0.91)
|
|
0.41(0.18–0.93)
|
|
0.84(0.56–1.25)
|
|
Can a living person donate kidney
|
|
< 0.001***
|
|
< 0.001***
|
|
0.015*
|
Yes
|
1
|
|
1
|
|
1
|
|
No
|
0.11(0.02–0.76)
|
|
0.16(0.03–0.87)
|
|
0.45(0.11–1.87)
|
|
Don't Know/Not sure
|
0.1(0.04–0.27)
|
|
0.13(0.05–0.33)
|
|
0.4(0.21–0.77)
|
|
Perception of quality of life after kidney transplant
|
|
0.004**
|
|
0.007**
|
|
0.173
|
Incorrect
|
1
|
|
1
|
|
1
|
|
Correct
|
3.11(1.42–6.78)
|
|
2.76(1.32–5.76)
|
|
1.32(0.89–1.96)
|
|
Would you ask for a kidney donation
|
|
< 0.001
|
|
< 0.001***
|
|
0.012*
|
No
|
1
|
|
1
|
|
1
|
|
Yes
|
5.82(2.53–13.43)
|
|
4.83(2.19–10.65)
|
|
1.99(1.16–3.42)
|
|
*p < 0.05, **p < 0.01, ***p < 0.001, CI: Confidence interval, aOR: Adjusted odds ratio, IRR: Incidence risk ratio, Background characteristics controlled for in the models were age, sex, dialysis status, insurance status, wealth quintile, religion, insurance status, |