An onio Ríos, Ana Isabel López-Na as, Ana Isabel López-López, F ancisco Ja ie Gómez, Jo ge I ia e,
Ra ael He uzo, Ge a do Blanco, F ancisco Ja ie Llo ca, Angel Asunsolo, Pila Sánchez-Gallegos,
Ped o Ramón Gu ié ez, Ana Fe nández, Ma ía Te esa de Jesús, Lau a Ma ínez-Ala cón, Albe o Lana,
Lo ena Fuen es, Juan Ramón He nández, Julio Vi seda, José Yelamos, José An onio Bondía,
An onio Miguel He nández, Ma co An onio Ayala, Pablo Ramí ez, Pascual Pa illa
An onio Ríos, Ana Isabel López-Na as, Lau a Ma ínez-
Ala cón, Ma co An onio Ayala, Pablo Ramí ez, In e na ional
Collabo a i e Dono P ojec (“P oyec o Colabo a i o In e nacional
Donan e” , 30007 Casillas, Mu cia, Spain
An onio Ríos, Pablo Ramí ez, Pa illa Pascual, Depa men
o Su ge y, Paedia ics, Obs e ics and Gynaecology, Uni e si y
o Mu cia, A enida de las Fue zas A madas, 30800 Espina do,
Mu cia, Spain
An onio Ríos, Lau a Ma ínez-Ala cón, Pablo Ramí ez,
Pascual Pa illa, T ansplan Uni , Su ge y Se ice, IMIB -
Vi gen de la A ixaca Uni e si y Hospi al, Ca e e a Mad id-
Ca agena s/n, 30120 El Palma , Mu cia, Spain
An onio Ríos, Pablo Ramí ez, Regional T ansplan Cen e,
Conseje ía de Sanidad y Consumo de la Región de Mu cia,
30008 Ronda de Le an e, Mu cia, Spain
An onio Ríos, Hospi al Clínico Uni e si a io Vi gen de la
A ixaca, Depa amen o de Ci ugía Gene al y del Apa a o
Diges i o, Unidad de T asplan es, 30007 Casillas, Mu cia, Spain
Ana Isabel López-Na as, Depa men o Psychology,
Uni e sidad Ca ólica San An onio (UCAM), A enida de los
Je ónimos, 30107 Guadalupe, Mu cia, Spain
Ana Isabel López-López, Depa men o U ology, San Juan
Uni e si y Hospi al o Alican e, 03010 Calle Pin o Baeza,
Alican e, Spain
F ancisco Ja ie Gómez, Uni e sidad de G anada, A enida del
Hospicio s/n, 18010 G anada, Spain
Jo ge I ia e, Uni e sidad de Na a a, Campus Uni e si a io,
31080 Pamplona, Na a a, Spain
Ra ael He uzo, Uni e sidad Au ónoma de Mad id, Ciudad
Uni e si a ia de can oblanco, 28049 Mad id, Spain
Ge a do Blanco, Se icio de Ci ugía HBP y T asplan e Hepá ico,
Complejo Hospi ala io Uni e si a io de Badajoz, Hospi al In an a
C is ina, A enida El as s/n, 06006 Badajoz, Spain
F ancisco Ja ie Llo ca, Uni e sidad de Can ab ia, A enida los
Cas os s/n, 39005 San ande , Can ab ia, Spain
Angel Asunsolo, Depa amen o de Ci ugía, Ciencias Médicas
y Sociales, Facul ad de Medicina y Ciencias de la Salud,
Uni e sidad de Alcalá Campus Cien í ico-Tecnológico, Plaza de
San Diego s/n, 28801 Alcala de Hena es, Mad id, Spain
Pila Sánchez-Gallegos, José An onio Bondía, Facul ad de
Medicina, Uni e sidad de Málaga, 29071 A enida de Ce an es,
Málaga, Spain
Ped o Ramón Gu ié ez, Se icio de U ología (Complejo
Hospi ala io Uni e si a io de Cana ias, CHUC) y Depa amen o
de Ci ugía (Uni e sidad de La Laguna, ULL), Calle Molinos
de Agua s/n, 38207 San C is óbal de La Laguna, San a C uz de
Tene i e, Spain
Ana Fe nández, Depa amen o de Ciencias Biomédicas Básicas,
Facul ad de Ciencias Biomédicas, Uni e sidad Eu opea de
Mad id, A enida de Fe nando Alonso, 28108 Mad id, Spain
Ma ía Te esa de Jesús, Uni e sidad Rey Juan Ca los, Calle
Tulipán s/n, 28933 Mos oles, Mad id, Spain
Albe o Lana, Facul ad de Medicina y Ciencias de la Salud. Á ea
de Medicina P e en i a y Salud Pública, Uni e sidad de O iedo,
Calle San F ancisco, 33003 O iedo, As u ias, Spain
Lo ena Fuen es, Depa amen o de Fa macología y Fisiología
Facul ad de Ciencias de la Salud y del Depo e, Uni e sidad de
Za agoza, 50018 Calle Ped o Ce buna, Za agoza, Spain
Juan Ramón He nández, Uni e sidad de las Palmas de G an
Cana ia, Calle Juan de Quesada s/n, 35001 Las Palmas de G an
Submi a Manusc ip : h p://www.wjgne .com/esps/
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DOI: 10.3748/wjg. 22.i25.5800
5800 July 7, 2016
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Wo ld J Gas oen e ol 2016 July 7; 22(25): 5800-5813
ISSN 1007-9327 (p in ) ISSN 2219-2840 (online)
© 2016 Baishideng Publishing G oup Inc. All igh s ese ed.
ORIGINAL ARTICLE
Obse a ional S udy
Accep ance o li ing li e dona ion among medical s uden s:
A mul icen e s a i ied s udy om Spain
Re ised: May 8, 2016
Accep ed: June 15, 2016
A icle in p ess: June 15, 2016
Published online: July 7, 2016
Abs ac
AIM: To analyze he a i ude o Spanish medical
s uden s owa d li ing li e dona ion (LLD) and o
es ablish which ac o s ha e an in luence on his
a i ude.
METHODS: S udy ype: A sociological, in e disciplina y,
mul icen e and obse a ional s udy. S udy popula ion:
Medical s uden s en olled in Spain (
n
= 34000) in he
uni e si y academic yea 2010-2011. Sample size: A
sample o 9598 s uden s s a i ied by geog aphical
a ea and academic yea . Ins umen used o measu e
a i ude: A alida ed ques ionnai e (PCID-DVH RIOS)
was sel -adminis e ed and comple ed anonymously.
Da a collec ion p ocedu e: Randomly selec ed medical
schools. The ques ionnai e was applied o each
academic yea a compulso y sessions. S a is ical
analysis: S uden ´s
es ,
χ
2 es and logis ic eg ession
analysis.
RESULTS: The comple ion a e was 95.7% (
n
= 9275).
89% (
n
= 8258) we e in a o o ela ed LLD, and 32%
(
n
= 2937) suppo ed un ela ed LLD. The ollowing
a iables we e associa ed wi h ha ing a mo e a o able
a i ude: (1) age (
P
= 0.008); (2) sex (
P
< 0.001); (3)
academic yea (
P
< 0.001); (4) geog aphical a ea (
P
= 0.013); (5) belie ing in he possibili y o needing
a ansplan onesel in he u u e (
P
< 0.001); (6)
a i ude owa d deceased dona ion (
P
< 0.001); (7)
a i ude owa d li ing kidney dona ion (
P
< 0.001); (8)
accep ance o a dona ed li e segmen om a amily
membe i one we e needed (
P
< 0.001); (9) ha ing
discussed he subjec wi h one's amily (
P
< 0.001)
and iends (
P
< 0.001); (10) a pa ne 's opinion abou
he subjec (
P
< 0.001); (11) ca ying ou ac i i ies
o an al uis ic na u e; and (12) ea o he possible
mu ila ion o he body a e dona ion (
P
< 0.001).
CONCLUSION: Spanish medical s uden s ha e a
a o able a i ude owa d LLD.
Key wo ds: A i ude; Li ing li e dona ion; Medical
s uden s; T ansplan a ion; O gan dona ion; Psychosocial
a iables; Spain
© The Au ho (s) 2016. Published by Baishideng Publishing
G oup Inc. All igh s ese ed.
Co e ip: S uden s o medicine ep esen a new
gene a ion o physicians, al hough hei a i ude
owa ds li ing li e dona ion (LLD) has no been s udied
o any g ea ex en , and mos o he s udies ca ied ou
use measu emen ools ha ha e no been alida ed.
The objec i e o he au ho s was o analyze he
Cana ia, Las Palmas, Spain
Julio Vi seda, Uni e sidad de Cas illa La Mancha, Campus
Uni e si a io de Albace e s/n, 02071 Albace e, Spain
José Yelamos, Depa men o Immunology, Hospi al del Ma ,
08003 Passeig Ma í im, Ba celona, Spain
An onio Miguel He nández, Endoc inology and Nu i ion
Se ice, Hospi al Clínico Uni e si a io Vi gen de la A ixaca,
Se icio Mu ciano de Salud, Ca e e a Mad id - Ca agena s/n,
30120 El Palma , Mu cia, Spain
Ma co An onio Ayala, Hospi al Regional de Al a Especialidad
del Bajío, San Ca los la Rocha, Guanajua o 37660, León,
Mexico
Ma co An onio Ayala, HGSZ No. 10 del Ins i u o Mexicano
del Segu o Social Delegación Guanajua o, Calle San Clemen e,
Guanajua o 36010, León, Mexico
Au ho con ibu ions: Ríos A designed he s udy; Ríos A,
López-Na as AI, López-López AI, Ayala MA, Ramí ez P
and Pa illa P analyzed and in e p e ed he da a; Ríos A and
López-Na as AI con ibu ed o s a is ical expe ise, d a ed
he manusc ip , and supe ised his p og am; Ríos A, López-
Na as AI, Ayala MA, Ramí ez P and Pa illa P c i ically e ised
he manusc ip o impo an in ellec ual con en ; all au ho s
con ibu ed o acquisi ion o a subs an ial po ion o da a,
ob aining unding o his p ojec o s udy, and inal app o al o
he e sion o be published.
Ins i u ional e iew boa d s a emen : The s udy was e iewed
and app o ed by he “P oyec o Colabo a i o In e nacional
Donan e” Ins i u ional Re iew Boa d.
In o med consen s a emen : All s udy pa icipan s p o ided
in o med e bal consen p io o s udy en ollmen .
Con lic -o -in e es s a emen : All au ho s decla ed ha he e
is no con lic o in e es o disclose.
Da a sha ing s a emen : No addi ional da a a e a ailable.
Open-Access: This a icle is an open-access a icle which was
selec ed by an in-house edi o and ully pee - e iewed by ex e nal
e iewe s. I is dis ibu ed in acco dance wi h he C ea i e
Commons A ibu ion Non Comme cial (CC BY-NC 4.0) license,
which pe mi s o he s o dis ibu e, emix, adap , build upon his
wo k non-comme cially, and license hei de i a i e wo ks on
di e en e ms, p o ided he o iginal wo k is p ope ly ci ed and
he use is non-comme cial. See: h p://c ea i ecommons.o g/
licenses/by-nc/4.0/
Manusc ip sou ce: In i ed manusc ip
Co espondence o: D . An onio Ríos, Hospi al Clínico
Uni e si a io Vi gen de la A ixaca, Depa amen o de Ci ugía
Gene al y del Apa a o Diges i o, Unidad de T asplan es, A enida
de la Libe ad No. 208, 30007 Casillas, Mu cia,
Spain. a z [email protected]
Telephone: +34-968-270757
Fax: +34-968-369716
Recei ed: Feb ua y 16, 2016
Pee - e iew s a ed: Feb ua y 17, 2016
Fi s decision: Ma ch 21, 2016
5801 July 7, 2016
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Ríos A
e al
. Medical s uden s and li ing li e dona ion in Spain
a i ude o Spanish medical s uden s owa ds LLD. The
p ojec is a sociological, in e disciplina y, mul icen e
and obse a ional s udy. A sample o 9598 s uden s
is s a i ied by geog aphical a ea and academic yea .
The ins umen is a alida ed ques ionnai e (PCID-
DVH RIOS) i was sel -adminis e ed and comple ed
anonymously.
Ríos A, López-Na as AI, López-López AI, Gómez FJ, I ia e J,
He uzo R, Blanco G, Llo ca FJ, Asunsolo A, Sánchez-Gallegos
P, Gu ié ez PR, Fe nández A, de Jesús MT, Ma ínez-Ala cón
L, Lana A, Fuen es L, He nández JR, Vi seda J, Yelamos J,
Bondía JA, He nández AM, Ayala MA, Ramí ez P, Pa illa P.
Accep ance o li ing li e dona ion among medical s uden s: A
mul icen e s a i ied s udy om Spain. Wo ld J Gas oen e ol
2016; 22(25): 5800-5813 A ailable om: URL: h p://www.
wjgne .com/1007-9327/ ull/ 22/i25/5800.h m DOI: h p://dx.doi.
o g/10.3748/wjg. 22.i25.5800
INTRODUCTION
Li e ansplan a ion o e s long su i al pe iods and
imp o ed quali y o li e o pa ien s wi h li e disease
whose i al p ognosis is sho i hey do no ha e a
ansplan . Howe e , he cu en ansplan o gan
dona ion a es a e insu icien o co e ing minimum
ansplan needs[1], and he sho age o a ailable li e s
means ha mo ali y on he wai ing lis is inc easing[1].
E en in Spain in he 21s cen u y, he coun y wi h he
highes dona ion a es, mo ali y on he li e ansplan
wai ing lis has been inc easing[1]. All o his is making
i necessa y o encou age al e na i es o deceased
li e dona ion. The ansplan a ion o he igh li e
lobe om a li ing dono o an adul ecipien has
been success ully ca ied ou and in coun ies such as
Japan, he Uni ed S a es and some Eu opean coun ies
i is becoming mo e common[2,3]. E en so, in many
coun ies li ing li e dona ion (LLD) is a a e y low
le el[1]. One o he possible ba ie s o i s de elopmen
could be he isk in ol ed o he dono and he ac
ha he esul s o he ansplan a e sligh ly wo se
han when he li e is ansplan ed om a deceased
dono [4,5]. Howe e , in expe ienced cen e s he esul s
a e accep able[6,7]. Ne e heless, i should be aken
in o accoun ha p o essionals in heal hca e cen e s do
no always ha e a a o able a i ude owa d LLD, and
consequen ly hey do no c ea e he igh kind o social
clima e o i s implemen a ion[8-10]. The e o e, heal hca e
p o essionals ha e a undamen ally impo an ole
o play in i s de elopmen , gi en ha hey ha e
he capaci y o gene a e a o able o un a o able
a i udes in o he g oups o he popula ion. In ac , in
he public i has been seen ha a i ude owa d o gan
dona ion which is based on he in o ma ion p o ided
by heal hca e wo ke s, whe he posi i e o nega i e, is
e y solid[11].
S uden s o medicine ep esen a new gene a ion
o physicians, al hough hei a i ude owa d LLD has
no been s udied o any g ea ex en [12]. I should be
emembe ed, howe e , ha he adequa e aining o
u u e physicians in he ansplan a ion and dona ion
p ocess in ol es speci ically inding ou hose a ia-
bles ha ha e an e ec on ce ain a i udes owa d
dona ion om he s age o being a s uden . In his
sense, a knowledge o he ac o s ha in luence
a i udes owa d dona ion will allow us o op imize
he esou ces in es ed in ca ying ou dona ion and
ansplan a ion p omo ion campaigns and o ac in a
mo e speci ic way.
The objec i e o his s udy was o analyze he
a i ude o medical s uden s om Spanish uni e si ies
owa d ela ed and un ela ed LLD.
MATERIALS AND METHODS
Type o s udy
A sociological, in e disciplina y, mul icen e and ob-
se a ional s udy ca ied ou in Spain in he uni e si y
academic yea o 2010-2011.
S udy popula ion
The s udy popula ion comp ised o s uden s s udying
a deg ee in medicine in Spain. The numbe o
s uden s en olled in he academic yea o 2010-2011
was es ima ed using da a published by he Spanish
Na ional Ins i u e o S a is ics (INE)[13]. The numbe
o s uden s in o he medical schools no included in
he in o ma ion o he INE was ob ained o e he
elephone. As a esul , he es ima ed numbe o
medical s uden s en olled in he academic yea o
2010-2011 was 34000. I should be no ed ha in
Spain a deg ee in medicine las s o 6 yea s. Once
he deg ee has been comple ed and in o de o s a
specialis aining, he s uden s ha e o ake he public
compe i i e (MIR) exam which in ol es a aining
pe iod las ing be ween 3 and 5 yea s.
Sample size
The sample size calcula ed o a popula ion o 34000
s uden s was 9598 s uden s, conside ing an es ima ed
p opo ion (a i ude in a o o dona ion) o 76%, a
con idence o 99% and a p ecision o ± 1%.
Sample s a i ica ion
Geog aphical s a i ica ion: In he academic yea
o 2010-2011 he e we e 40 medical schools in Spain
wi h ac i e eaching ac i i y. These medical schools
we e g ouped in o ou geog aphical egions co e ing
he coun y: (1) The No h: including he Au onomous
communi ies (Ac) o Galicia, he P incipali y o
As u ias, he Basque coun y, he Fo al communi y o
Na a a, La Rioja, can ab ia and cas illa León; (2) The
cen al a ea: including he Acs o cas illa-La Mancha,
Ex emadu a and he communi y o Mad id; (3) The
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o adminis e ed ques ionnai es) was g ea e han
80% o he s uden s p esen a he a o emen ioned
compulso y s uden sessions. A e a b ie explana ion
o he s udy was p o ided by he s udy pe sonnel
abou he s uc u e and con en o he ques ionnai e,
and a e speci ying he con iden iali y o he da a
ga he ed, a ques ionnai e was handed ou o each
s uden a one o he compulso y sessions. The
ques ionnai e was sel -adminis e ed, and comple ed
olun a ily and anonymously by each s uden in a
pe iod o 5-10 min.
The inal selec ion o he pa icipa ing g oups
was ca ied ou using non-p obabilis ic con enience
sampling un il he necessa y numbe o ques ionnai es
o each academic yea was eached acco ding o he
p opo ionali y ac o . Gi en ha he ques ionnai es
we e handed ou in compulso y s uden sessions, an
academic yea was conside ed o be ull when he
numbe o ques ionnai es adminis e ed had a ange o
± 5% o he numbe o ques ionnai es calcula ed o be
necessa y.
Ins umen o measu ing a i ude
The ins umen o measu emen used was a alida ed
ques ionnai e o a i ude owa d O gan Dona ion and
T ansplan a ion[8,9] [“PcID - DVH Rios”: A ques ionnai e
o he In e na ional collabo a i e Dono P ojec
abou Li ing Li e Dona ion (“P oyec o colabo a i o
In e nacional Donan e sob e Donación de Vi o Hepá ico”
in Spanish) de eloped by D . Ríos]. This ques ionnai e
included i ems dis ibu ed in o h ee subscales o
ac o s, and i was alida ed in he Spanish popula ion,
p esen ing a o al explained a iance o 63.995% and
a c onbach’s Alpha con idence coe icien o 0.778.
Each ac o has an in e nal consis ency, measu ed by
C onbach’s Alpha Con idence coe icien o α = 0.801,
0.696, and 0.559 espec i ely, and an explained
a iance o 38.461%, 14.228%, and 11.306% es-
pec i ely. In Addi ion an ad hoc ques ionnai e was
applied including o he a iables.
S udy a iables
As a dependen a iable we s udied a i ude owa d
ela ed and un ela ed LLD. The independen a iables
s udied we e classi ied in o he ollowing g oups: (1)
Socio-pe sonal: age and sex; (2) Uni e si y: Type o
uni e si y, academic yea o he deg ee in medicine
and geog aphical loca ion; (3) Knowledge o , and
a i ude owa d, o gan dona ion and ansplan a ion:
knowing a ansplan pa ien , knowing a dono ,
belie ing ha one migh need a ansplan in he
u u e, a i ude owa d deceased o gan dona ion,
a i ude owa d li ing kidney dona ion and accep ance
o a li e segmen om a li ing dono i i was
needed; (4) Social in e ac ion: discussion wi h amily
and iends abou dona ion and ansplan a ion, he
esponden ’s pa ne ’s opinion abou he dona ion o
a amily membe ’s o gans; (5) P o-social beha io :
Eas : including he Acs o ca alonia, A agon, Valencia
and Mu cia; and (4) The Sou h: including he Acs o
Andalucía, ceu a and Melilla, he cana y Islands, and
he Balea ic Islands.
In o de o ob ain he sample, an ini ial sampling
s age was planned which was s a i ied p opo iona ely
o he numbe o s uden s en olled in each geog aphical
egion. In he No h, 14% o he s uden s we e
en olled, co esponding o a sample o 1343; in he
cen al a ea he e we e 25% co esponding o 2400;
in he Sou h he e we e 23.5% co esponding o 2256;
and in he Eas he e we e 37.5% co esponding o
3,599 esponden s.
S a i ica ion by academic yea : In each geo-
g aphical a ea s a i ied sampling was ca ied ou
acco ding o each academic yea . In o de o do
his, he p opo ion o s uden s om each yea
in each geog aphical a ea was calcula ed and he
co esponding sample was ob ained. The pe cen age
and numbe o s uden s in each a ea in each academic
yea we e as ollows: In he No h: 28% o he
s uden s (co esponding o 376 esponden s) we e
en olled in he i s yea ; 15.5% (n = 208) we e
en olled in he second yea ; 16% (n = 215) in he
hi d yea ; 14% (n = 188) in he ou h; 12% (161)
in he i h and 14.5%( n = 195) in he six h yea ; In
he cen al A ea: 23% o he s uden (n = 552) we e
en olled in he i s yea ; 25.5% (n = 540) in he
second yea ; 12% (n = 288) in he hi d yea ; 13%
(n = 312) in he ou h yea ; 11.5% (n = 276) in he
i h yea ; and 18% (n = 432) in he six h yea ; In he
Sou h: 21% o he s uden s (n=474) we e en olled
in he i s yea ; 20% (n = 451) in he second yea ;
13% (n = 293) in he hi d yea ; 15% (n = 338) in
he ou h yea ; 15% (n = 338) in he i h yea ; and
16% (n = 362) in he six h yea ; In he Eas : 21% o
he s uden s (n = 756) we e en olled in he i s yea ;
22% (n = 791) in he second; 18% (n = 648) in he
hi d; 14% (n = 504) in he ou h; 11% (n = 396) in
he i h; and 14% (n = 504) in he six h.
Da a collec ion p ocedu e
In each geog aphical a ea, a numbe o andomly
selec ed medical schools we e o mally in i ed o
pa icipa e in he s udy. con ac was made wi h
he Dean o he school a each uni e si y o ob ain
au ho iza ion o conduc he esea ch. The ques-
ionnai es we e adminis e ed o medical s uden s by
membe s o collabo a o s om he “In e na ional Dono
collabo a i e P ojec ” g oup in he selec ed medical
schools ha ag eed o pa icipa e in he s udy.
Wi h he aim o p e en ing selec ion bias, he
ques ionnai e was applied o each academic yea and
in each selec ed school, a one o se e al compulso y
sessions (lec u es, semina s, o p ac ical classes). A
g oup was only conside ed as alid when he esponse
a e (numbe o comple ed ques ionnai es/numbe
Ríos A
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. Medical s uden s and li ing li e dona ion in Spain
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Volume 22
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Issue 25
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ca ying ou p o-social ype ac i i ies; (6) Religious:
he esponden ’s eligion and knowing he a i ude o
his o he eligion owa d dona ion and ansplan a ion;
and (7) A i ude owa d he body: conce n abou
possible mu ila ion o he body a e dona ion.
S a is ical analysis
The da a we e s o ed on a da abase and analyzed
using he SPSS 21.0 s a is ical package (IBM So wa e
G oup, chicago, IL, Uni ed S a es). A desc ip i e
s a is ical analysis was ca ied ou and in o de o
compa e he di e en a iables S uden ’s - es and
he
χ
2 es we e applied complemen ed by an analysis
o he emainde s. Fo de e mining and assessing
mul iple isks, logis ic eg ession analysis was unde -
aken using he a iables ha we e s a is ically
signi ican in he bi a ia e analysis. In all cases, p
alues below 0.05 we e conside ed o be s a is ically
signi ican . The s a is ical e iew o he s udy was
pe o med by a biomedical s a is ician.
RESULTS
Medical acul ies included and he esponse a e
ob ained
The 22 andomly selec ed medical schools ag eed o
ake pa in he s udy. O he 9688 selec ed s uden s
( he 9598 selec ed plus he 0.9% pe ype o sample)
9275 co ec ly comple ed he ques ionnai e (a es-
ponse a e o 95.73%). In Table 1, he sampling
and comple ion da a is gi en o each uni e si y and
academic yea .
In he No h, he lowes comple ion a e was ound
(84.4%) because one o he uni e si ies (N1) did no
p o ide any esponden s in he end. In he cen al
a ea he comple ion a e was 96.56%. In his a ea,
he hi d yea o medical school c5 and he second o
medical school c6 we e excluded om he analysis
because he 80% esponse a e was no eached in
he compulso y sessions when he ques ionnai e was
handed ou . In he Sou h he comple ion a e was
96.41%, wi h he esul ing exclusion o he ou h yea
o medical school S1, oge he wi h he i s and i h
yea o medical school S2 due o a esponse a e o
less han 80%. In he Eas he comple ion a e was
98.97%.
A i ude owa d li ing li e dona ion
89% (n = 8258) we e in a o o ela ed LLD, 1% (n
= 78) agains and 10% (n = 939) undecided. I he
dona ion was un ela ed, 32% (n = 2937) we e in
a o , 11% (n = 1001) we e agains and 57% (n =
Table 1 Sample and comple ion da a o uni e si y medical s uden s acco ding o geog aphical a ea, uni e si y and academic yea
1s 2nd 3 d 4 h 5 h 6 h TN0TNRTR
N0NRN0NRN0NRN0NRN0NRN0NR
N1 45 0 30 0 30 0 30 0 30 0 35 0 200 0
N2 96 91 96 91
N3 133 133 87 87 97 95 100 99 65 65 92 92 574 571
N4 100 100 89 88 84 84 58 58 73 73 72 71 476 474
NT 374 324 206 175 211 179 188 157 168 138 199 163 1346 1136 84.39%
C1 32 29 32 29
C2 107 107 116 116 61 61 73 73 62 52 77 77 496 486
C3 87 86 139 139 94 94 172 171 58 58 124 124 674 672
C4 95 93 128 128 53 53 42 42 62 62 123 123 503 501
C5 53 53 48 48 23 0 124 101
C6 120 120 29 0 23 22 172 142
C7 108 107 95 94 43 43 28 28 64 62 103 93 441 427
NT 570 566 555 525 297 273 315 314 278 263 427 417 2442 2358 96.56%
S1 12 0 25 25 38 38 75 63
S2 24 0 27 27 24 23 75 75 22 0 28 28 200 153
S3 193 193 241 238 155 153 99 98 144 143 145 143 977 968
S4 59 59 68 67 25 25 50 50 26 26 38 38 266 265
S5 181 179 116 125 86 85 115 114 152 141 119 112 769 756
NT 457 431 452 457 290 286 351 337 369 335 368 359 2287 2205 96.41%
L1 114 114 148 145 116 114 156 151 101 92 113 112 748 728
L2 69 69 122 122 98 98 76 76 84 84 110 110 559 559
L3 261 261 265 265 284 284 123 123 114 114 133 133 1180 1180
L4 83 82 57 57 140 139
L5 199 195 195 192 145 141 144 143 87 87 139 137 909 895
L6 49 48 28 27 77 75
NT 775 769 815 808 643 637 499 493 386 377 495 492 3613 3576 98.97%
NT2176 2090 2028 1965 1441 1375 1353 1301 1201 1113 1489 1431 9688 9275 95.73%
N1 o N4: Medical schools in he No h; C1 o C7: Medical schools in he Cen al A ea; S1 o S5: Medical schools in he Sou h; L1 o L6: Medical schools in
he Eas ; 1s o 6 h yea s: Academic yea s; N0: Ques ionnai es adminis e ed; NR: Ques ionnai es ob ained; TN0: To al numbe o ques ionnai es adminis e ed;
TNR: To al numbe o ques ionnai es ob ained; NT: To al ques ionnai es in he co esponding column; TR (%): Comple ion a e.
Ríos A
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. Medical s uden s and li ing li e dona ion in Spain
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Volume 22
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5337) we e undecided.
O he s uden s who we e in a o o his ype o
dona ion, 42% (n = 3506) belie ed ha LLD in ol ed
a conside able amoun o isk, 30% (n = 2484) qui e
a lo o isk, 10% (n = 817) ha dly any, 9% (n = 799)
had no conside ed his ma e and 8% (n = 652)
belie ed i o be a highly isky kind o dona ion.
Fac o s a ec ing a i ude owa d LLD
Socio-pe sonal a iables: Rega ding age, signi ican
di e ences ha e been ound in a o able a i udes
owa d LLD. In he ela ed ype o dona ion, he
younge esponden s had a mo e a o able a i ude (p
= 0.008), while in un ela ed dona ion i was he olde
s uden s who we e mo e in a o (p < 0.001) (Table
2). Wi h ega d o sex, his ac o has only been ound
o be associa ed wi h a i ude owa d ela ed LLD,
wi h emales ha ing a mo e a o able a i ude owa d
ela ed LLD han males (91% s 86%, p < 0.001)
(Table 2).
Uni e si y a iables: The esponden ’s academic
yea was an in luen ial ac o on a i ude owa d
LLD, wi h he la e yea s being he ones when a
mo e a o able a i ude has been obse ed. When
conside ing ela ed dona ion, o ins ance, a i ude
was mo e a o able among s uden s in he i h and
six h yea compa ed o hose in he i s yea (92%
s 87%, p < 0.001). The same was also ue o
un ela ed dona ion; he i h and six h yea s had he
s uden s wi h he mos a o able a i ude compa ed
o hose in he i s yea (40% and 37% s 25%, p <
0.001) (Table 2). Finally, wi h ega d o geog aphical
loca ion, signi ican di e ences ha e only been ound
in a i udes owa d ela ed LLD wi h he s uden s om
he cen al a ea and he Sou h ha ing a be e a i ude
compa ed o hose om he No h and Eas (90% s
88%, p = 0.013) (Table 2).
Va iables o knowledge abou , and a i ude
owa d, o gan dona ion and ansplan a ion:
Among he ac o s associa ed wi h a a o able a i ude
owa d ela ed LLD, we ha e ound ha a esponden ’s
belie ha he o she migh need a ansplan in he
u u e ended o encou age a a o able a i ude as
opposed o when he o she had no conside ed his
possibili y (90% s 81%, p < 0.001) (Table 3). In
addi ion, he accep ance o o he ypes o dona ion,
such as deceased (92% s 79%, p < 0.001) o li ing
kidney dona ion (96% s 75%) (p < 0.001), was also
associa ed wi h a mo e a o able a i ude compa ed
o when hese o he ypes o dona ion we e ejec ed.
Finally, i should be no ed ha he willingness o accep
a li e segmen om a amily membe also ended
o be associa ed wi h a a o able a i ude owa d LLD
compa ed o when he e we e doub s abou his op ion
o he e was an unwillingness o accep i (96% s
80%, p < 0.001) (Table 3).
Wi h ega d o a i udes owa d un ela ed LLD,
signi ican ela ionships ha e been ound wi h all he
a iables analyzed in his sec ion. We can see ha
hose who had had p e ious links wi h dona ion and
Table 2 Socio-pe sonal and uni e si y a iables ela ed o o gan dona ion and ansplan a ion a ec ing he a i ude o uni e si y
medical s uden s owa d un ela ed and ela ed li ing li e dona ion
n
(%)
Un ela ed li ing li e dona ion Rela ed li ing li e dona ion
Va iable In a o (
n
=
2937; 32%)
No in a o (
n
=
6338; 68%)
P
alue In a o (
n
=
8258; 89%)
No in a o (
n
=
1017; 11%)
P
alue
Socio-pe sonal a iables
Age (21 ± 3 y ) 22 ± 4 y 21 ± 3 y < 0.001 21 ± 3 y 22 ± 4 y 0.008
Sex 0.195 < 0.001
Male (n = 2702) 830 (31) 1872 (69) 2310 (86) 392 (14)
Female (n = 6499) 2086 (32) 4413 (68) 5889 (91) 610 (9)
DS/DK (n = 74) 21 53 59 15
Uni e si y a iables
Type o uni e si y 0.68 0.103
Public uni e si y (n = 8192) 2600 (32) 5592 (68) 7278 (89) 914 (11)
P i a e uni e si y (n = 1083) 337 (31) 746 (69) 980 (91) 103 (9)
Yea o medicine < 0.001 < 0.001
Fi s (n = 2090) 521 (25) 1569 (75) 1811 (87) 279 (13)
Second (n = 1965) 544 (28) 1421 (72) 1736 (88) 229 (12)
Thi d (n = 1375) 422 (31) 953 (69) 1212 (88) 163 (12)
Fou h (n = 1301) 480 (37) 821 (63) 1166 (90) 135 (10)
Fi h (n = 1113) 443 (40) 670 (60) 1020 (92) 93 (8)
Six h (n = 1431) 527 (37) 904 (63) 1313 (92) 118 (8)
Geog aphical loca ion 0.109 0.013
No h (n = 1136) 365 (32) 771 (68) 1002 (88) 134 (12)
Cen al a ea (n = 2358) 718 (30) 1640 (70) 2118 (90) 240 (10)
Sou h (n = 2205) 741 (34) 1464 (66) 1993 (90) 212 (10)
Eas (n = 3576) 1113 (31) 2463 (69) 3145 (88) 431 (12)
DS/DK: Does no say/does no know.
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ansplan a ion, ha is, people who knew a ansplan
pa ien (36% s 30%, p < 0.001), o dono (37%
s 31%, p < 0.001) (Table 3), had a mo e a o able
a i ude compa ed o hose esponden s who did no
ha e his pe sonal expe ience.
Va iables o social in e ac ion: As shown in Table
4, all o hese a iables we e associa ed wi h a i ude
owa d LLD. Acco dingly, he s uden s who had
discussed he subjec o dona ion and ansplan a ion,
bo h wi h hei amilies and iends, had a mo e
a o able a i ude owa d ela ed and un ela ed LLD.
I has also been ound ha he a o able a i ude
o a esponden ’s pa ne owa d dona ion and
ansplan a ion had a a o able in luence (Table 4).
Va iables o p o-social beha io : Among he
s uden s su eyed, a mo e a o able a i ude has
been obse ed owa d bo h ela ed and un ela ed LLD
among hose who ca y ou al uis ic ype ac i i ies o
who would be p epa ed o ake pa in hem (Table 4).
Religious a iables: In he p esen s udy no sig-
ni ican ela ionships we e ound be ween a i ude
owa d LLD and he eligious a iables analyzed
(Table 5). Howe e , i is no able ha belie e s who
conside ed ha hei doc ine was in a o o dona ion
and ansplan a ion we e mo e in a o o un ela ed
dona ion han hose who belie ed hei eligion was
agains (35% s 27%) (p < 0.001).
Va iable o a i ude owa d he body: Finally, i has
been seen ha no being conce ned abou he possible
mu ila ion o he o ganism a e dona ion ended o be
associa ed wi h a a o able a i ude owa d LLD unlike
in he case o hose who we e conce ned abou his
aspec (p < 0.001) (Table 5).
A mul i a ia e analysis o he ac o s a ec ing a i ude
owa d ela ed LLD
The mul i a ia e analysis has shown ha he ollowing
independen ac o s a ec ed a i ude owa d ela ed
LLD (Table 6): (1) Being a emale (OR = 1.356; p <
0.001); (2) S udying in he las academic yea s o he
deg ee in medicine ( i h and six h yea ) (OR = 1.485;
p = 0.005); (3) Being in a o o deceased o gan
dona ion (OR = 2.169; p < 0.001); (4) Being in a o
o li ing kidney dona ion (OR = 3.278; p < 0.001);
(5) Being willing o be a ecipien o a li e segmen
om a li ing dono (OR = 6.493; p < 0.001); (6) No
ha ing a pa ne , and he e o e, no being in luenced
by his pe son’s opinion (OR = 1.569; p = 0.040); and
(7) Being in ol ed in egula p o-social ac i i ies (OR =
1.620; p = 0.012).
Table 3 Va iables o he uni e si y medical s uden s' knowledge abou , and a i ude owa d, ela ed and un ela ed li ing li e
dona ion
n
(%)
Un ela ed li ing li e dona ion Rela ed li ing li e dona ion
Va iable In a o (
n
=
2937, 32%)
No in a o (
n
=
6338, 68%)
P
alue In a o (
n
=
8258, 89%)
No in a o (
n
=
1017, 11%)
P
alue
Knowing a ansplan pa ien
Yes (n = 2261) 813 (36) 1448 (64) < 0.001 2026 (90) 235 (10) 0.296
No (n = 6992) 2121 (30) 4871 (70) 6210 (89) 782 (11)
DS/DK (n =22) 3 19 22 --
Knowing a dono
Yes (n = 1305) 482 (37) 823 (63) < 0.001 1180 (90) 125 (10) 0.086
No (n = 7943) 2451 (31) 5492 (69) 7055 (89) 888 (11)
DS/DK (n = 27) 4 23 23 4
Possibili y o needing a ansplan
Yes (n = 7712) 2544 (33) 5168 (67) < 0.001 6951 (90) 761 (10) < 0.001
No (n = 118) 35 (30) 83 (70) 96 (81) 22 (19)
Doub s (n = 1372) 341 (25) 1031 (75) 1159 (85) 213 (16)
DS/DK (n = 73) 17 56 52 21
A i ude owa d deceased dona ion
In a o (n = 7376) 2603 (35) 4773 (65) < 0.001 6761 (92) 615 (8) < 0.001
Agains - undecided (n = 1899) 334 (18) 1565 (82) 1497 (79) 402 (21)
Dona ing a li ing kidney
Yes, I would dona e one (n = 2784) 1965 (71) 819 (29) < 0.001 2684 (96) 100 (4) < 0.001
No, I would no dona e one (n = 872) 111 (13) 761 (87) 656 (75) 216 (25)
I do no know (n = 5619) 861 (15) 4758 (85) 4918 (88) 701 (12)
Willingness o accep a li ing li e segmen om a
amily membe
Yes, I would accep i (n = 5342) 2187 (41) 3155 (59) < 0.001 5146 (96) 196 (4) < 0.001
No, I would wai on he wai ing lis (n = 907) 224 (25) 683 (75) 751 (83) 156 (17)
I do no know (n = 2932) 519 (18) 2413 (82) 2341 (80) 591 (20)
DS/DK (n = 94) 7 87 20 74
DS/DK: Does no say/does no know.
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Table 4 Va iables o social in e ac ion and p o-social beha io a ec ing he a i ude o uni e si y medical s uden s owa d un ela ed
and ela ed li ing li e dona ion
n
(%)
Un ela ed li ing li e dona ion Rela ed li ing li e dona ion
Va iable In a o (
n
=
2937, 32%)
No in a o (
n
= 6338, 68%)
P
alue In a o (
n
=
8258, 89%)
No in a o (
n
= 1017, 11%)
P
alue
Va iables o social in e ac ion
Family discussion
Yes (n = 6565) 2255 (34) 4310 (66) < 0.001 5946 (91) 619 (9) < 0.001
No (n = 2689) 675 (25) 2014 (75) 2297 (85) 392 (15)
DS/DK (n = 21) 7 14 15 6
Discussion wi h iends
Yes (n = 6841) 2307 (34) 4534 (66) < 0.001 6172 (90) 669 (10) < 0.001
No (n = 2418) 627 (26) 1791 (74) 2074 (86) 344 (14)
DS/DK (n = 16) 3 13 12 4
A pa ne 's opinion abou dona ion and ansplan a ion
Yes, i is a o able (n = 2740) 1045 (38) 1695 (62) < 0.001 2511 (92) 229 (8) < 0.001
I do no know (n = 2451) 603 (25) 1848 (75) 2101 (86) 350 (14)
Yes, he o she is agains (n = 247) 71 (29) 176 (71) 204 (83) 43 (17)
I do no ha e a boy iend/gi l iend (n = 3654) 1162 (32) 2492 (68) 3281 (90) 373 (10)
DS/DK (n = 183) 56 127 161 22
Dona ion o a amily membe 's o gans
Yes (n = 8424) 2776 (33) 5648 (67) < 0.001 7592 (90) 832 (10) < 0.001
No (n = 667) 128 (19) 539 (81) 536 (80) 131 (20)
DS/DK (n = 184) 33 151 130 54
Va iable o p o-social beha iou
Pa icipa ion in p o-social ac i i ies
Yes, egula ly (n = 882) 348 (40) 534 (60) < 0.001 778 (88) 104 (12) < 0.001
Yes, occasionally (n = 1968) 710 (36) 1258 (64) 1756 (89) 212 (11)
No, no am I going o (n = 598) 92 (15) 506 (85) 499 (84) 99 (16)
No, bu I would be willing o (n = 5766) 1774 (31) 3992 (69) 5201 (90) 565 (10)
DS/DK (n = 61) 13 48 24 37
DS/DK: Does no say/does no know.
Table 5 Religious a iables and a i ude owa d he body which a ec he a i ude o uni e si y medical s uden s owa d un ela ed
and ela ed li ing li e dona ion
n
(%)
Un ela ed li ing li e dona ion Rela ed li ing li e dona ion
Va iable In a o (
n
=
2937, 32%)
No in a o (
n
= 6338, 68%)
P
alue In a o (
n
=
8258, 89%)
No in a o (
n
= 1017, 11%)
P
alue
Religious a iables
Responden 's eligion
Ca holic (n = 5102) 1629 (32) 3473 (68) 0.607 4603 (90) 499 (10) 0.138
O he eligions (n = 266) 92 (35) 174 (65) 233 (88) 33 (12)
A heis /agnos ic (n = 3726) 1179 (32) 2547 (68) 3322 (89) 404 (11)
DS/DK (n = 181) 37 144 100 81
Knowing he a i ude o one's eligion
owa d dona ion and ansplan a ion
Yes, in a o (n = 3049) 1074 (35) 1975 (65) < 0.001 2755 (90) 1975 (65) 0.624
Yes, agains (n = 723) 193 (27) 530 (73) 645 (89) 530 (73)
I do no know (n = 1152) 325 (28) 827 (72) 1035 (90) 827 (72)
DS/DK (n = 444) 129 315 401 43
Va iable o a i ude owa d he body
Fea o mu ila ion o sca s
Yes, I am conce ned abou i a lo
(n = 1004)
262 (26) 742 (74) < 0.001 860 (86) 144 (14) < 0.001
I do no mind (n = 6318) 2230 (35) 4088 (65) 5746 (91) 572 (9)
I do no know (n = 1860) 427 (23) 1433 (77) 1582 (85) 278 (15)
DS/DK (n = 93) 18 75 70 23
DS/DK: Does no say/does no know.
Ríos A
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. Medical s uden s and li ing li e dona ion in Spain
5808 July 7, 2016
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Volume 22
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WJG
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A mul i a ia e analysis o he ac o s a ec ing a i ude
owa d un ela ed LLD
The mul i a ia e analysis has shown he ollowing
independen ac o s o a ec a i ude owa d un ela ed
LLD (Table 7): (1) Age (OR = 1.026; p < 0.001); (2)
S udying in he inal yea s o medicine ( ou h, i h
and six h yea s) (OR = 1.436 and p = 0.006; OR =
1.594 and p = 0.001; OR = 1.745 and p < 0.001);
(3) Being in a o o deceased o gan dona ion (OR =
1.724; p < 0.001); (4) Being in a o o li ing kidney
dona ion (OR = 12.820; p < 0.001); (5) Being willing
o be a ecipien o a li e segmen om a li ing dono
(OR = 3.115; p < 0.001); (6) Ha ing a pa ne who
is in a o o o gan dona ion (OR = 1.443; p < 0.001)
o no ha ing a pa ne , and he e o e, no being
in luenced by ha pe son (OR = 1.410; p < 0.001); (7)
Regula pa icipa ion in al uis ic ac i i ies (OR = 1.992;
p = 0.002); and (8) A esponden ’s belie ha his o
he eligion is in a o o dona ion and ansplan a ion
(OR = 1.398; p = 0.002).
DISCUSSION
Knowing abou people’s a i ude owa d o gan dona-
ion allows us o de e mine which ac o s a ec his
a i ude and o be able o c ea e adequa ely designed
and cos -e ec i e campaigns. The applica ion o
ques ionnai es is one o he mos widely-used da a
collec ion echniques in social esea ch, gi en ha
(1) i has a low cos ; (2) i makes i possible o each
a la ge numbe o pa icipan s; and (3) i acili a es
he analysis o he esul s ob ained[14]. Howe e ,
ques ionnai es also ha e hei limi a ions, such as
he loss o e bal communica ion. Fu he mo e, i
is undamen ally impo an o he ques ionnai e o
be designed so ha i can quan i y and uni e salize
his in o ma ion, and hus s anda dize he in e -
iew p ocess. The e o e, a ques ionnai e should be
subjec ed o a c ea ion and alida ion p ocess o
con i m o wha deg ee i e lec s he si ua ion ha we
a e ying o measu e. This basic p emise has no been
ul illed in esea ch in o a i ude owa d dona ion, gi en
ha mos o he s udies ca ied ou and published
use measu emen ools ha ha e no been designed
o such a pu pose and ha e no been alida ed.
Finally, we should emembe ha he in e p e a ion
o he esul s should in ol e he ecogni ion o ce ain
limi a ions ha a ise in opinion ques ionnai es. The
i s o hese is he esul o he endency o all he
pa icipan s o espond acco ding o wha is conside ed
o be “socially desi able” in he su oundings whe e
hey li e. The second is caused by he dis ance
Table 6 Va iables a ec ing he a i ude o uni e si y medical s uden s owa d ela ed li ing li e dona ion, a mul i a ia e s udy
Va iable Reg ession
coe icien (b)
S anda d e o OR (CI)
P
alue
Sex
Male (n = 2702) 1
Female (n = 6499) 0.304 1.356 (1.602-1.146) < 0.001
Academic yea o deg ee in medicine:
Fi s (n = 2090) 1
Second (n = 1965) 0.090 0.111 1.095 (1.360-0.880) 0.416
Thi d (n = 1375) 0.096 0.127 1.101 (1.412-0.858) 0.449
Fou h (n = 1301) 0.078 0.135 1.081 (1.408-0.830) 0.561
Fi h (n = 1113) 0.396 0.157 1.485 (2.024-1.091) 0.012
Six h (n = 1431) 0.396 0.143 1.485 (1.964-1.123) 0.005
A i ude owa d deceased dona ion
Agains – Undecided (n = 1899) 1
In a o (n = 7376) 0.774 0.088 2.169 (2.577-1.824) < 0.001
Dona ing a li ing kidney
I do no know (n = 5619) 1
Yes, I would dona e one (n = 2784) 1.189 0.127 3.278 (4.219-2.557) < 0.001
No, I would no dona e one (n = 872) 0.914 0.109 2.494 (2.016-3.086) < 0.001
Willingness o accep a li e segmen om a amily membe
I do no know (n = 2932) 1
Yes, I would accep i (n = 5342) 1.872 0.096 6.493 (7.874-5.376) < 0.001
No, I would wai on he lis (n = 907) 0.347 0.115 1.414 (1.769-1.129) 0.003
The esponden 's pa ne 's opinion abou dona ion and ansplan a ion
Yes, he o she is agains (n = 247) 1
Yes, i is a o able (n = 2740) 0.383 0.225 1.466 (2.277-0.943) 0.089
I do no know i (n = 2451) 0.157 0.220 1.169 (1.801-0.759) 0.477
I ha e no go a boy iend o gi l iend (n = 3654) 0.450 0.219 1.569 (2.409-1.021) 0.040
Pa icipa ion in p o-social ac i i ies
No, I ha e no in en ion o pa icipa e (n = 598) 1
Yes, egula ly (n = 882) 0.482 0.193 1.620 (1.110-2.364) 0.012
Yes, occasionally (n = 1968) 0.332 0.171 1.394 (0.997-1.948) 0.052
No, bu I would be p epa ed o (n = 5766) 0.168 0.154 1.183 (0.875-1.599) 0.276
Ríos A
e al
. Medical s uden s and li ing li e dona ion in Spain
