Abstract
Purpose:
Some 350,000 patients require corneal transplants each year in China, but a severe shortage of donated corneas limits the number of surgeries. We sought to better understand knowledge, attitudes and barriers towards donation among urban Chinese adults.
Methods:
Twelve communities were randomly selected from 3 of the 9 municipal districts composing Guangzhou city in southern China. Government residency registers were used to select individuals at random until > 35 respondents in pre-determined age strata from 20 to 60+ years had completed a 36-item, 20-minute questionnaire administered by trained study personnel at their home.
Results:
Among 1,217 randomly-selected persons, 430 (35.3%) completed the survey (mean [SD] age 40.4 [15.6] years, n=249 [57.9%] female). Refusers were older (44.8 [13.8] years, p＜0.001), but did not differ by gender (52.2% female, P=0.06) from participants. Among participants, 175 (40.7%) would be willing to donate corneas (WTD). Differences between those WTD and not WTD included: greater knowledge about donation (WTD knowledge score 6.91 +/- 2.21, not WTD 5.62 +/- 2.43, p＜0.001); having ever discussed donation (WTD n=46 [26.3%], not WTD n=22 [8.63%], p＜0.001); viewing donation as “unpopular” in society (WTD n=119 [68.0%], not WTD n=208 [81.6%], p=0.001); feeling that donation “damages the body” (WTD n=27 [15.4%], not WTD n=65 [25.7%], p＜0.001); “unlikely” to talk about donation (WTD n=46 [26.3%], not WTD n=196 [77.8%], p＜0.001); and “unlikely” to consent to donation of a relative’s cornea (WTD n=22 [12.6%], not WTD n=124 [49.0%], p＜0.001). In logistic regression models of WTD, the following remained significant: Knowledge (WTD OR=1.17 per point, 95% CI 1.05, 1.31, P =0.004), having discussed donation (WTD OR=2.28, 95% CI 1.13, 4.60, p=0.021); viewing donation as “unpopular” (WTD OR=0.31, 95% CI 0.12, 0.82, p=0.019); and disagreeing that donation damages the body (WTD OR= 3.51, 95% CI 1.86, 6.61, P＜0.001). Attitudes toward donation, and WTD (>60 years: 22/51, 43.1%; <=40 years: 99/241, 41.1%, p=0.96) did not differ by age.
Conclusions:
Even assuming all those refusing the survey would not donate, 14.3% (175/1217) agreed to, sufficient to sustain transplant programs. Interventions to improve knowledge about the process may be most likely to increase donation. Neither attitudes nor willingness to donate differed significantly between younger and old persons.