Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2016; 22(25): 5800-5813
Published online Jul 7, 2016. doi: 10.3748/wjg.v22.i25.5800
Acceptance of living liver donation among medical students: A multicenter stratified study from Spain
Antonio Ríos, Ana Isabel López-Navas, Ana Isabel López-López, Francisco Javier Gómez, Jorge Iriarte, Rafael Herruzo, Gerardo Blanco, Francisco Javier Llorca, Angel Asunsolo, Pilar Sánchez-Gallegos, Pedro Ramón Gutiérrez, Ana Fernández, María Teresa de Jesús, Laura Martínez-Alarcón, Alberto Lana, Lorena Fuentes, Juan Ramón Hernández, Julio Virseda, José Yelamos, José Antonio Bondía, Antonio Miguel Hernández, Marco Antonio Ayala, Pablo Ramírez, Pascual Parrilla
Antonio Ríos, Ana Isabel López-Navas, Laura Martínez-Alarcón, Marco Antonio Ayala, Pablo Ramírez, International Collaborative Donor Project (“Proyecto Colaborativo Internacional Donante” , 30007 Casillas, Murcia, Spain
Antonio Ríos, Pablo Ramírez, Parrilla Pascual, Department of Surgery, Paediatrics, Obstetrics and Gynaecology, University of Murcia, Avenida de las Fuerzas Armadas, 30800 Espinardo, Murcia, Spain
Antonio Ríos, Laura Martínez-Alarcón, Pablo Ramírez, Pascual Parrilla, Transplant Unit, Surgery Service, IMIB - Virgen de la Arrixaca University Hospital, Carretera Madrid-Cartagena s/n, 30120 El Palmar, Murcia, Spain
Antonio Ríos, Pablo Ramírez, Regional Transplant Centre, Consejería de Sanidad y Consumo de la Región de Murcia, 30008 Ronda de Levante, Murcia, Spain
Antonio Ríos, Hospital Clínico Universitario Virgen de la Arrixaca, Departamento de Cirugía General y del Aparato Digestivo, Unidad de Trasplantes, 30007 Casillas, Murcia, Spain
Ana Isabel López-Navas, Department of Psychology, Universidad Católica San Antonio (UCAM), Avenida de los Jerónimos, 30107 Guadalupe, Murcia, Spain
Ana Isabel López-López, Department of Urology, San Juan University Hospital of Alicante, 03010 Calle Pintor Baeza, Alicante, Spain
Francisco Javier Gómez, Universidad de Granada, Avenida del Hospicio s/n, 18010 Granada, Spain
Jorge Iriarte, Universidad de Navarra, Campus Universitario, 31080 Pamplona, Navarra, Spain
Rafael Herruzo, Universidad Autónoma de Madrid, Ciudad Universitaria de cantoblanco, 28049 Madrid, Spain
Gerardo Blanco, Servicio de Cirugía HBP y Trasplante Hepático, Complejo Hospitalario Universitario de Badajoz, Hospital Infanta Cristina, Avenida Elvas s/n, 06006 Badajoz, Spain
Francisco Javier Llorca, Universidad de Cantabria, Avenida los Castros s/n, 39005 Santander, Cantabria, Spain
Angel Asunsolo, Departamento de Cirugía, Ciencias Médicas y Sociales, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá Campus Científico-Tecnológico, Plaza de San Diego s/n, 28801 Alcala de Henares, Madrid, Spain
Pilar Sánchez-Gallegos, José Antonio Bondía, Facultad de Medicina, Universidad de Málaga, 29071 Avenida de Cervantes, Málaga, Spain
Pedro Ramón Gutiérrez, Servicio de Urología (Complejo Hospitalario Universitario de Canarias, CHUC) y Departamento de Cirugía (Universidad de La Laguna, ULL), Calle Molinos de Agua s/n, 38207 San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
Ana Fernández, Departamento de Ciencias Biomédicas Básicas, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Avenida de Fernando Alonso, 28108 Madrid, Spain
María Teresa de Jesús, Universidad Rey Juan Carlos, Calle Tulipán s/n, 28933 Mostoles, Madrid, Spain
Alberto Lana, Facultad de Medicina y Ciencias de la Salud. Área de Medicina Preventiva y Salud Pública, Universidad de Oviedo, Calle San Francisco, 33003 Oviedo, Asturias, Spain
Lorena Fuentes, Departamento de Farmacología y Fisiología Facultad de Ciencias de la Salud y del Deporte, Universidad de Zaragoza, 50018 Calle Pedro Cerbuna, Zaragoza, Spain
Juan Ramón Hernández, Universidad de las Palmas de Gran Canaria, Calle Juan de Quesada s/n, 35001 Las Palmas de Gran Canaria, Las Palmas, Spain
Julio Virseda, Universidad de Castilla La Mancha, Campus Universitario de Albacete s/n, 02071 Albacete, Spain
José Yelamos, Department of Immunology, Hospital del Mar, 08003 Passeig Marítim, Barcelona, Spain
Antonio Miguel Hernández, Endocrinology and Nutrition Service, Hospital Clínico Universitario Virgen de la Arrixaca, Servicio Murciano de Salud, Carretera Madrid - Cartagena s/n, 30120 El Palmar, Murcia, Spain
Marco Antonio Ayala, Hospital Regional de Alta Especialidad del Bajío, San Carlos la Rocha, Guanajuato 37660, León, Mexico
Marco Antonio Ayala, HGSZ No. 10 del Instituto Mexicano del Seguro Social Delegación Guanajuato, Calle San Clemente, Guanajuato 36010, León, Mexico
Author contributions: Ríos A designed the study; Ríos A, López-Navas AI, López-López AI, Ayala MA, Ramírez P and Parrilla P analyzed and interpreted the data; Ríos A and López-Navas AI contributed to statistical expertise, drafted the manuscript, and supervised this program; Ríos A, López-Navas AI, Ayala MA, Ramírez P and Parrilla P critically revised the manuscript for important intellectual content; all authors contributed to acquisition of a substantial portion of data, obtaining funding for this project or study, and final approval of the version to be published.
Institutional review board statement: The study was reviewed and approved by the ¡°Proyecto Colaborativo Internacional Donante¡± Institutional Review Board.
Informed consent statement: All study participants provided informed verbal consent prior to study enrollment.
Conflict-of-interest statement: All authors declared that there is no conflict of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Antonio Ríos, Hospital Clínico Universitario Virgen de la Arrixaca, Departamento de Cirugía General y del Aparato Digestivo, Unidad de Trasplantes, Avenida de la Libertad No. 208, 30007 Casillas, Murcia, Spain. arzrios@um.es
Telephone: +34-968-270757 Fax: +34-968-369716
Received: February 16, 2016
Peer-review started: February 17, 2016
First decision: March 21, 2016
Revised: May 8, 2016
Accepted: June 15, 2016
Article in press: June 15, 2016
Published online: July 7, 2016

AIM: To analyze the attitude of Spanish medical students toward living liver donation (LLD) and to establish which factors have an influence on this attitude.

METHODS: Study type: A sociological, interdisciplinary, multicenter and observational study. Study population: Medical students enrolled in Spain (n = 34000) in the university academic year 2010-2011. Sample size: A sample of 9598 students stratified by geographical area and academic year. Instrument used to measure attitude: A validated questionnaire (PCID-DVH RIOS) was self-administered and completed anonymously. Data collection procedure: Randomly selected medical schools. The questionnaire was applied to each academic year at compulsory sessions. Statistical analysis: Student´s t test, χ2 test and logistic regression analysis.

RESULTS: The completion rate was 95.7% (n = 9275). 89% (n = 8258) were in favor of related LLD, and 32% (n = 2937) supported unrelated LLD. The following variables were associated with having a more favorable attitude: (1) age (P = 0.008); (2) sex (P < 0.001); (3) academic year (P < 0.001); (4) geographical area (P = 0.013); (5) believing in the possibility of needing a transplant oneself in the future (P < 0.001); (6) attitude toward deceased donation (P < 0.001); (7) attitude toward living kidney donation (P < 0.001); (8) acceptance of a donated liver segment from a family member if one were needed (P < 0.001); (9) having discussed the subject with one's family (P < 0.001) and friends (P < 0.001); (10) a partner's opinion about the subject (P < 0.001); (11) carrying out activities of an altruistic nature; and (12) fear of the possible mutilation of the body after donation (P < 0.001).

CONCLUSION: Spanish medical students have a favorable attitude toward LLD.

Keywords: Attitude, Living liver donation, Medical students, Transplantation, Organ donation, Psychosocial variables, Spain

Core tip: Students of medicine represent a new generation of physicians, although their attitude towards living liver donation (LLD) has not been studied to any great extent, and most of the studies carried out use measurement tools that have not been validated. The objective of the authors was to analyze the attitude of Spanish medical students towards LLD. The project is a sociological, interdisciplinary, multicentre and observational study. A sample of 9598 students is stratified by geographical area and academic year. The instrument is a validated questionnaire (PCID-DVH RIOS) it was self-administered and completed anonymously.