Attitudes of Members of the Baptist Church Toward OrganTransplantation

G. Kobusa, J. Piotrowskaa, Jacek Malyszkob, H. Bachorzewska-Gajewskaa, and Jolanta Malyszkob,*aFaculty of Clinical Medicine, and bSecond Department of Nephrology, Medical University of Bialystok, Bialystok, Poland

ª 2014 by E360 Park Av

Transplantat

ABSTRACT

Introduction. The Baptist Church in Poland has not presented its official stance on organ,tissue, or cell transplantation so far. The aim of the work was to find out Baptists’ knowledgeand opinions concerning organ transplantation.Methods. The respondents were 296 members of the Baptist Church. The research toolused in the study was an original survey questionnaire.Results. The vast majority of Baptists (72%) would agree to have organs removed from adeceased family member. The fact of knowing someone who has had an organ transplantedwas a factor promoting such a decision. Three fourths of the respondents would agree onremoval of their organs for transplantation after death, but only 47% have talked about thatwith their families. Of the respondents, 37% think that the transplant recipient should havethe opportunity to meet the family of the donor. The respondents who did not agree to haveorgans removed from a deceased person most often mentioned such reasons as aversion toviolating bodily integrity of the deceased person (55%), religious beliefs (54%), failure toagree with the death of the deceased person (46%), not knowing the deceased person’s will(34%), and lack of trust in health service (32%).Conclusion. Propagation of knowledge of transplantation is the only effective method ofincreasing the number of organ transplantations, because many ethical, social, and religiousbarriers in the society result from insufficient education.

*Address correspondence to Professor Jolanta Malyszko,Second Department of Nephrology, Medical University, 15-276Białystok, M. Curie-Skłodowskiej 24a, Białystok, Poland. E-mail:jolmal@poczta.onet.pl

THE RAPID development of transplantology has allowedfor transplanting organs all over the world, but at the

same time has brought many new challenges and problems[1]. Problems related to removing and transplanting tissuesand organs exist on many planes: Medical, legal, psycholog-ical, and ethical. Different approaches to the issue of trans-plantation in the world often result from cultural differences,and are to a great extent affected by religions predominatingin certain regions or countries [2]. Religion is a very impor-tant element of nonmaterial culture; it allows many people tofind their place in the world and obtain the answers toquestions concerning the meaning of human existence.Whether it is Islam, Christianity, Judaism, Buddhism, orother belief system, religion is an inseparable part of humanexperience, the source of guidelines and principles forbehavior and thinking in many areas of life, including healthconditions [3]. That is why religion is not unimportant in theformation of social attitudes toward transplantation [4].Although none of the world’s biggest religions forbids

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ion Proceedings, 46, 2487e2491 (2014)

donating organs or having them transplanted, ethical prob-lems connected with it are perceived and interpreted invarious ways. When an extremely difficult decision must bemade, the donors’ families often refer to the authorities theyrecognize, and their religious community can be such an au-thority. One of the communities is the Baptist Church. TheBaptist Church has about 47 million adult members;including whole families, the Baptist community numbers inthe hundreds of millions. Baptists are Protestant Christianswho emphasize individual relationships with God and theoverriding role of the Holy Scriptures. According to Baptists,salvation is not attainable on the basis of one’s deeds, but isGod’s mercy through personal faith in the redemption fromsin by Jesus Christ’s ransom [5]. They base their lifestyle and

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principles on the Old and New Testament. For Baptists,faith is a matter of conscious choice, so they claim nobodyshould be forced to accept a religious identity [6,7]. TheBaptist Church in Poland has not presented its officialstance toward organ, tissue, or cell transplantation to date.Baptists think that donating organs and tissues for trans-plantation after death is a matter of conscience, but theyapprove of it as an act of compassion and union with all whosuffer and need help. In 1988 in the United States, theSouthern Baptist Convention adopted a resolution in whichdoctors were encouraged to discuss with patients the issue ofdonating organs should the need arise. Concerns connectedwith transplantation do not result from religious beliefs, butfrom lack of trust in the health care service, not knowingrelatives’ will concerning the donation of organs, and fromfailure to accept the fact that the beloved person has died.However, despite those real concerns, in Baptist Churchesbelievers are encouraged to support donation, exhorted totrust health care services, and informed that transplantationis not contrary to their religion. Baptists usually agree withthe medical diagnoses of brain death [8]. The aim of thiswork was to find out Baptists’ level of knowledge concerningorgan transplantation and to learn their attitudes andopinions regarding organ transplantation.

MATERIALS AND METHODS

This studywas carried out used a diagnostic poll. The respondents were296 members of the Baptist Church. Participation in the study wasanonymous and voluntary. All respondents gave their consent toparticipation in the study. The study was approved of by the localbioethics committee. The study tool was a survey questionnaireincluding 22 questions pertaining to transplantation. Pearson’s c2 testwas used to analyze the categorical data. Normality of numerical datadistribution was verified with ShapiroeWilk and KolmogoroveSmirnovtests. The 2 groups were compared with the ManneWhitneynonparametric test. P < .05 was regarded as significant. The statisticalanalysis was carried out with the use of Statistica 10.0 package fromStatsoft (Tulsa OK).

RESULTS

The group comprised 53% women and 47% men. Therespondents’ mean age was 37.7 � 18.5 years (range, 18e90).Nearly all of them (98%), regardless of age or gender, wereaware of what organ transplantation was. One half of therespondents (51%)had talked about transplantationwith theirrelatives and friends.Women significantlymore often initiateddiscussions on the subject of transplantation than men did(54% vs 42%; P ¼ .032).

Approval of Transplantation of Organs Taken From DeadDonors

The vast majority (87.5%) of members of the BaptistChurch approved of transplantation of organs from deaddonors. Those who accepted organ transplantation weresignificantly younger compared with those who opposed it

(37.3 vs 49.8 years; P ¼ .049). The mean age of those whowere undecided 28.9 years.

Consent to Have Organs Taken From a Deceased FamilyMember

Approximately three quarters of the respondents (72.29%)would give consent to removing organs from a deceased familymember; every fifth person was undecided and 7% wereagainst it. Those who did not agree were older compared withthose who gave consent (42.1 vs 37.3 years old). The mean ageof those whowere undecided was 31.6 years. People who knewsomeone who had received an allograft more often expressedtheir consent to the removal of organs (P¼ .036). Among therespondents who “did not know any recipient,” the answer“I have no opinion” was given more often (24%) than amongthose who “knew a recipient” (14%).

Consent to Having One’s Own Organs Removed forTransplantation After Death

Of the respondents, 75% expressed consent to having theirorgans removed for transplantation after death; the numberwas higher among women (81%) than men (69%). Comparedwith women, men were much more often undecided (27% vs11%). Among respondents, women more often expressedtheir objection to donating their own organs (8% vs 4%;P ¼ .000). In addition, a significant relationship was observedbetween declaring consent to giving one’s organs for trans-plantation after death and knowing a transplant recipient(P ¼ .033). The mean age of respondents giving consent tohaving their organs removed for transplantation after deathwas 36.9 years; those who did not agree were 42.9 on average,and the undecided, 35.9 years old.

Consent to Becoming a Related Donor

To the question of becoming a related donor, 11% of therespondents answered “definitely yes.” Their ages rangedfrom 18 to 65 (mean, 33.8). Another 43% answered “yes”(mean age, 37.1 years). There were 8% who were againstbecoming related donors, and their mean age was 39.8years. Four percent answered “definitely not,” and the meanage in that group was 31 years. Finally, 33% were unde-cided; their mean age was 40 years.

Regulations Concerning the Removal of Organs From DeadDonors

According to every third respondent, presumed consent issufficient to remove organs. Women opted for presumedconsent more often than men (39% vs 24%; P ¼ .021); 31%of the respondents recognized the consent of the family ofthe deceased person as necessary (22% of women and 40%of men). Overall, 15% believed that the deceased person’sconsent needed to be expressed before death (17% ofwomen and 14% of men); 9% did not know whose consentwas necessary (10% of women and 9% of men). Fourpercent of respondents, both women and men, thought that

BAPTIST ATTITUDES TOWARD TRANSPLANTATION 2489

nobody’s consent was necessary for taking organs from adead person.

Do You Think Organ Recipients Should Be More FrequentlyTalked About to Make People Aware That TransplantationSaves the Lives of Many?

Talking about organ recipients as a method of raising socialawareness to the fact that transplantation saves lives wassupported by 77% of the respondents, slightly more women(81%) than men (71%). Four percent, both women andmen, were against these discussions.

Do You Think the Transplant Recipient Should Have theOpportunity to Meet the Donor’s Family?

Of the respondents, 37% were of the opinion that the organrecipient should have the opportunity to meet the donor’sfamily; women and men answered alike; 38% of the re-spondents, both women and men, had no opinion.

What Is the Reason for Opposition to Having Organs TakenFrom a Relative?

Respondents usually indicated the following reasons forlack of consent to have organs removed from a dead person:Aversion to violating bodily integrity of the deceased per-son, 53% of women and 58% of men; failure to agree withthe death of the deceased person, 54% of women and 38%of men; religious beliefs, 52% of women and men; lack ofknowledge concerning the deceased person’s will, 34% ofwomen and men; and lack of trust in health care service,32% of women and men.

Necessity of Educational Campaigns PromotingTransplantation

More than one half of the respondents (59%) thought thatcampaigns promoting transplantation were necessary.Womensignificantly more often than men supported such education(62% vs 54%; P ¼ .030). The majority of the respondents(64%) pointed out that religious organizations should conducteducational campaigns promoting transplantation and 57%indicated the role of health-promoting foundations, namely,54% said schools, 40% said celebrities, and 34% pointed tothe media.

Declaration of Will

Eighty-five percent of respondents (85% of women and 82%of men) had heard of the declaration of will.

DISCUSSION

In literature discussing the issue of transplantation, thereare many works concerning the opinions of members ofparticular religious denominations. Most works conductedin Poland and abroad involve studying public opinion onorgan donation and transplantation. In our study, weattempted to learn and evaluate the barriers concerningtransplantation among the members of the Baptist Church.The study was carried out in one of the greatest Baptist

congregations in Białystok, in the Northeast part of Poland.In Podlaskie Voivodeship in 2012, the number of organremovals from dead donors was 11.7 per million residentsand was the lowest within the last 3 years. The number ofremovals in Podlaskie Voivodeship differs considerablyfrom the regions where the process of identification of deaddonors is actively promoted [8]. As our research shows, thevast majority of members of the Baptist Church (87.5%)approved of organ transplantation. That percentage issimilar to the results of research conducted by the PublicOpinion Research Center (CBOS) in 2012, in which thepercentage of persons accepting organ transplantation as atreatment method was 96% [9]. The respondents’ agesignificantly affected the answers given. More youngerpersons accepted this form of treatment than older ones.Among Christians, donating one’s organs for trans-plantation is considered to be the greatest act of mercy foranother human. Most religious groups have a positivestance toward donation of organs and transplantation [10],and their representatives encourage others to donate organsafter death, referring to transplantology as an act ofaltruism. In a study carried out among members of theBaptist Church, 72% of the respondents agreed to havetheir organs removed after death and to have the organstaken from a deceased relative. Knowing someone who hadhas undergone transplantation was a factor facilitating themaking a positive decision. Baptists are of the opinion thattransplantation and donating organs and tissues after deathis an individual matter for every human. The results ofCBOS of 2012 showed that 82% of Poles would agree to theremoval of organs after the death of a close relative. Oneyear before, 87% had answered that way [10]. The per-centage of objection resulting from the authors’ own ma-terials was 6%, which was similar in the case of the CBOSresearch [11]. Analyzing the data from literature, we canobserve the variety of views on the topic among people ofdifferent age. Definitely more young people support organdonation. That was confirmed by our study, too. Youngerpeople were more willing to donate their own organs andagree to have organs taken from the deceased relatives. Thetendency is similar all over the world, which is proved by theresults of a study carried out at the Teheran Universityamong medicine students, where most of the studied pop-ulation (85%) were willing to donate their organs afterdeath [12]. In a study by Wojciechowski and Szpringr [13],who studied the opinions of young Poles toward trans-plantology, most respondents would also agree to donatetheir organs after death (91.1%) as well as organs of adeceased relative (77.3%). Young people are also thegreatest enthusiasts of transplantations within the familyfrom a related living donor. That was shown in the IPSOSreport of 2012, where 71% of students, regardless of faculty,approve of transplantation [14]. In our study, 11% of therespondents had decided to become related donors; theirmean age was 33.8 years. In addition, 43% answered thatthey would be willing to become related donors; theywere slightly older (mean age, 37.1 years). Most of the

2490 KOBUS, PIOTROWSKA, MALYSZKO ET AL

population did not know that in Poland the legal basis forremoving organs for transplantation after death is presumedconsent [15], which means that in accordance with the law,an organ can be taken from a dead person who had notdeclared their objection. Only 32% of those surveyed gavethe correct answer. Usually, respondents indicated that theconsent of the dead person’s family was necessary (31%)and that the consent of the dead person expressed whilealive was necessary (15%). Our study was not the only oneto show that the respondents’ knowledge of the binding lawsconcerning transplantation is low. Nearly two thirds of Polesare convinced that the doctor is obliged to ask the family forconsent; about 21% of all the men and women taking part inthe study think that the law should decide of taking organsfrom a dead person [16]. Lack of knowledge of legal regu-lations and the opinions of our relatives regarding theconsent or objection to having organs removed, as well aslimited openness and willingness to discuss the issues ofconsent or objection, puts the families of the deceasedpersons in a difficult situation and contributes to the lownumber of donations. Therefore, perhaps, it is worthwhile tointroduce the community to that legal aspect within theframework of educational campaigns. We asked our re-spondents what they thought was the reason for families’objections to organs removal. Among more than a dozen ofthe reasons mentioned, the answer given most frequentlywas aversion to violating bodily integrity of the deceasedperson (55%), followed by religious beliefs (54%),emotional reasons (46%), and lack of knowledge concern-ing the deceased person’s will (34%). These are partlyconsistent with other scholars’ reports. Both in our ownmaterial and in the available literature, the most frequentlymentioned reasons are religious beliefs and emotional rea-sons. What is worrying is the fact that even one third of therespondents pointed out lack of trust in the health careservice. Other studies show that it is also allowed by 31.14%of the respondents among medical staff in PodkarpackieVoivodeship and 13.55% in Mazowieckie Voivodeship [17].Lack of trust in doctors dealing with organ transplantationamong people from the medical circle may be an importantbarrier in the process of obtaining organs fortransplantation.In many cases, the lack of consent on the part of the

family to removing organs from a deceased relative isrelated to the fact the deceased’s will is not known, whichwas confirmed by our study. In the Baptist Church, 49% ofrespondents had talked to their family members abouttransplantology; in comparison, from CBOS data, one halfas many Poles (24%) mentioned the topic of their attitudeto donating organs after death in conversations. Accordingto CBOS research, three fourths of Poles (75%) have nevertalked to their relatives about donating their organs afterdeath. Family members’ knowledge concerning trans-plantation is significant for their attitudes after the death ofthe beloved ones. We asked respondents whether cam-paigns promoting the idea of transplantation were neces-sary and who should carry them out. One half of

respondents could see the need for such campaigns; 64%thought the campaigns should be carried out by religiousorganizations, and 54% pointed out health foundations andschools. Every third respondent indicated the role of themedia. The vast majority of respondents (77%) thoughtthat talking about organ recipients is one of the methods ofmaking the community aware of organ donation. As ourresearch shows, knowing a person who had undergone atransplantation was an important factor contributing to theacceptance of having organs taken after the death of a closerelative and donating an organ while alive. Young peoplehad greater knowledge of and were more enthusiastic abouttransplantation.A high number of the respondents belonging to the Baptist

Church (87.5%) agree that organ transplantation is right.However, when the problem affects someone from theirclosest circle, a somewhat lower percentage of them agree tohave an organ taken while living or after death. On the onehand, transplantation is accepted as an achievement of thecontemporary medicine, and on the other hand, objections totaking organs from dead persons are quire frequent. It shouldbe concluded that there remains a need for campaignspromoting organ transplantation and encouraging all agegroups to talk to their relatives about their stance towardorgan transplantation, as well as to declare their will to bea living donor of paired organs and an organ donor afterdeath.

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