Vladimir Chadikovski, Aco Dimov, Mile Petrovski, Risto Simeonov, Branka Petrovska

University Clinic for Pediatric Surgery, Faculty of Medicine, Ss Cyril and Methodius University, Skopje, Republic of Macedonia

Background: Donation of organs is on a very low level and due to its specific nature is a very sensitive topic, especially in the post – conflict and multinational country like Republic of Macedonia.

Aim: The NGO National Transplant Foundation has conducted a study in order to gain understanding about factors that drive awareness, attitudes towards donation of organs and willingness to participate.
Material and Methods: The study was conducted on a representative sample of 1000 respondents using standardized questionnaire via face to face method in September 2009. Answers on all questions were cross tabulated in order to detect patterns. Factor analysis and cluster analysis were used for identification of different segments of respondents.

Results: The results revealed that majority of population in Macedonia is familiar with the term transplantation, but there is a very low awareness that a specific law for organ donation exists. Segmentation analysis identified several groups of responders: apostles (23%), mercenaries (11%), escapists (26%), neutral (13%) and hostages (28%). More precisely, apostles are people who perceive transplantation or donations of organ as human act and who already participate in some humanitarian activity like blood donation. The participants were divided upon their opinion whether they would donate their organs after death. The reasons for this are found in negative attitude towards donation and low level of trust in institutions.

Conclusion: The survey clearly indicates that there is a need for informing the population about the law and the process of donation of organs in Macedonia. Inclusion of certain benefits like health or social insurance will stimulate the process of donation of organs. Another important output is that mercenaries and escapists are groups which should be targeted, while apostles and neutral could be used as promoters of the idea.

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Citation: Chadikovski V, Dimov A, Petrovski M, Simeonov R, Petrovska B. Cadaver Transplantation in Balkans: Mission Possible? Maced J Med Sci. 2011 Dec 15; 4(4):411-416. http://dx.doi.org/10.3889/MJMS.1957-5773.2011.0196.
Key words: Cadaveric transplantation; interview; factor analysis; cluster analysis Balkans; Republic of Macedonia.
Correspondence: Vladimir Chadikovski, MD. University Clinic for Pediatric Surgery, Faculty of Medicine, Ss Cyril and Methodius University, Skopje, Republic of Macedonia. E-mail: vcadik73@yahoo.com; cadikovski@yahoo.com
Received: 17-Aug-2010; Revised: 20-Oct-2011; Accepted: 25-Oct-2011; Online first: 28-Nov-2011
Copyright: © 2011 Chadikovski V. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Competing Interests: The authors have declared that no competing interests exist.

Table 1: Description of profiles (extracted with cluster analysis) – factors of lifestyle and value system.

Figure 1: Have you ever participate in any kind of humanitarian activity?

Figure 2: Sample description.

Figure 3: Have you or some member of your family ever had the need of transplantation?

Figure 4: Do you know, if there is any law for organ transplantation in Republic of Macedonia?

Most of the participants would claim donation of their organs (22% certainly, and 40% probably) in case of death, of which Apostles are the most certain (31%). Mercenaries and Hostages are at least ready for voluntary sign of this document (Fig. 5).

Figure 5: Would you agree to sign for donation of your organs, in case of death?

As reasons for not signing this kind of document are verbalized: morbid to think about death while you’re alive (46), contrary to common views on life and death (20%) and no trust in Institutions (22%) (Fig. 6).

Figure 6: What are the reasons because of you wouldn’t sign for donation of your organs?

All segments are ready to sign this documents no matter to whom the organs will be donated except Escapists segment who will sign only for donating the organs to closely related people (Fig. 7).

Figure 7: Would you sign this statement no matter to whom your organs will be donated or you will have particular conditions?

Expectations of award significantly influence readiness for donation among participants of the survey. Mercenaries and Escapists express opinion that donating organs should be awarded by State Institutions. Awards should be: money, health insurance benefits and social insurance benefits. As a strongest motive for stimulation of donating organs is material compensation – money, exception of tax payment and other health or social insurance benefits (Fig. 8).

Figure 8: Do you think that donating organs should be awarded by some institutions?

Acceptance of organs in case of a need is pretty high but still seems connected with readiness of donating. The most ready to accept an organ from unknown donor are individuals in segments Neutrals and Apostles who are in the same time highly ready to donate organs to unknown person in need. The strongest motive for rejection of transplantation is belief in fate or belief that natural death is most appropriate end.

Making decision about donating organs for someone close is more difficult than decision about signing the document for him/her self. Significantly lower percent of respondents express readiness for signing the documents if some close to them is in situation to be potential donor (cerebral death). This decision could be made easier with support of other members of the family. In case of need of an organ from some member of the family, the respondent’s readiness for donating is significantly higher but still stratified in three segments: Mercenaries, Escapists and Hostages uncertainty is high. As main de-motivator (or uncertainty) are mentioned health problems, fear for adverse effects on their health and life in general (Fig.9).

Figure 9: What would be the strongest motive for people to decide to donate organs?

According to the general opinion, reasons for low readiness for donating organs are: low trust in Institutions and low awareness for this issue. Apostles are people who perceive transplantation or donation of organ as a human act – (significantly higher percentage than in other segments are ready to donate organs). Mercenaries and Escapist are segments who are pretty suspicious about the procedure, or they think that the transplantation/donation of organs is vulnerable to corruption and mismanagement. Opposite of his/her religion is characterization of only 36% of hostages (which is surprisingly low percentage for people who feel that religious barriers are real). One of the possible explanation for misuse of religion is no other argument to avoid discussion on this topic (Fig. 10).

Figure 10: What are the reasons people would not decide to donate organs?

High percentage of the Macedonian citizens know what the word “transplantation” means: high 89% of them describe it as transplantation of healthy organs from one person to another. Surprisingly 6% of the population have need for transplantation. The highest percentage has need for kidney transplantation. 2% of the population have had experience with organs donation – this 2% means that max 2.800 people experienced what transplantation means (N/A data does this experience was positive or negative) but still these people could be used as testimonials.

Almost half of the population knows that transplantations are being made in Macedonia. The awareness about the Law for Transplantation in Macedonia have shown that: people from segments Escapist and Hostages are informed better than other segments; apostles are people who perceive transplantation or donation of organ as a Human act – (significantly higher percentage than in other segments); Mercenaries and Escapist are segments who express opinion that transplantation/donation of organs is according to their opinion in higher % than other segments but unfortunately they are pretty suspicious about the procedure or more precisely they think that the transplantation/donation of organs is vulnerable to corruption and mismanagement; opposite of my religion is characterization of only 36% of hostages (which is surprisingly low % of people who feel that religious barriers are real) one of the possible explanation for misuse of religion is no other argument to avoid discussion on this topic.

Twenty two percent of total population are ready to sign statements (in case of death) their organs to be donated, the most ready for this act is Apostles segment, Mercenaries and Hostages are at least ready for voluntary sign of this document.

As reasons for not signing this kind of document are verbalized: Morbid to think about death while you’re alive; contrary to common views on life and death and no trust in Institutions. All segments are ready to sign this documents no matter to whom the organs will be donated except Escapists segment they will sign only for donating the organs to close people.

Making decision about donating organs of some close is more difficult than decision about signing the document for self. Significantly lower % of respondents express readiness for signing the documents if some close to them is in case as potential donor (cerebral death). This decision could be made easier with support of other members of the family.

In case of need of organ from some member of family, the respondent’s readiness for donating is significantly higher but still in three segments: Mercenaries, Escapists and Hostages uncertainty is high. As main de-motivator (or uncertainty) are mentioned health problems, fear for effects on health and life in general.

Acceptance of organs in case of need is pretty high but still seems connected with readiness of donating: the most ready to accept organ from unknown donor are segments Neutral and Apostles who are in the same time highly ready to donate organs to unknown person; the strongest motive for rejection of transplantation as a solution is fate or opinion that natural death is most appropriate end.

Expectations of award significantly influence readiness for donating. Mercenaries and Escapists express opinion (in higher % than Apostles and Neutral) that donating organs should be awarded by State Institutions, awards should be: money, health insurance benefits and social insurance benefits. As a strongest motive for stimulation of donating is material compensation – money, exception of tax payment and other health or social insurance benefits.

According to general opinion, reasons of low readiness for donating organs are: Low trust in Institutions and low awareness for this issue. 3% of population said that regularly participate in humanitarian actions and 43% that have participated few times. Neutral and Apostles have highest % of participation in humanitarian actions.

The conclusion clearly indicates that there is a need for informing the population about the law and the process of donation of organs in Macedonia. This implies need for further marketing activities in promoting the idea. Potential target groups are: Mercenaries and Escapists. Apostles and Neutral could be used as Promoters of ideas. As a promotions could be organized events (similar to those in Croatia and Slovenia) with active participation of doctors, professional soldiers or representatives from army; humanitarians, professors (educational system) and foreign factor in Macedonia .

Communication should be based on: raising the trust in Institutions involved in process of transplantation; minimization of fear for negative influence on health and life (security of data for these people who will sign this document); and act of humanism, altruism.

Inclusion of some benefits like health or social insurance will stimulate the process of donation of organs. Some material benefits (health of social insurance) should be communicated (for all profiles).

Support from abroad should also be accented – NFT as a part of Eurotransplant.

The research was conducted by GfK Skopje and National Foundation for Transplantation of Republic of Macedonia. The author would like to acknowledge assistance provided in the preparation of this study to GfK Skopje.

1. Ivanovski N, Masin J, Rambabova-Busljetic I, Pusevski V, Dohcev S, Ivanovski O, Popov Z. The outcome of commercial kidney transplant tourism in Pakistan. Clin Transplant. 2011;25(1):171-3.
2. Stojceva-Taneva O, Selim GJ, Zafirovska K, Polenakovic M. Differences in renal registries between the Balkans and Western Europe. Prilozi. 2006;27(2):37-47.
3. Law concerning conditions for taking, exchanging, passing on, and transplanting the human body parts for the purpose of patient treatment. Official gazette of the Republic of Macedonia nr.30/95, 14.06.1995.
4. Law on changes and amendments to the law concerning conditions for taking, exchanging, passing on, and transplanting the human body parts for the purpose of patient treatment. Official Gazette of RM no. 139, 04.11.2008.
5. Burns A, Bush R. Marketing Research. New Jersey: Prentice Hall, 2000.
6. Lind AD, Marchal GM, Wathen AS. Statistical Techniques in Business and Economics. New York: McGraw-Hill, 2005.
7. Parasuraman A. Marketing Research. Massachusetts: Addison-Wesley, 1986.

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- Chadikovski V
- Dimov A
- Petrovski M
- Simeonov R
- Petrovska B