Knowledge and attitudes towards kidney donation: A cross-sectional study from a single Sri Lankan centre

Introduction: Kidney transplantation is considered the definitive and most cost-effective treatment for end-stage renal failure. However, transplantation programmes are highly dependent on the availability of donor organs. Public knowledge and attitudes toward organ donation significantly affect the size of the potential donor pool. In Sri Lanka, no prior studies have explored this topic. 
Methods: A self-administered pre-tested questionnaire; a modified, simplified version of the original questionnaire developed by Khalid et al., was distributed among the relatives of the non-CKD patients in selected wards of National Hospital of Sri Lanka Colombo, upon discharge of the patient. The study was conducted on five consecutive days in January 2018.
Results: Out of the 250 questionnaires distributed, 194 were returned completed (response rate: 77.6%). The majority of respondents were male (77.6%), Sinhalese (89.8%), Buddhists (76.1%), and university graduates (51.1%). While 83.2% were willing to donate a kidney to a relative, only 36.5% were willing to donate to a stranger. Awareness that kidney failure can be treated with transplantation was high (97.5%), and 83.2% had heard of brain death. Awareness of brain death was associated with the level of education. A high proportion (94.9%) were willing to be deceased donors, and 82.1% wanted to declare this intention while alive. This intention was significantly associated with gender (p=0.002), civil status (p=0.039), and ethnicity (p=0.001).
More than half (55.3%) believed that kidney donation could lead to long-term health issues. A significant proportion expected compensation for live (66.2%) or deceased (25.9%) donation, and these beliefs were associated with lower education levels (p=0.042). 
Conclusions: Relatives of patients presenting to National Hospital of Sri Lanka, Colombo demonstrated both a strong willingness to donate and a notable expectation of compensation; an unusual combination. More research is needed to inform policies specific to the Sri Lankan context.