Supplemental digital content 1
Materials and Methods
Design. Two presentations were given by the same speaker to elementary and high school students. The first presentation was given at a girls’ school in Westmount, Québec, Canada and the second one at a co-ed school in Banfield, Buenos Aires, Argentina. The schools were selected based on the cities where three of the authors were located. Each presentation lasted 45minutes followed by a 15-minute questions and answers period. Thereafter, the students were invited to complete a written questionnaire to record their knowledge and perception about the topics that were presented and discussed.
Study subjects. A total of 362 students attended the presentations. There were 125 in Canada (elementary school: mean age 11 year-old, range 10 to 12; high school: mean age 14 year-old, range 13 to 16) and 237 students in Argentina (elementary school: mean age 12.9 year-old, range 11 to 14, 56% girls and 44% boys; high school: mean age 16 year-old, range 14 to 19, 63% girls and 37% boys). The duration of elementary school is 6 years in Canada and 7 years in Argentina, while the duration of high school is 5 years in both countries. Based on these differences, the students were divided into two groups: pre-adolescents (age ≤12 year-old) and adolescents (age ≥13 year-old). There were 31 pre-adolescents in Argentina and 55 in Canada, and 185 adolescents in Argentina and 45 in Canada.
Presentation. The presentations included information about basic concepts related to organ donation and transplantation, information to help students to work through the potential fear and discomfort about organ donation, and the formulation of a new message based on the following concept: “to donate means to share our body parts after death”.
The following notions were discussed: 1. What is end-stage organ failure?, 2. History of transplantation, 3. Transplant waiting lists, 4. Brain death, 5. The body at the end of life as a unique and irreplaceable source of health, 6. Monotheist religions attitude toward organ donation and transplantation, 7. Organ shortage contributes to the increased mortality on the waiting lists. 8. «The gift of life» means to share life; 9. People from all ages should comprehend through education that organ donation is an integral part of their citizen's responsibilities. It should be an implicit agreement between individuals and Society.
Questionnaire. The questionnaire consisted of seven questions (Q) targeting the following issues:
Q1. Previous knowledge: Before this presentation, did you know anything about organ transplantation? Answers included: 1: Yes, 2: No, 3: No answer.
Q2. Perception of the presentation: Did you enjoy the presentation? Answers included: 1: Yes, 2: No, 3: No answer.
Q3. Understanding of the topics that were presented: Did you understand all the topics? Answers included: 1: Yes, 2: No, 3: No answer. In case of a negative answer an additional question followed the previous one.
Q4. Which one did you not? Answers included student’s comments related to: 1. Technical issues (people dying on waiting lists, dialysis, mechanical hearts, religious positions towards organ donation, etc), 2. Pedagogical (understanding of the presentation), 3. No answer.
From questions 5 to 7, students were given the opportunity of expressing their views and opinions.
Q5. Students’ preference regarding the presented topics: Which is the information that you found more interesting? Answers included: 1: None, 2: Scientific, 3: History, 4: Religion, 5: Waiting lists; 6: No answer.
Q6. Students’ main conclusions: What did you think is the main conclusion that we should keep of this presentation? Answers included: 1: None, 2: Agreement, 3: Disagreement, 4: No answer.
Q7. Students’ willingness to talk about these topics: With whom would you discuss this topic? Answers included: 1: No one, 2: Parents, 3: Friends, 4: Both, 5: No answer.
The questionnaire included the students age and gender. It did not include the students’ race. In the Argentinean school, the majority of the students were from Caucasian background and in the Montreal school, it reflected the multicultural Canadian society, including students with Caucasian, African-American (Canadian),Middle Eastand Asian background.
Statistical analysis. Data was analysed by Chi-square test using the GraphPad Instat program, version 3.05 (GraphPad Software, San Diego, CA). A P value <0.05 was considered as significant.
Results
Of the 362 students, 360 questionnaires were returned, 316 were analysed and 44 were excluded due to incompleteness regarding gender, age and grade. There were 100 questionnaires from Canada (elementary school 55, high school 45) and 216 questionnaires from Argentina (elementary school 108, high school 108 students). The results were analyzed according to two groups of age: ≤12 year-old (pre-adolescents) and ≥13 year-old (adolescents).
Pre-adolescents. Forty-five percent of pre-adolescent students from Canada had previous information about organ donation and transplantation compared to 71% of Argentinean students (P=0.02, Figure 1A). There were no statistically significant differences between students from both countries in terms of the enjoyment of the presentation or the understanding of the topics (Figure 1B and Figure 2A). One hundred percent of Canadian and 97% of Argentinean students were interested on the topics (P=NS, Figure 3A). The most preferred topics included those related to scientific issues (36% in Canada and 58% in Argentina) and the waiting list (44% in Canada and 19% in Argentina) (Figure 3A). All Canadian and 87% of Argentinean students were in agreement with the presentation (P=NS, Figure 3B). Examples of comments from students are shown in Table 1. Twenty-five percent of Canadian students would not discuss about these topics with anyone, 45% would discuss the topics with their parents, 15% with their friends and 15% with both friends and family (Figure 3C). A higher percentage of Argentinean students would discuss the topics with their parents (65%) and with both parents and friends (19%, P=NS, Figure 3C).
Adolescents. Adolescent students from both countries were more aware about organ donation and transplantation than pre-adolescents (80% vs. 45% in Canada, P=0.008; and 90% vs. 71% in Argentina, P=0.01, Figure 1A). A high percentage of students from both countries enjoyed and understood the presented topics (Figure 1B). Seven percent of Canadian students did not enjoy the presentation compared to 25% of Argentinean students (P=0.007). Similar to what was seen with pre-adolescents, adolescent students preferred the scientific topics (42% in Canada, 48% in Argentina) and waiting list issues (29% in Canada and 24% in Argentina) (Figure 3A). There was a higher proportion of Canadian students that agreed with the presentation compared to Argentinean students (100% vs. 81.5%, P=0.008) (Figure 3B).Examples of comments from students are shown in Table 2. Interestingly, 49% of Argentinean students would discuss these topics with their parents compared to 29% of Canadian students. The latter group would prefer to talk to both friends and parents (42% vs. 30% in Argentina, P=0.01). Eighteen percent of Canadian and 15% of Argentinean students would not discuss these issues with anyone (Figure 3C).
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Table 1. Selected comments from Argentinean and Canadian pre-adolescents
Age /Argentinean students’ comments
11 / “My conclusion is that is very important to help other people.”12 / “My conclusion is that when you die the body is still useful for organ donation.“
12 / “I think that to improve our life we should accept that we should share our organs after death, and if needed we might have an organ donor.“
Age /
Canadian students’ comments
10 / “It is always good to save a life with transplantation and it is not fair that people die while waiting for a donor.“11 / “The most interesting information is the astronomical number of people in Canada that do not donate organs. I think that we should keep in mind that it is important to share. The waiting time to receive a new organ is very long.“
11 / “Your life is precious and some people are less fortunate. We can help.“
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Table 2. Selected comments from Argentinean and Canadian adolescents
Age /Argentinean students’ comments
14 / “I am astonished by the number of people waiting for a transplant. I believe that this presentation should be given in many countries of the world.“14 / “Nowadays, we must be conscious that organ donation is more than a gift, it is a chance to share health.“
17 / “It is important that people know about this subject to be ready to act in the future with responsibility,“
Canadian students’ comments
13 / “It is important to share. I learned that you will be more a recipient than a donor.“14 / “The shocking amount of days a patient has to wait for a transplant. Regardless of religion, organ transplantation is ethical.
14 / “Organ donors are rare and we should really take the time to do anything to help.“
Figure 1. Pre-adolescents and adolescents. Questions 1 and 2
Figure 2. Pre-adolescents and adolescents: Questions 3 and 4
Figure 3. Pre-adolescents and adolescents: Questions 5, 6 and 7
Legends to Figures
Figure 1
Panel A. Question 1: 71% of pre-adolescent students from Argentina knew about organ donation and transplantation compared to 45% of Canadian students, *P=0.02. There was a statistically significant differences between pre-adolescents and adolescents from both countries, Argentina (**P=0.01 and Canada ***P=0.008).
Panel B. Question 2: Pre-adolescents: There were no statistically significant differences between students from both countries. Adolescents: Less Argentinean students enjoyed the presentation compared to Canadian adolescents students (*P=0.007 or compared to Argentinean pre-adolescents **P=0.007).
Figure 2
Panel A. Question 3: There were no statistically significant differences between pre-adolescents and adolescents or between both countries.
Panel B. Pedagogical topics were less understood.
Figure 3
Panel A. Scientific and waiting list topics were the most liked by all students.
Panel B. There was a statistically significant difference between Canadian and Argentinean adolescent students in terms of agreement about the presented topics (*P= 0.008).
Panel C. There were no statistically significant differences regarding the distribution of answers of pre-adolescent students, while a difference was observed in adolescents (*P=0.01).
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