title: Knowledge and attitudes of Canadian First Nations people toward organ donation and transplantation: a quantitative and qualitative analysis.
abstract: BACKGROUND
  Organ donation and transplantation rates are low for aboriginal people in Canada, despite a high demand.
  
  
  METHODS
  An explanatory mixed-methods design was used to describe knowledge of and preferences for organ donation and transplantation among First Nations people and identify factors that may influence these preferences.
  
  
  METHODS
  We recruited on- and off-reservation First Nations adults.
  
  
  METHODS
  A 45-item survey was administered to 198 participants, of whom 21 were assessed further with a qualitative interview using a multiple case study approach.
  
  
  METHODS
  In an iterative process, themes were identified from qualitative data using critical realism as the theoretical framework. Critical realism is an approach that describes the interface between natural and social worlds to explain human behavior.
  
  
  RESULTS
  Although 83% of participants were in favor of transplantation, only 38% were willing to donate their organs after death, 44% had not thought about organ donation, and 14% did not believe it was important. Only 18.7% of participants reported that their cultural beliefs influenced their views on organ donation and transplantation. In the multivariable analysis, the only factors associated with willingness to donate organs were higher education and considering organ donation important. Four themes emerged from qualitative data: importance of traditional beliefs, recognition of need due to the epidemic of diabetes among Canadian aboriginal people, reconciliation between traditional beliefs and need, and general apathy in the community.
  
  
  CONCLUSIONS
  Cultural, socioeconomic, and political diversity exist between and within aboriginal groups. Findings may not be generalizable to other aboriginal communities.
  
  
  CONCLUSIONS
  Willingness to donate organs was lower in these First Nations participants compared to the general population. Education to address knowledge deficits, emphasize the negative impact of organ failure on the community, and contextualize organ donation within the older traditional native beliefs to help First Nations people understand how organ donation may be integrated into native spirituality likely is required to increase donation rates.
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. Electronic address: sara.davison@ualberta.ca.
authors.forename: Sara N
authors.initials: SN
authors.lastname: Davison
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Gian S
authors.initials: GS
authors.lastname: Jhangri
mesh_terms: D000328:Adult; D002170:Canada / Q000208:ethnology; D003469:Culture; D003625:Data Collection / Q000379:methods / Q000592:standards*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006801:Humans; D007198:Indians, North American / Q000208:ethnology* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000523:psychology; D009927:Tissue and Organ Procurement
keywords: Aboriginal; Canada; First Nations; diabetes; end-stage renal disease; indigenous communities; mixed methods; native spirituality; organ donation; qualitative; survey; transplantation