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Attitudes And Beliefs Towards Upper Extremity Donation In The United States
Siam Rezwan, N/A, Joseph S. Puthumana, MD, Gerald Brandacher, MD, Carisa M. Cooney, MPH.
Johns Hopkins University School of Medicine, Baltimore, MD, USA.

PURPOSE:
To date, upper extremity transplantation (UET) is the most frequently performed type of Vascularized Composite Allotransplantation (VCA). UET can most closely restore form, function, and sensation in upper extremity amputees. With 300,000 projected upper extremity amputees living in the United States by 2050, UET may become more common. Few studies have assessed the general US populationís attitudes and beliefs towards VCA transplantation and donation. We performed this study to characterize attitudes and beliefs of upper extremity donation by surveying Amazon Mechanical Turk (MTurk) workers who identified as US residents, with an emphasis on MTurk workers with a US Armed Forces (USAF) affiliation.
METHODS:
In May 2020, we administered a one-time Qualtrics survey to Amazon MTurk workers. Eligible participants were US residents aged ≥18 years who completed a study-specific survey. The study survey was further targeted within the MTurk system towards workers who self-reported an affiliation with the USAF. The 28-item survey included a brief description of UET followed by questions regarding opinions on organ and upper extremity transplantation and donation; whether respondents were aware that upper extremity is not included in state ID organ donor designations; and workersí military affiliation, amputee status, and sociodemographic characteristics. Descriptive statistics were used to summarize study data; frequencies and percentages were calculated for categorical variables. Comparative statistical analysis by Monte Carlo was used to analyze categorical variables. Statistical significance was assessed at 2-sided significance of p < 0.05.
RESULTS:
A total of 860 respondents completed the study questionnaire. Among these, 529 (61.5%) reported willingness to donate an upper extremity, 152 (17.7%) were undecided, and 179 (20.8%) were unwilling. Among those willing to donate, a significantly higher proportion were female (66.7%, p=0.009), non-Hispanic (63.9%, p=0.000), non-religious (71.3%, p=0.001), non-USAF affiliated (62.8%, p=0.000), and non-amputee or amputee-related (61.7%, p=0.008). Nearly half (n=429, 49.9%) of respondents felt that donating an organ such as a kidney or liver was different from donating a hand or arm with the most common explanation being that upper extremities are an external/visible part of the body. The majority of respondents (n=549, 63.8%) reported being designated organ donors as indicated on their state ID and 411 (47.8%) believed upper extremity donation is already included in this designation. Of those who were state ID designated organ donors, 395 (65.4%) were willing to donate both organs and upper extremities.
CONCLUSIONS:
Our Amazon MTurk survey found that being female, non-Hispanic, non-USAF affiliated, or not being an amputee were significantly associated with willingness to donate upper extremities. Descriptive studies characterizing the reasons that opinions of upper extremity donation differ from solid organ donation may help guide VCA programs, organ procurement organizations, and researchers in their efforts to develop targeted educational materials to broaden the publicís knowledge and awareness of VCA donation to further benefit all patients in need of or desiring transplantation.
Table 1. Sociodemographic Table of Willingness to Donate Upper Extremity

Willingness to Donate Upper Extremity
VariablesNo N=179 (%)Unsure N=152 (%)Yes N=529 (%)Total N=860p value
Sex
Male91 (23.0)86 (21.7)219 (55.3)3960.009
Female87 (18.9)66 (14.3)307 (66.7)460
Non-Binary1 (25.0)0 (0.0)3 (75.0)4
Age
18-25 years41 (24.4)31 (18.5)96 (57.1)1680.622
26-35 years69 (20.9)60 (18.2)201 (60.9)330
36-45 years36 (20.3)32 (18.1)109 (61.6)177
46-55 years19 (16.1)19 (16.1)80 (67.8)118
56-65 years7 (16.3)4 (9.3)32 (74.4)43
66-75 years6 (28.6)5 (23.8)10 (47.6)21
76 years or greater1 (33.3)1 (33.3)1 (33.3)3
Hispanic or Latino
Yes31 (17.0)55 (30.2)96 (52.7)1820.000
No148 (21.8)97 (14.3)433 (63.9)678
Ethnicity
White106 (17.0)118 (18.9)399 (64.0)6230.004
Black or African American27 (30.3)8 (9.0)54 (60.7)89
American Indian or Alaska Native6 (33.3)3 (16.7)9 (50.0)18
Asian29 (29.3)17 (17.2)53 (53.5)99
Native Hawaiian or Pacific Islander1 (50.0)1 (50.0)0 (0.0)2
Other10 (34.5)5 (17.2)14 (48.3)29
Religion
No religion41 (17.3)27 (11.4)169 (71.3)2370.001
Christianity110 (21.1)108 (20.7)303 (58.2)521
Islam10 (43.5)4 (17.4)9 (39.1)23
Hinduism1 (6.7)2 (13.3)12 (80.0)15
Judaism5 (23.8)4 (19.0)12 (57.1)21
Buddhism1 (9.1)0 (0.0)10 (90.9)11
Other11 (34.4)7 (21.9)14 (43.8)32
Educational Level
No formal education / some grade school0 (0.0)0 (0.0)1 (100.0)10.148
Some high school2 (14.3)4 (28.6)8 (57.1)14
High school diploma46 (24.9)29 (15.7)110 (59.5)185
Associate's degree39 (28.1)25 (18.0)75 (54.0)139
Bachelor's degree or higher92 (17.7)94 (18.0)335 (64.3)521
Employment Status
Employed full time91 (18.6)94 (19.2)305 (62.2)4900.057
Employed part time37 (24.8)26 (17.4)86 (57.7)149
Unemployed and looking for work14 (32.6)4 (9.3)25 (58.1)43
Unemployed16 (21.9)16 (21.9)41 (56.2)73
Retired7 (24.1)1 (3.4)21 (72.4)29
Student9 (13.8)11 (16.9)45 (69.2)65
Disabled5 (45.5)0 (0.0)6 (54.5)11
Annual Household Income
Less than $10,00020 (24.1)17 (20.5)46 (55.4)830.195
$10,000 - $19,99920 (19.8)10 (9.9)71 (70.3)101
$20,000 - $29,99918 (24.3)16 (21.6)40 (54.1)74
$30,000 - $39,99921 (22.8)19 (20.7)52 (56.5)92
$40,000 - $49,99915 (16.5)16 (17.6)60 (65.9)91
$50,000 - $59,99914 (16.9)17 (20.5)52 (67.2)83
$60,000 - $69,9997 (11.1)14 (22.2)42 (66.7)63
$70,000 - $79,99914 (21.2)11 (16.7)41 (62.1)66
$80,000 - $89,99910 (17.2)9 (15.5)39 (67.2)58
$90,000 - $99,9999 (22.0)8 (19.5)24 (58.5)41
$100,000 - $149,99922 (36.7)10 (16.7)28 (46.7)60
More than $150,0009 (18.8)5 (10.4)34 (70.8)48


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