To the Editor:
As is the case for many countries around the world, kidney failure is a public health problem in Mexico. The national prevalence of individuals in need of urgent renal replacement therapy in the previous years was above 129 000 and only 60 000 received some type of dialysis, with more than half of patients being untreated.1
It has been widely demonstrated that kidney transplantation is the best therapeutic alternative for replacing the loss of function, since it results in higher survival rates, a better quality of life and less physical wear in comparison with all other methods of replacement, as well as being less expensive.
There are over 8000 patients registered on the national kidney transplant waiting list and there have been less than 2500 transplants per year in recent years; 75% come from a living donor.
Mexico City introduced a Law on Advance Directives (LVA) in 2008.2 The objective of the aforementioned law is to respect the dignity of people whose health is declining and to avoid both the obstinacy and therapeutic abandonment of patients with a terminal illness. Article 8 of the law provides for the desire to be expressed to donate organs for transplantation. Nevertheless, this law, which could have beneficial effects for the obtaining of organs, is not very well known according to studies that we have carried out.
Qualitative research was carried out with a semi-structured interview, which had previously been validated, to document the knowledge of the inhabitants of Mexico City about the LVA.
In total, 278 people including patients and family members were interviewed in three emblematic hospitals of three socioeconomic levels in the city: a private hospital, a Social Security hospital and a general hospital for people without formal employment and with limited resources. The interview consisted of 17 questions and data included age, sex, occupation and education.
As regards the results, the average age was 41 years, 53% were female, 18% had basic education, 45% had secondary education and 37% had higher education.
Of the people surveyed, 64% did not know the LVA. Of those who did (n = 100), only 43% knew about the part that refers to the donation of organs. Independently from knowledge of the law, 68% of all those surveyed intend to donate their organs for transplantation.
The poor coverage that the LVA has been given by the Mexico City authorities is both surprising and regrettable. It is striking that other laws with bioethical implications in the same city have been very well broadcasted by all the mass media: television, radio, press, Internet, billboards, public transport video clips, metropolitan bus advertisements, etc. However, on this law, that could have had a positive impact for transplants, they remained silent.
On occasions it seems that laws which may have consequences for health matters may be stifled because of the ideology of the political party in power, which awaits conditions for legislation that agrees with their cultural ideology.
Conflicts of interest
The authors declare that they have no conflicts of interest related to the contents of this article.
