Medical students' knowledge,attitudes and awareness toward organ donation

ObjectiveThis survey study aimed to evaluate medical students' attitudes, knowledge, and awareness toward organ donation.MethodsFor this questionnaire-based cross-sectional study, 1000 medical students were interviewed, out of which 950 students agreed to participate in the study and were enrolled. A questionnaire form consisting of 29 questions was used to determine the students' socio-demographic characteristics and rate their knowledge, attitudes, and behaviors about organ donation.ResultsWhile 95.5% (n = 907) of the students stated that they had not donated organs, 41.1% stated that they had not yet decided to donate organs, and 59.7% stated that they had no specific reason for them not donating organs. Out of the participants, 68.1% stated that organ donation complies with the Islamic rules; 40.7% stated that the Directorate of Religious Affairs issued a fatwa on organ donation, and 39.4% stated that there are legal regulations on organ donation in the country. While 22.1% of the students stated that a person with brain death could come back to life, 19.7% stated that they did not know about this issue. The students who had donated organs and who did not show significant differences regarding the answers given to the questions about whether organ donation complies with religious rules (p < 0.001), where one must apply to donate organs (p = 0.032), the will to donate the organs of a relative with brain death (p = 0.004), and whether preaching in mosques and foundations is needed to increase organ donation rates (p = 0.042). Although there was a correlation between the students' grade and their attitude and knowledge about organ donation, this correlation was weak and showed no parallelism with increasing grades.ConclusionThis study indicates that medical students have inadequate knowledge, attitudes, and behaviors about organ donation. In our opinion, it is of paramount importance to provide physician candidates, who should set an example for society, with periodic training on organ donation throughout their academic life in shaping the national organ donation policy in the future.     

Nurse Intervention: Attitudes and Knowledge About Organ Donation and Transplantation in Adolescents

BackgroundThe problems involved in obtaining authorization in favor of organ donation have led us to evaluate the level of knowledge and attitudes of a group of Spanish adolescents (14-16 years) regarding organ donation, transplantation, and brain death. The evaluation was carried out before and after a health education intervention by nursing personnel.MethodsExperimental, prospective and quantitative study. The educational intervention was carried out at Las Salinas high school (Laguna de Duero, Spain). We collected 86 preworkshop questionnaires and 88 post-workshop questionnaires.ResultsThe composition of the groups did not differ significantly in sex (P = .653), age (P = .266), or in the desire to be a donor (P = .099). We found significant postworkshop improvements in knowledge about brain death (P < .001) and which organs can be donated (P < .001), as well as in the total score (18.29 ± 2.45 before vs 21.47 ± 2.70 after) (P < .001). We discovered a vast lack of knowledge about the organs that cannot be transplanted, which included the penis (38.4%), uterus (31.4%), prostate (41.9%), or bladder (37.2%); these beliefs decreased significantly after the intervention (P < .01). The increase in knowledge of the organs that can be donated, including eye (P = .024), lung (P = .025), stomach (P < .001), intestine (P = .001), and skin (P < .001), was also significant.ConclusionsThe good results reflected the importance of conducting educational programs taught by health personnel on donation and organ transplantation in adolescents.     

Investigation and Strategic Analysis of Family Barriers to Organ Donation in China

BackgroundFamilies play a prominent role in the eventual organ donation decision. Because the deceased cannot directly express their wishes, their families become the actual decision makers. In China, families are permitted to make decisions regarding organ donation that may not be in accordance with the wishes of the deceased family member, and objections by families are a main bottleneck in the donation process.MethodsFace-to-face questioning was conducted with organ procurement organization coordinators. At the same time, questionnaires were distributed in 11 cities in Zhejiang Province.ResultsOf the respondents, 69.9% considered family consent necessary and 77.1% thought that the view of their family had a great, even decisive, influence on them to decide to become donors. If the deceased family member had registered as an organ donor, 65.2% of families decided that they would respect the wishes of the deceased person. Adult children (58.6%) were more likely to donate than parents (37.4%; χ² = 123.009, P < .001). Those born after 2000 and after 1990 (62.5% and 52.8%, respectively) were much more likely to donate than those born after 1960 (18.1%; χ² = 191.485, P < .001). The interviews indicated that there were high rates of donation refusals within potential donation families. Most donor families chose to make hidden donations, and the majority of donor families had a simple family structure.ConclusionsTo promote organ donation, China needs to reconsider the role of families in the decision-making process. It is essential to increase organ donation awareness within the younger generation and encourage them to discuss with their families their willingness to donate.     

Modification of the education system for organ procurement coordinators in Japan after the revision of the Japanese Organ Transplantation Act

Background

From October 1997 to July 2010, only 86 brain-dead (BD) organ donations were obtained and no organs were retrieved from children under 15 years of age because of the strict Japan Organ Transplantation Act. The Act was revised on July 17, 2010, allowing organs to be donated after BD with family consent.

Objective

To manage the increased donations after the revision, the Japan Organ Transplant Network (JOT) employed 10 organ procurement coordinators (OPCs) and modified its education systems. We retrospectively reviewed the modified education programs to evaluate whether they were effective and whether the processes of organ donation were promptly performed after the revision of the Act.

Methods

The modifications of education program were: changing OPC to guideline manuals to correspond to the revised Transplant Act; OPCs were taught the new organ procurement system; and a special education program was provided for the 10 newcomers for 2 months.

Results

After 12 months of the revision, 58 BD organ donations were accomplished, whereas they had averaged 6.6 in a year before the revision. Two pediatric BD organ donations were accomplished without problem. One priority organ donation to a relative was performed uneventfully. After applying the modified education program, skilled JOT OPCs and leader JOT OPCs increased.

Conclusions

To manage increased organ donations after the revision of the Act, the educational system was modified and 58 brain dead organ donations were performed safely.     

Professional education and hospital development for organ donation

Because of the strict Organ Transplantation Act, only 81 brain dead (BD) organ donations had been performed in Japan for 13 years since 1997. The Act was revised on July 17, 2010, allowing, organs to be donated after BD with consent from the family, if the subject had not denied organ donation previously. This act has lead to an expectation of a 6-7-fold increase in BD donation. The 82 organ procurement coordinators (OPC) in Japan include 32 belonging to the Japanese Organ Network (JOT) and the others to each administrative division. JOT has guideline manuals of standard roles and procedures of OPC during organ procurement from BD and cardiac death donors.To manage the increased organ donations after the revision of the act, we have modified the education system. First, we modified the guideline manuals for OPC to correspond to the revised Transplant Act and governmental guidelines. Second, all OPC gathered in a meeting room to learn the new organ procurement system to deal with the revised Transplant Act and guidelines. Third, a special education program for 2 months was provided for the 10 newcomers. Last, the practical training in each donor case for newcomers was performed by older OPC.Topics of the education program were the revised transplant act and guidelines, family approach to organ donation, BD diagnosis, donor evaluation and management, organ procurement and preservation, allocation system, hospital development and family care.In the future, each OPC will be divided into special categories, such as the donor family OPC, the donor management OPC, and the operating room OPC. Therefore, we need to construct separate special education programs for each category.     

Predictors of nonuse of donation after circulatory death lung allografts

ObjectiveDespite growing evidence of comparable outcomes in recipients of donation after circulatory death and donation after brain death donor lungs, donation after circulatory death allografts continue to be underused nationally. We examined predictors of nonuse.MethodsAll donors who donated at least 1 organ for transplantation between 2005 and 2019 were identified in the United Network for Organ Sharing registry and stratified by donation type. The primary outcome of interest was use of pulmonary allografts. Organ disposition and refusal reasons were evaluated. Multivariable regression modeling was used to assess the relationship between donor factors and use.ResultsA total of 15,458 donation after circulatory death donors met inclusion criteria. Of 30,916 lungs, 3.7% (1158) were used for transplantation and 72.8% were discarded primarily due to poor organ function. Consent was not requested in 8.4% of donation after circulatory death offers with donation after circulatory death being the leading reason (73.4%). Nonuse was associated with smoking history (P < .001), clinical infection with a blood source (12% vs 7.4%, P = .001), and lower PaO₂/FiO₂ ratio (median 230 vs 423, P < .001). In multivariable regression, those with PaO₂/FiO₂ ratio less than 250 were least likely to be transplanted (adjusted odds ratio, 0.03; P < .001), followed by cigarette use (0.28, P < .001), and donor age >50 (0.75, P = .031). Recent transplant era was associated with significantly increased use (adjusted odds ratio, 2.28; P < .001).ConclusionsNontransplantation of donation after circulatory death lungs was associated with potentially modifiable predonation factors, including organ procurement organizations' consenting behavior, and donor factors, including hypoxemia. Interventions to increase consent and standardize donation after circulatory death donor management, including selective use of ex vivo lung perfusion in the setting of hypoxemia, may increase use and the donor pool.     

Reasons Why Organs From Deceased Donors Were Not Accepted for Transplantation

IntroductionThe rate of organ donations from deceased donors in Turkey is among the lowest in the world. We analyzed the reasons why some potential donors whose families had given consent did not become actual solid organ donors.MethodsWe retrospectively reviewed the organ donation, retrieval, and transplantation registries of 102 potential donors from the Ministry of Health Organ and Tissue Transplant Coordination Centre of Istanbul Region from the year 2015.ResultsCardiac arrest occurred in 8 of the potential donors while waiting for organ procurement or during surgery. The organ specific suitability ratio was 83% for kidneys, 82% for livers, 72% for hearts, and 75% for lungs. Of these suitable organs, the transplantation rates were as follows: kidneys 88%, livers 70%, hearts 30%, and lungs 13%. Medical reasons (donor unsuitable) (14%–24%) and poor organ function (2%–24%) were the reasons most organs were not accepted for transplant. These reasons included diabetes insipidus, electrolyte imbalance caused by neuro-humoral changes, inotrope/vasopressor requirement for hemodynamic instability, hypoperfusion, and myocardial dysfunction after brain death.ConclusionThe mismatch between organ donation and demand is a major problem worldwide. In addition to low organ donation rates, late diagnosis of potential donors or inappropriate management of the pathophysiological consequences of brain death reduce the number of transplantable organs even more in our country. In order to overcome these setbacks, we need education programs to improve quality and decrease donor losses in an intensive care unit goal-directed protocol for the management of potential donors.     

Influence of knowledge and religiousness on attitudes toward organ donation

There remains a great need for organ donation. Each year thousands of individuals wait for organs to be donated for transplantation. In this study, the Organ Donation Attitude Survey (ODAS) was developed. One hundred ninety undergraduate students (114 women with a mean age of 20.0 and 76 men with a mean age of 20.5 years) enrolled in general education classes at a small midwestern university participated. The present study determined that ODAS is a reliable and valid instrument to assess attitudes regarding organ donation. The data were analyzed by stepwise regression to determine which variables were related to attitudes regarding organ donation. The results indicated the impact of four variables: education regarding organ donation, knowledge of someone who had donated an organ after death, awareness of anyone who received a donated organ, and religious beliefs. These significant variables in the regression analysis explained 24.95% of the ODAS total score variability. The most important results of the present study indicated that the ODAS was psychometrically valid and it could be used to evaluate attitudes regarding organ donation.     

Attitude and awareness towards organ donation in western India

Abstract

Background: To determine the knowledge, attitudes and practices regarding organ donation in western India. Methods: Convenience sampling was used to generate a sample of 250; 200 interviews were successfully completed and used for analysis. Data collection was carried out via face to face interviews based on a pre-tested questionnaire in selected public areas of Ahmedabad, Gujarat state of India. Data entry was made in excel software in codes and analysis was done by SPSS software. Results: About 86% of participants were aware of the term organ donation but knowledge about its various aspects was low. About 48% aware people heard about organ donation through medical fraternity, whereas only about 21% became aware through mass media. About 59% of aware people believed there is a potential danger of donated organs being misused, abused or misappropriated. About 47% of aware people said they would consider donating organs, while only 16% said they would definitely donate irrespective of circumstances. Around 97.67% participants said they would prefer to donate to nonsmokers. About 74.41% participants were unaware about any legislation regarding organ donation. About 77% participants showed their will to donate to mentally sound persons, and 42.04% participants showed their will to donate even physically challenged people. Around 78 participants felt that they would donate organs to persons irrespective of their religion. About 81% of aware people were of the opinion that consent for organ donation after death should be given by family members. None of the interviewed participants had a donor card. Conclusion: Better knowledge and awareness will help in promoting organ donation. Effective campaign needs to be driven to educate people with relevant information with the involvement of media, doctors and religious scholars.     

Knowledge and Attitudes of Health Care Professionals and Laypeople in Relation to Brain Death Diagnosis and Organ Donation in Hungary: A Questionnaire Study

ObjectivesThe aim of the present work was to assess the knowledge and attitudes of different health care workers and laypeople toward the donation and transplantation procedure.Subjects and methodsA survey consisting of questions regarding brain death diagnosis, legal organization or organ donation, and the transplantation procedure were sent to participants: 56 intensive care unit (ICU) doctors, 76 ICU nurses, 188 sixth-year medical students, and 320 general practitioners (GPs). Laypeople were also asked to complete the survey.ResultsThe majority of participants reported being aware of legal regulations for organ donation in Hungary (88.5%). Roughly 25% of GPs and 60% of laypeople were unaware of the opt-out system effective in the country. Less than one-third of ICU physicians (26.9%) and nurses (34.7%) were able to list the organs that may be transplanted from a deceased donor; GPs (22.4%) and medical students (20%) performed even worse on this item. The willingness of ICU specialists (57%) and ICU nurses (45%) to support donating their own organs was moderate.ConclusionsThe results of this survey indicate a need for graduate and postgraduate education and regular teaching programs regarding organ donation and transplantation. More active use of modern media is proposed to improve public awareness and acceptance of organ donation.     

Issuing Donor Cards in a Single Center in Iran: Results of the First 3 Years

Introduction

Issuing an organ donation card has become a goal for procurement units to solve the organ shortage. The number of issued cards is an index of the attitudes or even actions of communities toward brain-dead donations. In the present study, we have reported the characteristics of issuing organ donation cards in a single organ procurement unit in Iran.

Materials and methods

This retrospective study used an organ donation willingness database for 3 years after launching the unit. We used the registration data of the first 3 years of its activity from August 1, 2005, to July 31, 2008. For each organ donation volunteer, we extracted demographic data, organs to be donated, and source of their knowledge about the organ donation card system.

Results

During the study period, donor cards were issued to 172,290 volunteers; a monthly mean of 4785 registries. Among the total volunteers, 54.2% were females: with 50.7% between 21 to 30 years, 35.2% with an educational level less than a high school diploma, and 35.7% introduced by their friends. The volunteers were more willing to donate heart, kidney, liver, lung, and tissue donations, respectively. Out of the total number of volunteers, 94.1% were willing to donate all organs. An increasing trend was seen in the donation cards issued during the study period.

Conclusion

Following 3 years of activity, a single center has issued nearly 200,000 cards. The rate at which organ donor cards are issued is increasing, which puts emphasis on establishment of funding for other organ procurement units. This information may be useful to program the field of brain-dead donations in this country.     

Outcomes from organ donation following medical assistance in dying: A scoping review

AimTo collate and summarize the current international literature on the transplant recipient outcomes of organs from Medical Assistance in Dying (MAiD) donors, as well as the actual and potential impact of organ donation following MAiD on the donation and transplantation system.BackgroundThe provision of organ donation following MAiD can impact the donation and transplantation system, as well as potential recipients of organs from the MAiD donor, therefore a comprehensive understanding of the potential and actual impact of organ donation after MAiD on the donation and transplantation systems is needed.DesignScoping review using the JBI framework.MethodsWe searched for published (MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Academic Search Complete), and unpublished literature (organ donation organization websites worldwide). Included references discussed the actual and potential impact of organ donation following MAiD on the donation and transplantation system. All references were screened, extracted and analysed by two independent reviewers.ResultsWe included 78 references in this review and our finding were summarized across three categories: (1) Impact in the donor pool: (2) statistics on organ donation following MAiD; and (3) potential and actual impact of MAiD on the donation and transplant system.ConclusionsThe potential impact of the MAiD donor on the transplant waiting list is relatively small as this process is still rare, however, due to the current organ shortage worldwide the contribution of this procedure should not be disregarded. Additionally, despite being limited, the existing research provided scanty evidence that organs retrieved from MAiD donors are associated with satisfactory graft function and survival rates and that outcomes from transplant recipients are comparable to those of organs from donation following brain death and may be better than those of organs from other types of donation after circulatory determined death. Still, further studies are required for comprehensive and reliable evidence.     

Satisfaction With the Organ Donation Process of Brain Dead Donors' Families In Korea

PurposeThe purpose of this study was to investigate the satisfaction of the families of brain dead donors with regard to donation processes as well as their emotions after the donation.MethodA cross-sectional survey study was performed that included 45 families of brain-dead donors in 1 hospital-based organ procurement organization (HOPO) in Korea between February 2007 and April 2011.ResultsDonor willingness and desire in life was the most frequent reason organs were donated (34.5%), followed by the advice of family members or friends (31.0%). Satisfaction with the organ donation processes was 4.04 of 6 points. In each category, the satisfaction with the decision of donation was the highest (4.96 points) and the satisfaction with the procedure of donation was the lowest (3.07 points); of each question, the satisfaction of “information and help on funeral arrangements was enough” and “the process of preparing the relevant documents was cumbersome” was the lowest. “Missing” the dead person and “pride” were the most common emotions experienced after organ donation (69.0% and 62.1%, respectively), followed by “grief,” “family coherence,” and “guilt.” Religious practices were observed to be most helpful for psychological stress relief after donation, followed by spending time with family and friends. Moreover, 24.1% responded that they had not yet overcome their suffering.ConclusionBecause donors' own willingness is the most common reason that families choose donation, it is necessary to remind the public of the importance of organ donation through education and public relations using mass communication approaches. Additionally, because the families felt grief and guilt as well as missing their loved ones and pride regarding their dead loved ones after organ donation, continuous and systematic supports are needed to promote their psychological stability.     

Risk factors for renal allograft survival with China novel donation category: Donation after brain death followed by cardiac arrest

IntroductionTo meet the need for transplantable organs, a new donation program was initiated by the Chinese government. This novel policy created three categories for deceased organ donations: donation after circulatory death cardiac death (DCD), donation after brain death (DBD), and donation after brain death followed by circulatory death (DBCD) meaning complete cardiac arrest. In fact, the DBCD method is a combination of both DBD and DCD methods. A DBCD donor meets the criteria of for brain death, but the organ procurement begins after the withdrawal of life support and the subsequent cardiac arrest death. The purpose of this study was to evaluate the long-term outcomes of kidney transplantation in our center with the DBCD policy. Potential risk factors for affecting the renal allograft survival were also analyzed based on our data.MethodA retrospective study, involving 421 kidney transplants derived from 214 donors, was conducted between December 2011 and October 2019. In particular, 373 (88.6%) transplanted organs met the criteria for DBCD, and 48 (11.4%) for DCD. The log-rank test was used to compare the difference in survival. The Cox regression analysis was used for risk factor screening.ResultAnalysis showed that the DBCD group was better than the DCD group in terms of overall (p = 0.031) as well as death-censored (p = 0.026) allograft survival using the log-rank test. A Cox regression analysis revealed that increasing donor age (p = 0.002, HR = 1.820/10 years incremental older), increasing recipient age (p = 0.028, HR = 1.521/10 years increment older), prolonged dialysis duration (p = 0.007, HR = 1.018), occurrence episodes of acute rejection (p = 0.016, HR = 2.697), delayed graft function (p = 0.012, HR = 2.962), mismatch ≥4 HLA loci (p = 0.038, HR = 3.606), and warm ischemia time > 15 min (p = 0.022, HR = 2.915), were all independent risk factors affecting the graft survival.ConclusionThe new DBCD policy of donation produced acceptable results similar or even better than the DCD practice. Based on our analysis, the graft survival of DBCD transplants may be better than DCD transplants. The main risk factors for allograft loss included an increasing donor age, recipient age, warm ischemia time > 15 min, prolonged dialysis duration, acute rejection, delayed graft function, and HLA mismatch ≥4 HLA loci.     

Religious aspects of organ transplantation

No religion formally forbid donation or receipt of organs or is against transplantation from living or deceased donors. Only some orthodox jews may have religious objections to "opting in." However, transplantation from deceased donors may be discouraged by Native Americans, Roma Gypsies, Confucians, Shintoists, and some Orthodox rabbis. Some South Asia Muslim ulemas (scholars) and muftis (jurists) oppose donation from human living and deceased donors because the human body is an "amanat" (trusteeship) from God and must not be desecrated following death, but they encourage xenotransplantation research. No religion formally obliges one to donate or refuse organs. No religion formally obliges one to consider cadaveric organs "a societal resource" or considers organ donation "a religious duty" (except some rabbis and isolated Muslim and Christian scholars) No religion has a formal position on "bonus points," which is priority on the waiting list. Living organ donation is strongly encouraged only between jesus christians (15 of 28 jesus christians worldwide have donated a kidney). No religion forbid this practice. Directed organ donation to people of the same religion has been proposed only by some Orthodox Jews and some Islamic Ulemas/Muftis. Only some Muslim Ulemas/Muftis and some Asian religions may prefer living donation over cadaveric donation. No religion prefers cadaveric over living donation. No religion formally forbid non-heart-beating donors (nhbd) cadaveric donation or cross-over donation. Due to the sacrad of human life, the Catholic Church is against donation from anencephalic donors or after active euthanasia. No religion formally forbid xenotransplantation. Addressing the participants of the First International Congress of the Society for Organ Sharing in 1991, Pope John Paul II said "There are many questions of an ethical, legal and social nature which need to be more deeply investigated. There are even shameful abuses which call for determined action on the part of medical association and donor societies, and especially of competent legislative bodies" and later on "In effect, the human body is always a personal body, the body of a person. The body cannot be treated as a merely physical or biological entity, nor can its organs and tissues ever be used as item for sale or exchange". Addressing the participants at the XVIII International Congress of the Transplantation Society in 2000, Pope John Paul II said "Accordingly, any procedure which tends to commercialize human organs or to consider them as items of exchange or trade must be considered morally unacceptable, because to use the body as an object is to violate the dignity of the human person" and later on added "The criteria for assigning donated organs should in no way be discriminatory (i.e. based on age, sex, race, religion, social standing, etc.) or utilitarian (i.e. based on work capacity, social usefulness, etc.)." To conclude, according to the Catechism of the Catholic Church Compendium signed by Pope Benedict XVI on june 28, 2005, 476. Are allowed transplantation and organ donation, before and after death? Organ transplantation is morally acceptable with the consent of the donor and without excessive risks for him/her. For the noble act of organ donation after death, the real death of the donor must be fully ascertained.