Survey of First-Year Medical Students to Assess Their Knowledge and Attitudes Toward Organ Transplantation and Donation

Background

The important shortage of organ donors is still a fundamental public health problem in France. Improving the knowledge and attitudes of health care professionals could help to promote organ donation. The aim of this survey was to evaluate the level of knowledge of medical students and their gaps about organ donation prior to any medical course.

Materials and Methods

A survey was conducted among 571 first-year medical students at a medical faculty in Lyon. Their knowledge, attitudes, personal views, and perceptions toward organ donation and transplantation were investigated prior to any medical course. A 31-item anonymous questionnaire including queries about personal views of organ donation, factual knowledge, and awareness of French law was distributed to the students.

Results

To “willingness to donate a kidney to a relative,” 97.7% of respondents consented, 0.9% objected, and 1.4% did not answer. Their attitudes toward cadaveric organ donation were different: 81.1% agreed, 13.5% refused, and 5.4% did not answer. Regarding their knowledge about which organs could be transplanted, 95% of the respondents were aware of the possibility to transplant a face and 14% thought that xenotransplantation was performed nowadays.

Conclusions

First-year medical students have a good knowledge level regarding the organ donation and transplantation system prior to their medical course. Some gaps remain which could be improved. The results of this study supported a greater emphasis on providing information regarding transplantation in medical schools to improve the knowledge of future health care professionals. A follow-up survey of the participants at the end of their medical course will be interesting to assess the progress of their attitudes.     

Organ Donation: Cross-Sectional Survey of Knowledge and Personal Views of Brazilian Medical Students and Physicians

Objective

To assess the knowledge, attitudes, and behavior associated with cadaver organ donation and transplantation among medical students and physicians.

Patients and Methods

We randomly selected 350 medical students, 150 physicians, and 150 intensive care unit physicians. Each completed a questionnaire consisting of 9 self-administered items, from which we gathered data about their knowledge about brain death and criteria for the diagnosis of brain death; their hypothetical behaviors, assuming willingness to donate their own or their family's organs; their trust in physicians; and their confidence in a diagnosis of brain death made by physicians.

Results

We observed that knowledge about brain death increased with medical education level; the best results were noted in intensive care unit physicians. Agreement to transplant organs from brain-dead donors (odds ratio [OR], 4.58), confidence in brain-death diagnosis by physicians (OR, 2.17), and knowledge about criteria for the diagnosis of brain death (OR, 2.26) were predictors of willingness to donate one's own organs.

Conclusion

Enhanced medical knowledge of and involvement in donation are needed to achieve cadaver organ donation.     

Causes of family refusal for organ donation

Introduction

Family refusal represents a barrier for organ donation together with other cultural and religious factors possible ignorance and clinical obstacles.

Methods

We performed this retrospective study by phone employing our organ procurement unit database, using a list of families of potential organ donors who had refused organ donation.

Results

In 2009, 146 potential organ donor families refused donation. We contacted 81 families. The main reason expressed by there families to justify the refusal to donate the deceased's organs was denial and rejection of brain-death criteria (44.4%). Other causes were believing in a miracle (13.6%); fear about organ trade and unknown organ destination (9.9%); religious beliefs (8.6%); insecutrity about the brain-death diagnosis (6.2%); unstable family mood (6.2%); unknown donor wishes about donation (4.9%); belief in body integrity after death (3.7%); and fear of objection by other family members (2.5%).

Conclusion

Our findings showed several reasons for family refusal for organ donation; among the main cause is poor acceptance of brain death. It seems that increasing the knowledge of people about brain death and organizing strategies to confirm brain death for families are necessary to meet the organ shortage.     

Causes of organ donation refusal in southern Iran

Background

Family refusal is an important factor that limits the number of organ donations. Some studies from different centers have reported various reasons for family decisions of organ donation refusal. This study evaluated the reasons for organ donation refusal by family members covered in our organ procurement organization.

Methods

This cross-sectional study was performed among families of potential organ donors who satisfied brain death criteria as identified between March 2009 and March 2010.

Results

Among 125 potential donors 73 (58.4%) families refused donation. Their main reasons were as follows: lack of acceptance of brain death n = 26 (35.6%), belief in miracle and patient recovery (n = 22; 30.1), fear of gossip regarding sale rather than autonomous organ donation (n = 11; 15.1%), and fear about deformation of the donor's body (n = 9; 12.3%).

Conclusion

Family members play an important role in the final decision for organ donation. The general public should be encouraged to register their donation preferences in the case of brain death.     

Attitudes toward organ donation: a survey on Iranian teachers

Background

Organs from brain dead patients are the main source for transplantation. However, in most societies, including Iran, the family consent rate for organ donation is low necessitating improvements in public knowledge. Because teachers' knowledge has an important role to educate the next generations, this study assessed their knowledge and attitudes about brain death and organ donation.

Methods

The present cross-sectional study included, 93 teachers selected from eight schools in Tehran, Iran, in 2009. We used a standardized questionnaire containing items which inquired about knowledge and attitudes of the participants regarding brain death and organ donation.

Results

The mean age of the participants was 37 years and 48 (52%) were males. Eighty-seven (94%) of them had heard or read about organ donation, among whom 91% favored organ donation. The main sources of their information were television, radio, and newspapers. Sixty-five (70%) were willing to donate their own organs after death. Those with lower organ donation desire were in contact with a small number of patients who have chronic diseases, had less trust in organ donation networks and brain death diagnostic tools, expressed less desire to receive an organ, and had a low record of blood donation (P < 0.05).

Conclusion

Our findings show that although most teachers had heard or read about brain death and organ donation, and approved of organ donation after death, a lack of exposure to patients with chronic diseases and a distrust of organ donation networks were greater among teachers with a lower desire to participate in this effort. Therefore, building trust in brain death diagnostic systems is necessary together with relevant educational programs.     

Knowledge and attitudes toward organ/tissue donation and transplantation among health care professionals working in organ transplantation or dialysis units

Objective

To evaluate the awareness and attitudes of health care professionals toward organ/tissue donation and transplantation.

Methods

We included 309 health care professionals from 27 dialysis centers and eight organ transplantation centers in Istanbu in the present study conducted from April 2008 to August 2008. The 24-item questionnaire, including items concerning sociodemographic features and knowledge about and attitudes toward organ/tissue donation and transplantation, was applied by face-to-face interviews.

Results

An organ/tissue donation card was completed among 77% of subjects, while 90% were identified as supporting transplantation. The main reasons identified for lack of donation were lack of confidence (59.7%), fear of procurement (31.5%), and inappropriate use of harvested organs (18.1%).

Conclusion

In conclusion, targeting health care professionals in the first place and development of nationwide media and educational campaigns on the ethical, moral, as well as religious dimensions of transplantation and donation seem crucial to increase the number of individuals who can act as role models via their positive impact on the general public's attitudes toward organ donation.     

Knowledge and Attitude of Donor Cardholders Toward Organ and Tissue Donation and Transplantation in an Iranian Tissue Bank: A Case-Control Study

Background

Cadaveric organ shortage is the most important obstacle to more widespread provision of transplants. Many factors influence the donation rate: social factors, religion, familial relations, and especially knowledge and attitudes toward organ and tissue donation and transplantation. Increasing public awareness can reform the incorrect beliefs and myths about donation and transplantation. This study investigated knowledge and attitudes of donor cardholders toward organ and tissue donation as well as transplantation.

Methods

This case-control study was performed in 2006 among 178 donor cardholders and the same number of a control group who completed a questionnaire including 23 questions and demographic information.

Findings

Knowledge and attitude among the cardholder was significantly greater than the control group (P < .05). We observed a inverse correlation between age and a positive attitude toward donation and transplantation among cardholders.

Conclusion

This study suggested that the main reasons for refusal to donate organ and tissue were insufficient knowledge and negative attitudes due to misinformation regarding donation and transplantation. We believe that educating and motivating the public via the mass media can increase the rate of consent for organ and tissue donation and transplantation.     

A National Program Toward Improving Renal Health: Advancing Organ Donation Awareness

Background

Despite the national advocacy campaign for kidney transplantation from deceased donors in the Philippines 96% of kidneys transplanted into 721 kidney transplants from 1999 to 2001 came from living donors. A national survey on the knowledge, attitudes and perceptions of Filipinos on organ donation in 2001 showed factors that disadvantaged deceased organ donation to be poor understanding of “brain death,” religion, and fear of the operation. These concerns were addressed and another survey was conducted in 2005.

Objectives

To compare knowledge, attitudes, and perceptions of Filipinos on organ donation between 2001 and 2005, and compare the number of kidney transplants from deceased donors between 2001 until 2008.

Methods

Two surveys in 15 regions of the Philippines were conducted using multistage sampling. Using a structured questionnaire there were 2000 respondents in 2001, and 2140 in 2005. Analysis was performed using chi-square analysis.

Results

The majority of respondents knew about kidney donation. Between 2001 and 2005, there was increased awareness that transplants came from both living and deceased donors (37% to 41%) and a decline in those believing transplants came only from deceased donors (14% to 9%). Willingness to become a living (59% to 87%) or a deceased donor (35% to 49%) increased. The increase in transplantation from deceased donors from an average of 10 per year from 1999 to 2001 to 31 per year from 2006 to 2008.

Conclusion

Increased awareness about kidney donation among Filipinos, improved consent to become an organ donor, and an increase in kidney transplantation from deceased donors occurred from 2001 to 2008.     

Detection of Potential Organ Donors: 2-Year Analysis of Deaths at a German University Hospital

Objective

In 2006, inhouse coordinators were introduced in all hospitals with intensive care units in Baden-Württemberg to improve organ donation. At our university hospital with a neurosurgery and a transplantation unit, we analyzed whether brain death certification and donation requests were always initiated (if possible).

Materials and Methods

We retrospectively reviewed all 1312 hospital deaths from 2006-2007 by studying medical records and consulting with physicians. The possibility of organ donation was questioned.

Results

Donation was requested among 68/702 deaths due to cerebral complications. A request was impossible in 8 cases. Consent for donation was obtained in 29 cases, and it was realized in 24 cases. In 14 cases of resuscitation from shock or cardiac failure, therapy was not continued because of questionable hemodynamic stability. In 17 cases admitted to peripheral wards and 19 to intensive care units death due to cerebral complications occurred within 48 hours, but medical records were not relevant for exclusion criteria for organ donation.

Conclusions

The detection of donors was not acceptable. In patients without a prognosis after resuscitation, further hemodynamic stabilization was frequently omitted, because organ donation had not been considered. In cases of donation requests the refusal rate was high. We initiated specific training.     

Organ and Tissue Donation Knowledge Among Intensive Care Unit Nurses

Introduction

Increased cadaveric donation may be achieved by improving medical staff education to enhance consent rates. This study was designed to examine the critical items that influence nurse knowledge regarding the concepts of brain death and the attitudes toward cadaveric donor renal transplantation. These findings may be useful to evaluate future progress in education.

Subjects and methods

A 31-item questionnaire was distributed to 418 nurses in 24 intensive care units (ICUs) in our hospitals. In addition to initial data regarding age, sex, and marital status, knowledge about donation was evaluated by eight questions. The first four questions pertained to judical and legal knowledge, the second two to economic knowledge, and the last two to concepts of brain death.

Results

Three hundred and two women and 116 men participated in this study. Their mean age was 31.98 years (range = 22-55 years). Two hundred fifty-six (61.2%) of them were married. Three hundred sixteen (75.6%) expressed favorable attitudes regarding cadaveric donation. The major reason for their consent was humanity, and the major reason for their disagreement was “body respect.” Of the 418 nurses, 105 (25.1%) stated positive attitudes toward living kidney donation.

Conclusion

The legal definition of death and the medical definition of death should be uniform in the view of society. To make all medical staff favor cadaveric renal transplantation, they should agree on a definition of death. It was observed that the relatively high rate of misinterpretation of the brain-death concept among respondents negatively affected nurses attitudes toward cadaveric renal transplant. It was concluded that the “concept of brain death” and the “preferences of transplant over other treatment modalities” are the two items that need further attention in educational programs for nurses.     

Impact of the educational resource one life … many gifts on attitudes of secondary school students towards organ and tissue donation and transplantation

Background

Increased awareness of organ donation/transplantation has been found to have a positive influence on organ donation rates. One Life … Many Gifts is a curriculum resource in Ontario, Canada, to educate and raise awareness for senior secondary school students about the importance of organ and tissue donation and transplantation. Teachers administered pre- and post- attitudinal surveys to senior secondary school students to evaluate changes in their attitudes toward organ and tissue donation and transplantation. In this study, the effect of the One Life … Many Gifts educational intervention on changing the attitudes and awareness of organ donation and transplantation of senior secondary students was assessed.

Methods

Mann-Whitney U tests were used to compare the pre- and post-surveys as a whole and then again for the data from individual schools. Kruskal-Wallis H-tests were used to compare data between schools.

Results

A total of 1832 pre- and 1440 post-educational surveys returned to Trillium Gift of Life Network were assessed in the 2008-2009 academic year. Overall, comparison of all pre- and post-educational program survey data showed significant improvement in the students' attitudes toward organs and tissue donation and transplantation (P = .00625).

Conclusion

The One Life … Many Gifts program made an impact on changing the attitudes toward and awareness of organ donation among high school students in Ontario. Evaluation of its impact on donor registration and organ donation among the students and their parents is complex and remains to be seen.     

The PIERDUB Project: International Project on Education and Research in Donation at University of Barcelona: Training University Students About Donation and Transplantation

Introduction

Donation and transplantation is an accepted therapeutic option when organ failure or tissue replacements are needed to save or improve the quality of life. However, in most medical schools there is no specific training for it, thus disregarding the key role of university students for the future success of the process.

Objectives

Knowledge diffusion about the donation procedure to clarify doubts and stimulate positive attitudes toward donation. Training university students in the donation and transplantation process. Research about the previous donation knowledge and the impact in donation indexes.

Methods

Three different phases have been designed: (1) Training the University of Barcelona Health Sciences School students; (2) Training the Health Sciences School students in other faculties of Catalonia, Spain, and International; and (3) research.

Results

Since 2005, we have offered yearly an Optional Credits Course to medical students with duration of 45 hours, and two Donation days opened to health sciences students. Since 2007, promotional campaigns have been carried out in medicine and other health sciences faculties. Until now, 818 answered surveys have been collected to evaluate previous knowledge among university students.

Conclusion

Training medical and other health sciences students in the donation process will improve quality of medical education and develop a trainer role for future professionals to help improve donation rates.     

Knowledge of the concept of brain death in the British and Irish population resident in southeast Spain

Introduction

The concept of brain death (BD) is not well understood among the general public, rendering it one of the main psychosocial barriers to favorable attitudes toward donation. Individuals from the British Isles are among the most important migratory groups in southeastern Spain. We sought to analyze the level of understanding of the concept of brain death among the British and Irish populations living in southeastern Spain, and to determine factors affecting their attitudes.

Material and Method

A random sample of the British and Irish population resident in Murcia was stratified according to nationality as part of the “International Collaborative Donor Program” (n = 1611). The self-administered survey in English was completed anonymously. For the statistical analysis, we used the χ² test and a logistical regression analysis.

Results

Approximately half of the respondents (45%; n = 692) understood the concept of BD; they considered it to mean the death of an individual. Among of the other respondents, 39% (n = 605) did not understand this concept, and the remaining 16% (n = 240) erroneously believed that it did not imply a person's death. Respondents coming from Great Britain showed a greater knowledge of the BD concept than did the Irish (46% vs 34%; P < .001). Those who understood the concept of BD were more in favor of deceased donation than those who had an erroneous understanding (49% vs 36%; P < .001). Significant associations were also noted among variables directly or indirectly related to donation and transplantation (P < .05).

Conclusion

The level of understanding of the concept of BD among the population from the British Isles resident in southeastern Spain was limited. Taking into account that the BD concept is a psychosocial factor that affects attitudes toward organ donation, information campaigns should be applied to this emerging population group in southeastern Spain.     

Organ Transplant Education: The Way to Form Altruistic Behaviors Among Secondary School Students Toward Organ Donation

Background

Organ shortage for transplantation is a crucial problem all over the world. Educational intervention may appeal to young people's altruism, increasing organ donation and decreasing the opposition.

Aim

This study assessed the influence of an educational program, including organ donation and transplantation, to forming students' altruistic behaviors.

Methods

A total 680 students of 25 secondary schools were asked about their attitudes, intentions, and knowledge about organ donation and transplantation from September 2008 to June 2009 during a 45-minute lesson.

Results

In this study, altruistic attitudes were measured through questions about the expression of will to give organs away after death; to give one kidney to relatives; to use the bone marrow from a foreign person; and to sign a donor card. Attitudes were assessed by questions about conversations with relatives, an evaluation of the educational project. More than 1500 donor card were distributed and more than 90% of students wanted to sign them; 73.6% agreed to sign a donor card with the ID card. Before the project, only 8% of students had a signed donor card. Almost everybody is ready to agree to give their organs after death (80.6% male; 92.2% female), or to relatives (100% male; 90.38% female), or bone marrow (80% male; 55.7% female). The students talked to their family, informing them about their decision (36.9% male; 45.9% female).

Conclusions

The proposed educational project successfully encouraged teenagers to make well-considered choices with regard to organ donation and created altruistic behaviors.     

International multicenter opinion study: administrative personnel from Spanish and Mexican health centers faced with human organ donation for transplantation

Introduction

Administrative personnel from healthcare centers are an important opinion group given their direct relationship to patients and the general public.

Objective

The objective of this study was to analyze the attitudes of administrative personnel in Spanish and Mexican healthcare centers toward various kinds of donation.

Material and Methods

A random selection of 418 administrative staff from 32 primary care centers and 9 hospitals in Spain and Mexico (“Proyecto Donante, Murcia”) used a validated questionnaire to explore attitudes.

Results

Most (76%) respondents favored deceased donation. Mexican workers had the most favorable attitude (P < .001). Factors influencing this attitude (P < .05) were as follows: type of healthcare center, clinical service, personal experience of organ donation and transplantation (ODT), attitude toward living donation, attitude toward the donation of a family member's organs, discussion of ODT, partner's attitude toward ODT, participation in pro-social activities, and variables related to attitudes toward the body. Most respondents (89%) favored related living kidney donation (LKD) and 87% favored living liver donation (LLD). Mexican respondents showed the most favorable attitudes (P < .05). Factors influencing this attitude (P < .05) were as follows: personal experience of ODT, belief that a transplant is needed, willingness to accept a living organ, family discussion about ODT, partner's attitude about the matter, and respondent's awareness of the view of his or her religion toward ODT.

Conclusion

Attitudes toward deceased organ donation were not favorable among administrative personnel from Spanish compared with Mexican centers, although attitudes toward LKD and LLD were favorable in both countries.     

Factors Limiting Deceased Organ Donation: Focus Groups' Perspective From Culturally Diverse Community

Background

In-depth understanding of cultural and religious factors limiting organ donation of three ethnic populations (Malay, Chinese, and Indian) in Southeast Asia is lacking. Identification of factors limiting organ donation among these three ethnic groups will provide insights into culturally appropriate strategies to promote acceptance of organ donation in a multiethnic Asian community.

Methods

A total of 17 focus group discussions (105 participants) were conducted between September and December 2008. Participants were members of the general public aged 18 to 60 years, recruited through convenient sampling around the Klang Valley area of Malaysia.

Results

Although the majority had favorable attitudes toward deceased organ donation and transplantation, a diversity of myths and misinformation were unearthed from the discussions across the ethnic groups. These include perceived religious prohibition, cultural myths and misperceptions, fear of disfigurement, fear of surgery, distrust of the medical system, and family disapproval. Culture and religious beliefs played important prohibitive roles among those opposed to organ donations. There were distinctive ethnic differences in cultural and religious concerns regarding organ donation. Less-educated and rural groups appeared to have more misconceptions than the well-educated and the urban groups.

Conclusion

Our findings may assist organ donation and transplantation organizations to reach diverse sociodemographic and ethnic communities with culture-specific information about organ donation. The involvement of community and religious leaders is critical in organ donation requests.     

Presumed Consent for Organ Donation: Is Romania Prepared for It?

Introduction

In November 2007, a legislative initiative regarding the presumed consent for organ donation was proposed for parliamentary debate in Romania and was followed by public debate. The study aimed to asses public opinions expressed in the Romanian media.

Materials and Methods

An Internet search was made. The pro and con reasons, the affiliation of parts involved in the debate and suggested future direction of action were identified.

Results

The Internet search had 8572 results. The parts involved in the pro and con debate consisted of governmental structures, physicians, ethicists, politicians, media, religious authorities, nongovernmental associations, and lay persons. The main pros were the low rate of organ donation and the long waiting lists, enhancement of organ procurement, avoidance of wasting valuable organs, avoiding responsibility, and the stress imposed to the family in giving the donation consent, humanitarian purposes (saving lives), going along with the scientific progress, and less bureaucracy. The main cons were an unethical issue, violation of human rights, denial of brain death, unethical advantage of public ignorance, unethical use of underprivileged people, little results in terms of organ procurement, but huge negative effects on public opinion, public mistrust in transplant programs and impossibility of refusal identification due to particularities of the Romanian medical system.

Conclusion

The con opinions prevailed. For the moment, Romania seems to be unprepared to accept presumed consent. A future change in public perception regarding organ transplantation may modify the terms of a public debate.     

Multivariate analysis to determine the factors affecting the attitudes toward organ donation of healthcare assistants in spanish and mexican healthcare centers

Background

Healthcare assistants are an important group of workers who can influence public opinion. Their attitudes toward organ donation may influence public awareness of healthcare matters; negative attitudes toward donation and transplantation could have a negative impact on public attitudes. Our objective was analyze the attitudes of healthcare assistants, in Spanish and Mexican healthcare centers toward organ donation and determine factors affecting them using a multivariate analysis.

Material and Methods

As part of the “International Collaborative Donor Project,” 32 primary care centers and 4 hospitals were selected in Spain and 5 hospitals in Mexico. A randomized sample of healthcare assistants was stratified according to healthcare services. Attitudes were evaluated using a validated questionnaire of the psychosocial aspects of donation, which was self-completed anonymously by the respondent. Statistical analysis used the chi-square test, Student t test, and logistic regression analysis.

Results

Of 532 respondents, 66% in favored donation and 34% were against it or undecided. Upon multivariate analysis, the following variables had the most weight: 1) country of origin (Mexicans were more in favor than Spanish; odds ratio [OR]) = 1.964; P = .014); 2) a partner with a favorable attitude (OR = 2.597; P = .013); 3) not being concerned about possible bodily mutilation after donation (OR = 2.631; P = .006); 4) preference for options apart from burial for handling the body after death (OR = 4.694; P < .001) and 5) accepting an autopsy if one was needed (OR = 3.584; P < .001).

Conclusions

The attitudes of healthcare assistants toward organ donation varied considerably according to the respondent's country of origin. The psycho-social profile of a person with a positive attitude to donation was similar to that described within the general public.