Attitudes of Medical Students About Brain Death and Organ Donation

Introduction

There have been publications on the attitudes of the general Iranian population and health care personnel about brain death and organ donation; however, there is little information about such attitudes of medical students. In 2006, a survey was conducted in Tehran about the attitudes of medical students in a hospital with a transplantation program.

Material and Methods

The general population, health care personnel, and medical students were surveyed, and data were extracted from interviews with 41 medical students. The survey included 35 items about attitudes toward brain death and organ transplantation.

Results

Nine students (22.0%) had ever seen a transplant recipient, and 7 (17.1%) had ever seen a brain-dead patient. Thirty-four students (82.9%) agreed with organ donation after brain death. Six students (14.6%) had received information through university lectures, and 40 (97.5%) perceived a need for further information about organ donation and brain death in the university curriculum. Nine students (22.0%) had an organ donor card.

Conclusion

Most Iranian medical students have neither been exposed to brain death or organ recipients nor received appropriate information about organ donation and transplantation.     

Attitudes, knowledge, and proficiency in relation to organ donation: a questionnaire-based analysis in donor hospitals in northern Denmark

The aim of this study was to assess knowledge, attitudes, and proficiency in relation to organ donation among staff members of intensive care units (ICUs) in donor hospitals, and possibly identify areas for improvement. The investigation was carried out as a collaboration between the transplant center and appointed key persons in all 17 ICUs in 15 hospitals in northern Denmark. A total of 1168 structured questionnaires were distributed to the health care professionals in the ICUs in the region; 689 were returned, giving a response rate of 59%. In general, there is a positive attitude among health care professionals toward organ donation. However, a considerable fraction of 11% declares to be against organ donation. Only 49% of the ICU health care professionals are willing to donate their own organs after death. By comparison, 74% of the general Danish population are willing to donate organs after death. Doctors are more positive toward organ donation than the nursing staff. Thus, 95% of the doctors are positive to organ donation compared to 81% of the nurses; 70% of the doctors will donate own organs after death compared to 45% of the nurses. Further, the survey demonstrates as expected a significant lack of experience in organ donation. Our data show a considerable need for more education and training, especially on how to inform and support the donor relatives and how to identify potential donors. The survey also discloses a substantial need for information regarding the results of transplantation.     

Development of a questionnaire to assess attitudes and beliefs toward organ donation among Asians

In the United Kingdom, people from the Indian subcontinent have a higher incidence of kidney failure, are less likely to receive a kidney transplant, and have a higher mortality rate from renal disease. In addition, Asians are reluctant donors; white people make up 95% of the donor pool. We developed a questionnaire to determine the knowledge and attitudes toward organ donation in the Asian communities. The setting was a public forum; the aims were (1) to study the attitudes of Asians toward organ donation, (2) to validate our questionnaire, and (3) to initiate a campaign of increasing awareness of organ donation and transplantation in the Asian community in the greater Glasgow area. Our survey suggested that Asians have an awareness of organ donation and transplantation, and they would donate an organ to a family member; however, they did not carry a donor card. Respondents unanimously agreed that lobbying by religious leaders was the best means to promote awareness.     

Hospital attitude survey on organ donation in the Emilia-Romagna region, Italy

The role of hospital staff in the organ procurement process is crucial. Nevertheless, there is little literature about their attitudes toward donation. The Donor Action Hospital Attitude Survey (HAS) comprises a series of questions to assess hospital staff's attitudes, beliefs, and knowledge on organ donation and transplantation. Further analysis of the data will help identify any weak areas in the staff viewpoint and information, highlight potential needs for more education on specific issues, and establish a baseline to monitor future improvements. We used the Donor Action HAS in the Emilia-Romagna region, Italy. The aim of this paper is to assess and better understand the personnel's viewpoint in the 12 main hospitals of the region. The survey was carried out among hospital staff involved in organ donation. 1576 responses were collected (52 % of distributed questionnaires), of which 1024 came from nurses, 475 from physicians, and 77 from other backgrounds. Questions were subdivided into categories, and for every point an overall mark (maximum 3/3) was calculated. Results: 1. Involvement in donation process during the past year: 1.24 /3, 2. Attitudes to organ donation (OD): 2.51 /3, 3. Skills / Self-confidence in donation practices: 1.36 /3, 4. Satisfaction with local transplant coordinator (TC) services: 2.31 /3. The attitude towards organ donation was positive, 1386 respondents support organ donation. A high percentage (93.6 % of respondents) is of the opinion that transplantation helps save other people's lives. Most uncertainty arises on the question whether donation helps families with grief. It is remarkable that only 53 % of those prepared to donate organs have informed the family of their wish. Many respondents do not feel comfortable performing key tasks close to donation. Major difficulties were observed in explaining to a family the concept of brain death (0.98 /3). Knowledge on the concept of brain-death was one of the most requested subjects for improvement. Emilia-Romagna is the region with one of the highest donation rates in Italy (29.9 pmp in 2000). Nevertheless, more profound knowledge of the local situation could help further improve donation. Received: 12 July 2000 Revised: 25 May 2001 Accepted: 10 September 2001     

Hospital personnel in surgical services in a transplant hospital faced with living liver donation: an attitudinal survey

Living liver donation is becoming a more widely accepted practice given the decrease in donor morbidity and mortality and the beneficial results in the recipient. Use of this technique is unusual in Spain. There are a number of workers against its use within the health care system. The objective of this study was to analyze attitudes toward and the variables that affect them concerning living liver donation among surgical services in a transplant hospital. MATERIALS AND METHODS: A random survey was stratified by surgical area and job category in a Spanish third-level hospital with an ongoing solid organ transplant program. Attitudes toward living liver donation were assessed using a questionnaire about organ donation and transplantation that evaluated various psychosocial variables. Student's t test and the chi square test were used. RESULTS: A total of 263 workers were surveyed (mean age as 40 +/- 9 years). Regarding attitudes toward living liver donation, the level of acceptance was 80% (n = 211) of respondents, whereas 10% were undecided (n = 26), and another 10% were against (n = 26), assuming that the donations were related. When we asked about unrelated living donation, the percentage in favor decreased to 10% (n = 27). No differences were found with respect to job category or type of service. The variables that are related to such an attitude are the following: (1) possibility of respondent needing an organ (P = .001); (2) favorable attitude toward living kidney donation (P < .000); and (3) a belief that medical errors exist (P = .004). An important finding was that attitudes toward living liver donation were not more favorable according to whether the respondent was in favor or against cadaveric organ donation (P = .175). CONCLUSION: There was a highly favorable attitude toward living liver donation among hospital personnel in surgical services, which is an important factor to take into account if this type of donation is to be encouraged in Spain.     

Cornea recipients: are their opinions and attitudes toward organ donation different from those of the general population?

BACKGROUND: Cornea transplantation provides a second chance for people with poor visual function. Unfortunately, there is a major shortage of donor cornea tissue. The purpose of this study was to evaluate the attitudes and willingness to donate organs among cornea transplant recipients. METHODS: Sixty-eight patients who underwent cornea transplantation between January 2002 and May 2003 were asked to complete a questionnaire dealing with their attitudes toward cornea and organ donation, and willingness to donate an organ. RESULTS: Religion was a contributing factor for a negative decision to donate organs. Only 29% of participants, most of whom were nonreligious were carrying a signed donation card. Fifty-eight percent of the patients knew that the cornea graft is derived from a deceased person; most of these patients were of European or American origin. Seventy-three percent knew that donation requires the agreement of a family member. Age, gender, marital status, and education were not significantly associated with attitude toward donation. CONCLUSION: Stronger efforts are needed by transplant coordinators, physicians, and nurses to improve the education and knowledge of patients and their families about the basic aspects of transplantation. Greater public awareness may increase the willingness to donate organs.     

Attitude toward deceased organ donation and transplantation among the workers in the surgical services in a hospital with a transplant program

INTRODUCTION: There are data that suggest that the percentage of hospital workers not in favor of donation is relatively high, even in services that are directly related to transplantation. The objective was to analyze attitudes toward decreased organ donation in the surgical services. MATERIALS AND METHODS: A random sample was stratified by the surgical service and the job category (n = 263) in a third-level hospital with a transplant program assessed attitudes toward the donation of ones own organs after death using a questionnaire including psychosocial factors as validated in our geographic surroundings. Student t test and the chi-square test were used for data analysis. RESULTS: Favorable attitudes toward donation were observed in 68% (n = 178) as opposed to 32% with an attitude that was undecided or against the act (n = 85). The psychosocial variables that showed significant relationships with this attitude were age (most in favor are younger; P = .021); nonmedical surgical staff (50% against donation; P = .0001); resident physicians (94% in favor; P = .001); discussion and prior consideration of donation (P = .016); knowledge of the concept of brain death (an important factor in nonhealth staff; P = .010); attitude toward manipulation of the deceased (P = .011) and concerns about mutilation (P = .026); partner's opinion toward organ donation (P = .0001); and existence of frequent medical errors (P = .003). No significant differences were found, depending on whether the services were involved in a specific transplant program (P = .853). CONCLUSIONS: Favorable attitudes toward donation among the hospital staff on surgical services, including those who perform transplants, did not reach more than 70% and was determined by multiple psychosocial factors. Donation promotion activities are necessary for these services, given the importance that this group's negative attitude could have on the attitude of the general population.     

Organ Donation: New Hope Through the Expected Amendment in Germany?

Introduction

The current organ donor shortage in Germany results in the death of 1000 patients on the transplant waiting list every year. In response, a recent amendment to the German Transplant Act aiming to increase donor rates was passed. Among a number of other measures, Germans are asked to decide whether they choose to donate organs or not in the event of a brain death or whether they would like to designate someone who should decide for them in this situation. The objective of this study was to collect and evaluate data on the public's attitude toward organ donation before the expected amendment.

Methods

A survey on the subject of organ donation was conducted in 2011 among clients of a public pharmacy in a major city in the federal state North Rhine-Westphalia, Germany. Data regarding sex, age, health behavior, and attitude toward the amendment were collected and association organ donor card possession was analyzed.

Results

A total of 1485 questionnaires were evaluated. Of those surveyed, only 14.1% had an organ donor card. No statistically significant associations between sex (P value .3045), age (P value .1453) and the possession of a donor card were observed. We found that 72.5% of respondents stated that they appreciated the expected amendment, and in the case of implementation, the majority would obtain an organ donor card.

Discussion

The future success of transplantation medicine relies on an increase in the public's overall willingness to donate organs. Educating the public and ensuring transparency in transplantation medicine are vital to achieving higher donation rates. The new German transplantation act may be an important step to increase society's awareness and participation in organ donation.     

Organ donation: a cross-sectional survey of the knowledge and personal views of Turkish health care professionals

Health care professionals (HCPs) represent a key element in the cadaveric organ donation process. This cross-sectional survey assessed HCPs' knowledge, attitudes, and behavior related to cadaveric organ donation and transplantation. One thousand one hundred eighty-four HCPs were randomly selected from various units of five health care institutions located in three major Turkish cities. Each individual completed a questionnaire. The ages ranged between 18 and 63 years. By examining the tendency to organ procurement, 78.6% of the physicians and 69.5% of the nurses stated that establishing brain death during ventilator support is the optimum condition. The results indicated good overall knowledge of the criteria for brain death. Physicians displayed significantly better understanding of the criteria for brain death and optimal conditions for organ procurement. While physicians have significantly better knowledge about kidney transplantation, there was no difference for liver transplantation. Compared to nurses, doctors had significantly better knowledge of which organs can be used in the current transplantation process. Although 44.2% claimed they were willing to donate their organs, only 17.9% actually carried a legal donation card. The rate of willingness to donate was significantly higher among doctors than nurses. Physicians have significantly better knowledge about legal aspects of organ donation and transplantation. Overall, the survey revealed that lack of knowledge has a negative impact on people's attitudes toward organ donation even among health care professionals. Improvements must be made to develop a nationwide Donor Hospital Education Program that will provide training concerning transplantation and organ donation.     

Knowledge and attitude regarding organ donation among medical students and physicians

BACKGROUND: There is a discrepancy between demand and supply of donor organs for kidney transplantation. Health care providers can influence the willingness to donate or hold an organ donor card. It is unclear how educated current and future health care professionals are about organ donation and what constitutes their attitude toward this topic. METHODS: The authors conducted a cross-sectional survey among 1136 medical students and physicians to evaluate the knowledge about and attitude toward organ donation and transplantation at a large academic medical center in Germany. The authors used a 28-item questionnaire that included items on knowledge, attitude, and demographics. RESULTS: Only 8% of the respondents felt sufficiently prepared for approaching relatives of potential organ donors. Knowledge about and attitude toward organ donation were highly associated with increasing level of medical education. In multivariate analyses, knowledge (odds ratio [OR], 1.17; 95% confidence interval [CI], 1.08-1.25), attitude (OR, 1.03; 95% CI, 1.02-1.04), and level of education (OR for preclinical students, 0.39; 95% CI, 0.20-0.76 compared with physicians) were significantly associated with the likelihood of holding an organ donor card, whereas age, gender, and personal experience with renal replacement therapy were not. CONCLUSIONS: Higher medical education is associated with greater knowledge about and a more positive attitude toward organ donation. Health care professionals with a higher education level are more likely to hold an organ donor card and also feel more comfortable in approaching relatives of potential organ donors. Educating health care professionals about the organ donation process appears to be an important factor in maximizing the benefits from the limited organ donor pool.     

Primary care doctors faced with living organ donation

OBJECTIVE: The attitudes of health care personnel, specifically doctors, have a significant influence on public attitudes toward organ donation and transplantation. The objective herein was to analyze the attitudes of Primary Care (PC) doctors toward living organ donation and to determine the psychosocial factors that condition these attitudes. MATERIALS AND METHODS: A random sample was stratified by geographical location (six health areas in our community) among PC doctors, including 155 respondents from 32 health centers. Attitudes toward donation were evaluated using a psychosocial questionnaire validated in our geographical area. Contact was made with the Doctor Coordinator in each center for distribution of the questionnaires, which were completed anonymously. The chi-square test and Student t test were applied to evaluate the data. RESULTS: When the living donor is not related, only 21% (n = 32) of PC doctors were in favor of living kidney donation, and only 20% (n = 31) for living liver donation (P > .05). In contrast, these percentages were 90% and 89% in favor of kidney and liver related donation, respectively. Upon analysis of the psychosocial variables affecting these attitudes, there was only an association with their partner's opinion (P = .009 for kidney and P = .000 for liver), and the possibility of needing a transplant oneself (P = .000). CONCLUSIONS: PC doctors have favorable attitudes toward related living donation. If living donation is promoted by transplant coordination units, such PC professionals could act as a source of positive information about the matter for the general public.     

Attitude survey of hospital workers in the surgical services toward living kidney donation

INTRODUCTION: A living donor kidney is currently the most accepted kind of solid organ donation, given the low level of morbidity and mortality and the good results in the recipient. In Spain, its use is still scarce; even many health service workers are not in favor. Our objective was to analyze the attitudes toward living kidney donation in a surgical department. MATERIALS AND METHODS: A random sample was stratified according to surgical services and job category in a tertiary hospital with an solid organ transplant program. Attitudes toward living kidney donation were evaluated using a questionnaire on donation and transplantation, which evaluated various psychosocial variables. Student's t test and the Chi square test were used. RESULTS: Two hundred sixty-three respondents of mean age 40 +/- 10 years were analysed for attitudes toward living kidney donation. The level of acceptance was 87% (n = 229) versus 13% undecided or against the procedure (n = 34). No differences were observed according to job category. The variables that showed a relationship with the attitude were the partner's attitude toward donation (P = .049); the possible need for an organ oneself (P = .0001); and belief that medical errors occur (P = .001). The attitude toward cadaveric organ donation was not reflective of that toward living kidney donation (P = .241). CONCLUSIONS: A favorable attitude toward living kidney donation was high among hospital staff of the surgical department. Those for whom it was not favorable were influenced by personal factors such as partner's attitude and the possibility of needing a kidney in the future.     

Socio-personal factors influencing public attitude towards living donation in south-eastern Spain.

OBJECTIVES: Our aim was to determine public attitudes towards living donation compared with cadaveric donation, and to analyse psycho-social factors that may influence this attitude. MATERIALS AND METHODS: An opinion poll was used to study a random sample in two geographical areas (urban and rural). Assessment was made of attitudes towards donation of one's own organs as a living donor to an unknown person, as a living donor to a relative and/or close acquaintance and, as a cadaveric donor, and of the different psycho-social variables that may influence this attitude. RESULTS: In the urban setting, 60% had a favourable response towards cadaveric donation; 29% were in favour of living kidney donation to an unknown person, a percentage which increased to 89% for donation to a relative or a friend. These rates were lower for liver (21 and 74%, respectively). When asked if they would accept an organ donated by a relative or a friend, 67% would accept a kidney and 60% a liver. Attitude towards living donation to an unknown person is more positive among those in favour of cadaveric donation and those who have had previous experience of donation. With respect to level of education, university students are more undecided about living donation to an unknown person than the other groups. In terms of attitude towards donation to relatives and/or friends, there is also the influence of social factors (sex, marital status). However, if the living donation is intended for oneself, there is no variable with which to associate this attitude. In the rural setting, 56% of the respondents refused to complete the survey due to fear of living donation. No statistical study was conducted due to the bias of the rural sample. CONCLUSIONS: There is great fear and ignorance of living donation among the rural population, and uncertainties in the urban population, although attitudes are more positive towards living donation to relatives and/or friends than towards cadaveric donation. These positive attitudes towards living donation are very strongly related to attitudes towards cadaveric donation, previous experience of donation and level of education.     

Health care professionals: what do they know about organ donation?

BACKGROUND: Although donor detection is influenced by the legal system and family refusal, underreporting due to erroneous knowledge of donation criteria and a lack of familiarity with the procedure among medical professionals is also a contributing factor. OBJECTIVE: To investigate the outlook of critical health professionals participating in our postgraduate courses (2001 to 2006) about organ donation. METHODS: We administered an in-depth survey, evaluating attitudes, knowledge, roles, and experiences related to organ and tissue donation and transplantation, to 350 participants before and after the postgraduate courses. RESULTS: We collected 690 surveys from 350 attendees. In the first survey, 280 (80%) of them showed a positive attitude toward organ donation, 210 (60%) toward tissue donation, and 24 (7%) declared lack of knowledge about the subject. Only 175 (50%) had relatives who had donated organs. Sixty-three participants (18%) believed brain death is not equivalent to death, 176 (50%) claimed a lack of adequate training in this area, and 211 (60%) felt uncomfortable approaching families for donation. Only 88 (25%) were able to state the percentage of people receiving an organ in Spain, and 36 (10%) reported the correct number. After the course, the participants declared progress in attitudes toward and comfort levels with donation. Furthermore, family refusal in our hospital decreased from 33% to 8% to 11%. CONCLUSION: Continuous training of health care professionals about transplant, the legal system, and communication skills are crucial for successful organ and tissue donation.     

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.     

Attitudes of hospital staff involved in organ donation to the procedure

Hospital staff have a key function in asking for potential organ donors, but little is known about their own attitudes towards donation. In a community hospital with 7–8 multi-organ extraction procedures each year 199 staff members were surveyed. Although only 7 % of the responding staff would personally refuse to donate an organ, 23 % would not give consent to organ donation from a close relative. 47 % of those prepared to be donors had signed a donor card. Donors informed their family more frequently (88 %) about their personal attitude towards organ donation than non-donors (60 %), or undecided personnel (43,8 %; chi-square P = 0,004). No significant difference in attitude according to medical profession subgroups was found. The findings are in line with general population surveys and indicate that much work needs to be done to encourage medical staff involved in organ donation to set an example to the community. Received: 14 June 1999/Revised: 17 February 2000/Accepted: 18 April 2000     

Internet-based intervention to promote organ donor registry participation and family notification

BACKGROUND: Little is known regarding the potential of Internet-based educational interventions to increase organ donor registry participation and family notification of donation wishes. We studied the effects of an Internet-based multimedia intervention (www.journey.transweb.org) on donor registry participation and family notification. METHODS: Visitors to a specially designed web site were studied between December 14, 2000, and March 31, 2002. Demographic characteristics were requested, and a pretest was administered to one half of the participants (selected randomly) before web site content exposure. All visitors were offered a posttest. Eight knowledge questions (true/false), three attitude questions (7-point scale), and three behaviors (yes/no) were assessed. RESULTS: A total of 10,884 visitors provided demographic data. Correct answers to knowledge questions increased from 85.1% to 87.0% overall (pretest vs. posttest; P<0.001) and from 80.6% to 82.0% for teenagers (P<0.001). Willingness to donate increased (scores of 6.34 vs. 6.39; P<0.001), as did willingness to join a donor registry (scores of 5.53 vs. 5.67; P<0.001). Willingness measures were less positive among teenagers but increased significantly after exposure to the intervention. Almost 10% of visitors directly linked to an online registry and 2,489 (23%) used the web site facilities to communicate donation wishes. Increases in knowledge were not associated with changes in attitudes, but an increase in pro-donation attitude was a significant predictor of donor registry participation (P<0.001). CONCLUSIONS: Increases in donation attitudes among visitors to an organ donation web site resulted in positive behaviors, such as enrollment in a donor registry and family notification. Future efforts should focus on using Internet-based interventions to improve attitudes toward donation and to facilitate pro-donation behaviors.