|Year : 2017 | Volume
| Issue : 3 | Page : 127-132
Knowledge, attitude, and practices regarding organ donation among adult visitors in a public hospital in Delhi, India
Sandeep Sachdeva, Anika Sulania, Nidhi Dwivedi
Department of Community Medicine, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India
|Date of Web Publication||20-Dec-2017|
Dr. Sandeep Sachdeva
Department of Community Medicine, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi - 110 007
Source of Support: None, Conflict of Interest: None
Objective: To assess knowledge, attitude, and practices regarding organ/tissue donation. Materials and Methods: A cross-sectional descriptive study was conducted among ambulatory, consenting adult (>18 years) visitors of a mid-level government hospital using a predesigned, pretested, semistructured interview schedule. Data were analyzed by calculating proportion, Chi-square test, and odds ratio (OR). Results: Of 450 respondents, 271 (60.2%) were aged more than 31 years, 264 (58.7%) were male, 345 (76.7%) were married, 374 (83.1%) were Hindu, 304 (67.6%) had studied up to 10th class, 278 (61.8%) were working, 217 (48.2%) had 0–2 previous visit to this hospital, and 142 (31.6%) reported history of hospitalization. Majority (337, 74.9%) of the respondents had heard the term organ donation (OD). On probing further, nearly 87.3% and 82.4% of respondents had ever heard of eye and kidney donation, respectively. Encouragingly, more than half of respondents, i.e., 261 (58.0%), showed willingness for OD. Statistically (P < 0.001) higher odds for OD willingness was found among participants who were aware of the term OD (unadjusted OR [UOR] = 2.8, 95% confidence interval [CI]: 1.82–4.39), eye donation (UOR = 3.2, 95% CI: 1.78–5.76), and kidney donation (UOR = 4.0, 9.5% CI: 2.40–6.84). Similarly, higher willingness was found among single/separated participant and with higher level of education (P < 0.05). About one-fourth (120, 26.7%) of respondents had donated blood in the past, but this practice had no statistical bearing on the willingness for OD (P = 0.61). Nearly half of the respondents, i.e., 239 (53.1%), were aware that organs could be removed from both living and dead person; 373 (82.9%) of respondents were aware that organs cannot be removed from the body without authorized permission (UOR = 2.7, 95% CI: 1.57–4.88 and adjusted OR [AOR] = 2.6, 95% CI: 1.27–5.66). However, only 119 (26.4%) respondents consented to sign a pledge card for OD. Higher odds (AOR = 12.8, 95% CI: 5.02–32.75) for OD willingness was found among those who consented to sign a pledge card. A high of 364 (80.9%) respondents had no misconception that a person will be born with missing organ following donation of organ/tissue in this life. Conclusion: A high awareness but low level of positive attitude and practices was noticed among sampled metropolitan respondents toward organ/tissue donation.
Keywords: Awareness, cornea, developing country, kidney, legislation, organ, perception, program, tissue, training, transplantation
|How to cite this article:|
Sachdeva S, Sulania A, Dwivedi N. Knowledge, attitude, and practices regarding organ donation among adult visitors in a public hospital in Delhi, India. Indian J Transplant 2017;11:127-32
|How to cite this URL:|
Sachdeva S, Sulania A, Dwivedi N. Knowledge, attitude, and practices regarding organ donation among adult visitors in a public hospital in Delhi, India. Indian J Transplant [serial online] 2017 [cited 2020 Mar 28];11:127-32. Available from: http://www.ijtonline.in/text.asp?2017/11/3/127/221188
| Introduction|| |
Organ transplantation is a successful medical intervention available for end-stage organ failure. For the last couple of decades, it has assumed public health significance due to shortage of high-quality human organs. In conjunction with other needs, it is one of the drivers of medical, reproductive, and transplant tourism across the globe., Currently, organ donors are broadly classified into two types: donor after brain death and donor after cardiac death with removal of organs/tissue possible during both living and deceased state. Organ and tissue transplantation is expensive medical intervention, primarily driven by private sectors in the country, and young deaths due to road traffic accident or cardiovascular event provide a best option for high-quality organ yield.
No country in the world till date collects sufficient organs to meet the needs of its citizens. It is estimated that currently organ transplantation covers <10% of the global needs. Spain, Austria, Croatia, USA, Norway, Portugal, Belgium, and France stand out as countries with high rates of deceased organ donors.,, Spain has consistently recorded highest deceased organ donation (OD) rate of 33–35 donors per million population and many countries across the world have been following Spanish model for OD., Contrary to general perception, the long-term cost of renal transplantation is lower compared to hemodialysis or peritoneal dialysis. Even the quality of life and survival are reportedly better among renal transplant recipients.,
India needs at least 260,000 organs every year, i.e., 180,000 kidneys, 30,000 livers, and 50,000 hearts whereas only 6000 kidneys, 1200 livers, and 15 hearts are transplanted annually (National Organ Transplant Program). Unfortunately, India with a 1.2 billion population is lagging in OD with a national deceased donation rate of <1 per million population. Country has well-developed corneal donation and transplant program; however, even eye donation after death has been relatively slow to take off.,,, In the backdrop of annual requirement of 100,000 corneas, around 50,000 were collected during the past few years and yet 40% could be transplanted due to quality issues (personal communication).
The government has initiated specific sustained actions for the promotion of organ and tissue donation, but it has not been able to come to a stage of full realization. The myriad reason for this state of affair could be due to individual, community, and health system issues. With this background, a study was conducted to assess the knowledge, attitude, and practice (KAP) regarding organ/tissue donation and transplantation among adult visitors of a government hospital in Delhi, India.
| Materials and Methods|| |
A cross-sectional descriptive study was conducted among ambulatory, coherent, consenting adults (>18 years) visiting a mid-level municipal teaching hospital of Delhi using a predesigned, pretested, semistructured interview schedule during the period of February–March 2016 after obtaining clearance from the institutional ethics committee. A sample size of 400 was calculated assuming the prevalence of OD awareness at 50%, relative error of 10%, and 95% confidence interval (CI). However, we were able to mobilize and interview 450 respondents visiting the outpatient department (OPD).
Study respondents either a patient or accompanying attendant were contacted based on convenience by the researchers after obtaining informed verbal consent in hospital premises, galleries, patient waiting area, garden, cafeteria, and snack corner in a comfortable, nonjudgmental, and confidential manner. On completion of successful interaction, participants were thanked for their cooperation and all related doubts cleared followed by prompt additional help, if any, was extended.
The study instruments consisted of two sections: Part-I which is sociodemographic background and Part II which captured specific items related to knowledge, perception, attitude, practices, and willingness of organ/tissue donation. The responses of some of the questions were categorized into Likert-based scale of agree, neutral, and disagree.
There were no missing values and data were entered into a Microsoft Excel sheet and analyzed using SPSS software version 16 (IBM Inc, Armonk, New York, USA) by calculating proportion, Chi-square test, odds ratio (OR) to assess the association with covariates and considered significant at P < 0.05.
| Results|| |
Of 450 respondents, 271 (60.2%) were aged more than 31 years, 264 (58.7%) were males, 345 (76.7%) were married, 374 (83.1%) were Hindu, 304 (67.6%) had studied up to 10th class, 278 (61.8%) were working, 217 (48.2%) had 0–2 previous visit to this hospital, and 142 (31.6%) reported “ever” history of hospitalization. Sociodemographic profile of study respondents is shown in [Table 1].
Encouragingly, more than half of respondents, i.e., 261 (58.0%), showed willingness for their organ/tissue donation. Higher willingness was found in participants who were single/separated (P < 0.05) and those having higher level of education (P < 0.05). There was no statistically significant difference noticed with regard to age, gender, religion, working status, and previous visits to this institution or hospitalization toward willingness for OD.
Majority (337 of 450 respondents, i.e., 74.9%) had heard the term OD (ang daan). Details are shown in [Table 2]. However, on probing further, nearly 87.3% and 82.4% of respondents had ever heard of eye and kidney donation, respectively. Statistically (P < 0.001) higher odds for OD willingness was found among respondents who were aware of the term OD (unadjusted OR [UOR] =2.8, 95% CI: 1.82–4.39), eye donation (UOR = 3.2, 95% CI: 1.78–5.76), and kidney donation (UOR = 4.0, 9.5% CI: 2.40–6.84). However, none of these variables could reach statistical significance on higher level of analysis (adjusted OR [AOR]).
More than half (239, 53.1%) of the respondents were aware that organs could be removed from both living and dead person. Significantly (P < 0.001) higher proportion, i.e., 82.9% (373) of the respondents, were aware that organs cannot be removed from the body without authorized permission (AOR) = 2.6, 95% CI: 1.27–5.66). Opinion was divided but 45.1% believed that the rich in comparison to general population are more likely to get organ transplantation in case of need.
[Table 3] depicts the attitude and practices related to organ/tissue donation. Nearly, 120 (26.7%) respondents had donated their blood in the past, but this practice had no significant bearing on the willingness for OD (P = 0.61). Nearly half, i.e., 230 (51.1%) respondents, suggested that they would authorize removal of organs from the bodies of their family member if situation so arise.
Higher prevalence (184, 70.5%) of willingness for OD was noticed for those who wanted more information on the current topic (P = 0.007). However, only 119 (26.4%) respondents consented to sign a pledge card for OD and was also found to be significantly (AOR = 12.8, 95% CI: 5.02–32.75) associated for willingness. A high of 364 (80.9%) respondents had no myth or misconception that a person will be born with missing organ following donation. Yet, only 182 (40.4%) respondents were of the opinion that OD should be made mandatory after death.
| Discussion|| |
India witnessed its first successful corneal, kidney, and cardiac transplant in the year 1960, 1967, and 1994, respectively. Till date, many new developmental milestones have been achieved in the country; however, OD has been consistently lower than expectations. The Government of India promulgated Transplantation of Human Organ and Tissues Act in 1994, and with the view to enlarge its scope and promote cadaver OD, the government has brought new amendments as of year 2014 and 2017. In the backdrop of this journey, a cross-sectional descriptive study was conducted among 450 adult ambulatory visitors of a mid-level government hospital in Delhi (India) regarding KAP of organ/tissue donation. In spite of inherent limitation of the study setting and convenience sampling, a high level of awareness (74.9%–87.3%) but low level of positive attitude and practices was deduced from the present study along with strong association with sociodemographic variables.
Willingness for OD (58%) and awareness on eye donation (87.3%) in our study was found to be near similar with a study conducted in Mangalore, India (59.6% and 98.1%, respectively). In addition, awareness on existence of legislation related to OD and transplantation was also found to be similar (28.7% vs. 29.3%). On the contrary, 67% of respondents believed that there should not be any monetary incentive for the promotion of OD. Studies conducted in Puducherry (India) reported high willingness for OD, i.e., 69.75% (2013) and 70.3% (2016)., A study conducted among 193 patients attending OPD of a tertiary center at Bengaluru (Karnataka) reported 93.8% awareness, 76.2% supported OD, 62.2% of respondents were willing to donate organs after death, 52.3% agreed that religious people do not oppose OD yet, only 5.7% had heard about OD law, and nearly 40.1% were willing to sign an OD card. This as well as many other studies confirmed that only level of education was of statistical significant predictor for OD willingness.
A recent study conducted in a large private hospital  of Delhi (India) reported high awareness on kidney (94.1%), eye donation (79%), and legislation (50.4%) along with 31.1% showing willingness for OD but 56.3% were consenting to sign a pledge card. While another decade old, a study conducted in Delhi showed 61.59% willingness for ODs. This is suggestive of stagnation or status quo in society even after a gap of more than 10 years.
On comparison with selected other countries, OD awareness in Pakistan was 60%, Kuwait (68.3%), South Africa (89%), Brazil (89%), and Saudi Arabia (98%).,,,,, A Canadian household telephonic survey highlighted that OD awareness and willingness was universal and 54% had actually registered or signed a pledge card but here also opinion was divided toward the rich who are more likely to receive an organ. However, a lower proportion (30.0%) of willingness was also reported from another developing country like Nigeria.
OD is a highly sensitive personal choice and arises only under pivotal circumstances of medical need, poverty/financial exploitation, or spiritual charity. All over the world, governments put forward variety of policy approaches or strategies to improve OD, i.e., informed consent (opt-in) or presumed consent (opt-out). In countries with informed consent or “opt-in” legislation, such as the UK, Germany, and Sweden, an individual or his/her family must give explicit permission for organ removal. Presumed consent countries such as Spain, Portugal, and Austria assume universal consent without explicit registration otherwise. In India, we follow opt-in system where donor/legal guardian gives consent at the time of OD.
Presumed consent policy means that individuals who have not opted out of OD will automatically donate their organs upon time of death depending on suitability of clinical condition. A research finding indicates that individuals are more likely to donate their organs than to consent for donation of a relative's organs. Both decisions are affected by regulation (presumed consent), awareness of regulation, and social interactions. Furthermore, education (more educated) and age (younger), expressing some sort of political affiliation, determine willingness to donate one's own organs and consent to the donation of those of a relative. Various studies have indicated that policy of presumed consent increases OD worldwide.,
The government at central/state level, nongovernmental organizations, and media have been undertaking awareness-generation activities and highlighting successful cases of OD and transplant since the last couple of years that has probably increased general awareness in the society. However, on the contrary, this heightened awareness is not translating into increased organ/tissue donation either because of bureaucratic procedures, lack of system preparedness, and poor specific communication by health staff to harness organs/tissue at critical phase of life.
| Conclusion|| |
This study not only reiterates high awareness of organ/tissue donation among sampled respondents visiting a mid-level government hospital in the metropolitan city but also reflects low level of positive attitude and practices.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Jose R, Sachdeva S. Keeping an eye on future: Medical tourism. Indian J Community Med 2010;35:376-8.
] [Full text]
Shroff S. Legal and ethical aspects of organ donation and transplantation. Indian J Urol 2009;25:348-55.
] [Full text]
Rudge C, Matesanz R, Delmonico FL, Chapman J. International practices of organ donation. Br J Anaesth 2012;108 Suppl 1:i48-55.
Garcia-Garcia G, Harden P, Chapman J. The global role of kidney transplantation. Indian J Nephrol 2012;22:77-82. [Full text]
Matesanz R, Domínguez-Gil B, Coll E, de la Rosa G, Marazuela R. Spanish experience as a leading country: What kind of measures were taken? Transpl Int 2011;24:333-43.
Matesanz R. Factors influencing the adaptation of the Spanish Model of organ donation. Transpl Int 2003;16:736-41.
Abraham G, Jayaseelan T, Matthew M, Padma P, Saravanan AK, Lesley N, et al.
Resource settings have a major influence on the outcome of maintenance hemodialysis patients in South India. Hemodial Int 2010;14:211-7.
Jensen CE, Sørensen P, Petersen KD. In Denmark kidney transplantation is more cost-effective than dialysis. Dan Med J 2014;61:A4796.
Abraham G, Reddy YN, Amalorpavanathan J, Daniel D, Roy-Chaudhury P, Shroff S, et al.
How deceased donor transplantation is impacting a decline in commercial transplantation-the Tamil Nadu experience. Transplantation 2012;93:757-60.
Jose R, Sachdeva S. Eye banking in India. J Postgrad Med Educ Train Res 2008;3:14-7.
Jose R, Rathore AS, Sachdeva S. Community ophthalmology: Revisited. Indian J Community Med 2010;35:356-8.
] [Full text]
Jose R, Sachdeva S. School eye screening and the national program for control of blindness. Indian Pediatr 2009;46:205-8.
Jose R, Rathore AS, Rajshekar V, Sachdeva S. Salient features of the National Program for Control of Blindness during the XI th
five-year plan period. Indian J Ophthalmol 2009;57:339-40.
] [Full text]
Sulania A, Sachdeva S, Jha D, Kaur G, Sachdeva R. Organ donation and transplantation: An updated overview. MAMC J Med Sci 2016;2:18-27. [Full text]
Mithra P, Ravindra P, Unnikrishnan B, Rekha T, Kanchan T, Kumar N, et al.
Perceptions and attitudes towards organ donation among people seeking healthcare in tertiary care centers of coastal South India. Indian J Palliat Care 2013;19:83-7.
] [Full text]
Little Flower JR, Balamurugan E. A study on public intention to donate organ: Perceived barriers and facilitators. BJMP 2013;6:a636.
Balajee KL, Ramachandran N, Subitha L. Awareness and attitudes toward organ donation in rural Puducherry, India. Ann Med Health Sci Res 2016;6:286-90.
] [Full text]
Vijayalakshmi P, Sunitha TS, Gandhi S, Thimmaiah R, Math SB. Knowledge, attitude and behaviour of the general population towards organ donation: An Indian perspective. Natl Med J India 2016;29:257-61.
] [Full text]
Kaistha M, Kaistha S, Mahajan A. A study of factors influencing decisions on organ donation among patient attendees in a Tertiary Care Hospital in North India. CHRISMED J Health Res 2016;3:101-5. [Full text]
Mishra PH, Aarti V, Sarma RK. Knowledge, attitude and practice study of organ donation and its problems in the metropolitan city of Delhi. Acad Hosp Adm 2004;16:11. Available from: http://www.indmedica.com/journals.php
. [Last accessed on 2015 Dec 16].
Saleem T, Ishaque S, Habib N, Hussain SS, Jawed A, Khan AA, et al.
Knowledge, attitudes and practices survey on organ donation among a selected adult population of Pakistan. BMC Med Ethics 2009;10:5.
Bosakhar BY, Al-Mesailekh ZA, Al-Farhan SA, Arab DA, Al-Tawheid NA, Al-Ali NF, et al
. Predictors of knowledge and attitude regarding organ donation in Kuwait. IMC J Med Sci 2016;10:1-9.
Etheredge HR, Turner RE, Kahn D. Public attitudes to organ donation among a sample of urban-dwelling South African adults: A 2012 study. Clin Transplant 2013;27:684-92.
Sasso-Mendes KD, Curvo PA, Silveira RC, Galvão CM. Organ donation: Acceptance and refusal among users of the public health system from Brazil. Transplant Proc 2008;40:660-2.
Agrawal S, Binsaleem S, Al-Homrani M, Al-Juhayim A, Al-Harbi A. Knowledge and attitude towards organ donation among adult population in Al-Kharj, Saudi Arabia. Saudi J Kidney Dis Transpl 2017;28:81-9.
] [Full text]
Odusanya OO, Ladipo CO. Organ donation: Knowledge, attitudes, and practice in Lagos, Nigeria. Artif Organs 2006;30:626-9.
Mossialos E, Costa-Font J, Rudisill C. Does organ donation legislation affect individuals' willingness to donate their own or their relative's organs? Evidence from European Union survey data. BMC Health Serv Res 2008;8:48.
Shepherd L, O'Carroll RE, Ferguson E. An international comparison of deceased and living organ donation/transplant rates in opt-in and opt-out systems: A panel study. BMC Med 2014;12:131.
Gimbel RW, Strosberg MA, Lehrman SE, Gefenas E, Taft F. Presumed consent and other predictors of cadaveric organ donation in Europe. Prog Transplant 2003;13:17-23.
[Table 1], [Table 2], [Table 3]