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ORIGINAL ARTICLE
Year : 2017  |  Volume : 11  |  Issue : 3  |  Page : 133-137

A study on knowledge and attitude about organ donation among medical students in Kerala


1 Consultant, National Health Mission, Chennai, Tamil Nadu, India
2 Centre for Hospital Management, School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, Maharashtra, India
3 Department of Psychiatry, Center for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

Date of Web Publication20-Dec-2017

Correspondence Address:
Dr. G S Adithyan
National Health Mission, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijot.ijot_49_17

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  Abstract 


Background: The knowledge and attitude of medical students regarding organ donation is quintessential for the success of the organ donation program in a country. Objective: This study aimed to assess the knowledge and attitude of medical students regarding organ donation at Government Medical College, Trivandrum, Kerala, India. Methodology: Data of this cross-sectional study were collected by self-administered questionnaire from 194 final-year MBBS students during 2016, who were selected by convenient sampling. The questionnaire had three sections to gather information of sociodemographic details of the students, knowledge on organ donation, and the attitude toward organ donation. Results: The findings showed that a majority of the students had adequate knowledge regarding organ donation, but it is not translated into their willingness for donation – both cadaveric and live. Conclusion: The study reiterates the need for educational interventions for medical students which cut across various disciplines to make them understand the nuances of the issue in a holistic way.

Keywords: Attitude, knowledge, medical students, organ donation


How to cite this article:
Adithyan G S, Mariappan M, Nayana K B. A study on knowledge and attitude about organ donation among medical students in Kerala. Indian J Transplant 2017;11:133-7

How to cite this URL:
Adithyan G S, Mariappan M, Nayana K B. A study on knowledge and attitude about organ donation among medical students in Kerala. Indian J Transplant [serial online] 2017 [cited 2019 May 23];11:133-7. Available from: http://www.ijtonline.in/text.asp?2017/11/3/133/221196




  Introduction Top


Organ donation is yet to gain momentum in India. The knowledge and attitude of a society toward organ transplantation is far from satisfactory even among the educated sections of the society. The major concerns causing organ shortage in the country are lack of awareness and correct knowledge among public, myths and misconception clouding organ donation due to religious and cultural barriers, etc.[1] Hence, imparting correct knowledge and awareness about the issue to the public is quintessential for the success of organ donation program in India. The health professionals, especially medical doctors, do have a key role in imparting correct knowledge and eliminating the barriers regarding organ donation among the public since they are the first individuals to create a relationship with a potential donor's family.[2] However, the ground reality in India is that the identification of brain death and requesting consent from the next to the kin is often given less priority by the doctors and hospital staffs. This change in attitude is partially because of the over work they have and more due to the lack of proper knowledge and attitude toward this issue.[3]

Initially, it was thought that sociocultural and religious issues and lack of knowledge on the issue are the major determinants that restrict organ donation. At present, it is apparent that there are many other factors such as lack of institutional mechanisms, organizational support, and legal and ethical issues.[3],[4] The medical students and doctors with correct vision and knowledge regarding the recent developments in the domain of organ donation can be the champions in this cause and can establish a robust organ donation program in the country by hand-holding other stake holders.

Medical professionals' knowledge, attitudes, and practices are vital in promoting an atmosphere that positively impacts organ donation and procurement rate.[5],[6] Therefore, it is necessary to understand and assess the knowledge, attitude, and practice about organ donation among the future doctors – the medical students – for the imminent success of the organ donation programs. However, there are very few studies conducted among medical students in India, especially in Kerala, in this regard. In most of the studies conducted among medical students in India, it was found that there exist gaps in the level of knowledge and their attitude toward organ donation.[1],[7]

Organ donation is steadily catching up in the Indian states such as Tamil Nadu, Telangana, Andhra Pradesh, and Kerala. On the lines of Tamil Nadu Government, Kerala also launched its cadaveric organ donation program, the Kerala Network for Organ Sharing (KNOS) – popularly called as Mritasanjeevani, a Kerala Government initiative established on August 12, 2012, for Kerala's Deceased Donor Organ Transplantation Program. Under the program, Kerala has achieved a lot in improving its cadaveric organ donation rate through years.

The objective of the study is to assess the knowledge and attitude of medical students in Kerala regarding organ donation.


  Methodology Top


The research was conducted among the medical students who were studying in the final years (third and fourth) of their graduation at Government Medical College (GMC), Trivandrum, Kerala, during 2016. The study was a cross-sectional study conducted using quantitative methods among 194 medical students who gave informed consent. GMC, Trivandrum, is the first medical college in the state, one of the best medical colleges in the country, and is also one among the thirty hospitals in Kerala which is authorized to conduct organ transplantation. The state government's organ donation initiative – the Mritasanjeevani Project – is also head quartered at GMC, Trivandrum. The unit of analysis and universe of the study was selected by convenience sampling. GMC, Trivandrum, was selected on the basis of accessibility, time constraints, and sanction of permission from the authorities.

Data collection was done using a structured questionnaire. The questionnaire was divided into three sections. The first section was to understand the general information of the respondents including sociodemographic profile and the basic understanding of the respondents toward organ donation. The second section was to understand the knowledge of the respondents toward organ donation. There were ten questions in the questionnaire to assess the knowledge of the respondents regarding organ donation. Two statements (1 and 9) were positively worded and the rest eight statements were negatively worded in the questionnaire. Three options – “Yes,” “No,” and “don't know” – were provided under each question for the respondents to answer. Most of the statements to assess knowledge among respondents were adopted from the research done by Morgan and Miller (2002).[8] They used nine statements in their research.

A self-constructed cumulative knowledge score was prepared by the authors by adding the number of correct answers (1 point per correct reply and 0 point for incorrect or don't know). The mean of the sample came to be 6.88, with standard deviation of 1.58. The median of the data set came to be 7. Respondents were then classified into two categories based on this. The students who have scored a summative knowledge score 7 or more were identified to have above-average knowledge level and students having summative knowledge score <7 were identified to have below-average knowledge level.

The third section was to assess the attitudes with regard to the participant willingness for cadaveric and live donation, reason for willingness and unwillingness, communication of intention to family, and preferences and possession of organ donor card. The section also assessed whether the concept of organ donation was adequately covered in the medical curriculum as per the opinion of the respondents.

Data were entered and analyzed on IBM SPSS Statistics for Windows, Version 20.0. (Armonk, NY: IBM Corp.). Chi-square test was applied, and P < 0.05 was considered statistically significant.


  Results Top


Sociodemographics

[Table 1] indicates the distribution of gender, age, religion, and marital status of the respondents.
Table 1: Sociodemographic details (n=194)

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Knowledge

All the respondents in the study have heard about organ donation and it was found that electronic media was the major source of information regarding the same for most respondents. It was also found that an overwhelming majority of 172 (88.7%) respondents have heard of the Mritasanjeevani Project, which is the Kerala state government's initiative for promoting organ donation.

The data reveal that more than half of the respondents were giving correct answers in every question except for one question [Table 2]. In the question stating, economically disadvantaged people are having lesser chance than the richer people in getting organ transplantation, considering equal needs, 144 (74.2%) respondents believed that the richer people were privileged to get an organ transplantation easily than a poorer fellow, superseding the wait list of recipients for organ donation in India.
Table 2: Knowledge regarding organ donation

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In the cumulative knowledge-level analysis, 37% of the respondents came in the “below-average knowledge level” category and the rest 73% of them in the “above-average knowledge level” category.

The cross-tabulation between knowledge level and gender showed that there is statistically significant association between these variables with P = 0.013 (P < 0.05) [Table 3].
Table 3: Cross tabulation between knowledge level and gender

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Attitude toward organ donation

The willingness of the medical students toward cadaveric organ donation as indicated in [Table 4] revealed that about 44% of the sample has strong willingness toward cadaveric donation.
Table 4: Willingness for cadaveric donation

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Among those with strong willingness for cadaveric donation (n = 86), a majority (96.5%) reported the reason for the same as to save a life. In addition, among those with strong willingness, only 43.1% of the sample reported that they had discussed their wish to donate after death to their families. Two respondents indicated their strong unwillingness to cadaveric donation and gave the reason that their religious beliefs are against organ donation.

The respondents' willingness for live kidney donation to a known recipient which included family members, friends, and relatives showed that 36.6% of them had strong willingness and 49.5% of them told that they will think about donating when a need arises. The rest were the undecided category and two samples told about their strong unwillingness.

However, when it comes to live donation for an unknown recipient, only 4.1% of sample showed strong willingness. Nearly 38.1% of the sample reported of donating under special circumstances whereas 28.4% of them were ready to think about it when a need arises and 19.6% were the undecided category. The rest 9.8% sample reported strong unwillingness toward live donation to an unknown recipient, suggesting reasons of threat to own life and fear.

Preference for organ donation

The preference for organ donation with respect to relationship status, age group, and religion as reported by the respondents is summarized in [Table 5].
Table 5: Preferences for organ donation (n=193)

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Revision of medical curriculum

A majority (91.2%) of the students felt the need for revision of medical curriculum on organ donation. It was also reported that only 29.9% of the students have motivated or encouraged others for donating organs. Among those who gave motivation, none of them motivated their patients toward organ donation.

Donor card

A majority (92.8%) of the respondents did not have a donor card at the time of the study while the rest (7.2%) possessed a donor card. It was also reported by the respondents that none of them have ever done the act of organ donation.


  Discussion Top


The aim of the study was to assess the knowledge level and attitude of medical students toward organ donation. The study found that electronic media was the prime source of information to them regarding organ donation. This shows the role of media in propagating the concept of organ donation. The study by Agarwal (2015) on medical students also came up with similar findings.[7]

The cumulative knowledge among the respondents appeared to be satisfactory (73% respondents belonged to the “above-average knowledge level” category). However, the majority (74.2%) of medical students believed that, given equal needs, the richer people were privileged to get an organ transplant easily than a poorer fellow. Also in the question which stated that caste discrimination prevents minority patients in receiving organs, 22.7% of them stated in supporting the statement and 23.7% of them marked the “don't know” option.

The National Organ and Tissue Transplant Organization (NOTTO) which was made to streamline all the organ procurement and distribution activities in the country clearly laid that the factors such as caste, gender, age, income, and celebrity status are never considered when determining organ recipients. The organ allocation system is blind to those determinants. As per the protocol, when a transplant hospital adds an individual to the waiting list, it is placed in a pool of names. When any deceased organ donor becomes available, all the patients in the pool are compared to that donor. Factors such as medical urgency, time spent on the waiting list, organ size, blood type, and genetic makeup are considered. The organs would be distributed locally within the state first, and if no match is found, they are then offered regionally, and then nationally, until a recipient is found.[9] Even though the protocols are there as per the NOTTO, the Transplantation of Human Organs Act (THOA) did not elaborate clearly on how the donated organs should be distributed equitably and also the current allocation policies for deceased donors differ from state to state and only few states have a state-level organ registry to streamline the activities.[3],[10] The medical students having less knowledge regarding these developments happening in the organ transplantation scenario in the country is a sad state of affair.

The need for revision of medical curriculum to incorporate more portions on organ donation was also echoed by a clear majority of students. Many other researchers also echoed the same concern and pressed the importance of introducing the subject of organ donation at an early stage in the medical curriculum.[7],[11] An intervention study in Germany showed that there is substantial change in the attitude of students toward organ donation after a lecture on organ donation.[12] A similar study in the United States also stated that students with some training of organ donation prior to or during the medical school were more knowledgeable and comfortable with obtaining information and answering patients' donation questions.[13] Since organ donation in India cuts across various disciplines, it should be taught in a holistic way and not just as a medical topic alone to the students. The positive finding in knowledge analysis is that more female folks were having “above-average” knowledge level compared to males and there is a statistically significant association between those variables.

There exists a gap between knowledge regarding organ donation and willingness to donate among medical students. The study shows that the willingness among medical students for cadaveric donation is greater than that of live donation. Among willingness for live donation, the willingness to donate to a known recipient is higher compared to an unknown one. The study conducted among medical students in Pakistan yielded almost similar results with regards to willingness to donate after death.[14] But, the willingness to donate was lower compared to similar studies conducted among medical students in United States,[13] Turkey,[15] Brazil,[16] and France.[5] The other important aspect is that among those medical students who showed strong willingness to donate their organs after death, more than half of them hasn't communicated their desire to donate with the family members and only 14 possessed a donor card. The role of effective communication to family members as a strong determinant for cadaveric organ donation was highlighted by many researchers.[8],[17] Even though most of the students showed preference for donation to same family member and to younger people, none of the participants said any religious preferences in organ donation.


  Conclusion Top


A consistent cadaveric organ donation program is the only viable solution which can bridge the gap of organ shortage in India. The medical students have a distinct role in it being the future torch bearers. In the current study, even though less students showed strong willingness to donate after death, the majority told about thinking it in the future and were in the undecided category. By giving right knowledge and orientation to them by giving more importance of the topic of organ donation in the medical curriculum as well as through continuous medical education, they can be pooled into the category of future organ donors who can then easily motivate their potential patients to follow the path. The educational interventions should cut across all the disciplines since organ donation in India is not just a medical issue.

Acknowledgement

The authors are grateful to Dr. Arun B.S from Government Medical College, Trivandrum who helped immensely during the data collection phase of the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Sucharitha ST, Siriki R, Dugyala RR, Mullai, Priyadarshini, Kaavya, et al. Organ donation: Awareness, attitudes and beliefs among undergraduate medical students in South India. Natl J Res Community Med 2013;2:79-148.  Back to cited text no. 1
    
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Agarwal S. Are medical students having enough knowledge about organ donation. IOSR J Dent Med Sci 2015;4:29-34.  Back to cited text no. 7
    
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National Organ and Tissue Transplant Organization (NOTTO); C2013. Available from: http://www.notto.nic.in/faqs.htm. [Last accessed on 2016 Aug 16].  Back to cited text no. 9
    
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Government of India. Ministry of Law, Justice and Company Affairs (Legislative Department). Transplantation of Human Organs (Amendment) Rules; 2014. Available from: http://www.notto.nic.in/WriteReadData/Portal/images/THOA-Rules-2014.pdf. [Last accessed on 2016 May 15].  Back to cited text no. 10
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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