|Year : 2018 | Volume
| Issue : 2 | Page : 113-118
Knowledge, attitude, and practice of organ donation among pharmacy students
Prasanna R Deshpande1, Preeti Damle2, Gopal Bihani3, Somshekhar S Khadabadi4, Anantha N Naik5, Atmaram P Pawar6
1 Department of Clinical Pharmacy, Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Pune, India
2 Samavedana (NGO), Pune, India
3 Department of Pharmacology, Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Pune, India
4 Department of Pharmacognosy, Government College of Pharmacy, Amravati, Maharashtra, India
5 Amity Institute of Pharmacy, Amity University of Madhya Pradesh, Gwalior, Madhya Pradesh, India
6 Department of Pharmaceutics, Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Pune, India
|Date of Web Publication||29-Jun-2018|
Dr. Prasanna R Deshpande
Department of Clinical Pharmacy, Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
Objective: To assess knowledge, attitude, and practice (KAP) of organ donation (OD) among pharmacy students. Methodology: A web-based, cross-sectional study of students pursuing different pharmacy courses was conducted. A specially designed questionnaire was used to survey the students. Results: A total of 160 students responded to survey. Nearly, three-fourth students wished to donate organs to anyone, 83.1% wanted to donate by considering the health status of the recipient, and 98.1% feel that OD should be promoted. Some negative findings were as follows: less knowledge about some uncommon organs that can be donated, for example, blood vessels, bone, intestine, and heart valves; 76.3% students do not know the process of registering while 84.4% have not registered/pledged for OD. Average knowledge about law related to OD was also poor, i.e., 1.87. Conclusion: Overall KAP for OD was positive for except for a few issues. There is need to add some OD related topic/s in the pharmacy curriculum.
Keywords: India, organ donation, pharmacy, students
|How to cite this article:|
Deshpande PR, Damle P, Bihani G, Khadabadi SS, Naik AN, Pawar AP. Knowledge, attitude, and practice of organ donation among pharmacy students. Indian J Transplant 2018;12:113-8
|How to cite this URL:|
Deshpande PR, Damle P, Bihani G, Khadabadi SS, Naik AN, Pawar AP. Knowledge, attitude, and practice of organ donation among pharmacy students. Indian J Transplant [serial online] 2018 [cited 2019 Mar 20];12:113-8. Available from: http://www.ijtonline.in/text.asp?2018/12/2/113/235586
| Introduction|| |
Organ donation (OD) is nothing but surgical removal of an organ/tissue from one person (organ donor) and placing it into another person (organ recipient). OD may help a person, especially with end stage organ disease. Many factors such as medical, legal, societal, ethical, and organizational are involved behind willingness of a donor to donate the organ/s.
Although India is one of the highly populated countries in the world, it is facing acute shortage of the organ donors. In India, only 2%–3% of the demands for new organs are met. According to global observatory on donation and transplantation data of 2015, total organ transplants in India were 7715 while its rate per million population was 5.88 which is far less than the Western countries.
In literature, different students have been surveyed for determination of knowledge, attitude, and practices (KAP) about OD such as medical, dental, nursing, physiotherapy, engineering, commerce, and high school . However, we could not find a study surveying “pharmacy” students' KAP about OD. Since pharmacy students are a part of healthcare team, they can influence the willingness of the public to donate organs. Moreover, pharmacy students have very less exposure to OD in their syllabi. Hence, it is important and interesting to know KAP of OD among pharmacy students. Therefore, we aimed for the same.
To determine KAP of pharmacy students about OD.
| Methodology|| |
First, we obtained the approval from institutional review board for conducting the study.
This was a web-based, prospective, cross-sectional study involving multiple pharmacy institutes in India.
Designing survey questionnaire
The survey questionnaire was designed by using 2 methods: literature review and student interviews. We referred various student surveys (as mentioned before) about OD. We also conducted 5–10 min exploratory interview of 6 pharmacy students to determine the possible domains in the questionnaire.
Validation of the questionnaire
After making the draft questionnaire, it was reviewed by 4 experts for content, flow, language, grammar, and options. The questionnaire was further tested on 13 students on pilot basis. The respondents in pilot study were asked to check easiness in responding, range of options, and feasibility. The answers obtained in pilot study were not included in main results. The 24-item questionnaire was finalized for collecting the data.
Sending the questionnaire
The survey questionnaire was sent to the students in different institutes. We sent the survey form through following means: our contacts (primary, secondary, and tertiary), Facebook groups, Whatsapp groups, and pharmacy student networks. We also solicited the students to send the survey form to their “pharmacy” friends. Mixture of convenience and snowball sampling was used. Informed consents were obtained from the responders.
The data obtained after survey was entered in MS Excel sheet and was assessed. Raosoft calculator  was used to determine margin of error of the study. Chi-square test was used to determine the association of the responses with gender, course, marital status, and age. Values P < 0.05 were accepted as statistically significant. An online Chi-square calculator  was used.
Methodology used to calculate average values for age and awareness of the law regarding organ donation
For calculating the average age, we determined the median of the range of the age. Then, we multiplied the median by number of responses to get the total responses a particular age range. Afterward, we summed the total age for each range and divided the sum value by total number of respondents, i.e., 160. For example, for age group 17–20 years, the number of responses was 78. The median for 17 and 20 was 18.5. Hence, multiplication of median and number of responses will be 78 × 18.5 = 1443. Likewise, the total values were calculated for all age ranges, and the total was divided by total number of responses (160). The similar methodology has been used in some other research articles for determining the average values of ranges.,,
For calculating average level of awareness of the law regarding OD, we considered the level of awareness and multiplied it by number of responses since no “ranges” or “medians” were there. The rest procedure was same as for calculating average age value as mentioned previously in the text.
| Results|| |
The survey was mainly conducted in 6 counted course-wise (1 offering D. Pharm, 1 offering B. Pharm, 1 offering M. Pharm and 3 offering PharmD). Total 160 pharmacy students responded to the survey. According to Raosoft calculator, margin of error of the study was 7.72% with 95% confidence level and 50% response distribution.
Number of males and females responded the survey were 39 (24.4%) and 121 (75.6%), respectively. In our survey, D. Pharm (n = 17, 10.6%), B. Pharm (n = 42, 26.3%), PharmD (n = 67, 41.9%), PharmD (postbaccalaureate) (n = 16, 10%), M. Pharm/M. S.(Pharm)/M. Tech (Pharm)/MBA (Pharm) (n = 12, 7.5%), and PhD (n = 6, 3.7) students were involved. Out of the total respondents, 153 (95.6%) were unmarried while 7 (4.4%) were married. The number of responses and their percentages by age groups were as follows: 17–20 years (n = 78, 48.8%), 21–25 years (n = 75, 46.9%), 26–30 years (n = 3, 1.9%), 31–35 years (n = 1, 0.6%), 36–40 years (n = 2, 1.2%), and 41–50 years (n = 1, 0.6%). Other outcomes of the survey were as mentioned in [Table 1]. Since the question “what are the organs that can be donated?” was a checkbox question, we received more than 160 responses for the question.
|Table 1: Knowledge, attitude, and practices of pharmacy students about organ donation|
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We calculated average values for age and level of awareness about the law related to OD. The average age was 21.29 years while the average level of awareness about the law was 1.87 [Table 2].
|Table 2: Average responses for age and awareness level about law related to organ donation|
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P values for association between responses and the factors such as gender, marital status, age, and course (by Chi square test) were as shown in [Table 3]. Significant association was found between question number 3 and gender, question number 8 and 13 and gender; question number 12 and 19 and age; question number 17 and course and marital status [Table 3].
| Discussion|| |
Like other health-care professionals, pharmacists too, are the part of the health workforce in India but pharmacy students' KAP about OD have not been studied in the literature so far. To the best of our knowledge, this was the first documented survey determining KAP about OD of “pharmacy” students in India. We compared our results with other student surveys in India.
Brain-dead patients cannot come back to normal. They are clinically and legally dead. While, most deceased organ donors are brain dead. According to Ilango et al.'s study, 63.4% of medical, 66.5% of dental, and 57.3% of nursing students had correct knowledge about different aspects of brain death. Nearly, half of the nursing students knew the meaning of brain death in Poreddi et al.'s study. Whereas Wig et al. reported that 55% of the highschool children were aware that brain death is legal in India. Bapat et al. have also reported that 93% of the postgraduate medical students do not think persistent vegetative existence and brain death are the same and 23% of the students believe that cadavers are brain dead. In our survey, we too had asked few questions about brain death to know the knowledge level of the students. However, 38.1% (n = 61) students reported “Brain dead person can get back to normal” to be a fact; 41.3% (n = 66) reported “Most deceased organ donors are brain dead” to be a myth. Similarly, 28.1% (n = 45) and 63.1% (101) have reported that “Brain-dead patients” are “clinically” and “legally” dead, respectively.
Many students in different surveys showed interest to donate their organs to “anybody,” and the percentage in the studies were as follows: Mane et al. 78.4% and Ramadurg et al. 61.4%. This percentage was comparatively less in Patthi et al. study, i.e., 44.7%. In Poreddi et al.'s study, 76.8% students were interested to donate their organs to any person from other race. In our study, the percentage to donate organs to “anyone” was 75.6%.
Organs can be donated both during and after life. However, according to Shah et al.'s study, 26.5% commerce students were aware about this while the percentage reported by our study was higher, i.e., 53.1%.
In reality, many organs may be donated by human being which include kidney, eyes, heart, lungs, skin, bone marrow, liver, pancreas, intestine, heart valves, bone, and blood vessels. Mane et al., Naveen et al., and Wig et al. have reported adequate knowledge of students about the organs that can be donated for kidney, heart, eyes, and liver. Organs receiving less hits in those studies involved skin, pancreas, lung, and bone marrow. We found similar trend of responses in our study. Knowledge about organs that can be donated was comparatively higher for kidneys, eyes, heart, liver bone marrow than blood vessels, intestine, heart valves, bones, pancreas, lungs, and skin.
The “Transplantation of Human Organs Act” was passed in 1994 in India. However, many studies have reported poor awareness of students about the national and/or international law such as Kaur et al. (16.5%), Patthi et al. (23.2%), Poreddi et al. (6%), Ramadurg et al. (15.7%), and Shah et al. (43.5%). In the same way, only one-fourth students in our survey stated to have appropriate knowledge about the law regarding OD. Average level of awareness of the law related to OD was poor as well, i.e., 1.87 [Table 2].
OD should be supported and promoted throughout the world. Majority of the students in many studies are willing to donate their organs, for example, Bapat et al. (89%), Kaur et al. (85%), Mane et al. (88.6%), and Poreddi et al. (82.4%). Aligning to this, the present study also reports the percentage to be 86.3%. More than 87% of the respondents support OD in studies such as Ilango et al., Kaur et al., Poreddi et al., and Sucharita et al.; in similar fashion, 98.1% students in our survey proclaimed that OD should be promoted.
Most of the students (>88%) had not registered their organs for donation in Ilango et al.'s study. In like manner, 84.4% students in our survey haven't pledged/registered their organs for donation. Further to add 76.3% students were unaware about the process to register for OD.
Effective communication about OD in families is one of the important factors converting a potential donor to a real donor. A donor with constructive approach and appropriate awareness toward OD may efficiently discuss and convince the family members. Therefore, we asked a question “Do you discuss about OD with your family members?” to the students to which 46.9% (n = 75) students have responded positively. Identically, as per Poreddi et al.'s study, 45.3% students have discussed about OD with their family members.
As per Gauher et al.'s study, Indian students are hesitant to donate organs because of many factors. Moreover, reasons for refusal for OD have been discussed in diverse studies as one's body will be disfigured, misused/abused, fear of organ trading, religion not allowing, and feel risk in donating.,,,,,,,,, The current study declares the restrictions as health problem/s (35%), don't feel body cut up or disfigured (3.8%), too young/old to donate (28.8%), and fear of organ trading (27.5%).
Health status of the recipient was the highest reported factor (83.1%) impacting the decision of the donation. Relation to the recipient and his age have shown varied responses in studies such as Kaur et al. (31.5% and 36%, respectively), Naveen et al. (9.1% and 18.8%), and Ramadurg et al. (12.9% and 8.6%, respectively) as compared to our study (3.8% and 8.8%, respectively). Like our study (0.6%), religion was one of the least significant factors affecting decision to donate organs in studies such as Kaur et al. (6%), Naveen et al.(1.5%), and Ramadurg et al. (2.9%).
Naveen et al. (91.60%) and Ramadurg et al. (87.1%) have proclaimed “to save someone's life” as the topmost motive behind OD while the topmost motives in the present study were “to help somebody/out of sympathy” (45.6%) and “to contribute to science and society” (51.3%).
It was observed that internet/websites have rarely been solicited as a source of information to update knowledge about OD. However, since current era in India is of internet, we asked the question as “Have you ever visited any website related to OD?” For this, 26.9% students responded positively. However the percentage was much less than Alex et al. (53%) and Shah et al. (66%) studies while it was higher than Mane et al.'s study  (3.4%).
We used limited sample size for conducting the research. We could not approach every pharmacy student in the nation so the survey results are not the national figures. We could not determine the response rate for the study. Although we calculated the average values for age and level of awareness about the law regarding OD, it was not a standard methodology for average value calculation. Like many other student surveys, our samples were also overestimated by females. We did not ask few more demographic details such as family income, family type (nuclear/joint), and religion of the responder.
| Conclusion|| |
To the best of our knowledge, this was the first documented study for evaluating KAP of “pharmacy” students about organ transplantation in India. Overall KAP of the students was quite positive toward OD. However, at the same time, the students' KAP was deficit in areas such as knowledge of brain death and the organs that can be donated; registering himself for OD. This study emphasizes the requirement for incorporating a topic about OD into the pharmacy curriculum. Further research is definitely needed to explore other aspects of the students about the process.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]