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ORIGINAL ARTICLE
Year : 2021  |  Volume : 15  |  Issue : 1  |  Page : 56-61

Perceptions and attitude toward cadaveric organ donation among health-care professionals at a tertiary health-care setting: A cross-sectional study


1 3rd Year MBBS Student, Goa Medical College, Bambolim, Tiswadi, Goa, India
2 Department of Preventive and Social Medicine, Goa Medical College, Bambolim, Tiswadi, Goa, India

Date of Submission30-May-2020
Date of Acceptance04-Oct-2020
Date of Web Publication31-Mar-2021

Correspondence Address:
Dr. Delia Basil Dsouza
Department of Preventive and Social Medicine, Goa Medical College, Bambolim, Tiswadi, Goa
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijot.ijot_50_20

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  Abstract 


Introduction: Organ donation provides a life-saving opportunity for those individuals with organ failure who have no other options. The knowledge, attitude, and practices of medical professionals play a vital role in promoting the positive impact of organ donation. Therefore, it is necessary to understand and assess the knowledge and attitude about cadaveric organ donation among the medical health professionals. Objectives: To assess the knowledge, attitude, and practices of health-care professionals toward cadaveric organ donation and to know their awareness regarding legislations pertaining to cadaveric organ donation. Materials and Methods: A self-administered questionnaire was filled out by consenting consultants, resident doctors, and nurses working at a tertiary health-care setting, to evaluate their knowledge, attitude, and practices regarding cadaveric organ donation. Data were analyzed and summarized as frequencies and proportions. Results: Majority (74%) of the participants were females and most (67.8%) of them below 40 years of age. Hindus comprised 55.2% and Christians 41% of the study population. All consultants, 99.1% of resident doctors and 83.1% of nurses were familiar with the concept of cadaveric organ donation. Although willingness to donate organs was expressed by a majority of the health-care professionals, only a few have actually taken the initiative and pledged to donate their organs. Conclusion: The knowledge of the health-care professionals pertaining to cadaveric organ donation was found to be relatively good, whereas their attitude was found to be favorable. As far as practices were concerned, they were found to be unsatisfactory. Awareness level regarding legislations pertaining to organ donation was relatively high.

Keywords: Attitude, cadaveric, consultants, deceased, health care, knowledge, nurses, organ donation, perceptions, practices, resident doctors


How to cite this article:
Da Silva KX, Dsouza DB, Mascarenhas VR, Kankonkar PN, Vaz FS, Kulkarni MS. Perceptions and attitude toward cadaveric organ donation among health-care professionals at a tertiary health-care setting: A cross-sectional study. Indian J Transplant 2021;15:56-61

How to cite this URL:
Da Silva KX, Dsouza DB, Mascarenhas VR, Kankonkar PN, Vaz FS, Kulkarni MS. Perceptions and attitude toward cadaveric organ donation among health-care professionals at a tertiary health-care setting: A cross-sectional study. Indian J Transplant [serial online] 2021 [cited 2021 Apr 11];15:56-61. Available from: https://www.ijtonline.in/text.asp?2021/15/1/56/312752




  Introduction Top


Organ donation provides a life-saving opportunity for those individuals with organ failure, who have no other options. The deceased organ donation rates in India, which vary in different parts, have been estimated to be 0.08 per million population per year.[1] Although India is listed in the second position for live donor transplants undertaken in the world after USA, it ranks very low in the list of countries undertaking deceased donor transplants.[2],[3],[4],[5] There is limited understanding of the concept of brain death among health-care professionals and the society at large. Knowledge, attitude, and practice surveys conducted among various stakeholders with regard to cadaveric organ/tissue donation in the country indicate diverse but moderately good knowledge with poor practices. A large number of willing people/family members of deceased individuals are unable to donate organs due to lack of system preparedness and poor inter-institutional linkage.[6] There is an increasing discrepancy between the number of patients on the waiting list for organ transplantation and the available number of deceased donor organs. Each year thousands of individuals wait for organs to be donated for transplantation.[7] The cadaveric organ donation program in India is still in its infancy and is hindered by the lack of awareness about the criteria and guidelines for declaration of brain death, among doctors. There is an immense need for increasing awareness about organ donation among the health-care professionals who in turn can motivate the general population. Under reporting due to erroneous knowledge of donation criteria, lack of familiarity with procedure among professionals, and difficulty in obtaining consent from family are factors that tend to contribute toward the decreased rates of cadaveric organ donation.[8] Health-care professionals are the most critical links in the organ procurement process because they are the first individuals to establish a relationship with the potential donor's family.[9] This study was conducted with the objective of assessing knowledge, attitude, and practices pertaining to organ donation among health-care professionals and awareness of legislations pertaining to organ donation.


  Materials and Methods Top


A cross-sectional study was conducted at a tertiary care hospital in Goa, over a period of 2 months from April to May 2018. A sample size of 400 was obtained using the following formula: N = Zᾳ2 pq/d2; Where Zᾳ =1.96, P = 0.14 (proportion of health-care professionals who lacked awareness about cadaveric organ donation that was obtained from a previous study),[10] q = (1-p) = 0.86, d = 5%. Substituting these values in the above formula, the desired sample size worked out to be 185. Anticipating a dropout rate of 7.5%, an effective sample size of 200 was obtained. Using stratified random sampling method with a design effect of 2, the sample size obtained was 400. The study population was grouped into three strata comprising 91 consultants, 114 resident doctors, and 195 nurses. Within each stratum, the participants were selected by the simple random sampling method.

Inclusion and exclusion criteria

All the consultants, resident doctors, and nurses who submitted complete questionnaires were included in the study. A self-administered questionnaire was developed based on previous studies.[11],[12] Questionnaire was pilot tested on a sample of respondents to check for comprehensibility and based on the feedback obtained, questionnaire was revised. Anonymity and confidentiality of respondents were maintained, and participation was voluntary. Willingness to answer the questionnaire was obtained as implied consent. The questionnaire included socio-demographic details of the consultants, resident doctors, and nurses, as well as questions that assessed their knowledge, attitude, and practices pertaining to deceased organ donation.

Only completed questionnaires were analyzed for the study.

Statistical analysis

Data were entered using EpiData EntryClient 4.4.1.0, The EpiData Association, Denmark, JM Lauritsen and were analyzed using IBM SPSS (International Business Machines - Statistical Package for the Social Sciences) for Windows® version 22. IBM SPSS Inc., Chicago, Illinois, Norman Nie, Dale Bent and Hadlai Hull. The Chisquare test was used for the categorical variables. p < 0.05 was considered statistically significant.

Patient consent

The patient consent has been taken for participation in the study and for publication of clinical details and images. Patients understand that the names, initials would not be published, and all standard protocols will be followed to conceal their identity.

Ethics statement

Ethics approval for this study was obtained from the Institutional Ethics Committee (Dated February 3, 2018). IRB number: ECR/83/Inst/GOA/2013/RR-20. All protocols were followed as per the Declaration of Helsinki.


  Results Top


The questionnaire was completed by 400 out of the 405 health-care professionals who were invited to participate (completion rate 98.76%). Out of a total of 400 health-care professionals who participated in the study, majority (74%) of the participants were females. The mean age of the study population was 35.13 ± s10 years. Hindus and Christians constituted 55.2% and 41% of the study population, respectively [Table 1]. All the consultants, 99.1% of resident doctors, and 83.1% of nurses were familiar with the concept of cadaveric organ donation. The organs that are donated in cadaveric organ donation programmes, as reported by the participants, included the cornea, kidney, heart, and lungs with response rates of 89.3%, 80%, 68.3%, and 25.3%, respectively. Majority of the participants, i.e., 96.7% consultants, 99.1% resident doctors, and 89.7% nurses correctly answered that brain dead patients could donate organs. The fact that human leukocyte antigen of donor and recipient must be identical for any cadaveric organ transplantation was known by 83.5% consultants, 84.2% of resident doctors, and 63.6% of nurses. The fact that carriers of Hepatitis B and C cannot donate their solid organs was known by 81.3% of consultants, 85% of resident doctors, and 90.8% of nurses. Majority (89%) of the consultants and 85.1% of resident doctors were aware that there is an “act” governing organ donation and transplantation. Majority (82.4%) of consultants, 83.3% of resident doctors, and 85.1% of nurses opined that a certified brain-dead registered organ donor cannot be immediately disconnected from ventilation support, without consent of family members [Table 2]. Only a few (13.2%) consultants, resident doctors (14%), and nurses (22.1%) correctly answered that parents/guardians could not take decision on behalf of mentally disabled persons regarding organ donation. Less than a third (30.8%) of consultants, 32.5% resident doctors, and 9.7% nurses were aware about the source from where organ donation cards could be obtained from. Organs presently being donated in Goa were correctly identified by 68.5% of participants, whereas 77.5% of participants correctly named the organization dealing with the donation of the deceased organ. Only 10.5% of participants named the “act” governing organ donation and transplantation. Majority of the health-care professionals, i.e., 51% were aware that “Neurosurgeon/Neurophysician” could certify brain death but less than a third (30%) knew about the recent amendment that included “Surgeons/Physicians and anaesthetists/intensivists” as certifiers of brain death.
Table 1: Demographic details

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Table 2: Knowledge about the various aspects of cadaveric organ donation

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Less than one fourth, i.e., 23.1% consultants, 19.3% resident doctors, and 26.2% nurses felt that there would be premature termination of medical treatment following brain death. Majority (63.7%) of consultants and 71.1% of resident doctors were not very particular that their bodies be kept intact following death, indirectly showing a positive attitude in their willingness to donate. While on the other hand, a vast majority of nurses (58.8%) preferred that their body be kept intact after death. A vast majority (63.7%) of the consultants, 62.3% of resident doctors, and 39.5% nurses, were willing to donate organs of a brain dead relative. Willingness to donate is an indicator of an individual's positive attitude. Most (70.3%) of the consultants, 71.9% of resident doctors, and 46.7% of nurses were willing to donate their own organs. Around 85.7% consultants, 98.5% resident doctors, and 80.5% nurses were willing to attend a talk/lecture covering the various aspects of cadaveric organ donation [Table 3]. The study revealed that very few (6.6%) consultants, 14.9% resident doctors, and 6.2% nurses have pledged to donate their organs. The present study also revealed that 31.9% consultants, 43% resident doctors, and 19% nurses had spoken to their family members regarding organ donation and among those who had not spoken to their family members, 66% were willing to do so. A small proportion, i.e., 20% of consultants, 29.8% resident doctors, and 16.4% nurses reported that they had spoken to their patients regarding organ donation and among those who had not 68.8% were willing to do so. Half (50.5%) of the consultants, 54.4% resident doctors, and 41.5% nurses had spoken to their fellow colleagues regarding organ donation and among those that had not, 77.3% were willing to do so [Table 3].
Table 3: Attitude and perceptions of health-care professionals toward cadaveric organ donation

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  Discussion Top


In our study, a good response rate (98.76%) was perhaps due to on-the-spot filling and collection of questionnaires from the health-care professionals. The majority (67.8%) of participants in our survey were <40 years of age and about 74% of the study population were women. Greater proportion (74%) of female participants in our study could be due to the fact that nursing and medical staff predominantly consisted of females. The study population comprised 55.2% Hindus and 41.0% Christians. Willingness to donate organs was expressed by 62.4% of Hindus and 53.7% of Christians. Most religions proclaim the virtues of “giving” and “helping others”; taking this fact into consideration one would expect a higher percentage of willing organ donors. Only 3.6% of the study population stated that their “religious beliefs” were responsible for their unwillingness to donate. This indicates that it was not their religious belief that restricted the participant's willingness to donate their organs, but probably other factors such as mistrust in the system (8.5%) and the fact that they had never given it a thought (22.5%). A vast majority (91.5%) of our study population were familiar with the concept of cadaveric organ donation; this can be attributed to their line of work as all the participants were closely associated with health care. The proportion of participants who were familiar with the concept of organ donation in our study (91.5%) was lower as compared to the proportions obtained in the studies conducted among health-care professionals by Reddy et al.[13] (96%) and among medical students by Bapat et al.[14] (97%). Our study reported that newspapers (44.8%) were the most common source of information about cadaveric organ donation, followed by Television (40.5%), Continuing Medical Educations (CMEs) (36.8%), advertisements on posters and billboards (30.5%), friends/family (21%), and MBBS and nursing courses (15.5%). The findings of our study were very similar to the findings obtained in a study by Figueroa et al.,[15] in which it was found that the newspaper (52%) was the most common source of information, followed by television (38%) [Figure 1]. In Spain, a study among primary health-care workers also reported a positive influence of understanding of the concept of brain death on attitude toward organ donation from deceased donors.[16] Our study revealed that majority (94%) of the participants knew that brain dead people could donate organs. About half the participants (51%) knew that neurosurgeons/neurophysicians could certify brain death, whereas only 30% of the participants were aware of the recent inclusion of surgeon/physician and anesthetist/intensivist as the certifiers of brain death. This lack of knowledge about brain death among health-care professionals is a major contributing factor toward the lack of progress in the field of cadaveric organ donation in our state. In a study conducted in South India, it was found that awareness about kidney donation was the highest (94%), followed by heart (82%), liver (78%), cornea (59%), and lungs (57%).[17] In contrast, our study revealed that cornea was the most common organ to be donated (89.3%), followed by the kidney (80%), heart (68.3%), and lungs (25.3%). This can be explained by the fact that at the time of data collection, it was only corneal transplantation that was being fully operational. Knowledge was assessed by a series of questions covering the various aspects of cadaveric organ donation. Based on the participant's responses, the overall knowledge of the participants has been found to be favorable. A study in Turkey revealed that 75.5% of physicians and 67.2% of nurses had good knowledge of legislations pertaining to cadaveric organ donation in their country,[18] our study revealed that the awareness level among consultants was better (89%) as compared to that of the nurses (42.1%). Our study also showed an overall awareness rate of 65%, which was lower than that obtained by Dasgupta et al. (72.7%).[19] A significant difference was seen between the different categories of health care professionals with respect to willingness for organ donation after death, with 70.3% of consultants, and 46.7% of nurses willing to do so. This is similar to a more positive attitude among doctors compared to nurses as reported from a multicenter study from Northern Denmark.[20] In our study, age was not a factor which influenced willingness to donate organs. Overall, the attitude of all health-care workers regarding willingness to donate organs has been reported to be favorable. In a study conducted by Prottas et al.,[21] among health professionals and hospital administrators in the US, it was found that 71% of the nurses and 52% of neurosurgeons had spoken to their family members about organ donation. In contrast, our study revealed that only 31.9% nurses and 19% consultants had spoken to their family members regarding organ donation. This indicates poor practices on part of the health-care professionals toward cadaveric organ donation. The findings of our study revealed that 84.3% of the study participants showed interest in attending a talk/lecture about cadaveric organ donation. A similar study conducted by Alhawat et al.[22] revealed that about 41% of participants expressed a desire to know more about organ donation, which was much lower as compared to our findings. This indicates that our study population had a much more positive attitude. The relatively favorable attitudes, the lack of awareness, and indecisiveness regarding cadaveric organ donation in this selected study population reinforce the need for interventions in the form of awareness programmes to improve the responsiveness to cadaveric organ donation.
Figure 1: Sources of information about cadaveric organ donation. (multiple responses therefore total will not add up to 100%)

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Limitations of the study

It is a single centre study. Multicentric study is needed to further validate the findings.


  Conclusion Top


The knowledge of the health-care professionals, pertaining to cadaveric organ donation, was found to be relatively good, with a vast majority of the study population giving correct responses to the questions put forth. Knowledge levels of consultants and resident doctors were found to be higher than that of nurses. The attitude of the consultants and resident doctors was found to be positive with respect to deceased organ donation, but the same did not reflect in their practices which were deficient and unsatisfactory. Awareness levels regarding legislations pertaining to organ donation were relatively high, with consultants, and resident doctors having a much higher level of awareness as compared to nurses. This study having assessed the knowledge, perceptions, and attitude of different health-care professional, necessitates organizing awareness programmes to focus on the importance of cadaveric organ donation, and the provision of the necessary communication skills to promote it. This could help improve the outlook of the health-care professionals toward deceased organ donation hopefully motivating them to enlist themselves and their family members for organ donation and also to encourage their patients and colleagues to do the same.

Recommendations

Planning educational programmes in the form of CME for consultants, resident doctors, and nurses, to equip them with necessary skills to approach the family members of potential organ donors. Incorporation of various aspects of cadaveric organ donation, as a part of MBBS and nursing curriculum to increase the awareness among them.

Acknowledgment

The authors gratefully acknowledge and thank the Indian Council of Medical Research (ICMR) for having selected this study proposal for its Short-Term Studentship Program. We express our gratitude to the consultants, resident doctors, and nurses who gave us their valuable time and participated in our study.

Financial support and sponsorship

Research grant awarded by ICMR to the first author (undergraduate student from III MBBS) to conduct this experimental pilot study through its Short-Term Studentship program 2018 (REFERENCE ID: 2018-04466).

Conflicts of interest

There are no conflicts of interest.



 
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