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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 16  |  Issue : 4  |  Page : 411-418

Awareness, attitude, and willingness of organ donation among adult population in Western Rajasthan: A cross-sectional hospital-based survey


1 College of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
2 Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Date of Submission02-Apr-2022
Date of Acceptance20-Oct-2022
Date of Web Publication30-Dec-2022

Correspondence Address:
Mr. Nipin Kalal
College of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijot.ijot_38_22

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  Abstract 


Background: Organ transplantation is a life-saving treatment for patients with end-stage organ failure all over the world, and the demand for organs has increased as a result. Organ donation involves legal, psychological, and ethical considerations. Many countries around the world have reported that people's attitudes toward organ donation are influenced by various factors such as knowledge, education, and religion. The existing study sought to explore the awareness, attitude, and willingness of organ donation among adult population in Western Rajasthan. Materials and Methods: A cross-sectional hospital-based survey was conducted with 445 adult populations who were visiting the hospital. Self-Structured Awareness Assessment Scale for Organ Donation and Attitude Assessment Scale for Organ Donation were used. Data analysis was done using the SPSS software 22.0 version. Results: 74.61% of participants were aware about organ donation. Statistically (P < 0.001) higher odds for organ donation willingness was found among participants who were aware that organ such as eye (odd ratio [OR]: 10.34, 95% confidence interval [CI]: 4.40–24.25, P < 0.001), heart (OR: 4.71.95% CI: 2.68–8.25), P ≤ 0.001), intestine (OR: 2.26, 95% CI: 1.41–3.6, P = 0.001), skin OR: 2.93, 95% CI: 1.83–4.70) P ≤ 0.001), extremities (Lower and upper) (OR: 2.46,95% CI: 1.53–3.95, P ≤ 0.001) can be donated or transplanted. 40.6% of the participants disagree that it is better to die than to receive an organ from another person. Interestingly, 35.28% of the participants agreed that organ donation is a true donation and a real service to mankind. Conclusions: This study not only echoes low awareness of organ donation among the adult population in Western Rajasthan, India but also reflects low and neutral level of positive attitude and willingness for organ donation.

Keywords: Attitude, awareness, donor, organ donation, transplantation


How to cite this article:
Kalal N, Sharma SK, Rana N, Kumar A, Mathur D. Awareness, attitude, and willingness of organ donation among adult population in Western Rajasthan: A cross-sectional hospital-based survey. Indian J Transplant 2022;16:411-8

How to cite this URL:
Kalal N, Sharma SK, Rana N, Kumar A, Mathur D. Awareness, attitude, and willingness of organ donation among adult population in Western Rajasthan: A cross-sectional hospital-based survey. Indian J Transplant [serial online] 2022 [cited 2023 Feb 8];16:411-8. Available from: https://www.ijtonline.in/text.asp?2022/16/4/411/364622




  Introduction Top


Worldwide, organ transplantation has been and continues to be the standard treatment for individuals with end-stage organ disease. Organ donation is a multifaceted topic with medical, legal, ethical, organizational, and social components.[1] Organ transplantation has become more possible because to technological advancements in recent decades, resulting in a rise in demand for organs. As a result, organ shortage has become a worldwide issue.[2]

Human organ donation has been legalized in India since 1994 through “The transplantation of Human Organs Act, 1994.”[3] India has a well-developed corneal donation program, but postbrain death donation is slow. In 2011, the government enacted an amendment to the “Organ Transplant Law” to promote organ donation after brain death.[4] For more support, they revised it in 2014, titled “the transplantation of human organs and tissue rules, 2014.”

Every year, over 5 lakh people in India require organ donation, according to the National Organ and Tissue Transplant Organization. Every day, 17 people in the country die while waiting for an organ transplant. Only 0.01% of Indians have decided to give their organs after death, suggesting a need for more organ donors.[5] In the year 2020, around 39,000 transplants were done. Every 9 min, someone is added to the transplant waiting list.[6]

Lack of awareness along with myths and misconceptions,[1] religious reasons,[7] are major causes of opposing organ donation. Knowledge, attitude, and behavior are the key factors that influence the rates of organ donation. Furthermore, culture and religion have been shown to influence organ donation decision-making.[3] It is increasingly critical to analyze the adult population's knowledge, attitudes, and readiness to donate organs.

Approximately 500,000 people have died due to nonavailability of organ in India. India is the second most densely populated country in the world, but shows a poor organ donation rate of only 0.86/million people, compared to 31.96 in the United States and 46.9 in Spain. The only way to eliminate such a depressing situation in the society is to raise awareness and inspire people to donate their organs. The greater the number of potential donors, the more likely organs will become accessible to save lives.[8]

In India, published data on organ donation is primarily from diverse areas of the country, although there is inadequate research on comparable topics in Rajasthan State. In this context, we conducted this cross-sectional hospital-based survey to assess awareness, attitude, and willingness regarding organ donation among the adult population of Western Rajasthan.


  Materials and Methods Top


Study design

A hospital based cross-sectional study was conducted among adults (>18 years) visiting Tertiary Care Hospital using a self-structured questionnaire during the period of May to August 2021.

Study setting and study subjects

Study participants either a patient or accompanying attendant were contacted based on convenience by the researchers after obtaining informed verbal consent in hospital premises, in a comfortable, nonjudgmental, and confidential manner. The sample size was calculated with Z1−α/2 = Critical value and a standard value for the corresponding level of confidence (At 95% confidence interval [CI] or 5% level of significance (Type-I error) it is 1.96 and at 99% CI it is 2.58). On the basis of a study done by Devi et al;[9] Considering P = 0.57; q = 0.43; d = 0.05, the sample size was calculated as 369, while considering 20% nonresponse rate, a total sample size of 445 participants were considered for the present study.

Data collection tool and technique

The survey questionnaire and consent form were designed in bilingual language (English and Hindi) and interview technique was used for collecting the data. Scale was validated by experts and found to be 80% reliable with Cronbach's α = 0.82. The content validity ratio for the scale was 0.89, showing an acceptable level of internal consistency of the scale. The details of the questionnaires used in the study are as follows:

Sociodemographic sheet

This section includes 11 items related to the demographic variables of the respondents about age, gender, religion, education qualification, occupation, place of living, marital status, have you heard about organ donation, source of information about organ donation, any family history of organ donation or recipient, have you donated blood in past. The profile sheet sought validation from physicians and nursing experts and was pretested in an eligible population before final use.

Awareness assessment scale for organ donation

This scale included a total 12 questions which had a box checking format consisting of the options “yes,” “no,” and “don't know. Each correct option was awarded with score 1 and incorrect response with score 0.

Attitude assessment scale for organ donation

The questions on attitude were rated using a Likert scale, with answer choices of “strongly agree,” “agree,” “neutral,” “disagree,” and “strongly disagree.” It consists 15 statement where question No. 2, 4, 5, 7, 10, and 12 are negative statement. Higher scores indicated higher degrees of positive attitude regarding organ donation.

Willingness for organ donation

This section was used to know the willingness of organ donation among adult population with a response options “yes,” “no,” and “undecided.

Statistical analysis

Data were coded and entered an Excel sheet and analyzed using the SPSS software version 16 (IBM Inc., Armonk, New York, USA). The demographic characteristics were compared with the level of awareness score using the Chi-square test. By calculating proportion, Chi-square test, odds ratio (OR) to assess the association with covariates and considered significant at P < 0.05. Binary logistic regression analysis was used to find the factors which are significantly associated with the level of awareness on organ donation. ORs with 95% CI were used to quantify the strength of association between sociodemographic characteristics and level of awareness on organ donation.

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 and initials would not be published, and all standard protocols will be followed to conceal their identity.

Ethical consideration

Ethical Clearance was obtained from the Institutional Ethics Committee-wide letter no.AIIMS/IEC/2021/3462. On the completion of successful interaction, participants were thanked for their cooperation. The confidentiality and anonymity of the subjects was maintained throughout the study. The study was done according to the principles of Declaration of Helsinki.


  Results Top


[Table 1] presents the participants' characteristics. Data of 445 participants were used for the final analysis in this study. The participants' mean age was 34.52 ± 11.56. Male participants (36.90%) were more aware about organ donation than females (39.40%); however, the association was not significant. A majority of participants were Hindu (94.60%), where only 37.20% were aware about organ donation compare to other religion (Muslim and Christian) which was not associated with religion. A substantial number of participants (27.10%) had completed graduation, and 24.90% had a secondary education. Interestingly, level of awareness was significantly affected (P < 0.001) by educational qualification. Interestingly, the specific occupations of participants showed significant associations level of awareness (P < 0.001), a substantial number of participants from government sector were having level of awareness 84.90%, followed by students (51.85%), and business (32.69%). Surprisingly, participants from the urban (53.22%) and unmarried (53.27%) we're having more awareness regarding organ donation. Both the variables were significantly associated. Interestingly, level of awareness was significantly associated (P < 0.001) by have you heard about organ donation 51.80% of the respondents yes about the response. Further, a source of information about organ donation had a significant association (P = 0.005) with level of awareness of organ donation. The level of awareness found significantly associated with participants' any of family/friend is organ donor or recipient (P < 0.05), and have you ever donated blood in past (P < 0.05).
Table 1: Sociodemographic characteristics and level of awareness on organ donation (n=445)

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Encouragingly, more than half of participants were aware that eye (69.2%), kidneys (66.2%), liver (53.2%), heart (59.7%), and brain (73.0%) are the organ can be donated or transplanted. Statistically (P < 0.001) higher odds for organ donation willingness was found among participants who were aware that organ such as eye (OR: 10.34, 95% CI: 4.40–24.25, P < 0.001), heart (OR: 4.71.95%CI: 2.68–8.25), P ≤ 0.001), intestine (OR: 2.26, 95%CI: 1.41–3.6, P = 0.001), skin OR: 2.93,95% CI: 1.83–4.70) P ≤ 0.001), extremities (OR: 2.46,95% CI: 1.53–3.95, P ≤ 0.001) can be donated or transplanted. There was no statistically significant difference noticed with regard to organ like kidney and liver.

Less than half (47.8%) of the participants were aware that organs can be donated by live person only. Significantly (P < 0.001) higher proportion, i.e., (61.7%) of the participants, were aware that one person cannot donate several organs (OR: 3.09, 95% CI: 1.97–4.86). Further, greater proportion of participants (69.4%) were aware that organ donation pledge cannot be taken regardless of any age (OR: 3.15, 95% CI: 2.00–4.98, < 0.001). Significantly higher proportion, i.e., (77.5%) of the participants, were not aware that person who is HIV/HCV/HBV positive cannot donate the organs (OR: 3.05, 95% CI: 1.88–4.94, P ≤ 0.001). Maximum number of participants is not aware that large number of people are dying every day due to insufficient availability of required organs in our country. [OR: 2.97, 95% CI: 1.89–4.66, P ≤ 0.001, [Table 2]].
Table 2: Awareness and willingness of organ donation (n=445)

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Findings reported that 40.6% of the participants disagree that it is better to die than to receive an organ from another person. Interestingly, (35.28%) of the participants agreed that organ donation is a true donation and a real service to mankind. Further, 40.89% and 45.16% of the participants had neutral attitude that organ donation of dead a person is not acceptable in most of societies and if people donate their organs, they may achieve heaven after death respectively [Table 3]. [Figure 1] showing the willingness for organ donation.
Figure 1: The willingness for organ donation

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Table 3: Attitude regarding organ donation

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Binary logistic regression analysis results revealed that adult population level of awareness on organ donation is significantly associated with place of living (OR: 529, 95% CI: 0.339–826, P = 0.005*), heard about organ donation (OR: 2.824, 95% CI: 1.656–4.800, P = 0.000), source of information about organ donation (OR: 0.460, 95% CI: (0.330–0.642, P = 0.000*), and donated blood in past [OR: 2.142, 95% CI: 1.107–4.147, P = 0.024*, [Table 4]].
Table 4: Binary logistic regression analysis on factors significantly associated with level of awareness on organ donation

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  Discussion Top


Donated organs represent the final alternative for millions of people with failing organs globally. In compared to the number of patients awaiting transplantation, there is a global shortage of donor organs. The public's understanding and attitude toward organ donation has an impact on people's willingness to donate their organs. Persuading healthy people to be hospitalised, subject their bodies to mutilation, and risk death is difficult. To solve the scarcity of donor organs, the general public's attitude toward organ donation is critical.[10] The awareness, attitude, and willingness of adult people in Western Rajasthan were assessed in this study.

The current study found that only 36.90% of males and 39.40% of females are aware of organ donation. These findings contrast with prior work by Devi et al., who found that 74.4% of males and 25.6% of females are aware of organ donation. These findings are also consistent with those of earlier investigations.[9]

On comparison with selected other countries, organ donation awareness in Pakistan was 60%, Kuwait 68.3%, South Africa 89%, Brazil 89%, and Saudi Arabia 98%. A Canadian household telephonic survey highlighted that organ donation 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.[7],[11],[12],[13],[14],[15],[16]

It is identified in the present study that qualification was found to have a significant association (P ≤ 0.001*), these findings are comparable to previous study done in Puducherry (India).[10]

The mean age in the present study population was 34.52 ± 11.56, whereas study conducted by Agrawal et al. reported the mean age 29.32 ± 9.32.[7]

Additionally, the majority of participants were aware that eye 69.2%, kidneys 66.2%, liver 53.2%, heart 59.7%, brain 73.0% are the organ can be donated or transplanted and these findings are in loop with some of the previous study.[1],[7],[17]

Interestingly, the present study found 74.61% participants had heard about organ donation from family and friends 46.68%, mass media 41.26%. These findings are similar with study done by Annadurai et al. where 53% of the respondents heard about organ donation from print and electronic media and only 34.1% heard from health care workers.[1]

Awareness about legislation for organ donation and transplants in India 41.57% in our study was found to be contrary with a study conducted in Tamilnadu, Bengaluru (India) only 13.9% and 5% were aware of legislation regarding organ donation respectively.[1],[2]

Our study shows that 63.2% participants are agree that organ donation is a good thing, these findings are similar to earlier study which reported that 51.9% participant's organ donation is a true donation and a real service to mankind 51.9%.[2]

Moreover, the current study findings suggested that 45.1% participants ae agree that only rich and VIPs are provided organs for transplantation, these findings are consisted with previous study demonstrated by Sachdeva et al. where they reported (32.58%) participants that donated organs are preferably used for rich and influential people of society.[17]

The 22.9% of participants agree that organ donations by a dead person are generally misused or sold for monetary benefit. These findings are in line with previous study where 55.2% participant's barriers perceived that there is misuse of organs.[18]

In our survey 29.88% of the respondents agreed to donate their organs donate or receive organs to/from persons of any caste, creed, religion and region, whereas finding in a similar survey conducted in Saudi Arabia 51% in 2016 and slightly lower than the finding in Tunisia 53.9% in 2010 and in China 53.5% in 2016.[19],[20],[21] Twenty-eight percent participants are willing to donate organ can only to close relatives. Comparing findings from other studies, where 51% respondents mentioned that they would like to donate their organs to family members.[11]

The factors have you heard about organ donation, place of living, source of information about organ donation, any of family/friend is organ donor or recipient, have you ever donated blood in past is significantly associated with level of awareness on organ donation in current study.

Limitations

The present study findings should be appraised under few limitations. First, the study findings are limited to the western Rajasthan India, the population is merely patients and their attendant visiting a single tertiary care centre. Second, considering the cross-sectional study, chances of subjectivity and responses might not represent patients' actual behavior. Third, the number of males is more in contrast to female participants in the present study and may be a reason of bias in actual findings. We have used a quantitative approach; this may pose some methodological problems in the attaining of all necessary information for this study. Therefore, future studies should include larger samples and qualitative studies such as focus group discussions for an in-depth understanding of the issues. A similar study can be undertaken among college students, different healthcare professionals. More studies should be carried out to rectify the decline in organ donation rate. Similarly, government organizations should take up the awareness programs to the masses through the social media.


  Conclusions Top


This study not only echoes low awareness of organ donation among adult population in Western Rajasthan, India but also reflects the low and neutral level of positive attitude and willingness. Our study highlights that less than half participants were aware of the legislation for organ donation. Measures should be taken to educate people with relevant information, including the benefits of organ donation and possible risks as well so that people can make informed choices in future. The outcome of this research designates that there is a need for more intensified interdisciplinary discussion and information to prepare the general population about organ donation.

Acknowledgment

Authors are thankful to all the participants.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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