The Saudi Journal of Forensic Medicine and Sciences

ORIGINAL ARTICLE
Year
: 2018  |  Volume : 1  |  Issue : 2  |  Page : 35--40

Knowledge and attitude toward organ donation among medical and nonmedical (Engineering) students in Bhopal, India


Shuchi Soni, Janmejaya Samal, Sumit Singh Baghel, Shailja Vaghela, Manish Singh Chundawat 
 Independent Public Health Researcher, Bhopal, India

Correspondence Address:
Dr. Janmejaya Samal
C/O- Mr. Bijaya Ketan Samal, At-Pansapalli, Po-Bangarada, Via-Gangapur, Ganjam - 761 123, Odisha
India

Abstract

Background: India is facing a massive dearth of organs for transplantation. Nationally, with a population of 1.2 billion people, the organ donation rate (ODR) per million population (PMP) for India stands at 0.26 PMP. Although limited knowledge is considered as one of the major factors for low donation rates, studies also quote that knowledge may not have any impact on positive attitude and practice toward organ donation. Furthermore, countries with presumed consent policy like the one in Spain and Croatia have much higher ODRs (36 and 36.5 PMP) as compared to India, which has informed consent policy. Objectives: The objectives of this study is to understand correlation between knowledge and attitude toward organ donation among medical and nonmedical students and identify barriers to deceased organ donation; to look into participant's perception for adoption of presumed consent policy in Indian context; and understanding the acceptance of donor acknowledgment in the form of organ incentivization. Materials and Methods: An institution-based cross-sectional study was carried out among the students of medical and engineering colleges. A total of 100 students from each institute were interviewed randomly constituting a total sample of 600 students. A pre-designed, pre-tested, semi-structured questionnaire was used for collecting the data. The collected data were entered into Epi Info 7, and statistical tests were applied to find significant differences between two groups. Results: Of the total 600 students, 55.7% were male while 44.3% were female. The mean age of the study population was 19.73 ± 1.24 standard deviation years with majority of them (90.5%) under 21 years. Age and gender found to have a significant association with knowledge on organ donation. Study revealed a positive correlation between knowledge and attitude in both medical (r = 0.189) and nonmedical groups (r = 0.21). Almost 51.7% of students were in favor of adoption of Spain's “opt-out policy” policy, while 82.6% supported donor acknowledgment to increase the rates of organ donation in India. Most common source of information about organ donation identified in the study was television (71%), newspaper (38.5%), and doctor (33.7%). Conclusion: Positive correlation between knowledge and attitude suggests that a well-designed awareness campaign can improve attitude and practice toward organ donation, and successful examples from countries such as Spain and Singapore can be adopted in national context, to increase ODRs and saving millions of lives waiting for organs from deceased donors.



How to cite this article:
Soni S, Samal J, Baghel SS, Vaghela S, Chundawat MS. Knowledge and attitude toward organ donation among medical and nonmedical (Engineering) students in Bhopal, India.Saudi J Forensic Med Sci 2018;1:35-40


How to cite this URL:
Soni S, Samal J, Baghel SS, Vaghela S, Chundawat MS. Knowledge and attitude toward organ donation among medical and nonmedical (Engineering) students in Bhopal, India. Saudi J Forensic Med Sci [serial online] 2018 [cited 2019 Nov 12 ];1:35-40
Available from: http://www.sjfms.org/text.asp?2018/1/2/35/252534


Full Text

 Introduction



Organ transplantation is the most viable treatment option available for the last stage organ collapse cases. Worldwide more than 20% of the patients on transplant waiting lists, die annually due to shortage of donor organs.[1] According to the WHO guiding principle III, donations from deceased donors should be encouraged to their maximum therapeutic potential, to avoid the inherent risks to live donors.[2] Demand of deceased organs for the transplantation process is very high, and the gap between organs available and the number of patients waiting in queue for a transplant is increasing day-by-day across the globe.[3]

Since past several years, India is facing shortage of organs for transplantation.[4] Nationally, with a population of 1.2 billion people, the organ donation rate (ODR) per million population (PMP) for India stands at 0.26 PMP.[5] This is an incredibly small and insignificant number, as compared to countries having highest ODRs such as the US, Spain, and Croatia where the ODRs are 26, 36, and 36.5 PMP, respectively.[6] Half a million people die due to nonavailability of organs annually. There are long waiting lists for organ procurement, against the handful of organ donors; this resultantly leads to a massive dearth of cadaveric organs for transplantation.[6],[4]

Factors that may contribute to the limited availability of donor organs can be lack of knowledge and awareness on organ donation[7],[8] Limited knowledge on the legal and procedural details of organ donation has also been identified as another contributing factor for low ODRs.[9] Misunderstandings concerning religious attitudes, and superstitious beliefs, have generated fright and apprehension among the general population, toward OD,[10],[4] for example, being reborn with a missing organ is considered a reason against giving consent for organ donation by 40% people while 26% believed that a mutilated body would not exempt a person from the cycle of life, death and rebirth.[11]

On the premise of low knowledge and awareness, a Chennai-based study recommended an intensified and sustained medical campaign as a strategy to increase ODR.[12] On the contrary, handful of studies conducted nationally and internationally doubt on knowledge as the motivational factor behind positive attitude toward donating organs. In an attempt to study mental setup of population toward cadaveric organ donation, A. Saha and his team found very low motivational levels toward OD even among the aware and educated population.[13] That is, not all the people who have knowledge and awareness on organ donation were found to have enough motivation to actually donate organs or register themselves for donation. Similarly, a study from Northwest Ohio University suggested that not everyone having knowledge, and awareness is willing to be a posthumous organ donor.[14]

While much work has been done to assess the barriers toward organ donation in the Indian context, there seems a paucity of studies assessing the correlation between knowledge and attitude toward organ donation. Thus, this study was designed to assess whether there is any significant difference in the level of knowledge among medical and nonmedical students and tried to understand whether this difference in the level of knowledge on organ donation has any correlation with the attitude and practice toward registering themselves as potential organ donors in future. The study also tried to delve deeper to understand other fears and reservations toward organ donation.

In a research evaluating how countries increase organ donation, Sydney Lupkin recognized presumed consent or “opt-out policy” to be the reason behind Spain's high ODR of 36 PMP.[15],[16] Another study conducted in 22 countries over a period of 10 years found presumed consent to have a positive and sizable effect on ODRs, as compared to countries having informed consent.[17] Under Presumed Consent Legislation over cadaveric organ donation, a deceased individual is designated as a potential donor in the absence of explicit opposition expressed in writing to donation before death, while also retaining families' power on having final decision for deceased organ extraction. Since there were no studies to understand the acceptance of presumed consent in Indian context, this study also tried to determine participant's perception on adoption of presumed consent policy in India.

Besides the study also tried to look into population perception on donor acknowledgment in the form of either incentive as in countries like Singapore[18] or other recognitions or benefits, since not much work has been done to look into people's perceptions toward its acceptance.

Objectives

The main objective of this study was to compare the knowledge and attitude toward organ donation between medical and nonmedical students and identify barriers to deceased organ donation; to understand the willingness of participants toward the adoption of presumed consent or “opt-out” policy in Indian context; and understanding the acceptance of participants toward donor acknowledgement in the form of organ incentivization.

 Materials and Methods



Study sample

An institution based cross-sectional study was carried out among students of three different medical colleges and three different engineering colleges of Bhopal, Madhya Pradesh, India. The study population included two groups of students with the age group of 17 years and above. A total of 100 students were interviewed randomly from each institute in the study.

Study instrument

A pre-designed, semi-structured questionnaire was administered to the participants after a brief orientation of the participants on the purpose and implications of the study. Pilot testing of the questionnaire was done before conducting the study, and the questionnaire was validated using Corn Bach's Alpha Index test, and the internal consistency of the questionnaire was 0.78.

The questionnaire was divided into four main sections. Questions in section-1 focused on collecting demographic information such as age, sex, marital status, religion, education, and organ donor status. The options under “organ donor statuses' have been further classified into two groups. A response of having a donor card and willing to have a donor card was taken as a “positive practice” toward donation. While respondents not willing to have a donor card and those falling in undecided category were considered “negative in their practice.” Section-2 was exclusively designed to examine the knowledge of students over basics of organ donation and transplantation using 15 variables which were marked as true and false. Each correct response was allotted one point, and total score of 8 and above was considered good knowledge toward organ donation, while a score <8 was considered as poor knowledge. Section-3 focused on understanding the attitude of participants on 14 hypothetical statements toward organ donation. The responses were marked on 5 point Likert's Scale, ranging from totally disagree to totally agree. A net score on all the 14 variables were calculated for each participant, to get each participant's overall attitude level. Section-4 had miscellaneous questions to get the participant's perception on presumed consent, donor acknowledgment, and most popular source of information on OD. An open-ended question was also kept to understand their personal barrier to OD.

Data analysis

Data from the questionnaires were entered in MS-Excel 2013 and were analyzed using Epi Info-7.2, CDC, Atlanta, USA and P < 0.05 was considered statistically significant. Microsoft Excel 2013 was used for generating charts and pie diagrams. Data were represented in proportions and percentages. ANOVA test was used to find the variations of knowledge and attitude scores. Bivariate analysis was performed using Chi-square test (Fischer's exact test wherever applicable) and P < 0.05 was considered statistically significant.

 Results



Of the total 600 students (300 medical and 300 engineering), 55.7% were male while 44.3% were female. The mean age of the study population was 19.73 ± 1.24 standard deviation (SD) years with majority of them (90.5%) were under 21 years of age (Chi-square and P = 5.772 and 0.016).

Among the age group of > 21 years (94.7%) had good knowledge when compared to the age group of < 21 years (82.3%). The association between age and level of knowledge found to be statistically significant (P < 0.05). Among gender, female had good knowledge when compared to male, and a significant association was found between gender and knowledge (Chi-square and P = 5.813 and 0.016) on organ donation (P < 0.05). Marital status, religion had no association with knowledge (Chi-square and P = 1.029 and 0.794) on organ donation as shown in [Table 1].{Table 1}

The mean score of knowledge on organ donation among medical students was 9.84 ± 2.04 SD and among engineering group was 9.36 ± 2.14 SD, and a significant difference was found in between these two groups (P < 0.05) as shown in [Table 2] (Student's t-test = 2.83, P = 0.005). Box plot chart shows that median scores of knowledge increase more in females when compared to males as shown in [Figure 1].{Table 2}{Figure 1}

The mean score of attitude on organ donation among medical students was 48.82 ± 7.74 SD and among engineering group was 47.97 ± 8.74 SD, and there was no significant difference in between two groups (P < 0.05) as shown in [Table 3] (Student's t-test = 1. 261, P = 0.208).{Table 3}

The mean knowledge and attitude scores were higher for students who were found positive in their practice toward organ donation. There was a significant difference between willingness toward organ donation and knowledge, attitude level (P < 0.05) as shown in [Table 4] (ANOVA test for knowledge – F = 2.644, P = 0.048; ANOVA test for attitude – F = 10.430, P = 0.000).{Table 4}

However, there was no significant difference found between medical and engineering group's willingness toward organ donation (P > 0.05) as shown in [Table 5] (Chi-square test = 2.481, df = 3, P = 0.479).{Table 5}

Nearly half of the students were in favor of adoption of presumed consent policy toward organ donation in India. Moreover, a significant difference was found between medical (44.3%) and engineering (38.3%) groups who were in favor of providing monetary incentives for organ donors, as shown in [Figure 2]. Most common source of information about organ donation identified in the study was television (71%), newspaper (38.5%), and doctor (33.7%) as shown in [Table 6].{Figure 2}{Table 6}

 Discussion



The study was designed with the main objective of understanding correlation between knowledge and attitude toward OD among two groups of population, having a significant difference in the level of knowledge. In an attempt to decide whether the presence of knowledge has any association with a positive attitude toward OD, the study tried to evaluate the mindset of two groups of population and medical and nonmedical/engineering students from six different institutions. The demographic factors considered were gender, age, marital status, religion, and current donor status.

Age and gender found to have a significant association with knowledge. Other demographic factors such as religion, marital status had no association with knowledge, which was similar to studies conducted by Reddy et al.[4] and Gauher et al.[19] The median scores of knowledge increased more among females when compared to males as shown in [Figure 1]. With the increase in knowledge toward organ donation, there was decrease in median attitude score toward organ donation among females when compared to males as shown in [Figure 2].

Significant difference in knowledge was observed in between medical and nonmedical groups (P < 0.05), and the mean score of knowledge on organ donation among medical students of 9.84 ± 2.04 SD was high when compared to nonmedical group of 9.36 ± 2.14 SD. No significant difference in attitude was observed in between two groups (P < 0.05), and the mean score of attitude on organ donation among medical students of 48.82 ± 7.74 SD was slightly higher when compared to nonmedical group of 47.97 ± 8.74 SD. A study conducted by Schaeffner et al.[9] also reported that the knowledge and attitude of medical students toward organ donation was high when compared to the nonmedical group. Furthermore, studies conducted by Singh et al., Gauher et al., Bapat et al.,[20],[19],[7] Tokalak et al.,[21] Ramadurg et al.[22] had reported that lack of knowledge and awareness about organ donation is the major barrier for organ donation.

While studies conducted earlier reported that not all people with knowledge and awareness have enough motivation for donating organs or registering themselves for donation,[13] results from this study revealed a positive correlation between knowledge and attitude in both medical (r = 0.189) and nonmedical groups (r = 0.21). This indicates that with the increase in knowledge toward organ donation, students' attitude toward donation may increase, that may further increase the number of people ready to sign organ donation policy.

The mean knowledge and attitude scores of students, who were found positive in their practice toward donation, were high when compared to students who were found negative in their practice toward organ donation [Table 4]. Significant difference was observed between practice toward organ donation, knowledge, and attitude level; however, no significant difference observed between medical and nonmedical groups' practice toward organ donation.

Unlike the results from NW Ohio university study,[14] the current study results revealed that with the increase in knowledge toward organ donation in both groups, the students' attitude toward organ donation increases that may further increase the number of people ready to sign the organ donation policy. From [Table 4], percentage of students found positive in their practice toward donation (those having donor cards and those who are willing to donate) were 35.5% (213/600) of the cohort population, while those who are strictly against donation were 9.5% (57/600). The remaining cohort of 55% (330/600) falling under “not-decided” category can be considered as window of opportunity which can be tapped into positive category through meticulously designed knowledge, awareness and sensitization campaigns.

The study also tried to look into other major barriers to organ donation. Surprisingly, a big percentage of participants think religious beliefs to be the biggest reason for not donating organs. The study carried out by Reddy et al.[4] also reported that unlike the actual religious literature which support altruistic behaviors there were many misconceptions based on false religious beliefs restricting organ donation. Hence, a suggested remedy to this lack of awareness can be to distribute the literature in religious gatherings and get people motivated by religious leaders over benefits of organ donation and transplantation. Since most religions have very strong stand and belief systems on life and death people will undoubtedly feel comfortable in thinking and discussing over the issues pertaining to death and cadaveric organ donation in these forums.

Fear of death and departing from their loved ones, failure to get a positive consent from one's family, possessiveness for one's own organs, and fear of misuse accompanied with fear of illegal trafficking of organs are some of the other reasons holding back people from donating organs. There must be other factors intimidating minds of people that need to be looked into, studied and analyzed before making any policy amendments toward increasing donation rates. A continuous process of education and motivation is required not only among the general population but also among healthcare professionals, to overcome these barriers; and popular sources of information as identified in the survey, such as television (71%), newspaper (38.5%), and medical practitioners (33.7%) can be roped in for appropriate advocacy.

Countries having presumed consent were observed to have much higher rates of OD as compared to countries with informed consent.[16],[17] One of the researches evaluating how countries increase organ donation, Sydney Lupkin recognizes “opt-out policy” to be the reason behind Spain's success.[15] Analyzing results toward the adoption of presumed consent policy in India, 64% of students among the medical group showed positive response as against nonmedical students where only 49% students were in favor of endorsement of this policy. This, in a way, can also be interpreted as medical students being more open and eager to find drastic ways to promote and improve ODRs.

There have been much debates on payments for OD in the form of compensations, reimbursements, gifts, etc., and such gestures are highly criticized by experts and legal authorities of most nations. In addition, Government of India's Transplantation of Human Organs Act, 1994 regulates the removal, storage, and transplantation of human organs for therapeutic purposes and prohibits commercial trade of human organs to protect the human rights of poor and marginalized section of society and prevents the poor people from becoming victims into the hands of illegal organ trade. The study still tried to look into population perception on donor acknowledgment in the form of monetary incentives [Figure 3]. Among the study subjects, 89% among the medical and 76% among the nonmedical group responded in favor of providing monetary incentives to the donors which are in contrary to study conducted by H. El-Shoubaki et al.[23] where the public was against monetary incentives; however, the later was conducted in high-income nation. Incentivization issue, though sensitive one, however, demands for more expert discussions and regulations which can protect the rights of poor and weaker sections of the society, simultaneously acknowledging the altruistic demeanor of individuals and families which come forward to save the lives of people at risk. This acknowledgment may not restrict itself regarding monetary benefits but can be explored through other forms of certification, recognitions, tax benefits or coadoption with other government schemes.{Figure 3}

 Conclusion



On account of observing a positive correlation between knowledge and attitude, it can be suggested that a well-designed and structured awareness campaign has the potential to alter neutral and negative attitudes of people into positive, and can motivate more people to register for organ donation. Religious leaders and renowned community figures can play a vital role in mobilizing the population toward organ donation. A continuous process of education and motivation done through most accepted and identified advocacy channels such as television and newspapers can also bring a significant change in the behavior patterns of population.

A considerably good percentage of population in both the groups especially the medical, supported policies such as adoption of presumed consent and donor acknowledgment, indicating a sensitized and aware population that is not only open but also eager to adopt innovative ways and methods to increase ODRs.

However, all the barriers in the form of fears and misconceptions in the minds of people need to be looked into, studied and analyzed before making any policy amendments toward increasing organ donation. Hence, more and more studies, population-based surveys and expert group discussions need to be conducted to work on innovative approaches toward increasing the country's ODR and hence saving millions of lives on the waiting lists for organ transplantation.

Limitations of the study

Since only students were participated in this study, the results cannot be generalized to the population. In addition, nonrandomization can lead to sampling or selection bias. Further, there can be biasness in the responses of the participants.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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