A Study to Assess the Knowledge, Attitude and Misconceptions regarding Organ Donation after Brain Death among common People in Rural Areas
Mr. Deepu Prasad1*, Ms. Prasasya C R1 , Ms. Neethu Philip1, Ms. Jyothi T Babu2
1Lecturer, Amrita College of Nursing, Amrita Institute of Medical Sciences (AIMS), Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
22nd Year Post Basic B.Sc. Nursing Students, Amrita College of Nursing, Amrita Institute of Medical Sciences (AIMS), Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
*Corresponding Author’s Email: sdaljit473@gmail.com
ABSTRACT:
Demand of organs for transplantation continues to exceed the limited supply all over the world. This gap of demand and supply is themain obstacle to transplantation. There is lack of awareness and correct knowledge among public and there are many misconceptions surrounding organ donation leading to hesitancy in donating organs. In the western world, 90% of donations are from brain dead donors and only 10% are from living donors. Currently in India, about 95% of all the transplants are living donations and just 5% are from brain dead. The present study intends to assess the knowledge, attitude and misconceptions regarding organ donation after brain death among common people in selected rural areas . Methodology: A quantitative cross sectional design with convenience sampling was used. Knowledge, attitude and misconceptions of 100 people were assessed using a structured knowledge questionnaire, Five point Likert and structured dichotomous questionnaire respectively. Major findings: Majority of the samples were in the age group 41-50 years (27%) and higher proportions (80%) and them were females. Regarding the educational status, majority (35%) was having higher secondary education and 21% of the samples were graduates. Only 5% of samples have good knowledge level regarding organ donation after brain death and majority (70%) has average knowledge. The mean knowledge score is 10.03 +/_ 3.373 (max score =20). It is interesting to note that one by third (25%) of the people has poor knowledge about organ donation after brain death. Even though the knowledge level is poor, nearly half of the subject (45%) has good attitude regarding organ donation. Majority of the study participants (54%) has average attitude towards organ donation after brain death. The mean attitude score is 38.1+/- 4.461 (max score=50). Regarding the various misconceptions about organ donation after brain death, 40% of the samples think that the mind of the recipient will change if we transplant the heart. Half of the people (50%) believe that organs of a female cannot be transplanted to a male. 64% of the study participants feel that there is a chance to misuse the donated organs. Nearly half of the people (44%) believe that treatments are available to reverse the brain death. Conclusion: Assessment of knowledge, attitude and misconceptions on organ donation is essential for better understanding of the community on different aspects of organ donation. This study implies the need for intensified and sustained education campaign to raise the knowledge on organ donation after brain death and thereby removing the hurdles behind organ donation.
KEYWORDS:. Attitude, Knowledge, Misconceptions, Organ donation, Brain death.
INTRODUCTION:
Organ donation is defined as the removal of tissues from the human body, from a living or dead person, for the purpose of transplantation as a treatment1. Organ transplantation is the most preferred treatment modality for end stage organ disease and organ failures2. Organ transplants save thousands of lives every year. The success of transplants surgery has improved remarkably. It offers a better quality of life and also has better long term survival benefits3.
Brain death is the total and irreversible loss of all brain function and the circumstances under which the donation of vital organs most commonly takes place. Brain death occurs in patients who suffered a severe injury to the brain. As a result of the injury, the brain cells and obstruct it’s own blood supply causing brain tissue to die and permanent loss of brain function. However the vital organ such as heart, lungs, liver, pancreas and kidneys can be kept viable for a few days if supported by artificial or mechanical support. Because life support machine maintain the persons breathing and heart rate, they are warm to touch. This gives the illusion to the family members that the person is still alive. Family members may hold a falls hope that the persons is just comatose and could wake up with time or treatment. But it is during this time, the family members should understand the meaning of brain death can opt for donating the vital organs of dead persons to an end stage patient who is waiting for a second chance at life. But due to the lack of knowledge of people, patient deemed fit for transplantation by the transplant team often wait expectantly for a donor organ or these patients may die while waiting for that gift of life.
The era of clinical organ transplantation began in 1954 when Joseph Murray transplants a kidney from one identical twin to another. Following which, worldwide organ transplantation saves thousands of lives. But the issues of organ donation is complex and multifactorial involving medical, legal, Ethical, Organisational and social factors. According to WHO; kidney transplants are carried out in 91 countries. Around 66,000 kidney donations, 21,000 liver donations 6000 heart donations were transplanted globally in 2005. But still there is an increasing disharmony between the no of patients on the waiting list for the organ transplantation and the available number of deceased donor organs.
According to WHO, with rise in case of kidney disease and renal failure, there are 2,00,000 people on waiting lists for kidneys. Organ shortages are a global problem, but Asia lags behind much of rest of the world. Organ donation following brain stem death is infrequent in India. The current organ donation for cadaver in India is 0.08 per million while Spain tops the list with 35 per million. There is a huge shortage of organs in India, and the patients die while on the waiting list as they do not get an organ on time. Only 5% of all patients with end stage kidney disease are successfully in undergoing kidney transplantation. The current demand in the country for kidney transplantation is 1,50,000, liver 2,00,000 and heart 1,50,0004.
Statistics show that Australia has 11 organ donors per million, Britain has 27, Canada has 14, Spain has 35.1 donors, U.S.A has 26 donors per million where as India has only 0.08 donors per million population. The annual deaths are approximately 5,00,000 because of non-availability of organs of whom 2,00,000 people die of Liver disease, 50,000 people die from heart disease5. At least 1,50,000 people await for kidney transplant but only 5000 get organs and almost 1,000,000 lakh people suffer from corneal blindness and await transplant. According to a study in 2009, India ranked second in the world in live related kidney transplants but only 40 in the total number of transplants6.
From the statistics, it is a clear that, in India there is a great need for human organs as there is critical shortage of the same for transplantation. The shortage in organ supply is due to lack of awareness and correct knowledge among public, myths and misconceptions surrounding organ donation due to religious and cultural barriers leading to hesitancy in donation of human organs6. The greatest impediment to organ donation after brain death is the refusal of family consent. Organ donation rates could be increased by enhancing the quality of hospital care and ensuring that the request for donation is handled in a way that meets the families informational and emotional needs.
A study conducted in Chennai, to assess the knowledge, attitude and practice about organ donation among college students reveals that, though all the participants were aware of the term organ donation, knowledge about different aspects was low. 86.1% were not aware legislation 75% respondents were in favour of organ donation, but only about 2% were registered for organ donation7.
Health care providers play a key role in educating the public and act as a critical link to engage the community members in spreading the awareness to the public. Thus understanding their knowledge, attitude and misconceptions regarding organ donation after brain death will help to identify the gaps and provide training on organ donation. In this context the present study was conducted to evaluate the knowledge, attitude and misconceptions about organ donation among people.
MATERIALS AND METHODS:
A quantitative cross sectional design with convenience sampling was used. Knowledge, attitude and misconceptions of 100 people selected were assessed using a structured knowledge questionnaire, Five point Likert and a structured dichotomous questionnaire respectively. Both descriptive and inferential statistics were used to analyse the data collected, Frequency distribution and percentage was used to calculate demographic data, level of knowledge, attitude and misconceptions. Association between variables were computed using chi -square analysis.
RESULTS:
Sample characteristics based on demographic profile.
Table 1: Distribution of subjects based on socio – demographic characteristics (n=100)
Socio-Demographic variables Percentage
1. Age in years
a) 20-30 25
b) 31-40 17
c) 41-50 27
d) 51-60 20
e) >60 11
2. Gender
a) Male 20
b) Female 80
3. Religion
a) Hindu 73
b) Christian 23
c) Muslim 2
d) Others 2
4. Education
a) Illiterate 0
b) Primary 25
c) High school 18
d) Higher secondary 35
e) Graduate
5) Occupation
a) Government sector 14
b) Private sector 10
c) Self employee 9
d) Unemployment 56
e) Retired 2
f) Student 9
6) Type of family
a) Nuclear 81
b) Joint family 19
7) Family income
a) Below Rs5000/- 79
b) Rs5001 - 10000/- 14
c) Rs10001 - 15000/- 6
d) > Rs15000/- 1
Knowledge level of people regarding organ donation after brain death
Figure 1: knowledge level of people regarding organ donation
Attitude regarding organ donation after brain death
Figure 2: Attitude regarding organ donation after brain death
Major Misconceptions about Organ Donation after Brain Death
Table 3: Misconceptions about organ donation after brain death (n=100)
|
Sl. No |
Misconceptions |
Percentage of people |
|
1. |
If heart is transplant, can change one’s mind |
40% |
|
2.
|
If your loved one is in a coma does that mean they are in brain dead |
43% |
|
3. |
There is treatment available to reverse brain death |
44% |
|
4. |
The organs from a female brain dead donor cannot transplant to a male recipient |
50% |
|
5. |
The person with alcoholism and smoking can donate organs after brain death if organs are in good condition |
25% |
|
6. |
Organ donation after brain death is disfigures the dead body |
35% |
|
7. |
ABO compatibility is necessary when transplant an organ after brain death |
13% |
|
8. |
A doctor can create brain death artificially and according to his will |
37% |
|
9. |
The donated organs can be sold and misused by hospital authority |
64% |
|
10. |
The donated organs after brain death should transplant immediately as early as possible |
10% |
Association between knowledge of the people with selected demographic variables
Table 4: Association between knowledge of the people with selected demographic variables
|
Demographic Variable Poor Average Good Total Chi- Square value |
Age
20 – 30 5 18 2 25
31 - 40 3 12 2 17 0.465
41 - 50 5 21 1 27
51 - 60 8 12 0 20
>60 4 7 0 11
Sex
Male 7 12 1 20 0.507
Female 18 58 4 80
Religion
Hindu 18 51 4 73
Christian 5 17 1 23
Muslim 0 2 0 2 0.315
Others 2 0 0 2
Education
Illiterate 0 0 0 0
Primary 14 10 1 25
High school 3 15 0 18 0.001*
Higher secondary 6 28 1 35
Graduates 2 17 3 22
Occupation
Govt. service 2 12 0 14
Private Service 4 5 1 10
Self – employed 4 5 0 9 0.441
Unemployed 14 39 3 56
Retired 1 1 0 2
Student 0 8 1 9
Type of family
Nuclear family 20 57 4 81 0.986
Joint family 5 13 1 19
Income
Below Rs 5000/- 19 56 4 79
Rs5001 – 10000/- 6 7 1 14
Rs10001 – 15000/- 0 6 0 6 0.452
Above Rs15000/- 0 1 0 1
|
⃰ P value <0.05 was considered statistically significant |
Association between attitudes of the people with selected demographic variables
Table 5: Association between attitudes of the people with selected demographic variables
Demographic Variable Poor Average Good Total Chi- Square value
Age in years
20 – 30 1 12 12 25
31 - 40 0 8 9 17
41 - 50 0 20 7 27 0.046*
51 - 60 0 15 5 20
>60 0 11 0 11
Sex
Male 1 14 5 20 0.103
Female 0 52 28 80
Religion
Hindu 0 50 23 73
Christian 1 15 7 23
Muslim 0 0 2 2 0.253
Others 0 1 1 2
Education
Illiterate 0 0 0 0
Primary 0 22 3 25
High school 0 12 6 18 0.181
Higher secondary 1 21 13 35
Graduate 1 10 11 22
Occupation
Govt. service 0 11 3 14
Private Service 0 7 3 10
Self – employed 0 5 4 9 0.871
Unemployed 1 37 18 56
Retired 0 2 0 2
Student 0 4 5 9
Type of family
Nuclear family 1 56 24 81 0 .311
Joint family 0 10 9 19
Income
Below Rs5000/- 1 49 29 79
Rs5001 – 10000/- 0 11 3 14 0.871
Rs10001 – 15000/- 0 5 1 6
Above Rs15000/- 0 1 0 1
|
⃰ P value <0.05 was considered statistically significant |
DISCUSSION:
Table 1 shows that among the selected population majority belongs to the age group 41 - 50 years (27%) and 20 - 30 years (25%). Regarding gender, 20% were males and 80% were females. Most of them belong to Hindu religion (73%). Regarding educational status, majority (35%) was having higher secondary education and 21%of the samples were graduates. As far as occupation is concerned 56% of them are unemployed 14% are working in government sector and 10% of them were working in private sector. Majority (81%) of them belongs to nuclear family.
A study conducted by Rakesh Shah et al (2015), to assess the knowledge and attitude about organ donation among commerce college students reveals that majority of the study participants were males (73.5%) and majority belongs to Hindu religion. In the present study finding also majority belongs to Hindu religion (73%). But regarding the gender, in the present study majority were females (80%). Similar studies were conducted to assess the knowledge and attitude of college students regarding organ donation in different setting3.
Even though organ and tissue transplantation has become an integral part of health care in every nation, the figure 1 depicts that only 5% of the samples have good knowledge level and majority (70%) has average knowledge. One by third (25%) of people has poor knowledge about organ donation after brain. The mean knowledge score was 10.8 with a standard deviation of 3.373. A similar study conducted by Jose A (2010) to assess the knowledge and attitude regarding organ donation among 200 adults in Bangalore. The finding shows that majority (52.22%) had moderate knowledge, only 5.56 % had adequate knowledge and 42.22% of persons had inadequate knowledge regarding organ donation. The present study findings coincide with the findings of the above quoted study in Bangalore. Assessment of attitude revealed that the majority (50%) had neutral attitude and 6.67% had favourable attitude towards organ donation.8 A study on knowledge, attitude and practices about organ donation among college students in Chennai, Tamil Nadu by Annadurai et al (2012) also highlights the importance of creating awareness among people regarding organ donation. Even though the participants of the study were college students, the knowledge about different aspects about organ donation was low. 86.1% were not aware of legislation.75 % of respondents were in favour of organ donation. When comparing with the results of the present study with the various studies done at International and national level majority of the people lacks knowledge about organ donation even though majority of them were willing to donate organs. This findings shows that there should be intensive health education campaigns to create awareness and to motivate people to donate organs after brain death in order to save many lives.
Even though the knowledge level is poor, the figure 2 highlights that nearly half of the subjects (45%) has good attitude regarding organ donation. Majority of the study participants (54%) has average attitude towards organ donation after brain death. And only one subject is not favour of organ donation. The mean attitude score was 38.1 with a standard deviation of 4.461. A cross sectional study was conducted by K KManojan, Ramiz Raja and Vincy Nelson to assess knowledge and attitude towards organ donation in rural Kerala. It was published on February 5, 2014 in Academic Medical Journal of India. In this study majority (97%) of the participants had hear about organ donation but only 53% had a good knowledge, 48% had poor attitude towards being an organ donor. 50% thought that live organ donation can cause severe health problems. This finding contradicts with the present study findings. In the present study, even though only 5% had good knowledge about organ donation, 45% of the study participants had good attitude towards organ donation. But in the above quoted study, even though the knowledge level is high, the attitude of people towards organ donation is poor9. A cross sectional study was conducted by PrasannaMithra, Prithvishree Ravindra and other group members on perceptions and attitudes towards organ donation among people seeking health care in tertiary care centres. This study included 863 people seeking general healthcare as outpatients. This study published in Indian Journal of palliative care in August 2013. Overall, 59.6% participants showed the willingness to donate organs. Females (64.1%) and participants from upper socio economic status (62.7%) had higher willingness rates for organ donation. Hindus (63.6%) and Christians (63.3%) had higher willingness rights for organ donation than Muslims (38.2%). Also, 23.7% participants showed willingness to donate eyes and 33.6% wished to donate any organs after death. The findings of the present study also highlights that majority of the females are willing to donate the organs10. In the light of present study and result from the other studies, it can be concluded that the reason for higher level of attitude towards organ donation is due to the effect of mass media. It might positively influence the attitude of people towards organ donation after brain death.
Regarding the various misconceptions about organ donation after brain death, table 3 shows that 40% of the samples think that mind of the recipient will change if we transplant the heart. 50% of people believe that organs of a female cannot be transplanted to a male. 64% of the study participant beliefs that there is a chance to misuse the donated organs. Nearly half of the people (44%) beliefs that treatments are available to reverse the brain death. Michelle J. Irving, Allison tong, Stephen jan, Alan cass conducted a study to assess the factors that influence to the decision to be an organ donor it is an qualitative study that explore community attitudes towards living and deceased solid organ donation. The sample size was 1019 the decision to be an organ donor was influenced by relational ties, religious beliefs, cultural beliefs, family influences, body integrity, previous interaction with the health care system-medical mistrust, validity of brain death and fear of early organ retrieval, the individual knowledge about the organ donation process, major reservation about the process of donation. The review of qualitative study highlights that some intractable such as religion and culture, are often tied in more complex issues such as distrust of the medical system. Misunderstanding about religious beliefs and ignorance of donation occurs. Some religious beliefs obtained “I don’t want have of my body buried and half to go to heaven (90%)”. “After you die, you may go to another world. If you don’t have an eye, you cannot see”. Some cultural beliefs are generally concerned broader issues around health care, death and dying. Often these were based on superstition, including beliefs that discussing death of signing a donor card would lead one’s on death11.
The statistical analysis of present study showed in table 4 reveals that there is a significant association between education and knowledge level of people. (p< 0.05). There is no significant association between attitude of people with any of the demographic variables except age (p <0.05). A descriptive study was conducted by Taimur Saleem, Sidra Ishaque, Nida Habib and others (2009) on knowledge, attitude and practices survey on organ donation among a selected adult population on f Pakistan. Convenience sampling was used to generate the sample of 440. Data collection was carried out via face to face interview pretested questionnaire. Knowledge about organ donation was significantly associated with education (p=0.000) and socioeconomic status (p=0.038). 70/198 (35.3%) people expressed a high motivation to donate. Multiple logistic regression analysis revealed that higher level of education and higher socio economic status were significant (p<0.05) independent predictors of knowledge status of organ donation. In the present study, there is no significant association between knowledge levels with any other demographic variables12.
This study found out that even though there was the willingness for organ donation the knowledge regarding the same was lacking. In India, there is a significant demand for organ donation in spite of availability of organs. The implication of this study is to emphasize the need for educating the public about organ donation after brain death.
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Received on 16.06.2016 Modified on 30.06.2016
Accepted on 27.07.2016 © A&V Publication all right reserved
Int. J. Adv. Nur. Management. 2016; 4(3): 203-208.
DOI: 10.5958/2454-2652.2016.00047.0