|Year : 2000 | Volume
| Issue : 2 | Page : 98-105
Attitudes of health care professionals towards organ donation
Amalraj R Edwin, D Raja
Department of Epidemiology, The Tamil Nadu Dr MGR Medical University, Chennai, India
Amalraj R Edwin
Dept. of Epidemiology, The Tamil Nadu Dr. MGR Medical University, 40, Anna Salai, Guindy, Chennai - 600 032
| Abstract|| |
This study aims to assess the awareness and attitudes of health care professionals towards organ donation. 691 medical students participated in the study. There were 595 undergraduates, 65 interns and 31 postgraduate students.
The general consensus was that there is a need for organ donation. 75% of the participants were able to understand the concept of brain death. The definition of brain death was not known to 20%. None of the participants had complete knowledge as to who should authorize brain death as stated in the "Transplantation of Human Organs Bill". 20% emphasized the need for the presence of a neurologist/neurosurgeon, along with other qualified personnel, in a team to certify brain death. It was noticed that participants committed to organ donation encouraged their friends and relatives to donate their organs. They agreed that organ donation should be included in the medical curriculum.
The study reveals that there is a poor understanding of the concept of brain death and organ donation even among medical students. It was also observed that they were interested in knowing more about the subject of organ donation.
Keywords: Organ Donation; Medical Students; Knowledge; Attitude; Brain Death
|How to cite this article:|
Edwin AR, Raja D. Attitudes of health care professionals towards organ donation. Indian J Urol 2000;16:98-105
| Introduction|| |
The Transplantation of Human Organ Bill (1993) introduced in the House of Parliament in India provides for the regulation of removal, storage and transplantation of human organs for therapeutic purposes, to prevent commercial dealings in human organs and for matters connected therewith or incidental thereto. Brain death in the Bill is defined as the stage at which all functions of the brain stem have permanently and irreversibly ceased. Health care providers need to have a better understanding of their role in organ donation so as to encourage and motivate the public in general and the family members of patients with brain stem death, in particular, towards organ donation. This should be done in order to save the lives of many patients with organ dysfunctions.
Two reasons motivated this study. Firstly, in the short period of time after the introduction of the Bill in India, it was observed from local news reports that the understanding of brain death differs among doctors and a controversy arises in declaring a patient as "brain dead". In order to harvest the organs of the brain dead patients, doctors should be in a position to access the end stage "window time" of the brain death and initiate steps to motivate the family members of the brain dead person for organ donation. Reports ,,,, in these aspects were available on different segments of health care providers from other countries. Secondly, the Tamil Nadu Dr. MGR Medical University in Chennai, South India is about to start a computer-based Central Organ Registry with the leading hospitals in the city to be connected by network to assess the details of both donors as well as patients with organ dysfunction. Interns and postgraduate doctors who are in charge of the patient all the time are expected to understand all the aspects of the Transplantation of the Human Organ Bill and also to co-operate with the Central Organ Registry. Thus this study was undertaken to assess knowledge, perceptions, attitudes and motivation of medical graduates towards organ donation.
| Material and Methods|| |
Three groups of medical graduates (i) Undergraduates (UG), (ii) Interns, and (iii) Postgraduates (PG) from two medical colleges (a) Kilpauk Medical College, and (b) Sri Ramachandra Medical College in Chennai, Tamil Nadu, participated in this study during mid 1996. No disciplinewise selection was made for the participation.
The questionnaire was designed to test the knowledge of the medical students regarding organ donation.
According to the Bill, brain stem death is certified by the Board of Medical experts consisting of (i) a Registered Medical Practitioner (RMP) in charge of the Hospital, (ii) an independent medical practitioner, being a specialist, to be nominated by the RMP in-charge of the hospital, (iii) a neurologist or neurosurgeon, and (iv) the Registered Medical Practitioner treating the patient.
A semi-structured proforma containing both open ended and structured questions addressed areas such as participants' understanding of the term "organ donation", definition of brain death, medical experts certifying brain death, organs to be donated, organ donation from a living person and the role of the media. This questionnaire was discussed with senior surgeons and pretested on medical students before finalisation.
The data were entered into PC/AT and analyzed through SPSS/PC+. A Chi-square test was used to find out the association between various factors and study groups. A p-value of less than 0.05 was considered significant. Multiple logistic regression analysis was used to identify the participants' knowledge and attitudes associated with his/ her commitment towards organ donation.
| Results|| |
Out of 691 individuals who participated in this study, 595 were UG students, 65 were interns and 31 were PG students. The sex ratio was 1:1 and it was maintained in the other groups except PGs where there were more males than females. 617 (90%) of the students were Hindus, 44 (6.4%) Christians, 18 (2.6%) Muslims and others 12 (1.7%).
The students were asked about their understanding of the term "organ donation" in five different statements. 623 (90.2%) of them said that organ donation was the donation of a normal, functioning part of the human body at the time of the individual's death. 72% of the UG students and 66% of the PG students said that organ donation was donating an organ after death. 61% of the UG students, 74% of the Interns and 84% of the PG students said organ donation was donating a normal functioning part of the human body while the individual is still alive. 42% UG students, 62% Interns and 52% PG students agreed to the statement on donating a portion of the normal functioning organ.
93% participants accepted that there was a need for donating organs. The commonly stated reasons given by the participants were (i) to save a patient, (ii) to help the people in need when the donor is dying, (iii) to make a diseased person normal.
A quarter of the participants could not define the term "brain death". 45% of the students defined it as "brain lost its function, but other organs are functioning normally" and half of them added that other organs were functioning by artificial ventilation which was favored only by 4.2% of the UG students. 25% of the PG insisted on consideration of EEG findings which was not conceivable in the minds of the UG students. 45% of the UG students, 28% of the Interns and 13% of PG students gave a vague definition such as "brain tissue death" or "brain lost its function" or "coma" or "loss of consciousness" or "vegetative existence" [Table 1].
One third of the participants, most of them UG students, did not know who formed the Board of Medical Experts as stipulated by the Govt. to certify brain stem death. 20% of the UG students, 14% of the Interns and 62% of the PGs indicated that either a neurosurgeon or neurophysician, independently or jointly with other medical officers, declare brain death. Some of the participants (27% UG students, 34% Interns and 16% PGs) have written that a team or committee of doctors or panel should certify brain death [Table 2].
30% of UG students did not express their opinion on who should certify brain death. 20% of the UG students, 17% of the Interns and 42% of PGs suggested that either a neurophysician or neurosurgeon, independently or jointly with other medical officers, should certify brain death. 15% of UGs and 29% of the PGs suggested that either a Medical Officer or attending physician or famiy doctor can still diagnose brain death. 30% of the participants said that a committee of doctors should certify brain death [Table 2].
Only 12% of the participants felt that religion was an obstacle for organ donation. Half the UGs and three fourths of the PGS said that they had already discussed organ donation with family members. Almost all the participants knew about eye and kidney donations. Around 80% of the participants said that the heart and liver could be donated too. Half the participants said skin could be donated. 50% of Interns and PGs as against 22% of UG students knew about lung transplantation [Figure 1]. Blood as a transplantable organ was not mentioned.
When asked about which organs can be donated even after death, 88% of the participants mentioned the eye, 33% kidney and 27% liver.
Three fourths of the participants said that live donation should continue. As to who should counsel family members on cadaver donation, 185 (31%) participants favored only the team of doctors certifying brain death and 259 (43%) the attending physician or family doctor while 123 (21 %) participants thought that it should be the team of doctors involved in treating the patient who should counsel the family members.
641 (93%) participants admitted that they would encourage their friends and relatives to donate organs and also felt the need of awareness and education on this subject. The participants have suggested that the media such as TV, radio, newspaper, public meetings, religious meetings, in this order, could be used effectively to educate the community on organ donation [Figure 2].
90% of the participants felt that including a subject of organ donation in the syllabus of the undergraduate medical course would be welcome. 38% of UG students, 54% Interns and 61 % PGs committed to donating an organ. 14% of UG students, 4.6% Interns and 7% PGs did not commit to donating an organ. The rest were neutral [Figure 3].
90% of the participants welcomed the method of carrying a donor card, as in western countries, permitting organ donation at the time of death or in a death due to an accident. The participants who were committed towards organ donation wanted the continuance of live donations and said they would encourage friends and relatives in organ donation. This was not so with the participants who were not committed (p<0.05). All participants, irrespective of their commitment to organ donation, felt that the community needed to be educated on this subject. A significantly higher proportion of participants committed to organ donation in each educational category would like to see organ donation in the curriculum of undergraduate medicine. The non-committed participants (83%) did not think so [Table 3].
The multivariate analysis taking into account all the independent variables was performed. The factors that were most significant in having a positive attitude to organ donation (as shown by the commitment on the part of the individual to donate organs) were knowledge and understanding of what constitutes brain death, an awareness of the need for educating the public, and a desire to have the subject included in the medical curriculum.
| Discussion|| |
This study, Attitudes of Health Care Professionals towards Organ Donation, was undertaken to evaluate the level of understanding of the various aspects of brain death and organ donation among medical personnel. Various questions were put forward to the participants on terms such as "Organ Donation", "Definition of Brain Death", "the certifying team" and the sociocultural aspects of Organ Donation.
It is noticed that there is a variation in the definition of brain death among the participants. Postgraduates emphasized the need for an EEG and 50% favored the use of a ventilator to sustain other organs; this was supported by 4.2% of undergraduates. There is varying opinion on the donation of organs after death and donation of a part of a normal functioning organ.
Information about who should certify brain death was varied. Most felt the need for a neurophysician/neurosurgeon. 30% of the participants favoured a panel of experts to certify brain death. They also felt the need for a family doctor to play a vital role in encouraging relatives of the dying/dead patients to donate organs.
There is a need for increasing and improving awareness and stressing the importance of brain death and organ donation respectively. This can be achieved through newspaper, radio, television, religious meetings and discussions among family members and friends. This will help overcome cultural and religious stigmata (12% felt that religion was an obstacle). Enhanced public awareness of the need for transplants was seen as the most important means of increasing organ harvest.  Donor cards have been used in western countries to encourage awareness and practice of organ donation. Six percent of the Spanish population  and 5% of the Swedish were carrying donor cards.  After an intensive campaign to promote organ donation by distributing brochures, the rate increased threefold in the following year in the same countries. It indicates that individuals who are aware of organ donation may come forward to donate organs. Thus organ donation ought be made by the person before death.  This also helps in removing myths about ventilating patients with a hopeless prognosis. Some felt that many of the problems faced by the kith and kin of the patients can be overcome by using donor cards. An intensive public awareness compaign should be launched periodically.
The finding from the multivariate analysis that knowledge and understanding of brain death was thus the single factor responsible for a positive attitude towards organ donation is significant. It suggests that more emphasis should be placed in the medical curriculum on brain death and organ donation.
Inclusion of organ donation in the medical curriculum was welcomed by the majority of the participants. It would help physicians to gain access to viable organs during the crucial window period and also to remove incorrect assumptions about the medical suitability of organs.
| Acknowledgement|| |
We are grateful to the Dean of Sri Ramchandra Medical College & Research Institute and the Dean of Kilpauk Medical College, Chennai for permitting us to carry out this study. I also thank Dr. N.M. Samuel and the staff of Experimental Medicine for their assistance with the questionnaire development and to Dr. Manjula Datta, Professor and Head, Dept. of Epidemiology of this Medical University, and Dr. JR. Sankaran, former Professor and Head, Dept. of Internal Medicine, Madras Medical College, Chennai, for their valuable suggestions to improve the manuscript.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]