Research Article
Attitude of the Community towards Organ Donation
Güzide Özdemir, M. Ahmet Denizli and Alp Gürkan*
Department of Organ Transplantation, Çamlıca Medicana Hospital, Istanbul, Turkey
*Corresponding author: Alp Gürkan, Department of Organ Transplantation, Çamlıca Medicana Hospital, Alemdağ Cad. No: 113 Üsküdar, Istanbul, Turkey
Published: 21 Aug, 2017
Cite this article as: Özdemir G, Denizli MA, Gürkan A.
Attitude of the Community towards
Organ Donation. Clin Surg. 2017; 2:
1598.
Abstract
Objective: Identification of attitudes related to organ donation helps achieving a better understanding
of willingness for individuals about donation.
Method: We surveyed dialysis patients (group 1), relatives of dialysis patients (group 2) and
patients hospitalized for different reasons (group 3); about their opinions for organ donation, their
educational and economic status. Their educational status was categorized according educational
parameters from illiterate to university degree; as economical parameters 5 categorizations were
made with intervals of 1000TL (Turkish Lira).
Results: Positive answers to question on accepting a deceased organ were 74.7, 82.3 and 79.8%
in groups 1, 2 and 3, respectively (p= 0.081). Willingness for donation of organs in occurrence
of brain death were 62.1, 58.21 and 63.64% in groups 1, 2 and 3, respectively (p= 0.170). Positive
answers to question about donating a relative’s organs were 48.4, 64.7 and 55.5% in groups 1, 2 and
3, respectively (p= 0.382). Answers to question about accepting organ donation came out to be “yes”
55.5% in illiterate group; while this rate tended to increase as level of education went higher.
Conclusion: There were no significant differences about the willingness for organ donation among
three groups. This perspective tended to be positive in percentage as level of education went higher.
Keywords: Deceased donor; Organ transplantation; Organ donation
Introduction
The worldwide lack of organ donors creates an imbalance between the urgent need for
transplants and the number of transplantations performed, as it is in Turkey [1,2]. The formation
of a trusting attitude towards organ donation within a society increases the willingness to donate
organs and thus is a key to future success in the field of transplantation [3,4]. The identification of
specific areas of knowledge, attitudes and perceptions related to kidney donation helps to achieve a
better understanding of variations in willingness to donate.
Although many surveys have been done among medical staffs, medical students and community
about willingness of organ donation [2-4], there is no study have been performed among dialysis
patients and their relatives. The objective of this study is to examine the attitudes of Turkish people
with different social-economic and education levels, dialysis patients and their relatives, and healthy
persons as well, towards organ donation. We investigated the education level, income status and
perspectives in case organ transplantation would be necessary for themselves or their relatives in
groups including dialysis patients (group 1), relatives of dialysis patients (group 2) and patients
hospitalized for different reasons (group 3).
Material and Methods
Within the time frame between November 2014 and February 2015, we have surveyed 3 groups
of patients about their opinions for organ donation, their educational and economical status. The
survey has been done by our organ coordinator (GO) face to face. In group 1; 99, in group 2; 17 and
in group 3; 95 patients were enrolled in this study. Their educational status has been categorized
according to educational parameters as; illiterate, be literate, elementary, middle, high school
graduates and having a university degree; as economical parameters 5 groups of categorization were
made with intervals of 1000TL from 1000 to over 5000TL (Turkish Lira).
Age and gender were found to be statistically similar among the three groups (Table 1 and
Table 2). The educational status of group 3 was concluded to be lower than the others (Table 3).
The educational status of the group 1 patients tended to be higher compared to the rest (p= 0.001).
Group 3 patients' education level was lower (18.18% illiterate, 12.12% literate, 43.43% elementary school graduate) than dialysis patients (27.37% high school, 28.42%
university graduate). The educational status of the group 2 was found
to be evenly distributed compared to the other groups. Economic
status was found to be statistically insignificant (Table 4).
Table 1
Table 2
Statistical Analysis
Data were analyzed using the SPSS 16.0 statistical package (SPSS Inc., Chicago, IL, USA). Pearson's chi square tests were used. The Mann Whitney test was used to test the difference of the percentage distributions in gender, age and education. P-values < 0.05 were considered as statistically significant.
Results
The answers to the question on accepting an organ from a
deceased donor were positive in 79.80% of the group 3, 74.74% in
group 1 patients and 82.35% among group 2 (p= 0.081) (Table 5). The
answers for the question on whether to donate their organs in case of
occurrence of brain death were “yes” 63.64% in the group 3 patients,
62.11% in the group 1 patients and 58.21% in the group 2 (p= 0.170)
(Table 6). The answers to the question about donating a relative’s
organs came out to be positive 55.56% in the group 3 patients, 48.42%
in group 1 patients and 64.71% among the group 2 (p= 0.382) (Table
7)
The answer to the question about accepting an organ donation in
case of necessity came out to be “yes” 55.56% in the illiterate group;
while this rate tended to increase as the level of education went higher
(Table 8).
The rate of the willingness for organ donation in case of brain
death, increased as the level of education went higher. The answers
to this question among illiterate people were found to be 29.63%
“yes” and 51.85% “no”. The answers of college graduates were found
to be 66.67% “yes” and 8.33% “no” (p= 0,0000) (Table 9). There is
a significant difference among the groups with different education
levels for the answers given to the question about the donation of
relatives’ organs in occurrence of brain death. As the education level goes higher, the rate of positive answers to this question also shows a
tendency to increase (p= 0.007) (Table 10).
The answers to the questions “would you accept a diseased organ”
(p= 0.347) (Table 11) and “would you donate your organs in case
of occurrence of brain death” (p= 0.147) (Table 12) did not show a
statistically significant difference among different income groups. The
rate of positive answers to question “would you donate the organs
of relatives in case of brain death” went higher as the income levels
increased (p= 0.047) (Table 13). Here the difference is created with the answers given by the group having the lowest income (0–1000
TL).
Table 3
Table 4
Table 5
Table 6
Table 7
Table 8
Table 9
Table 10
Table 10
Decision of donation of the organs of the relatives after brain death according to education status.
Table 11
Discussion
The lack of organ donation is a major limiting factor in
transplantation in most countries. Public knowledge of organ
donation, moral consciousness, and social responsibility will be
greatly improved through increased publicity and education. In the
current inadequate supply of organs for transplantation causing
thousands of patients on organ waiting lists to die each year. The donation and transplantation system represents a complex practice
and is dependent on individual attitudes, social structures, cultural
practices and religious beliefs. Western countries have conducted
several studies showing that attitudes towards organ donation and
transplantation are influenced by many factors, including education,
socioeconomic status, culture, and religion.
Family decisions relied heavily on knowledge of the deceased
person’s desire to donate. In cases where the deceased did not specify,
most participants agreed that they would be unwilling to offer their
family member’s organs because of cultural beliefs about the body
and spirit. People generally express favorable views towards organ
donation, very few actually agree to donate before they die or agree
to have family members’ organs donated upon their deaths. So, it is
important to raise awareness about organ donation the persons before
they die. One study found that a predicted final consent rate as high as
93% when the deceased patient’s preference was known, as compared
with 47% when the preference was unknown [5]. Gross et al. reported
that 57% of young people felt that their families were insufficiently
informed of their willingness to donate, and a significantly more
positive attitude towards organ donation was found among people
whose relatives were fully informed of their preference [6].
Efforts to increase donation rates have included public awareness
and professional educational programs. In our study, there was no
significant difference about the perspective on organ donation among
the three groups. This perspective tended to be positive in percentage
as the level of education went higher. The income status of the groups
did not create a difference among the groups on this perspective. It
is also strange that even though the dialysis patients are reluctant to
donate their organs. This might be one of the indicators of lacking
of awareness about organ donation among the community. Family
permission is necessary for organ procurement in our country, and
family objection plays a significant role in the low donation rates.
Since family members are often unaware of the deceased’s preference,
they are likely to reject the request for donation.
Organ donor awareness was high among the total population, with 88% of the sample having some knowledge of organ donation [7]. In
this study, the 25 - 35-year-olds were more aware of organ donation in
general than the other age groups. The willingness to donate an organ
was more problematic. Of the total sample, 36% indicated they would
not donate organs; 33% indicated they might donate organs; and 31%
indicated their willingness to donate organs. Educational levels were
found to be factors that influence the willingness to become an organ
donor. Respondents that had an education further than high school
approximately 33% indicated a greater willingness to participate as
an organ donor. Twenty-eight percent of the sample that indicated
they would not donate organs had less than a high school education.
Maintaining body integrity after death is a common reason for
unwillingness to donate organs [8]. The trust for doctors and the
medical system appears to be crucial with respect to the likelihood
of donating organs. Widespread mistrust in the medical system,
low educational levels, and poor economic situations also serve as
obstacles to organ donation. Therefore, improving publicity and
education efforts is essential in generating positive attitudes towards
organ donation.
Yılmaz collected data on perceptions of organ donation in a
military unit in Turkey [9]. Participants were given a survey on organ
donation, followed by a lecture that answered the questions in the
survey; 2 months after the lecture, they were given the survey again.
The study showed that 84.8% of participants were willing to donate
their organs after attending the lecture on organ donation, as opposed
to the 45.4% willing prior to the lesson (P< 0.001). The author also
found that general knowledge about organ donation increased from
34.8% to 93.7% after participants attended the lecture (P< 0.001).
Another study showed that after receiving an educational
session, students demonstrated a more extensive knowledge of organ
donation, with 31% changing previously held negative attitudes, as
compared with a 7% change in the control group [10].
One of the limitations of this study is the smaller number of
relatives of dialysis patients of the second group compared to the others 2 groups. Additionally, the 1st group had a significant higher
educational status versing the other two. The current results of the
study could be affected by these two variables.
As a conclusion, there is an urgent need to increase the number of
organ sources to meet the ever-increasing demand for transplantation.
Public awareness even among dialysis patients and their relatives
is not sufficient in Turkey. Efforts in advancing knowledge about
organ donation, promoting family discussions, training medical
staff and students, establishing an organ donation incentive system,
and implementing relevant legislation can reshape public attitudes
towards organ donation.
Table 12
Table 13
Table 13
Decision of donation of the organs of the relatives after brain death according to economic status.
References
- Turkish organ donation data 2015; https://organ.saglik.gov.tr/web/
- Newton JD. How does the general public view posthumous organ donation? A meta-synthesis of the qualitative literature. BMC Public Health. 2011;11:791-802.
- Kaiser GM, Heuer M, Stanjek M, Schoch B, Müller O, Waydhas C, et al. Process of organ donation at a maximum care hospital. Dtsch Med Wochenschr. 2010;135(42):2065-70.
- Bardell T, Hunter DJ, Kent WD, Jain MK. Do medical students have the knowledge needed to maximize organ donation rates? Can J Surg. 2003;46(6):453-7.
- Smith SW, Lindsey LL, Kopfman JE, Yoo J, Morrison K. Predictors of engaging in family discussion about organ donation and getting organ donor cards witnessed. Health Commun. 2008;23(2):142–52.
- Gross T, Martinoli S, Spagnoli G, Badia F, Malacrida R. Attitudes and behavior of young European adults towards the donation of organs – a call for better information. Am J Transplant. 2001;1(1):74–81.
- Minniefield WJ, Muti P. Organ donation survey results of a Buffalo, New York, African-American community. J Natl Med Assoc. 2002;94(11):979-86.
- Siminoff LA, Burant C, Youngner SJ. Death and organ procurement: public beliefs and attitudes. Kennedy Inst Ethics J. 2004;14(3):217–34.
- Yilmaz TU. Importance of education in organ donation. Exp Clin Transplant. 2011;9(6):370-5.
- Cárdenas V, Thornton JD, Wong KA, Spigner C, Allen MD. Effects of classroom education on knowledge and attitudes regarding organ donation in ethnically diverse urban high schools. Clin Transplant. 2010;24(6):784–93.