Attitudes of medical students and staff toward organ donation in cases of brain death: a survey at Shiraz University of Medical Sciences Context—Organ transplant is one of the most important management strategies for end-of-life patients. The demand for organs in patients awaiting transplant is increasing, and many of these patients die before a donor is found. Objective—To determine the attitudes of medical students and staff at clinical institutions affiliated with a large medical university in the Eastern Mediterranean region toward organ donation in cases of brain death. Participants—A total of 500 medical students, physicians, and nurses recruited at hospitals and medical centers affiliated with Shiraz University of Medical Sciences in Shiraz, Iran. Design and Setting—Information about participants’ demographic characteristics, knowledge of organ donation, and willingness to donate their own organs after death was collected by using self-administered questionnaires. Results—Most participants (78%) had favorable attitudes toward donating their own organs after brain death. However, only about 25% of them carried an organ donation card. In addition to public media, the main sources of information about organ donation after brain death were their professors and textbooks. An association in charge of improving public awareness and facilitating the process of registration and issuance of donation cards appears to be necessary. (Progress in Transplantation. 2014;24:91-96) ©2014 NATCO, The Organization for Transplant Professionals doi: http://dx.doi.org/10.7182/pit2014248
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nd-stage organ failure can be treated with organ transplant. Because of the increasing number of requests for vital organs, the number of living donors is insufficient. An alternative source of organs for transplant is thus organ donation from individuals in whom brain death or cardiac death has been confirmed.1-3 Brain death is defined as the irreversible loss of all brain functions, apnea, and the absence of brainstem reflexes.4 In these situations, the medical team has sufficient time to accomplish the necessary tests to ensure successful organ transplant. Most brain-dead patients are young people who are injured in an accident; if the desired organs are not physically damaged, they are ideal for transplant. The rate of donation authorized by the next of kin of persons determined to be brain dead is between 65% and 90% in many European countries, with the highest rate in Spain.5 Among Asian countries, Iran is experiencing an increasing rate of organ
Progress in Transplantation, Vol 24, No. 1, March 2014
Mozhgan Zahmatkeshan, MD, Ebrahim Fallahzadeh, MD, Mozhgan Moghtaderi, MD, Khadijeh-sadat Najib, MD, Shirin Farjadian, PhD Shiraz University of Medical Sciences, Iran Corresponding author: Shirin Farjadian, Department of Immunology, Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (e-mail: [email protected]) To purchase electronic or print reprints, contact: American Association of Critical-Care Nurses 101 Columbia, Aliso Viejo, CA 92656 Phone (800) 899-1712 (ext 532) or (949) 448-7370 (ext 532) Fax (949) 362-2049 E-mail [email protected]
transplant, and the transplant center of Shiraz University of Medical Sciences is a referral center for this treatment.6 As in other countries, however, there is a gap between the demand and supply of organs; improving public awareness and encouraging people to donate organs are 2 measures that are being considered to fill this gap. The aim of this study was to determine the attitudes of medical students and staff in Shiraz toward organ donation in cases of brain death. Participants and Methods The participants in this cross-sectional study were recruited from the medical students and staff of Namazi, Shahid Faghihi, and Shahid Dastgheyb hospitals, and Shahid Motahari and Imam Reza medical centers, all of which are affiliated with Shiraz University of Medical Sciences in Shiraz, Iran. We approached undergraduate and recent graduate medical students, physicians
91
Zahmatkeshan et al Table 1 Associations between demographic characteristics and willingness to donate organs after brain death among medical students and staff in Shiraz No. of respondents
Agree
Against
Undecided
Statistics, agree vs disagreea
Sex Male Female
159 341
117 273
22 27
20 41
P = .10, OR = 0.69 0.44 < OR < 1.11
Marital status Single Married
383 117
305 84
37 12
40 21
P = .07, OR = 1.56 0.94 < OR < 2.56
Children Yes No
52 65
36 48
6 6
10 11
P = .58, OR = 0.8 0.33 < OR < 1.93
Mother’s educational level ≤ High school > High school
294 206
240 150
28 21
26 35
P = .02, OR = 1.66 1.06 < OR < 2.60
Father’s education level ≤ High school > High school
178 322
148 242
17 32
13 48
P = .04, OR = 1.63 1.00 < OR < 2.67
Occupation category Medical students Physicians Nurses
340 82 78
269 58 63
32 10 7
39 14 8
P = .21
Demographic information
Abbreviation: OR, odds ratio. a The “disagree” category is the sum of “against” and “undecided” categories.
(residents, fellows, and specialists), and nurses. The survey was approved by the ethics committee of Shiraz University of Medical Sciences in 2010. The data for this study were collected with an anonymous self-administered questionnaire adapted from the instrument used by Rios et al.7,8 The questionnaire was pretested on a random sample of 50 participants to ensure practicability, validity, and clarity. The validity of the questionnaire was assessed with the Kuder-Richardson test for reliability, and internal consistency was assessed by calculating the Cronbach α coefficient. Eight hundred questionnaires were distributed randomly to the medical students and staff of the participating centers, with stratification according to job category. The data for this study were collected between January 2011 and February 2012. The questionnaire consisted of 32 items in 3 categories: demographic information, participants’ knowledge, and opinions regarding consent for organ donation from individuals older and younger than 18 years of age. The items were either yes/no or multiple-choice questions. The estimated time needed to complete the questionnaire was 10 minutes. The data were analyzed with a χ2 test using SPSS version 15, and the α level was set at 5%. Results Of the 800 questionnaires that were distributed, a total of 500 completed questionnaires (62.5%) were
92
returned. Mean age of the participants (159 men, 341 women) was 24.8 (SD, 6.4 years; range, 17-57 years) and all were Muslims. The associations between demographic characteristics and the participants’ willingness to donate their own organs are shown in Table 1. Sex, marital status, and having children had no influence on individuals’ opinions about organ donation. However, a direct correlation was found between mothers’ educational level and willingness to be an organ donor after brain death. In the 3 occupational categories studied here, willingness to donate organs in case of brain death was expressed by 79.1% of medical students (269 of 340), 70.7% of physicians (58 of 82), and 80.8% of nurses (63 of 78). The difference in the proportion of respondents willing to donate organs did not differ significantly among these 3 occupational groups (P = .21). Overall, 78% of the participants had a favorable attitude toward donating their organs in case of brain death. Among the 110 participants who indicated that they would not be organ donors, 49 individuals disagreed with the practice and 61 respondents were undecided. The reasons for refusing to be a donor were described as no specific reason by 73 persons, fear of possible commercial abuse by 13, doubts about the suitability of their organs by 13, and religious rules by 11 persons. Table 2 summarizes the participants’ responses to items regarding their knowledge of and attitudes toward
Progress in Transplantation, Vol 24, No. 1, March 2014
Attitudes of medical students and staff toward organ donation Table 2 Associations between attitudes toward organ donation and willingness to donate organs after brain death among medical students and staff in Shiraz No. of respondents
Agree
Against
Undecided
Statistics, agree vs disagreea
Personal experience with brain death Yes No
73 427
57 333
8 41
8 53
P = .96, OR = 1.01 0.53 < OR < 1.92
Hearing about brain death Yes No
481 19
374 16
47 2
60 1
P = .77, OR = 0.66 0.15 < OR < 2.45
Sufficient knowledge of brain-death criteria Yes No A little
202 72 226
162 50 178
21 8 20
19 14 28
P = .16
Confidence in the diagnosis of brain death by physicians Yes No
420 80
338 52
32 17
50 11
P = .002, OR = 2.22 1.28 < OR < 3.85
Thinking about brain death for yourself Yes No Don’t know
244 48 208
209 32 149
20 7 22
15 9 37
P = < .001, OR = 2.47 1.55 < OR < 3.97
Experience of relatives or friends receiving a donated organ Yes No
55 445
48 342
6 43
1 60
P = .08, OR = 2.07 0.87 < OR < 5.16
Possible request for an organ as a recipient Yes No Don’t know
460 14 26
359 11 20
45 0 4
56 3 2
P = .99
Experience of relatives or friends donating an organ Yes No
46 454
37 353
6 43
3 58
P = .68, OR = 1.18 0.52 < OR < 2.72
Cooperation in voluntary live organ donation Yes No
186 314
152 238
14 35
20 41
P = .12, OR = 1.43 0.89 < OR < 2.3
Awareness and opinion
Abbreviation: OR, odds ratio. a The “disagree” category is the sum of “against” and “undecided” categories
organ donation after brain death. Participants who trusted the diagnosis of brain death by physicians were significantly more likely to donate their organs (P = .002). Respondents who had thought about their own vulnerability to brain death were also significantly more willing to donate their organs than were those who had not given thought to this eventuality (P
E
nd-stage organ failure can be treated with organ transplant. Because of the increasing number of requests for vital organs, the number of living donors is insufficient. An alternative source of organs for transplant is thus organ donation from individuals in whom brain death or cardiac death has been confirmed.1-3 Brain death is defined as the irreversible loss of all brain functions, apnea, and the absence of brainstem reflexes.4 In these situations, the medical team has sufficient time to accomplish the necessary tests to ensure successful organ transplant. Most brain-dead patients are young people who are injured in an accident; if the desired organs are not physically damaged, they are ideal for transplant. The rate of donation authorized by the next of kin of persons determined to be brain dead is between 65% and 90% in many European countries, with the highest rate in Spain.5 Among Asian countries, Iran is experiencing an increasing rate of organ
Progress in Transplantation, Vol 24, No. 1, March 2014
Mozhgan Zahmatkeshan, MD, Ebrahim Fallahzadeh, MD, Mozhgan Moghtaderi, MD, Khadijeh-sadat Najib, MD, Shirin Farjadian, PhD Shiraz University of Medical Sciences, Iran Corresponding author: Shirin Farjadian, Department of Immunology, Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (e-mail: [email protected]) To purchase electronic or print reprints, contact: American Association of Critical-Care Nurses 101 Columbia, Aliso Viejo, CA 92656 Phone (800) 899-1712 (ext 532) or (949) 448-7370 (ext 532) Fax (949) 362-2049 E-mail [email protected]
transplant, and the transplant center of Shiraz University of Medical Sciences is a referral center for this treatment.6 As in other countries, however, there is a gap between the demand and supply of organs; improving public awareness and encouraging people to donate organs are 2 measures that are being considered to fill this gap. The aim of this study was to determine the attitudes of medical students and staff in Shiraz toward organ donation in cases of brain death. Participants and Methods The participants in this cross-sectional study were recruited from the medical students and staff of Namazi, Shahid Faghihi, and Shahid Dastgheyb hospitals, and Shahid Motahari and Imam Reza medical centers, all of which are affiliated with Shiraz University of Medical Sciences in Shiraz, Iran. We approached undergraduate and recent graduate medical students, physicians
91
Zahmatkeshan et al Table 1 Associations between demographic characteristics and willingness to donate organs after brain death among medical students and staff in Shiraz No. of respondents
Agree
Against
Undecided
Statistics, agree vs disagreea
Sex Male Female
159 341
117 273
22 27
20 41
P = .10, OR = 0.69 0.44 < OR < 1.11
Marital status Single Married
383 117
305 84
37 12
40 21
P = .07, OR = 1.56 0.94 < OR < 2.56
Children Yes No
52 65
36 48
6 6
10 11
P = .58, OR = 0.8 0.33 < OR < 1.93
Mother’s educational level ≤ High school > High school
294 206
240 150
28 21
26 35
P = .02, OR = 1.66 1.06 < OR < 2.60
Father’s education level ≤ High school > High school
178 322
148 242
17 32
13 48
P = .04, OR = 1.63 1.00 < OR < 2.67
Occupation category Medical students Physicians Nurses
340 82 78
269 58 63
32 10 7
39 14 8
P = .21
Demographic information
Abbreviation: OR, odds ratio. a The “disagree” category is the sum of “against” and “undecided” categories.
(residents, fellows, and specialists), and nurses. The survey was approved by the ethics committee of Shiraz University of Medical Sciences in 2010. The data for this study were collected with an anonymous self-administered questionnaire adapted from the instrument used by Rios et al.7,8 The questionnaire was pretested on a random sample of 50 participants to ensure practicability, validity, and clarity. The validity of the questionnaire was assessed with the Kuder-Richardson test for reliability, and internal consistency was assessed by calculating the Cronbach α coefficient. Eight hundred questionnaires were distributed randomly to the medical students and staff of the participating centers, with stratification according to job category. The data for this study were collected between January 2011 and February 2012. The questionnaire consisted of 32 items in 3 categories: demographic information, participants’ knowledge, and opinions regarding consent for organ donation from individuals older and younger than 18 years of age. The items were either yes/no or multiple-choice questions. The estimated time needed to complete the questionnaire was 10 minutes. The data were analyzed with a χ2 test using SPSS version 15, and the α level was set at 5%. Results Of the 800 questionnaires that were distributed, a total of 500 completed questionnaires (62.5%) were
92
returned. Mean age of the participants (159 men, 341 women) was 24.8 (SD, 6.4 years; range, 17-57 years) and all were Muslims. The associations between demographic characteristics and the participants’ willingness to donate their own organs are shown in Table 1. Sex, marital status, and having children had no influence on individuals’ opinions about organ donation. However, a direct correlation was found between mothers’ educational level and willingness to be an organ donor after brain death. In the 3 occupational categories studied here, willingness to donate organs in case of brain death was expressed by 79.1% of medical students (269 of 340), 70.7% of physicians (58 of 82), and 80.8% of nurses (63 of 78). The difference in the proportion of respondents willing to donate organs did not differ significantly among these 3 occupational groups (P = .21). Overall, 78% of the participants had a favorable attitude toward donating their organs in case of brain death. Among the 110 participants who indicated that they would not be organ donors, 49 individuals disagreed with the practice and 61 respondents were undecided. The reasons for refusing to be a donor were described as no specific reason by 73 persons, fear of possible commercial abuse by 13, doubts about the suitability of their organs by 13, and religious rules by 11 persons. Table 2 summarizes the participants’ responses to items regarding their knowledge of and attitudes toward
Progress in Transplantation, Vol 24, No. 1, March 2014
Attitudes of medical students and staff toward organ donation Table 2 Associations between attitudes toward organ donation and willingness to donate organs after brain death among medical students and staff in Shiraz No. of respondents
Agree
Against
Undecided
Statistics, agree vs disagreea
Personal experience with brain death Yes No
73 427
57 333
8 41
8 53
P = .96, OR = 1.01 0.53 < OR < 1.92
Hearing about brain death Yes No
481 19
374 16
47 2
60 1
P = .77, OR = 0.66 0.15 < OR < 2.45
Sufficient knowledge of brain-death criteria Yes No A little
202 72 226
162 50 178
21 8 20
19 14 28
P = .16
Confidence in the diagnosis of brain death by physicians Yes No
420 80
338 52
32 17
50 11
P = .002, OR = 2.22 1.28 < OR < 3.85
Thinking about brain death for yourself Yes No Don’t know
244 48 208
209 32 149
20 7 22
15 9 37
P = < .001, OR = 2.47 1.55 < OR < 3.97
Experience of relatives or friends receiving a donated organ Yes No
55 445
48 342
6 43
1 60
P = .08, OR = 2.07 0.87 < OR < 5.16
Possible request for an organ as a recipient Yes No Don’t know
460 14 26
359 11 20
45 0 4
56 3 2
P = .99
Experience of relatives or friends donating an organ Yes No
46 454
37 353
6 43
3 58
P = .68, OR = 1.18 0.52 < OR < 2.72
Cooperation in voluntary live organ donation Yes No
186 314
152 238
14 35
20 41
P = .12, OR = 1.43 0.89 < OR < 2.3
Awareness and opinion
Abbreviation: OR, odds ratio. a The “disagree” category is the sum of “against” and “undecided” categories
organ donation after brain death. Participants who trusted the diagnosis of brain death by physicians were significantly more likely to donate their organs (P = .002). Respondents who had thought about their own vulnerability to brain death were also significantly more willing to donate their organs than were those who had not given thought to this eventuality (P
