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Attitude and Impact Factors Toward Organ Transplantation and Donation Among Transplantation Nurses in China
Attitude and Impact Factors Toward Organ Transplantation and Donation Among Transplantation Nurses in China J.-F. Xiea,b, C.-Y. Wangb, G.-P. Heb, Y.-Z. Minga, Q.-Q. Wana, J. Liua, L.-N. Gonga, and L.-F. Liua,* a Third Xiangya Hospital, Central South University, Changsha, HuNan Province, China; and the bXiangya Nursing School, Central South University, Changsha, HuNan Province, China
ABSTRACT Background. Health workers’ awareness and knowledge of transplantation medicine can improve people’s sensitivity and reduce their degree of opposition to donations. The medical literature contains numerous examples of attitudes toward organ transplantation and donation aimed at university students or medical staff members, but rarely for transplantation nurses. Objective. The purposes of the study were to investigate the attitudes toward organ transplantation and donation among transplantation nurses and to explore the impact factors. Methods. The study was conducted in 37 transplantation surgery wards in 22 hospitals using cross-sectional approach. SPSS (International Business Machines Corporation, Armonk, New York, USA) 7.0 software was used to analysis descriptive and inferential statistics for data. Results. Five hundred thirty-six effective questionnaires were received and the effective rate was 89.33%. Nurses’ mean age was 28.40 years with a mean service length of 6.54 years. Among these nurses, 66.6% and 78.0% were willing to accept organ transplantation surgery for themselves and their relatives, respectively. Of these nurses, 33.4% would donate their organs after death; whereas 39.9% were uncertain. Only 38.2% were willing to register in the national organ donation system. Of these nurses, 28.2% were willing to sign the organ donation consent forms when their relatives became potential organ donors, and 45.7% were uncertain. Eight independent variables that affected nurses’ attitudes toward donating their organs from most to least significant were: ratio of nurse to bed, title, employment form, age, length of service, position, monthly income, and the highest educational degree earned. Pearson correlation analysis showed a significant correlation among nurses’ attitudes toward organ transplantation, organ donation, and online registration. Conclusion. The attitude toward donation and transplantation in the hospitals was not too optimistic, and an improvement in the training regarding transplantation and donation among nurses in China is necessary. Nurses are an important group who generate opinion in the patient population, and their negative attitudes can have a significant negative impact on society’s attitudes toward organ donation.
O
RGAN transplantation has become the optimal choice to save and extend lives [1]. After February 2013, when the human organ donation plan was officially launched in China, donation after cardiac death has become the main source of organ donation, which eases the great tension of the Chinese donor market to a certain extent. 0041-1345/17 http://dx.doi.org/10.1016/j.transproceed.2017.02.060
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Supported by the National Natural Science Foundation of China Youth Science Fund Project (NO. 81502701). *Address correspondence to Li-Fang Liu, Third Xiangya Hospital, Central South University, Changsha, HuNan province, No.138 Tongzipo Road, Changsha, HuNan Province 410013, China. E-mail: [email protected] ª 2017 Elsevier Inc. All rights reserved. 230 Park Avenue, New York, NY 10169
Transplantation Proceedings, 49, 1226e1231 (2017)
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However, the organ donor shortage has always been a problem disturbing transplantation professionals worldwide. Attitudes about organ donation and volunteerism are important factors in the lack of donors. Health care professionals are key elements in facilitating the cadaveric organ donation process [2], especially the transplantation nursing professionals who have more contact with patients than any other professionals. The nurses’ awareness and knowledge of transplantation and donation can affect other people’s sensitivity and attitudes. There have been many medical studies regarding attitudes toward organ transplantation and donation aimed at university students or medical staff members [3e5], but these are rarely about transplantation department nurses. As direct participants in the transplantation and donation process, transplantation nurses are thought to have more active attitudes toward transplantation and donation. Their attitudes and behaviors are on behalf of the transplantation and donation organization, which will have significant impact on the general patient population. The aims of the present study were to assess the attitudes toward to organ transplantation and donation among transplantation nurses using a questionnaire designed by the authors, to identify influencing factors, and then to provide information for the governor to make changes to the educational policy and program. MATERIAL AND METHODS Design This study used a cross-sectional approach. Between July 2015 and November 2015, 600 nurses of transplantation surgery wards completed a self-designed questionnaire for assessing the attitudes toward organ transplantation and donation. The study was conducted in 37 transplantation surgery wards in 22 hospitals.
Subjects The inclusion criteria were as follows: 1) length of service for at least 1 year; 2) working in organ transplantation surgery ward; 3) agreeing to participate in the study. The study group consisted of a convenience sample of 600 nurses. Informed consent was obtained from each subject and this work was approved by the Ethics Committee of the Third Xiangya Hospital of Central South University.
Data Collection Procedure Each nurse completed a two-part questionnaire. The first part concerns general data (i.e., gender, age, length of service, employment form, title, first degree, highest degree, and monthly income). The second part of the questionnaire regarding transplantation and donation-related data (attitude toward organ transplantation for yourself or relatives if necessary, attitude toward donating your organs after death, willingness to sign the organ donation consent when facing your relatives becoming potential organ donors, attitude toward online registration for self-donation, understanding of transplantation procedures, and understanding of donation procedures, had received specific training in donation and transplantation procedures, and attitude to receive training). At present, there is no standard questionnaire to measure the attitude toward organ transplantation and donation of medical personnel throughout the world. The
1227 questionnaire was self-designed and consisted of several questions. These types of questionnaires have been proven to be effective tools for assessing the attitudes of organ transplantation and donation of hemodialysis patients in our preliminary research [6]. The study team was comprised of 22 nurse managers and 4 nursing postgraduates. Firstly, team members explained the purpose of the study and associated concepts. All questionnaires were completed anonymously. To increase the accuracy of the questionnaires, 30 minutes to 45 minutes were allowed for completion.
Data Analysis All information from the questionnaires was input to a computer according to sequential numbers. Both descriptive and inferential statistics were used for data analysis using SPSS 17.0 software (International Business Machines Corporation, Armonk, New York, USA). A value of P < .05 was considered statistically significant. An alpha of .05 was determined a priori.
RESULTS Demographic Information of Subjects
A total of 600 questionnaires were sent out; 591 were completed and returned, and 536 were valid for our study (89.33%). The mean age of the study group was 28.40 years (SD ¼ 4.800, range: 20w51 years), and the mean length of service was 6.54 years (SD ¼ 5.302, range: 1w31 years). The mean ratio of nurse to bed was 0.38 (SD ¼ 0.11, range: 0.22w0.59 years). As shown in Table 1, the majority of the participants were female (96.3%), their ages were between 26 years and 30 years (42.5%), they were temporarily employment (39.7%), primary nurses (44.4%), with no title (86.2%), their first degree was junior college (50.4%), their highest degree was undergraduate (80.2%), they were married (52.1%), had no children (57.6%), their monthly income was between 3001w5000 Yuan ($460w$790) (42.0%), their length of service was less than 5 years (44.2%), the ratio of nurses to beds was less than 0.4 (58.4%), and their number of night shifts were more than 8 per month (48.3%). Attitudes Toward Organ Transplantation and Donation
Attitudes toward organ transplantation and donation among transplantation nurses were shown in Table 2. Among these nurses, 66.6% were willing to accept the organ transplantation surgery for themselves, 14.4% were not, and 19.0% were uncertain. Of the participants, 78.0% were willing to accept the organ transplantation surgery for their relatives, 8.6% were not, and 13.4% were uncertain. Of the nurses, 33.4% would donate their organs after death, 26.7% would not, 39.9% were uncertain, and only 38.2% were willing to register in the national organ donation system. Of the nurses, 28.2% were willing to sign the organ donation consent when their relatives became potential organ donors, 26.1% were not, and 45.7% were uncertain. Among the replies regarding understanding of the transplantation procedures of the participants, 22.2% strongly agreed, 64.0% agreed, 10.1% were uncertain, 3.0% disagreed, and 0.7% strongly disagreed. Replies regarding the understanding of donation procedures, 24.6% strongly
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XIE, WANG, HE ET AL Table 1. Characteristics of the Participants (n [ 536) Characteristics
Gender Male Female Age, yrs <25 26e30 31e35 36e40 >40 Employment form Temporary Contractor Employee Missing Title Nurse Senior nurse Supervisor nurse Associate chief nurse Position General nurse Team leader Head nurse Supervisor First degree Below junior college Junior college Undergraduate Master degree or above Highest degree Below junior college Junior college Undergraduate Master degree or above Marriage Married Widowhood Divorced Unmarried Children None Had children Missing Monthly income (RMB) <3000 3000e5000 5001e7000 7001e9000 >9000 Length of service, yrs <5 5e10 11e15 >15 Missing Ratio of nurse to bed <0.4 0.4e0.5 >0.5
N
Table 1. (continued) %
Characteristics
N
%
20 516
3.7 96.3
Number of night shifts per month (day) 0 1e8 >8
64 213 259
11.9 39.7 48.3
172 228 100 20 16
32.1 42.5 18.7 3.7 3.0
213 141 181 1
39.7 26.3 33.8 0.2
208 238 86 4
38.8 44.4 16.0 0.7
462 46 24 4
86.2 8.6 4.5 0.7
70 270 192 4
13.0 50.4 35.8 0.8
4 80 430 22
0.7 14.9 80.2 4.1
279 4 2 251
52.1 0.7 0.4 46.8
308 224 4
57.5 41.8 0.7
58 225 167 60 26
10.8 42.0 31.2 11.2 4.9
237 179 77 42 1
44.2 33.4 14.4 7.8 0.2
313 84 139
58.4 15.7 25.9
agreed, and 45.9% agreed, 22.0% were uncertain, 5.4% disagreed, and 2.1% strongly disagreed. With regard to training, 39.7% of respondents said they had received specific training on donation procedures at some time during their job training, although 77.1% acknowledged that they would like to receive training in this area. The Influence of Basic Characteristics on Attitudes to Organ Donation
The influence of basic characteristics on nurses’ attitudes toward organ donation was analyzed (Tables 3 and 4). Different employment forms (temporary, contract, etc.), positions, highest degrees earned, and ratios of nurses to beds groups had statistical significance in the difference of the attitudes toward donating their own organs after death (P < .05). Compared with the general nurse group (32.5%) and the quality control leader group (34.8%), the head nurse group (46.4%) exhibited significantly greater willingness to donate their organs after death. In the highest degree earned group, the education level above undergraduate group (50.0%) was significantly higher than those whose education levels were undergraduate (34.7%), and junior college (23.8%). The ratio of nurses-to-beds-greaterthan-0.5 group (50.4%) was statistically higher than the other two groups. There were no statistical differences between males and females regarding self-donations and relatives’ donations (P > .05). Results showed that different employment forms, positions, ratios of nurses to beds, and lengths of service had statistical significance effect on the attitudes toward signing the organ donation consent forms when their relatives became potential organ donors (P < .05). The ratio of nurses-to-beds-greater-than-0.5 group (46.0%) was statistically higher than the other two groups. Comparison of positive attitude responses based on length of service revealed that the length between 11w15 years’ group (45.5%) had a higher positive attitude as compared to other groups. The differences of intention to donate among different understandings of transplantation procedures and donation procedures groups were statistically significant (P < .05). Nurses who were willing donate their own organs and their relatives’ organs were statistically higher in the “strongly agreed” group for understanding of transplantation procedures and donation procedures, respectively. Multiple Linear Regression Equation of Nurses’ Attitudes Toward Their Organ Donation and Associated Variables
The F test revealed that F ¼ 2.171, P ¼ .008 which was less than 0.01. That is, the multiple linear regression equation
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Table 2. Attitudes Toward Organ Transplantation and Donation Among Transplantation Nurses (N [ 536) Variables
n
Table 3. The Influence of Basic Characteristics on Nurses’ Attitudes to Self-organ Donation (n [ 536)
%
Willingness to accept the organ transplant surgery for their relatives Yes 418 78.0 Not sure 72 13.4 No 46 8.6 Willingness to donate organs after death Yes 179 33.4 Not sure 214 39.9 No 143 26.7 Willingness to register in the national organ donation system Yes 205 38.2 Not sure 228 42.5 No 103 19.2 Willingness to sign the organ donation consent when facing their relatives becoming potential organ donors Yes 151 28.2 Not sure 245 45.7 No 140 26.1 Willingness to accept a donated organ for transplantation if necessary Yes 357 66.6 Not sure 102 19.0 No 77 14.4
fitting the data showed statistical significance. The high absolute value of the standardized regression coefficient indicated a significant effect of corresponding independent variables on Y. Eight independent variables that affected nurses’ attitudes toward donating their organs from most to least significant were: ratio of nurses to beds, title, employment form, age, length of service, position, monthly income, and highest degree. DISCUSSION
Public acceptance of routine medical procedures is nearly universal, but controversy over invasive procedures such as transplantation is common. Organ transplantation is the most preferred treatment for end-stage organ disease and organ failure. It offers a better quality of life with better survival benefits. Therefore, the magnitude of organ retrieval is extremely important. Nurses play vital roles in imparting positive knowledge towards organ transplantation and donation. The multiple linear regression equation has shown that the effects of eight independent variables on nurses’ attitudes toward donating their organs from large to small were as follows: ratio of nurses to beds, title, employment form, age, length of service, position, monthly income, and highest degree. Factors determining attitudes toward signing the organ donation consent form when facing their relatives becoming potential organ donors are similar to attitudes toward self-donation. Ratio of nurses to beds in human resources management has been a sensitive topic in China. In this study, there were 58.4% participants in a ward with a ratio less than 0.4, which exposed a serious shortage of nurses. The group with a ratio of nurses to beds
Attitude Toward Own Donation Variables
Yes (%)
No (%)
Uncertainty
Employment form Temporary 48 (22.5) 75 (35.2) 90 Contractor 58 (41.1) 39 (27.7) 44 Employee 73 (40.3) 29 (16.0) 79 Position General nurse 150 (32.5) 128 (27.7) 184 Team leader 16 (34.8) 15 (32.6) 15 Head nurse and 13 (46.4) 0 (0) 15 above Highest degree Below junior college 0 (0) 2 (50.0) 2 Junior college 19 (23.8) 31 (38.8) 30 Undergraduate 149 (34.7) 106 (24.7) 175 Master degree or 11 (50.0) 4 (18.2) 7 above Ratio of nurse to bed <0.4 85 (27.2) 87 (27.8) 141 0.4e0.5 24 (28.6) 19 (22.6) 41 >0.5 70 (50.4) 37 (26.6) 32 Understanding of transplantation procedures Strongly agree 61 (51.3) 17 (14.3) 41 Agree 102 (29.7) 105 (30.6) 136 Uncertainty 13 (24.1) 18 (33.3) 23 Disagree 3 (18.8) 0 (0) 13 Strongly disagree 0 (0) 3 (75.0) 1 Understanding of donation procedures Strongly agree 57 (43.2) 16 (12.1) 59 Agree 88 (35.8) 88 (35.8) 70 Uncertainty 27 (22.9) 33 (28.0) 58 Disagree 4 (13.8) 4 (13.8) 21 Strongly disagree 3 (27.3) 2 (18.2) 6
c2
P Value
(42.3) 29.787 .000 (31.2) (43.6) (39.8) 12.931 .044 (32.6) (53.6)
(50) 12.673 .049 (37.5) (40.7) (31.8)
(45.0) 30.543 .000 (48.8) (23.0) (34.5) 42.083 .000 (39.7) (42.6) (81.3) (25.0) (44.7) 51.485 .000 (28.5) (49.2) (72.4) (54.5)
greater than 0.5 (50.4%) was statistically higher than the other two groups on attitudes toward self-donation and signing the organ donation consent form when facing their relatives becoming potential organ donors. Thus, the ratio of nursing beds is the biggest influencing factors on nurses’ attitudes toward organ donation, and it indicates that we must pay more attention to this issue. In this study, the head nurse group (46.4%) exhibited significantly greater willingness in attitudes toward deceased donation when compared to the general nursing group (32.5%) and the quality control leader group (P < .05). The education-level-aboveundergraduate group (50.0%) was significantly higher than those whose education levels were undergraduate (34.7%) and junior college (23.8%). Higher education positively promotes desirable knowledge and willingness of organ donation. This is similar to the findings of other study groups [5,7]. In China, nurses are mostly female. This has been identified in the present study; the majority (n ¼ 516, 96.3%) of the study participants were females. In our study, there were no statistical differences between males and females regarding self-donation of organs and relatives’ organ donation. This finding contradicts with other studies
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XIE, WANG, HE ET AL
Table 4. The Influence of Basic Characteristics on Nurses’ Attitudes to Relatives’ Organ Donation (n [ 536) Attitudes Toward Relatives’ Donation Variables
Yes (%)
No (%)
Uncertainty
Employment form Temporary 32 (15.0) 73 (34.3) 108 Contractor 57 (40.4) 38 (27.0) 46 Employee 62 (34.3) 29 (16.0) 90 Position General nurse 128 (27.7) 125 (27.1) 209 Team leader 14 (30.4) 15 (32.6) 17 Head nurse and 9 (32.1) 0 (0) 19 above Ratio of nurse to bed <0.4 58 (18.5) 84 (26.8) 171 0.4e0.5 29 (34.5) 19 (22.6) 36 >0.5 64 (46.0) 37 (26.6) 38 Length of service, yrs <5 68 (28.7) 51 (21.5) 118 5e10 38 (21.2) 65 (36.3) 76 11e15 35 (45.5) 17 (22.1) 25 >15 10 (23.8) 7 (16.7) 25 Understanding of transplantation procedures Strongly agree 55 (46.2) 16 (13.4) 48 Agree 80 (23.3) 103 (30.0) 160 Uncertainty 12 (22.2) 18 (33.3) 24 Disagree 4 (25.0) 0 (0) 12 Strongly disagree 0 (0) 3 (75.0) 1 Understanding of donation procedures Strongly agree 52 (39.4) 16 (12.1) 64 Agree 62 (25.2) 85 (34.6) 99 Uncertainty 29 (24.6) 33 (28.0) 56 Disagree 4 (13.8) 4 (13.8) 21 Strongly disagree 4 (36.4) 2 (18.2) 5
c2
P Value
(50.7) 42.516 .000 (32.6) (49.7) (45.2) 12.421 .053 (37.0) (67.9)
(54.6) 43.624 .000 (42.9) (27.3) (49.8) 28.446 .000 (42.5) (32.5) (59.5) (40.3) 40.936 .000 (46.6) (44.4) (75.0) (25.0) (48.5) 34.743 .000 (40.2) (47.5) (72.4) (45.5)
[8e10] that found that females had more positive attitudes as they may have more emotional values compared to males. A possible reason for this may be that the amount of males in our study were so small, which was insufficient to compare with females. In this study, there were 66.6% nurses who would undergo transplantation for themselves if necessary, less than what was reported by foreign countries (73.3%) [11]. This finding may be related to the relatively young ages, shorter lengths of service, and temporary appointment in transplantation nurses (Table 1). Moreover, 48.3% nurses’ numbers of late night shifts were greater than 8 per month. People tend to have only one job in their lifetime in China; therefore, job stability, guaranteed income, and flexible work time were the main factors influencing the nurses’ emotional failure and professional minds. Thus, temporary appointment is bound to affect young nurses’ professional minds [12]. A study in Poland found that the attitude toward organ donation of nursing students was favorable in 69% [13]. In Georgiadou’s study conducted in Greece, nearly half of the people (48.3%) wanted to become donors and 49.1% would donate the organs of their relatives after death [10]. A study about primary health care personnel faced with cadaveric
organ donation in Southeastern Spain found that there was a very favorable attitude toward organ donation, especially among physicians, among who up to 88% are in favor of donation [14]. However, in our study, the attitude toward donation of the transplantation nurses were not very favorable; only 33.4% of nurses would donate their organs after death, which was less than what had been reported by foreign countries (56.6%w70.8%) [15e17]. The proportion of nurses who would register in the national organ donation system for cadaveric donation was only 38.2% and less than a third of nurses (28.2%) were willing to sign the organ donation consent form when facing their relatives become potential organ donors. Health professionals are a fundamental link between society and the health system when it comes to fostering donation and transplantation. Several studies have found that health professionals are not always properly aware of the question of donation and brain death and display a lack of knowledge in this area [18]. This lack may influence the way in which donation is presented to the relatives of potential donors, resulting in an unfavorable outcome. Other studies revealed that, despite a positive attitude toward donation, health professionals can be reticent when it comes to talking to relatives about donation [19]. Almost half of the health workers studied was undecided regarding transplantation. This implies activities that motivate and encourage positive attitudes through appropriate information dissemination are still needed. With regard to training, 39.7% of respondents said they had received specific training on donation procedures at some time during their job training, and 77.1% acknowledged that they would like to receive training in this area. Evanisko et al [20] reported in their study that less than one-third of those taking part had received specific training, whereas Jenilek et al [4] found that only one-quarter of the sample population had received training in donation and transplantation. Attitudes and lack of knowledge among health care workers have been identified as barriers and pivotal to successful organ donation [21]. Knowledge level had a significant direct effect on attitudes and an indirect effect on subjective norms and perceived behavioral controls [22]. In this study, nurses willing to donate their own organs and their relatives’ organs were statistically higher in the “strongly agreed” group for understanding of transplantation procedures and donation procedures, respectively. When people have a greater understanding of the transplantation and donation procedures, they are likely to have more active attitudes toward transplantation and donation. It shows that transplantation nurses with higher levels of information about transplantation and donation showed plausible attitudes toward transplantation and donation. More specific education directed toward organ donation rather than general education is more relevant in improving attitude of health workers to organ donation [23,24]. In a study about knowledge of the brain death concept conducted by personnel in Spanish and Latin-American health care centers, a direct relationship had been found
TRANSPLANTATION NURSES IN CHINA
between understanding of the concept and attitudes toward deceased donation (P < .001); people who understand the concept more were more likely to have a positive attitude toward deceased donation [25].Within 13 years, Portugal reported more than 100% increases in organ donation by training health professionals [26]. Medical staff members are the first to establish contact with potential donors, and if they are well-informed and convinced, they could engender successful organ donation [27] d both living and cadaveric. Nursing plays a fundamental role within the process of organ donation and transplantation. In this respect, nurses of transplantation surgery wards have major influence on the opinions of the rest of the general patient population regarding organ donation and transplantation, especially nurse managers [1]. The primary limitation of our study was that it was questionnaire-based. More valid research tools are needed to develop more detailed data. Also, the study was conducted among only 22 hospitals of nurses in transplantation surgery wards. Therefore, our results cannot be generalized to the community. More studies should be performed to rectify the decline in organ donation rate. CONCLUSIONS
This study showed that Chinese transplantation department nurses have little willingness toward transplantation and donation in the hospitals. They are a group that generates opinion in the population, and their negative attitudes can have a significant negative impact on society’s attitudes toward organ donation. The proposed line of work to follow in the future is to ensure that health professionals, especially the transplantation nurses, are given adequate training regarding transplantation and donation so as to increase donation rates. On the other hand, government organizations should take up the awareness programs to the masses through social media. REFERENCES [1] Tam WW, Suen LK, Chan HY. Knowledge, attitudes and commitment toward organ donation among nursing students in Hong Kong. Transplant Proc 2012;44(5):1196e200. [2] Chakradhar K, Doshi D, Srikanth Reddy B, et al. Knowledge, attitude and practice regarding organ donation among Indian dental students. Int J Organ Transplant Med 2016;7(1): 28e35. [3] Potenza R, Guermani A, Peluso M, et al. Effectiveness of an education program on donation and transplant aimed at students of the nursing degree course. Transplant Proc 2015;47(7): 2097e101. [4] Jelinek GA, Marck CH, Weiland TJ, et al. Organ and tissue donation-related attitudes, education and practices of emergency department clinicians in Australia. Emerg Med Australas 2012;24(3):244e50. [5] Schaeffner ES, Windisch W, Freidel K, et al. Knowledge and attitude regarding organ donation among medial students and physicians. Transplantation 2004;77:1714e8. [6] Qiao B, Liu L, Liu J, et al. A study on the attitude toward kidney transplantation and factors among hemodialysis patients in China. Transplant Proc 2016;48:2601e7.
1231 [7] Gore JL, Singer JS, Brown AF, et al. The socioeconomic status of donors and recipients of living unrelated renal transplants in the United States. J Urol 2012;187(5):1760e5. [8] Burra P, De Bona M, Canova D, et al. Changing attitude to organ donation and transplantation in university students during the years of medical school in Italy. Transplant Proc 2005;37(2): 547e50. [9] Mekahli D, Liutkus A, Fargue S, et al. Survey of first-year medical students to assess their knowledge and attitudes toward organ transplantation and donation. Transplant Proc 2009;41(2): 634e48. [10] Georgiadou E, Sounidakis N, Mouloudi E, et al. Attitudes and behavior toward organ donation in Greece. Transplant Proc 2012;44(9):2698e701. [11] Kabbali N, Mikou S, Bardai G, et al. Attitude of hemodialysis patients toward renal transplantation: a Moroccan interregional survey. Transplant Proc 2014;46(5):1328e31. [12] Xiao XL, Hu QQ, Liu YP, et al. Perceptions of benefits and its effects on job burnout in nurses. Chinese Nurs Manag 2014;14(1):56e60. [13] Mikla M, Rios A, Lopez-Navas A, et al. Factors affecting attitude toward organ donation among nursing students in Warsaw, Poland. Transplant Proc 2015;47(9):2590e2. [14] Ríos A, Ramírez P, Galindo PJ, et al. Primary health care personnel faced with cadaveric organ donation: a multicenter study in south-eastern Spain. Clin Transplant 2008;22:657e63. [15] Lomero MM, Rasero MJ, Fuentes L, et al. Knowledge and attitude of health personnel at the Garraf Health Consortium regarding donation and transplantation. Transplant Proc 2015;47(8):2318e21. [16] Wale J, Arthur A, Faull C. An analysis of knowledge and attitudes of hospice staff towards organ and tissue donation. BMJ Support Palliat Care 2014;4(1):98e103. [17] Wakefield CE, Watts KJ, Homewood J, et al. Attitudes toward organ donation and donor behavior: a review of the international literature. Prog Transplant 2010;20(4):380e91. [18] Bøgh L, Madsen M. Attitudes, knowledge, and proficiency in relation to organ donation: a questionnaire-based analysis in donor hospitals in northern Denmark. Transplant Proc 2005;37(8): 3256e7. [19] Chernenko SM, Jensen L, Newburn-Cook C, et al. Organ donation and transplantation: a survey of critical care health professionals in nontransplant hospitals. Prog Transplant 2005;15(1):69e77. [20] Evanisko MJ, Beasley CL, Brigham LE, et al. Readiness of critical care physicians and nurses to handle requests for organ donation. Am J Crit Care 1998;7(1):4e12. [21] Li Y, Song A, Li N, et al. The Research on the medical students’ willing of body donation. J Jining Med Univ 2015;2:145e8. [22] Kim EA, Choi SE. Structural equation modeling on living and brain death organ donation intention in nursing students. J Korean Acad Nurs 2015;45(6):802e11. [23] Kim JR, Fisher MJ, Elliott D. Undergraduate nursing students’ knowledge and attitudes towards organ donation in Korea: implications for education. Nurse Educ Today 2006;26:465e74. [24] Irving MJ, Tong A, Jan S, et al. Factors that influence the decision to be an organ donor: a systematic review of the qualitative literature. Nephrol Dial Transplant 2012;27:2526e33. [25] Ríos A, López-Navas AI, Ayala-García MA, et al. Knowledge of the brain death concept by personnel in Spanish and LatinAmerican healthcare centers. Int J Artif Organs 2014;37(4):336e43. [26] The Madrid resolution on organ donation and transplantation: national responsibility in meeting the needs of patients, guided by the WHO principles. Transplantation 2011;91(Suppl. 11): S29e31. [27] Kosieradzki M, Czerwinski J, Jakubowska-Winecka A, et al. Partnership for transplantation: a new initiative to increase deceased organ donation in Poland. Transplant Proc 2012;44(7): 2176e7.
ABSTRACT Background. Health workers’ awareness and knowledge of transplantation medicine can improve people’s sensitivity and reduce their degree of opposition to donations. The medical literature contains numerous examples of attitudes toward organ transplantation and donation aimed at university students or medical staff members, but rarely for transplantation nurses. Objective. The purposes of the study were to investigate the attitudes toward organ transplantation and donation among transplantation nurses and to explore the impact factors. Methods. The study was conducted in 37 transplantation surgery wards in 22 hospitals using cross-sectional approach. SPSS (International Business Machines Corporation, Armonk, New York, USA) 7.0 software was used to analysis descriptive and inferential statistics for data. Results. Five hundred thirty-six effective questionnaires were received and the effective rate was 89.33%. Nurses’ mean age was 28.40 years with a mean service length of 6.54 years. Among these nurses, 66.6% and 78.0% were willing to accept organ transplantation surgery for themselves and their relatives, respectively. Of these nurses, 33.4% would donate their organs after death; whereas 39.9% were uncertain. Only 38.2% were willing to register in the national organ donation system. Of these nurses, 28.2% were willing to sign the organ donation consent forms when their relatives became potential organ donors, and 45.7% were uncertain. Eight independent variables that affected nurses’ attitudes toward donating their organs from most to least significant were: ratio of nurse to bed, title, employment form, age, length of service, position, monthly income, and the highest educational degree earned. Pearson correlation analysis showed a significant correlation among nurses’ attitudes toward organ transplantation, organ donation, and online registration. Conclusion. The attitude toward donation and transplantation in the hospitals was not too optimistic, and an improvement in the training regarding transplantation and donation among nurses in China is necessary. Nurses are an important group who generate opinion in the patient population, and their negative attitudes can have a significant negative impact on society’s attitudes toward organ donation.
O
RGAN transplantation has become the optimal choice to save and extend lives [1]. After February 2013, when the human organ donation plan was officially launched in China, donation after cardiac death has become the main source of organ donation, which eases the great tension of the Chinese donor market to a certain extent. 0041-1345/17 http://dx.doi.org/10.1016/j.transproceed.2017.02.060
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Supported by the National Natural Science Foundation of China Youth Science Fund Project (NO. 81502701). *Address correspondence to Li-Fang Liu, Third Xiangya Hospital, Central South University, Changsha, HuNan province, No.138 Tongzipo Road, Changsha, HuNan Province 410013, China. E-mail: [email protected] ª 2017 Elsevier Inc. All rights reserved. 230 Park Avenue, New York, NY 10169
Transplantation Proceedings, 49, 1226e1231 (2017)
TRANSPLANTATION NURSES IN CHINA
However, the organ donor shortage has always been a problem disturbing transplantation professionals worldwide. Attitudes about organ donation and volunteerism are important factors in the lack of donors. Health care professionals are key elements in facilitating the cadaveric organ donation process [2], especially the transplantation nursing professionals who have more contact with patients than any other professionals. The nurses’ awareness and knowledge of transplantation and donation can affect other people’s sensitivity and attitudes. There have been many medical studies regarding attitudes toward organ transplantation and donation aimed at university students or medical staff members [3e5], but these are rarely about transplantation department nurses. As direct participants in the transplantation and donation process, transplantation nurses are thought to have more active attitudes toward transplantation and donation. Their attitudes and behaviors are on behalf of the transplantation and donation organization, which will have significant impact on the general patient population. The aims of the present study were to assess the attitudes toward to organ transplantation and donation among transplantation nurses using a questionnaire designed by the authors, to identify influencing factors, and then to provide information for the governor to make changes to the educational policy and program. MATERIAL AND METHODS Design This study used a cross-sectional approach. Between July 2015 and November 2015, 600 nurses of transplantation surgery wards completed a self-designed questionnaire for assessing the attitudes toward organ transplantation and donation. The study was conducted in 37 transplantation surgery wards in 22 hospitals.
Subjects The inclusion criteria were as follows: 1) length of service for at least 1 year; 2) working in organ transplantation surgery ward; 3) agreeing to participate in the study. The study group consisted of a convenience sample of 600 nurses. Informed consent was obtained from each subject and this work was approved by the Ethics Committee of the Third Xiangya Hospital of Central South University.
Data Collection Procedure Each nurse completed a two-part questionnaire. The first part concerns general data (i.e., gender, age, length of service, employment form, title, first degree, highest degree, and monthly income). The second part of the questionnaire regarding transplantation and donation-related data (attitude toward organ transplantation for yourself or relatives if necessary, attitude toward donating your organs after death, willingness to sign the organ donation consent when facing your relatives becoming potential organ donors, attitude toward online registration for self-donation, understanding of transplantation procedures, and understanding of donation procedures, had received specific training in donation and transplantation procedures, and attitude to receive training). At present, there is no standard questionnaire to measure the attitude toward organ transplantation and donation of medical personnel throughout the world. The
1227 questionnaire was self-designed and consisted of several questions. These types of questionnaires have been proven to be effective tools for assessing the attitudes of organ transplantation and donation of hemodialysis patients in our preliminary research [6]. The study team was comprised of 22 nurse managers and 4 nursing postgraduates. Firstly, team members explained the purpose of the study and associated concepts. All questionnaires were completed anonymously. To increase the accuracy of the questionnaires, 30 minutes to 45 minutes were allowed for completion.
Data Analysis All information from the questionnaires was input to a computer according to sequential numbers. Both descriptive and inferential statistics were used for data analysis using SPSS 17.0 software (International Business Machines Corporation, Armonk, New York, USA). A value of P < .05 was considered statistically significant. An alpha of .05 was determined a priori.
RESULTS Demographic Information of Subjects
A total of 600 questionnaires were sent out; 591 were completed and returned, and 536 were valid for our study (89.33%). The mean age of the study group was 28.40 years (SD ¼ 4.800, range: 20w51 years), and the mean length of service was 6.54 years (SD ¼ 5.302, range: 1w31 years). The mean ratio of nurse to bed was 0.38 (SD ¼ 0.11, range: 0.22w0.59 years). As shown in Table 1, the majority of the participants were female (96.3%), their ages were between 26 years and 30 years (42.5%), they were temporarily employment (39.7%), primary nurses (44.4%), with no title (86.2%), their first degree was junior college (50.4%), their highest degree was undergraduate (80.2%), they were married (52.1%), had no children (57.6%), their monthly income was between 3001w5000 Yuan ($460w$790) (42.0%), their length of service was less than 5 years (44.2%), the ratio of nurses to beds was less than 0.4 (58.4%), and their number of night shifts were more than 8 per month (48.3%). Attitudes Toward Organ Transplantation and Donation
Attitudes toward organ transplantation and donation among transplantation nurses were shown in Table 2. Among these nurses, 66.6% were willing to accept the organ transplantation surgery for themselves, 14.4% were not, and 19.0% were uncertain. Of the participants, 78.0% were willing to accept the organ transplantation surgery for their relatives, 8.6% were not, and 13.4% were uncertain. Of the nurses, 33.4% would donate their organs after death, 26.7% would not, 39.9% were uncertain, and only 38.2% were willing to register in the national organ donation system. Of the nurses, 28.2% were willing to sign the organ donation consent when their relatives became potential organ donors, 26.1% were not, and 45.7% were uncertain. Among the replies regarding understanding of the transplantation procedures of the participants, 22.2% strongly agreed, 64.0% agreed, 10.1% were uncertain, 3.0% disagreed, and 0.7% strongly disagreed. Replies regarding the understanding of donation procedures, 24.6% strongly
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XIE, WANG, HE ET AL Table 1. Characteristics of the Participants (n [ 536) Characteristics
Gender Male Female Age, yrs <25 26e30 31e35 36e40 >40 Employment form Temporary Contractor Employee Missing Title Nurse Senior nurse Supervisor nurse Associate chief nurse Position General nurse Team leader Head nurse Supervisor First degree Below junior college Junior college Undergraduate Master degree or above Highest degree Below junior college Junior college Undergraduate Master degree or above Marriage Married Widowhood Divorced Unmarried Children None Had children Missing Monthly income (RMB) <3000 3000e5000 5001e7000 7001e9000 >9000 Length of service, yrs <5 5e10 11e15 >15 Missing Ratio of nurse to bed <0.4 0.4e0.5 >0.5
N
Table 1. (continued) %
Characteristics
N
%
20 516
3.7 96.3
Number of night shifts per month (day) 0 1e8 >8
64 213 259
11.9 39.7 48.3
172 228 100 20 16
32.1 42.5 18.7 3.7 3.0
213 141 181 1
39.7 26.3 33.8 0.2
208 238 86 4
38.8 44.4 16.0 0.7
462 46 24 4
86.2 8.6 4.5 0.7
70 270 192 4
13.0 50.4 35.8 0.8
4 80 430 22
0.7 14.9 80.2 4.1
279 4 2 251
52.1 0.7 0.4 46.8
308 224 4
57.5 41.8 0.7
58 225 167 60 26
10.8 42.0 31.2 11.2 4.9
237 179 77 42 1
44.2 33.4 14.4 7.8 0.2
313 84 139
58.4 15.7 25.9
agreed, and 45.9% agreed, 22.0% were uncertain, 5.4% disagreed, and 2.1% strongly disagreed. With regard to training, 39.7% of respondents said they had received specific training on donation procedures at some time during their job training, although 77.1% acknowledged that they would like to receive training in this area. The Influence of Basic Characteristics on Attitudes to Organ Donation
The influence of basic characteristics on nurses’ attitudes toward organ donation was analyzed (Tables 3 and 4). Different employment forms (temporary, contract, etc.), positions, highest degrees earned, and ratios of nurses to beds groups had statistical significance in the difference of the attitudes toward donating their own organs after death (P < .05). Compared with the general nurse group (32.5%) and the quality control leader group (34.8%), the head nurse group (46.4%) exhibited significantly greater willingness to donate their organs after death. In the highest degree earned group, the education level above undergraduate group (50.0%) was significantly higher than those whose education levels were undergraduate (34.7%), and junior college (23.8%). The ratio of nurses-to-beds-greaterthan-0.5 group (50.4%) was statistically higher than the other two groups. There were no statistical differences between males and females regarding self-donations and relatives’ donations (P > .05). Results showed that different employment forms, positions, ratios of nurses to beds, and lengths of service had statistical significance effect on the attitudes toward signing the organ donation consent forms when their relatives became potential organ donors (P < .05). The ratio of nurses-to-beds-greater-than-0.5 group (46.0%) was statistically higher than the other two groups. Comparison of positive attitude responses based on length of service revealed that the length between 11w15 years’ group (45.5%) had a higher positive attitude as compared to other groups. The differences of intention to donate among different understandings of transplantation procedures and donation procedures groups were statistically significant (P < .05). Nurses who were willing donate their own organs and their relatives’ organs were statistically higher in the “strongly agreed” group for understanding of transplantation procedures and donation procedures, respectively. Multiple Linear Regression Equation of Nurses’ Attitudes Toward Their Organ Donation and Associated Variables
The F test revealed that F ¼ 2.171, P ¼ .008 which was less than 0.01. That is, the multiple linear regression equation
TRANSPLANTATION NURSES IN CHINA
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Table 2. Attitudes Toward Organ Transplantation and Donation Among Transplantation Nurses (N [ 536) Variables
n
Table 3. The Influence of Basic Characteristics on Nurses’ Attitudes to Self-organ Donation (n [ 536)
%
Willingness to accept the organ transplant surgery for their relatives Yes 418 78.0 Not sure 72 13.4 No 46 8.6 Willingness to donate organs after death Yes 179 33.4 Not sure 214 39.9 No 143 26.7 Willingness to register in the national organ donation system Yes 205 38.2 Not sure 228 42.5 No 103 19.2 Willingness to sign the organ donation consent when facing their relatives becoming potential organ donors Yes 151 28.2 Not sure 245 45.7 No 140 26.1 Willingness to accept a donated organ for transplantation if necessary Yes 357 66.6 Not sure 102 19.0 No 77 14.4
fitting the data showed statistical significance. The high absolute value of the standardized regression coefficient indicated a significant effect of corresponding independent variables on Y. Eight independent variables that affected nurses’ attitudes toward donating their organs from most to least significant were: ratio of nurses to beds, title, employment form, age, length of service, position, monthly income, and highest degree. DISCUSSION
Public acceptance of routine medical procedures is nearly universal, but controversy over invasive procedures such as transplantation is common. Organ transplantation is the most preferred treatment for end-stage organ disease and organ failure. It offers a better quality of life with better survival benefits. Therefore, the magnitude of organ retrieval is extremely important. Nurses play vital roles in imparting positive knowledge towards organ transplantation and donation. The multiple linear regression equation has shown that the effects of eight independent variables on nurses’ attitudes toward donating their organs from large to small were as follows: ratio of nurses to beds, title, employment form, age, length of service, position, monthly income, and highest degree. Factors determining attitudes toward signing the organ donation consent form when facing their relatives becoming potential organ donors are similar to attitudes toward self-donation. Ratio of nurses to beds in human resources management has been a sensitive topic in China. In this study, there were 58.4% participants in a ward with a ratio less than 0.4, which exposed a serious shortage of nurses. The group with a ratio of nurses to beds
Attitude Toward Own Donation Variables
Yes (%)
No (%)
Uncertainty
Employment form Temporary 48 (22.5) 75 (35.2) 90 Contractor 58 (41.1) 39 (27.7) 44 Employee 73 (40.3) 29 (16.0) 79 Position General nurse 150 (32.5) 128 (27.7) 184 Team leader 16 (34.8) 15 (32.6) 15 Head nurse and 13 (46.4) 0 (0) 15 above Highest degree Below junior college 0 (0) 2 (50.0) 2 Junior college 19 (23.8) 31 (38.8) 30 Undergraduate 149 (34.7) 106 (24.7) 175 Master degree or 11 (50.0) 4 (18.2) 7 above Ratio of nurse to bed <0.4 85 (27.2) 87 (27.8) 141 0.4e0.5 24 (28.6) 19 (22.6) 41 >0.5 70 (50.4) 37 (26.6) 32 Understanding of transplantation procedures Strongly agree 61 (51.3) 17 (14.3) 41 Agree 102 (29.7) 105 (30.6) 136 Uncertainty 13 (24.1) 18 (33.3) 23 Disagree 3 (18.8) 0 (0) 13 Strongly disagree 0 (0) 3 (75.0) 1 Understanding of donation procedures Strongly agree 57 (43.2) 16 (12.1) 59 Agree 88 (35.8) 88 (35.8) 70 Uncertainty 27 (22.9) 33 (28.0) 58 Disagree 4 (13.8) 4 (13.8) 21 Strongly disagree 3 (27.3) 2 (18.2) 6
c2
P Value
(42.3) 29.787 .000 (31.2) (43.6) (39.8) 12.931 .044 (32.6) (53.6)
(50) 12.673 .049 (37.5) (40.7) (31.8)
(45.0) 30.543 .000 (48.8) (23.0) (34.5) 42.083 .000 (39.7) (42.6) (81.3) (25.0) (44.7) 51.485 .000 (28.5) (49.2) (72.4) (54.5)
greater than 0.5 (50.4%) was statistically higher than the other two groups on attitudes toward self-donation and signing the organ donation consent form when facing their relatives becoming potential organ donors. Thus, the ratio of nursing beds is the biggest influencing factors on nurses’ attitudes toward organ donation, and it indicates that we must pay more attention to this issue. In this study, the head nurse group (46.4%) exhibited significantly greater willingness in attitudes toward deceased donation when compared to the general nursing group (32.5%) and the quality control leader group (P < .05). The education-level-aboveundergraduate group (50.0%) was significantly higher than those whose education levels were undergraduate (34.7%) and junior college (23.8%). Higher education positively promotes desirable knowledge and willingness of organ donation. This is similar to the findings of other study groups [5,7]. In China, nurses are mostly female. This has been identified in the present study; the majority (n ¼ 516, 96.3%) of the study participants were females. In our study, there were no statistical differences between males and females regarding self-donation of organs and relatives’ organ donation. This finding contradicts with other studies
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XIE, WANG, HE ET AL
Table 4. The Influence of Basic Characteristics on Nurses’ Attitudes to Relatives’ Organ Donation (n [ 536) Attitudes Toward Relatives’ Donation Variables
Yes (%)
No (%)
Uncertainty
Employment form Temporary 32 (15.0) 73 (34.3) 108 Contractor 57 (40.4) 38 (27.0) 46 Employee 62 (34.3) 29 (16.0) 90 Position General nurse 128 (27.7) 125 (27.1) 209 Team leader 14 (30.4) 15 (32.6) 17 Head nurse and 9 (32.1) 0 (0) 19 above Ratio of nurse to bed <0.4 58 (18.5) 84 (26.8) 171 0.4e0.5 29 (34.5) 19 (22.6) 36 >0.5 64 (46.0) 37 (26.6) 38 Length of service, yrs <5 68 (28.7) 51 (21.5) 118 5e10 38 (21.2) 65 (36.3) 76 11e15 35 (45.5) 17 (22.1) 25 >15 10 (23.8) 7 (16.7) 25 Understanding of transplantation procedures Strongly agree 55 (46.2) 16 (13.4) 48 Agree 80 (23.3) 103 (30.0) 160 Uncertainty 12 (22.2) 18 (33.3) 24 Disagree 4 (25.0) 0 (0) 12 Strongly disagree 0 (0) 3 (75.0) 1 Understanding of donation procedures Strongly agree 52 (39.4) 16 (12.1) 64 Agree 62 (25.2) 85 (34.6) 99 Uncertainty 29 (24.6) 33 (28.0) 56 Disagree 4 (13.8) 4 (13.8) 21 Strongly disagree 4 (36.4) 2 (18.2) 5
c2
P Value
(50.7) 42.516 .000 (32.6) (49.7) (45.2) 12.421 .053 (37.0) (67.9)
(54.6) 43.624 .000 (42.9) (27.3) (49.8) 28.446 .000 (42.5) (32.5) (59.5) (40.3) 40.936 .000 (46.6) (44.4) (75.0) (25.0) (48.5) 34.743 .000 (40.2) (47.5) (72.4) (45.5)
[8e10] that found that females had more positive attitudes as they may have more emotional values compared to males. A possible reason for this may be that the amount of males in our study were so small, which was insufficient to compare with females. In this study, there were 66.6% nurses who would undergo transplantation for themselves if necessary, less than what was reported by foreign countries (73.3%) [11]. This finding may be related to the relatively young ages, shorter lengths of service, and temporary appointment in transplantation nurses (Table 1). Moreover, 48.3% nurses’ numbers of late night shifts were greater than 8 per month. People tend to have only one job in their lifetime in China; therefore, job stability, guaranteed income, and flexible work time were the main factors influencing the nurses’ emotional failure and professional minds. Thus, temporary appointment is bound to affect young nurses’ professional minds [12]. A study in Poland found that the attitude toward organ donation of nursing students was favorable in 69% [13]. In Georgiadou’s study conducted in Greece, nearly half of the people (48.3%) wanted to become donors and 49.1% would donate the organs of their relatives after death [10]. A study about primary health care personnel faced with cadaveric
organ donation in Southeastern Spain found that there was a very favorable attitude toward organ donation, especially among physicians, among who up to 88% are in favor of donation [14]. However, in our study, the attitude toward donation of the transplantation nurses were not very favorable; only 33.4% of nurses would donate their organs after death, which was less than what had been reported by foreign countries (56.6%w70.8%) [15e17]. The proportion of nurses who would register in the national organ donation system for cadaveric donation was only 38.2% and less than a third of nurses (28.2%) were willing to sign the organ donation consent form when facing their relatives become potential organ donors. Health professionals are a fundamental link between society and the health system when it comes to fostering donation and transplantation. Several studies have found that health professionals are not always properly aware of the question of donation and brain death and display a lack of knowledge in this area [18]. This lack may influence the way in which donation is presented to the relatives of potential donors, resulting in an unfavorable outcome. Other studies revealed that, despite a positive attitude toward donation, health professionals can be reticent when it comes to talking to relatives about donation [19]. Almost half of the health workers studied was undecided regarding transplantation. This implies activities that motivate and encourage positive attitudes through appropriate information dissemination are still needed. With regard to training, 39.7% of respondents said they had received specific training on donation procedures at some time during their job training, and 77.1% acknowledged that they would like to receive training in this area. Evanisko et al [20] reported in their study that less than one-third of those taking part had received specific training, whereas Jenilek et al [4] found that only one-quarter of the sample population had received training in donation and transplantation. Attitudes and lack of knowledge among health care workers have been identified as barriers and pivotal to successful organ donation [21]. Knowledge level had a significant direct effect on attitudes and an indirect effect on subjective norms and perceived behavioral controls [22]. In this study, nurses willing to donate their own organs and their relatives’ organs were statistically higher in the “strongly agreed” group for understanding of transplantation procedures and donation procedures, respectively. When people have a greater understanding of the transplantation and donation procedures, they are likely to have more active attitudes toward transplantation and donation. It shows that transplantation nurses with higher levels of information about transplantation and donation showed plausible attitudes toward transplantation and donation. More specific education directed toward organ donation rather than general education is more relevant in improving attitude of health workers to organ donation [23,24]. In a study about knowledge of the brain death concept conducted by personnel in Spanish and Latin-American health care centers, a direct relationship had been found
TRANSPLANTATION NURSES IN CHINA
between understanding of the concept and attitudes toward deceased donation (P < .001); people who understand the concept more were more likely to have a positive attitude toward deceased donation [25].Within 13 years, Portugal reported more than 100% increases in organ donation by training health professionals [26]. Medical staff members are the first to establish contact with potential donors, and if they are well-informed and convinced, they could engender successful organ donation [27] d both living and cadaveric. Nursing plays a fundamental role within the process of organ donation and transplantation. In this respect, nurses of transplantation surgery wards have major influence on the opinions of the rest of the general patient population regarding organ donation and transplantation, especially nurse managers [1]. The primary limitation of our study was that it was questionnaire-based. More valid research tools are needed to develop more detailed data. Also, the study was conducted among only 22 hospitals of nurses in transplantation surgery wards. Therefore, our results cannot be generalized to the community. More studies should be performed to rectify the decline in organ donation rate. CONCLUSIONS
This study showed that Chinese transplantation department nurses have little willingness toward transplantation and donation in the hospitals. They are a group that generates opinion in the population, and their negative attitudes can have a significant negative impact on society’s attitudes toward organ donation. The proposed line of work to follow in the future is to ensure that health professionals, especially the transplantation nurses, are given adequate training regarding transplantation and donation so as to increase donation rates. On the other hand, government organizations should take up the awareness programs to the masses through social media. REFERENCES [1] Tam WW, Suen LK, Chan HY. Knowledge, attitudes and commitment toward organ donation among nursing students in Hong Kong. Transplant Proc 2012;44(5):1196e200. [2] Chakradhar K, Doshi D, Srikanth Reddy B, et al. Knowledge, attitude and practice regarding organ donation among Indian dental students. Int J Organ Transplant Med 2016;7(1): 28e35. [3] Potenza R, Guermani A, Peluso M, et al. Effectiveness of an education program on donation and transplant aimed at students of the nursing degree course. Transplant Proc 2015;47(7): 2097e101. [4] Jelinek GA, Marck CH, Weiland TJ, et al. Organ and tissue donation-related attitudes, education and practices of emergency department clinicians in Australia. Emerg Med Australas 2012;24(3):244e50. [5] Schaeffner ES, Windisch W, Freidel K, et al. Knowledge and attitude regarding organ donation among medial students and physicians. Transplantation 2004;77:1714e8. [6] Qiao B, Liu L, Liu J, et al. A study on the attitude toward kidney transplantation and factors among hemodialysis patients in China. Transplant Proc 2016;48:2601e7.
1231 [7] Gore JL, Singer JS, Brown AF, et al. The socioeconomic status of donors and recipients of living unrelated renal transplants in the United States. J Urol 2012;187(5):1760e5. [8] Burra P, De Bona M, Canova D, et al. Changing attitude to organ donation and transplantation in university students during the years of medical school in Italy. Transplant Proc 2005;37(2): 547e50. [9] Mekahli D, Liutkus A, Fargue S, et al. Survey of first-year medical students to assess their knowledge and attitudes toward organ transplantation and donation. Transplant Proc 2009;41(2): 634e48. [10] Georgiadou E, Sounidakis N, Mouloudi E, et al. Attitudes and behavior toward organ donation in Greece. Transplant Proc 2012;44(9):2698e701. [11] Kabbali N, Mikou S, Bardai G, et al. Attitude of hemodialysis patients toward renal transplantation: a Moroccan interregional survey. Transplant Proc 2014;46(5):1328e31. [12] Xiao XL, Hu QQ, Liu YP, et al. Perceptions of benefits and its effects on job burnout in nurses. Chinese Nurs Manag 2014;14(1):56e60. [13] Mikla M, Rios A, Lopez-Navas A, et al. Factors affecting attitude toward organ donation among nursing students in Warsaw, Poland. Transplant Proc 2015;47(9):2590e2. [14] Ríos A, Ramírez P, Galindo PJ, et al. Primary health care personnel faced with cadaveric organ donation: a multicenter study in south-eastern Spain. Clin Transplant 2008;22:657e63. [15] Lomero MM, Rasero MJ, Fuentes L, et al. Knowledge and attitude of health personnel at the Garraf Health Consortium regarding donation and transplantation. Transplant Proc 2015;47(8):2318e21. [16] Wale J, Arthur A, Faull C. An analysis of knowledge and attitudes of hospice staff towards organ and tissue donation. BMJ Support Palliat Care 2014;4(1):98e103. [17] Wakefield CE, Watts KJ, Homewood J, et al. Attitudes toward organ donation and donor behavior: a review of the international literature. Prog Transplant 2010;20(4):380e91. [18] Bøgh L, Madsen M. Attitudes, knowledge, and proficiency in relation to organ donation: a questionnaire-based analysis in donor hospitals in northern Denmark. Transplant Proc 2005;37(8): 3256e7. [19] Chernenko SM, Jensen L, Newburn-Cook C, et al. Organ donation and transplantation: a survey of critical care health professionals in nontransplant hospitals. Prog Transplant 2005;15(1):69e77. [20] Evanisko MJ, Beasley CL, Brigham LE, et al. Readiness of critical care physicians and nurses to handle requests for organ donation. Am J Crit Care 1998;7(1):4e12. [21] Li Y, Song A, Li N, et al. The Research on the medical students’ willing of body donation. J Jining Med Univ 2015;2:145e8. [22] Kim EA, Choi SE. Structural equation modeling on living and brain death organ donation intention in nursing students. J Korean Acad Nurs 2015;45(6):802e11. [23] Kim JR, Fisher MJ, Elliott D. Undergraduate nursing students’ knowledge and attitudes towards organ donation in Korea: implications for education. Nurse Educ Today 2006;26:465e74. [24] Irving MJ, Tong A, Jan S, et al. Factors that influence the decision to be an organ donor: a systematic review of the qualitative literature. Nephrol Dial Transplant 2012;27:2526e33. [25] Ríos A, López-Navas AI, Ayala-García MA, et al. Knowledge of the brain death concept by personnel in Spanish and LatinAmerican healthcare centers. Int J Artif Organs 2014;37(4):336e43. [26] The Madrid resolution on organ donation and transplantation: national responsibility in meeting the needs of patients, guided by the WHO principles. Transplantation 2011;91(Suppl. 11): S29e31. [27] Kosieradzki M, Czerwinski J, Jakubowska-Winecka A, et al. Partnership for transplantation: a new initiative to increase deceased organ donation in Poland. Transplant Proc 2012;44(7): 2176e7.