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Knowledge, attitude, and willingness towards cadaveric organ donation among Jimma University medical centre health care professionals
Translational Research in Anatomy 18 (2020) 100056
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Translational Research in Anatomy journal homepage: www.elsevier.com/locate/tria
Knowledge, attitude, and willingness towards cadaveric organ donation among Jimma University medical centre health care professionals
T
Asfaw Gerbi, Mekdes Bekele, Solomon Tesfaye, Getachew Chane, Yohannes Markos∗ Department of Biomedical Sciences, Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
A R T I C LE I N FO
A B S T R A C T
Keywords: Cadaveric organ donation Knowledge Attitude Willingness JUMC
Background: Organ donation and transplant rates vary widely across the globe, but there remains an almost universal shortage of deceased donors. The success of clinical transplantation as a therapy for end-stage organ failure is limited by the availability of suitable organs for transplant. Objective: To assess knowledge, attitude, and willingness of Jimma university medical centre (JUMC) health care professionals towards cadaveric organ donation (COD). Method: Institution based cross-sectional study was conducted among 296 health care professionals in JUMC. Data were collected from March to June 2018. A structured and pre-tested questionnaire was used to collect data. Data analysis was done by SPSS version 20.0. Result: Result: Out of 296 healthcare professionals 153 (51.7%) were males and 143 (48.3%) were females. Their mean age was 28.03 ± 4.56 years. The proportion of the participants who had adequate knowledge about COD was 233 (78.7%). More than half of the respondents (54.1%) know the shortage status donated organs for patients with end stage organ failure in the country. About 164 (55.4%) of the professionals had good attitude towards COD; of these, only 40 (13.5%) showed strong agreement. The willingness to donate COD among the participants of the study was found to be 117 (39.5%). Conclusion: Majority of health care professionals in JUMC were well aware of COD. But, their attitude and willingness to BD is highly lower than their knowledge. Hence, intensive education is required to up raise their attitude and willingness in order to develop COD program in the country.
1. Introduction Organ donation is giving an organ to help someone who needs a transplant. Organ transplant becomes an essential mode of treatment when there is an end stage organ failure in a patient [1]. Transplantation provides benefits to society as a whole as well as to the individuals who receive transplants. It is often the most cost-effective form of treatment for end-stage disease patients and offers the opportunity for patients disabled by illness to play a fuller and more active role in society, thus reducing the costs of health care and social care. The success of clinical transplantation as a therapy for end-stage organ failure is limited by the availability of suitable organs for transplant [1–3]. Organ donation can be done in two ways. The first is live donation in which the person donates as he is alive. Kidney and blood can be donated in this way. The second way of organ donation is deceased
donation. This type is called cadaveric organ donation (COD). After death, several organs such as heart, lungs, kidneys, liver, small bowel, pancreas, corneas, tissue, bone marrow and others can be donated and transplanted to the patient seeking transplantation [1,4–7]. In general, acquired or developmental damage of any organ due to any reason leaves the victim crippled. In such circumstances, to overcome the problems organ transplant becomes an essential mode of treatment [2,6,7]. The good results have led to a more general application of this procedure to save the lives of the patients. Despite the fact that organ transplantation is saving the lives of several people all over the world, there is an increasing discrepancy between the number of potential donors and recipients [8-10]. Organ trafficking; the sale and purchase of human organs for transplantation; is a widespread crime. One reason for this criminal is shortage of donated organs. Estimates put the worldwide number of commercial transplantations; transplantations that involve payment for
∗
Corresponding author. Department of Biomedical sciences, Faculty of medical sciences, Institute of health, Jimma University, P.O.Box: 378, Jimma, Ethiopia. E-mail addresses: [email protected] (A. Gerbi), [email protected] (M. Bekele), [email protected] (S. Tesfaye), [email protected] (G. Chane), [email protected] (Y. Markos). https://doi.org/10.1016/j.tria.2019.100056 Received 24 August 2019; Received in revised form 23 October 2019; Accepted 14 November 2019 Available online 20 November 2019 2214-854X/ © 2019 The Authors. Published by Elsevier GmbH. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/BY-NC-ND/4.0/).
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level of 50%; 95% CI and 5% margin of error. Based on this, the sample size became 384. But a correction formula was used as indicated by Kotrlik JW et al. [25] and because the total source population was less than 10,000. As a result, two hundred and sixty nine health care professionals were selected. A 10% non-response rate (27 people) was also calculated and allocated. This finally enabled us to include 296 health care professionals into the study. Systematic sampling technique was used to recruit the study participants. First document containing permanently employed healthcare professionals was reviewed from the statistics office of the hospital. Then, the total study population size (N; which was 896) was divided by the calculated sample size (nf; which was 296) to find sample interval (k; which was calculated to be 3). After the first participant was randomly selected from the professionals listed from one to three; every third healthcare professional was recruited until we found 296 individuals.
the organ; at about 10,000 annually, roughly 10% of all transplantations. Organ trafficking is an illegal means of meeting the shortage of transplants. It is a stateless crimes, legitimacy, and international criminal. The activity also flourishes for several interacting reasons, such as medical needs, poverty and criminality [11]. Organ steal and trafficking is commonly seen in human trafficking. Ethiopia is one of the major countries in which humans are trafficked. Reports indicate that many people in the world were killed by traffickers for their organs. Developing donation practice is essential to control organ trafficking [12–15]. Public awareness and attitude are critical for the development of donation program. Organ donation and transplant rates vary widely across the globe, but there remains an almost universal shortage of deceased donors. The unmet need for transplants has resulted in many systematic approaches to increase donor rates [16]. In Germany approximately 3000 organs are transplanted annually [17]. Yet, in the Netherlands, like in many other European countries, there is a considerable shortage of vital organs (hearts, kidneys etc … for transplantation purposes [18]. In countries where donation practice is highly developed, organ donors prefer deceased donation to live donation. This is confirmed by a study conducted in China which reported 60.1% of study participants approved deceased donation where as only 48.5% approved living donation [19]. According to a study from Nigeria, the attitude of health care workers towards organ donation is cardinal to the successful implementation and sustainability of transplant programs [20]. To achieve COD, it is necessary to act at two levels: the general public and healthcare workers [10and21]. Specifically, the attitudes of healthcare workers about organ donation and transplantation are fundamental to obtaining organs. This is because the medical profession plays a central role in raising public awareness of both living and postmortem organ donation. Healthcare professionals are the critical link in augmenting public awareness about organ donation [21]. Many developed countries have designed programs specifically to allow medical professionals to promote better public understanding and awareness of organ and body donation. The approach of health care workers influences not only potential donors but also donor families. In Ethiopia, there are studies that assessed knowledge, attitude, and practice towards blood donation and their associated factors among health care providers [22,23]. Unfortunately, there is no any study conducted on knowledge, attitude and willingness regarding COD among health care workers in Ethiopia.
2.4. Data collection Data were collected by a structured and pre-tested questionnaire. The questionnaire had four sections: Part one which contained questions that assessed socio-demographic factors, Part two which contained questions that assessed knowledge (9 questions), Part three which contained questions that assessed attitude (11 questions) and Part four which contained questions that assessed willingness (4 questions) regarding COD. Three B.Sc. nurses were recruited as data collectors and the researchers supervised the data collection process. 2.5. Data quality control The quality of data was assured by proper designing of the questionnaire and pre-testing of the questionnaire in healthcare professionals working in Shenen Gibe hospital which is a public hospital in the same town. Training was given for the data collectors. The completed questionnaires were reviewed and cross-checked. 2.6. Data processing and analysis Data were entered into EPI data version 3.0, and transferred to SPSS version 20.0 for analysis. Frequencies, proportions, and measures of central tendency and variation were used for descriptive analysis. PValue < 0.05 was employed to declare the statistically significance. Chi-squared test is used to determine whether there is a significant difference between the expected and observed frequencies. Finally, Hosmer and Lemshow test at p-value > 0.05 was applied to test model fitness.
2. Methods 2.1. Study design and setting This is an institution based cross-sectional study which was conducted in JUMC. JUMC is found in Jimma town; 378 km to Southwest of Addis Ababa, Ethiopia. The hospital is a university hospital where 896 permanently employed health care professionals give 24 h service in all aspects of health. The study period was from March to June 2018.
2.7. Ethical consideration Ethical approval was done by Jimma University Institute of Health Research Review Board and letter of permission for data collection was obtained from medical director of the hospital. The purpose of the study was explained and written consent was obtained from the study subjects.
2.2. Source and study population All healthcare professionals who were permanent employee of JUMC were the source population. Meanwhile, healthcare professionals who were selected by systematic sampling technique from employees’ list and worked in JUMC for at least six months were included. The professionals in annual leave and those who were not willing to participate in the study were excluded from the study.
3. Result 3.1. Socio-demographic characteristics A total of 296 health care professionals responded to the survey out of whom 153 (51.7%) were male and 143 (48.3%) were female. The mean age of the respondents was 28.03 ± 4.56 years and they ranged in age from 21years to 60years. About 184 (62.2%) of the professionals had bachelor degree (98males and 86 females); 40 (13.5%) had medical doctorate degree (20 male and 20 female); 18 (6.1%) had masters
2.3. Sample size determination and sampling procedure The sample size was calculated using single population proportion formula as indicated by Daniel, 1999 [24] by taking the knowledge 2
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Table 1 Socio-demographic (n = 296). Variables
characteristics
of
study
participants,
Frequency (n)
Sex Male 153 Female 143 Age 21–25 76 26 - 30 173 31–35 28 36 - 40 13 41–45 4 46 - 50 1 51–55 0 56 - 60 1 Level of education you currently achieved Diploma 53 Bachelor 184 Master 18 Doctor 40 Specialty certificate 1 Category of profession Nurses 125 Clinical Lab 54 Pharmacists 28 Anesthesiologists 15 Radiologists 4 Gen doctors 40 Special doctors 1 Others 29 Year of service as healthcare professional (years) 1-5 192 6 - 10 85 11-15 9 16-20 9 21-25 0 26-30 0 31-35 0 36-40 0 ≥41 1 Marital status Single 137 Married 158 Divorced 1 Widowed 0 Married but live in separated place 0 Religion Orthodox 153 Muslim 62 Protestant 61 Catholic 6 Others 14 Ethnicity Oromo 135 Amhara 61 Tigre 3 Kefa 9 Others 88 Self-perceived health status Excellent 147 Very Good 135 Good 14 Poor 0
JUMC,
Table 2 Knowledge of study participants regarding cadaveric organ donation, JUMC, 2018 (n = 296).
2018
Percentage (%)
Knowledge variable Have you ever heard of organ donation from dead body?
51.7 48.3
Organ donation can be done in which way?
25.8 58.5 9.6 4.4 1.3 0.3 0 0.3
From which of the following sources did you hear about cadaveric organ donation?
17.9 62.2 6.1 13.5 .3 42.2 18.2 9.5 5.1 1.4 12.8 0.3 9.8
Had you taken part in some training courses or lectures about cadaveric organ donation in Ethiopia or abroad? Do you know the shortage status of organ? Do you know the purpose of cadaveric organ donation?
64.9 28.7 3.0 3.0 0 0 0 0 0.3
Do you know the time with in which the organ is taken from a dead body and reserved? The reason for organ shortage in health and education is?
46.3 53.4 .3 0 0
Which diseases are donated organs screened for?
51.7 20.9 20.6 2.0 4.7
What is the clinical reasonable criterion to judge death?
45.6 20.6 1.0 3.0 29.7
Who determines whether a patient in your hospital is dead or not?
49.7 45.6 4.7 0
Frequency
Percent
Yes No Total From A Living Person Only After Death Of A Person Both Not Sure Total From Doc Internet TV Radio News Paper Friends Other Total
233 63 296 30
78.7 21.3 100.0 12.9
74
31.8
116 13 233 41 57 68 39 4 15 9 233
49.8 5.6 100.0 17.6 24.5 29.2 16.7 1.7 6.4 3.9 100.0
Yes No Total
35 261 296
11.8 88.2 100.0
Yes No Total Study And Research Transplantation Both No Idea Total Yes No Total Tradition Economy No System Mistrust No Compensation Luck Of Knowledge Total HIV Hepatitis TB Spore Total Cardiopulmonary Brain Not Sure Total Anesthesiologist Neurologist Cardiologist Not Sure Other Total
136 160 296 41 75 131 49 296 111 185 296 94 11 70 21 22 69 296 193 85 17 1 296 171 59 66 296 18 13 70 105 90 296
45.9 54.1 100.0 13.9 25.3 44.3 16.6 100.0 37.5 62.5 100.0 31.8 3.7 23.6 7.1 7.4 23.3 100.0 65.2 28.7 5.7 .3 100.0 57.8 19.9 22.3 100.0 6.1 4.4 23.6 35.5 30.4 100.0
3.2. Knowledge of JUMC health care professionals about cadaveric organ donation
degree (12 male and 6 female); and 1 (0.3%) had specialty certificate in ophthalmology. Nurses, clinical laboratory technologists, pharmacists, anesthesiologists, radiologists, generic doctors, ophthalmologist, and others were included into the study. The mean year of service was 5.4 ± 4.17. Data regarding socio-demographic variables are indicated in Table 1.
Table 2 indicates the finding from the analysis of questions assessing knowledge of the professionals about COD. The proportion of the participants who had heard of COD was 233 (78.7%). Out of the total health care professionals who had heard of COD, about 88 (37.7%) were nurses, 40 (17.2%) were clinical laboratory technologists, 36 (15.4%) were generic doctors, 27 (11.7%) were clinical pharmacists, 13 (5.5%) were anesthesiologists, 3 (1.2%) were radiologists, 1 (0.4%) was special doctor, and 26 (11.2%) were others. When knowledge about COD is cross tabulated to the level of 3
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education, it was found that out of the total health care professionals who had heard of COD, about 145 (62.3%) were bachelor degree holders, 37 (15.9%) were medical doctorate degree holders, 34 (14.9%) were diploma holders, 16 (6.8%) were masters degree holders, and 1 (0.4%) had specialty certificate in ophthalmology. Out of the nurses, about 88 (70.4%) had heard of but out of generic doctors 37 (92.5%) had heard of COD. There was no a significant difference between males and females regarding knowledge of COD (p = 0.195). Regarding the source of knowledge about COD, about 68 (29.2%) had got the knowledge from television; 57 (24.5%) had got it from internet; 41 (17.6%) had got from medical doctors; 39 (16.7%) had got from radio; 15 (6.4%) had got from friends; 4 (1.7%) had got from newspaper; and 9 (3.9%) had got it from other sources. Despite this, the proportion of health care professionals who took training on COD was only 35 (11.8%). The result of the study also indicated that more than half of the respondents (54.1%) know the shortage status donated organs for patients with end stage organ failure. In similar manner, the professionals knowledge regarding the purpose of organ donation indicated that about 75 (25.3%) of the them know that organs are donated for transplantation purpose only, 41 (13.9%) know that organs are donated for research and education, 131 (44.3%) know that organs are donated for both but 49 (16.6%) had no idea about the purpose of organ donation. Moreover, about 185 (62.5%) of them do not know the time with in which an organ is taken from a dead body and reserved for transplantation or study. Yet, about 69 (23.3%)of them argued that it is because of absence of knowledge among the whole community in the country regarding COD that is responsible for shortage of donated organs.
Table 3 Attitude of JUMC health care professionals towards Cadaveric Organ Donation, 2018 (n = 296). Attitude variable Cadaveric organs are donated for medical science, research and transplantation in developed countries. Should it be encouraged in Ethiopia (belief in the usefulness of body donation)? As a medical professional, what is your attitude towards the possibility of your organs being used for donation after you die? Is cadaveric organ donation acceptable from a religious point of view in Ethiopia? Would your personal decision be in favor of cadaveric organ donation if you hear/see that a known person had donated his/her organs? If you know/see someone near by you (eg professional colleague) donating his/her body, would it affect your decision to donate?
Frequency
Percent
Yes No Total
199 97 296
67.2 32.8 100.0
Strongly Agree Agree Not Sure Disagree Strongly Disagree Total Yes No Not Sure Total Yes No Not Sure Total
40 124 92 24 16 296 44 77 175 296 67 86 143 296
13.5 41.9 31.1 8.1 5.4 100.0 14.9 26.0 59.1 100.0 22.6 29.1 48.3 100.0
Strongly Agree
Yes No Not Sure Total
19 6 15 32 43 49 15 25 52 1 9 14 0 3 13 97 123 76 296
47.5 15.0 37.5 25.8 34.6 39.5 16.3 27.1 56.5 4.1 37.5 58.3 0.00 18.7 81.2 32.8 41.6 25.7 100.0
Yes No Not Sure Total
180 30 86 296
60.8 10.1 29.1 100.0
Strongly Agree Agree Not Sure Disagree Strongly Disagree Total Strongly Agree Agree Not Sure Disagree Strongly Disagree Total Strongly Agree Agree Not Sure Disagree Strongly Disagree Total No One Family Spouse Doc Other Don't Know Total
7 43 109 73 64 296 61 151 65 10 9 296 22 124 100 36 14 296 30 191 17 5 40 13 296
2.4 14.5 36.8 24.7 21.6 100.0 20.6 51.0 22.0 3.4 3.0 100.0 7.4 41.9 33.8 12.2 4.7 100.0 10.1 64.5 5.7 1.7 13.5 4.4 100.0
Agree
Not Sure
3.3. Attitude of JUMC health care professionals towards cadaveric organ donation
Disagree
The findings of the study regarding the attitude towards COD indicate that about 164 (55.4%) of the professionals had good attitude towards COD; of these, only 40 (13.5%) showed strong agreement. Likewise, about two-third or 199 (67.2%) of the professionals encouraged it to be done in Ethiopia. The respondents who did not have good attitude towards COD were asked whether or not their personal decision regarding the attitude to donate cadaveric organ would be changed if a known person donates his/her organ. Accordingly, the finding indicated that only 1 (2.5%) of the respondents said he will be in favor of donating cadaveric organ if he sees a known person donating cadaveric organ. Similarly, they were asked what their attitude would be if they meet/see someone who was their friend is donating cadaveric body. According to the result, none of them would change their decision if they would see someone who was their friend donating cadaveric organ. In the similar manner, they were asked whether or not they would believe that donated organs are misused. Consequently, about 50 (16.9%) believe that donated organs are misused. Questions were also raised for the health care professionals whether or not they would recommend the general public/community to donate their cadaveric organs. The result indicated that about 211 (71.6%) of them recommend the general public to do so. Please see Table 3 about the details of this part.
Strongly Disagree Is the thought of your body being cut, following donation, affecting your decision regarding donating your cadaveric organs? If you donate cadaveric organs, do you feel that you are helping patients with end stage organ failure and the medical profession? As a health professional, do you believe that donated organs are misused?
Do you recommend the general public to donate cadaveric organs for patients suffering from organ failure and medical science education? Is it good to give incentives for people who are willing to donate their organs after death (opinions on incentive based organ donation)?
3.4. Willingness of JUMC health care professionals to donate cadaveric organ
Following the death of the donor, who do you think has the authority to give consent for cadaveric organ donation?
The willingness to donate cadaveric organs among the participants of the study was found to be 117 (39.5%) of whom 72 (61.5%) are male and 45 (38.5%) are female. Their major reason for their willingness is because they want to save the lives of patients with end stage organ failure (About 59.1% responded in this way). The respondents who said ‘to avoid unnecessary wastage of organs’ were 24.6%; those who said ‘to facilitate medical teaching and research’ were 8.9% and those who 4
Yes No Not Yes No Not Yes No Not Yes No Not Yes No Not
Sure
Sure
Sure
Sure
Sure
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Fig. 1. Pie graph indicating the willingness of health care professionals to donate their body; 2018.
said ‘to be lived by other people's life’ were 7.4%. Respondents who were unwilling to donate their cadaveric organs were also asked what their reasons were for their unwillingness. According to the findings of the study, about 22.4% said that they feel psychological anxiety when they think of it; 18.0% said that their families do not like it, 17.3 said that they do not like to be cut into pieces, 12.9% said that they did not have any reason, 9.2% said religious barrier, 8.5% said that organs could be wasted, 8.2% said that organs could be wasted, and 3.4% said that they have their own reason which they do not like to reveal (see Figs. 1 and 2) (see Fig. 3).
of knowledge about living organ donation and 0.3% level of knowledge about COD among its study participants [2]. The findings of these two studies are lower than we found. This might be because these studies were conducted among medical, nursing, and general science students. The findings of the present study regarding the attitude towards COD indicate that about 55.4% of the professionals had good attitude towards COD. Similarly, good attitude has been reported in many studies around the world. For instance, in a study conducted among 263 health care professionals who had been participating in transplantation activity, it was found that about 68% of the professionals had good attitude towards deceased organ donation [28]. The same study also indicates that the attitude towards deceased organ donation among the general population is 63% which is slightly lower than the data of health care professionals. Still a higher level of good attitude was seen in a study conducted in Ahwaz, Egypt in which 75% of the participants were pro organ donation, while 22% were against it and the remaining 3% had no specific idea [29]. Concerning the willingness to donate cadaveric organs, the present study found that about 39.5% of the professionals were willing to donate their cadaveric organs. In contrary to the finding of the present study, a study conducted among anatomy department staff at Autonomous University of Nuevo Leon, Monterrey, Mexico, reported that the willingness among technical assistants, anatomy research students and professors were 94.7%, 73.9%, and 93.7% [30]. In comparison to our study, the level of willingness that was found in this study is very high. The difference could be resulted from the difference in the socio-demographic characteristics of the study subjects and the better level of awareness that was seen among the participants of the study conducted in Mexico.
4. Discussion Health care professionals can play great potential role in maximizing the limited organ supply for patients with end stage organ failure in Ethiopia which is essential and deserves several studies. Despite this, there is no data in the literature regarding the knowledge, attitudes, and willingness of Ethiopian health care professionals toward COD. For this reason, an attempt has been made in the current study to assess the problem. The finding of the present study has showed that about 78.7% JUMC health care workers had heard of COD. This finding is lower than the finding of a study conducted among medical residents in St John medical college hospital in South India which reported which reported 97% [26]. The differences in the findings might be resulted from the differences in the study subjects. In contrast to the finding of our study, a study conducted among medical students in Faculty of Medicine, Mansoura University, Egypt, found a knowledge level of 11.7% [27]. But, another study from Southern Odisha, India, reported 63.7% level
Fig. 2. Bar graph indicating the reasons of health care professionals for willingness to donate their cadaveric organs; 2018. 5
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Fig. 3. Bar graph indicating the reasons of health care professionals for unwillingness to donate their cadaveric organs; 2018.
Ethics approval and consent to participate
Similarly, in a study conducted in USA it was found that out of 385 participants, 254 (66%) were extremely willing to donate to a sibling but only 179 (47%) had designated themselves a cadaveric donor on their drivers' licenses [31]. In another study conducted in China, 60.1% of the participants of the study approved deceased donation; however, only 48.5% approved living donation [19] which indicates that deceased donation is preferred to living donation. When the above two studies are compared to the present study, their findings are higher than our study. The difference might be resulted because the countries have developed live and deceased organ donation programs which are results of well developed awarenesses among their communities. The awareness that is created is the most responsible factor to increase willingness. This has been confirmed by a study conducted by Shaheen FA [32]. Some studies have come with a low level of willingness as compared to the present study. For example, a study from Turkey indicated that only 34.4% showed willingness [33]. Similarly, according to the report of a study conducted in Kuala Lumpur, Malaysia, less than a third of the participants of the study pledged to donate their organs upon death with women (35.6%) showing a higher incidence compared with men (33.2%). The probable reason that made the findings of these studies lower than the present study might be the differences in the study sample population. The study conducted in Kuala Lampur was conducted in the general community [34]. This study could not take into consideration of the knowledge and attitude, and willingness of general population. Moreover, the present study could not establish a cause-effect relationship between the explanatory variables and outcome variables because of the cross-sectional nature of the study. These are the limitations of the current study. Nevertheless, as the first study of Ethiopian health professional knowledge, attitudes, and willingness toward COD, it provides a somewhat important perspective on COD and it paves a way for further studies in the country.
The study was approved by the Institutional Review Board of Jimma University. The study respected freedom to participate and adhered to research principles pertaining to privacy and confidentiality and written consent was sought from all the study participants. Financial disclosure The proposal of this research was reviewed by IRB of Jimma University. Yet, it was funded by the authors. Declaration of competing interests The authors declare that they have no competing interests. Acknowledgements Not Applicable. Abbreviations COD CI
Cadaveric organ donation Confidence interval
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5. Conclusion Majority of health care professionals in JUMC were well aware of COD. But, their attitude toward COD is not as much as their knowledge. In addition, their willingness to COD is highly lower than the willingness levels reported by similar studies. Hence, intensive education is required to up raise their attitude and willingness in order to meet the need of donated organs.
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Apher. Sci. 56 (3) (2017 Jun 1) 434–438. [23] G. Arage, S. Ibrahim, E. Adimasu, Blood donation practice and its associated factors among health professionals of University of Gondar Hospital, Northwest Ethiopia: a cross sectional study, BMC Res. Notes 10 (1) (2017 Dec) 294. [24] W.W. Daniel, Biostatistics: A Foundation for Analysis in the Health Sciences, seventh ed., John Wiley & Sons, New York, 1999. [25] J.W. Kotrlik, C.C. Higgins, Organizational research: determining appropriate sample size in survey research appropriate sample size in survey research, Inf. Technol. Learn. Perform. J. 19 (1) (2001) 43. [26] Usha Bapat, G. Prashanth, Gokulnath Kedlaya, Organ donation, awareness, attitudes and beliefs among post graduate medical students, Clin. Transplant. 1 (2) (2004) 193–200 18. [27] Hosam Hamed, Mohamed Elhosseny Awad, Khaled Nassreldin Youssef, BahaaEldin Fouda, Ayman El Nakeeb, Mohamed Abdel Wahab, Knowledge and attitudes about organ donation among medical students in Egypt, 1 (7) (2011) 23–26. [28] A. Ríos, C. Conesa, P. Ramírez, P.J. Galindo, L. Martínez, M.J. Montoya, J.A. Pons, M.M. Rodríguez, P. Parrilla, Attitude toward deceased organ donation and transplantation among the workers in the surgical services in a hospital with a transplant program, Transplant. Proc. 1 (37) (2005) 3603–3608. [29] H. Shahbazian, A. Dibaei, M. Barfi, Public attitudes toward cadaveric organ donation: a survey in Ahwaz, Urol. J. 3 (4) (2009 Feb 18) 234–239. [30] A. Quiroga‐Garza, C.G. Reyes‐Hernández, P.P. Zarate‐Garza, C.N. Esparza‐Hernández, O.J. Gutierrez‐de la, D. de la Fuente‐Villarreal, R.E. Elizondo‐Omaña, S. Guzman‐Lopez, Willingness toward organ and body donation among anatomy professors and students in Mexico, Anat. Sci. Educ. 10 (6) (2017 Nov 1) 589–597. [31] L.E. Boulware, L.E. Ratner, J.A. Sosa, L.A. Cooper, T.A. LaVeist, N.R. Powe, Determinants of willingness to donate living related and cadaveric organs: identifying opportunities for intervention, Transplantation 27 (10) (2002) 1683–1691 73. [32] F.A. Shaheen, Organ donation in the Middle East countries, Ethn. Dis. 19 (1 Suppl 1) (2009) S1–S16. [33] N. Ozdag, C. Bal, The nurses knowledge, awareness and acceptance of tissue‐organ donation, J. Ren. Care 12 (4) (2001) 201–206 27. [34] R. Rasiah, R. Manikam, S.K. Chandarsekaran, G. Thangiah, S. Puspharajan, D. Swaminathan, The influence of socioeconomic and demographic variables on willingness to donate cadaveric human organs in Malaysia, Medicine 93 (23) (2014 Nov).
[9] J. AbbasiAsl, H. Nikzad, A. Taherian, M.A. Atlasi, H. Naderian, G. Mousavi, M.M. Kashani, A. Omidi, Cultural acceptability and personal willingness of Iranian students toward cadaveric donation, Anat. Sci. Educ. 1 (2) (2017) 120–126 10. [10] C. Conesa, A. Ríos, P. Ramírez, et al., Socio-personal profile of teenagers opposed to organ donation, Nephrol. Dial. Transplant. 19 (2004) 1269. [11] S. Lundin, Organ economy: organ trafficking in Moldova and Israel, Public Underst. Sci. 21 (2) (2012 Feb) 226–241. [12] F.A. Shaheen, M.Z. Souqiyyeh, B. Attar, A. Ibrahim, A. Alsayyari, Organ donation from deceased donors: a proactive detection program in Saudi arabia, Exp. Clin. Transplant. Off. J. Middle East Soc. Organ Transplant. 13 (2015 Nov) 1–3. [13] M. Manyalich, C.A. Mestres, C. Ballesté, G. Páez, R. Valero, M.P. Gómez, Organ procurement: Spanish transplant procurement management, Asian Cardiovasc. Thorac. Ann. 19 (3–4) (2011 Jun) 268–278. [14] A. Baigenzhin, Z. Doskaliyev, S. Tuganbekova, S. Zharikov, S. Altynova, A. Gaipov, Organ transplants in Kazakhstan, Kidney 20 (1787) 1807. [15] Y. Yankol, N. Mecit, T. Kanmaz, B. Cimsit, Y. Cakaloglu, K. Acarli, M. Kalayoglu, Lessons learned from Review of a single center experience with 500 consecutive liver transplants in a region with insufficient deceased-donor support, Exp. Clin. Transplant. Off. J. Middle East Soc. Organ Transplant. 14 (2) (2016 Apr) 191–200. [16] L. Shepherd, R.E. O'Carroll, E. Ferguson, An international comparison of deceased and living organ donation/transplant rates in opt-in and opt-out systems: a panel study, BMC Med. 12 (1) (2014) 131. [17] T.1 Goroll, G. Gerresheim, W. Schaffartzik, SchwemmerU, Post-mortem organ donation, Anaesthesist 64 (7) (2015 Jul) 543–556, https://doi.org/10.1007/s00101015-0054-2 quiz 557-8. [18] S. Gevers, A. Janssen, R. Friele, Consent systems for post mortem organ donation in Europe, Eur. J. Health Law 11 (2) (2004 Jul 1) 175–186. [19] D. Hu, H. Huang, Knowledge, attitudes, and willingness toward organ donation among health professionals in China, Transplantation 1 (7) (2015) 1379–1385 99. [20] E.I. Agaba, I.E. Ocheke, P.A. Agaba, O.T. Idoko, S.O. Ugoya, Y. Yerima, M. Iroezindu, Willingness of Nigerian healthcare workers to donate kidneys, Int. J. Artif. Organs 31 (4) (2008 Apr) 329–332. [21] U. Bapat, P.G. Kedlaya, Organ donation, awareness, attitudes and beliefs among post graduate medical students, Saudi J Kidney Dis. Transplant. 21 (1) (2010 Jan 1) 174. [22] B. Abera, B. Mohammed, W. Betela, R. Yimam, A. Oljira, M. Ahmed, W. Tsega, W. Mulu, E. Yizengaw, Knowledge, attitude, and practice towards blood donation among health care providers in hospitals at Bahir Dar City, Ethiopia, Transfus.
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Translational Research in Anatomy journal homepage: www.elsevier.com/locate/tria
Knowledge, attitude, and willingness towards cadaveric organ donation among Jimma University medical centre health care professionals
T
Asfaw Gerbi, Mekdes Bekele, Solomon Tesfaye, Getachew Chane, Yohannes Markos∗ Department of Biomedical Sciences, Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
A R T I C LE I N FO
A B S T R A C T
Keywords: Cadaveric organ donation Knowledge Attitude Willingness JUMC
Background: Organ donation and transplant rates vary widely across the globe, but there remains an almost universal shortage of deceased donors. The success of clinical transplantation as a therapy for end-stage organ failure is limited by the availability of suitable organs for transplant. Objective: To assess knowledge, attitude, and willingness of Jimma university medical centre (JUMC) health care professionals towards cadaveric organ donation (COD). Method: Institution based cross-sectional study was conducted among 296 health care professionals in JUMC. Data were collected from March to June 2018. A structured and pre-tested questionnaire was used to collect data. Data analysis was done by SPSS version 20.0. Result: Result: Out of 296 healthcare professionals 153 (51.7%) were males and 143 (48.3%) were females. Their mean age was 28.03 ± 4.56 years. The proportion of the participants who had adequate knowledge about COD was 233 (78.7%). More than half of the respondents (54.1%) know the shortage status donated organs for patients with end stage organ failure in the country. About 164 (55.4%) of the professionals had good attitude towards COD; of these, only 40 (13.5%) showed strong agreement. The willingness to donate COD among the participants of the study was found to be 117 (39.5%). Conclusion: Majority of health care professionals in JUMC were well aware of COD. But, their attitude and willingness to BD is highly lower than their knowledge. Hence, intensive education is required to up raise their attitude and willingness in order to develop COD program in the country.
1. Introduction Organ donation is giving an organ to help someone who needs a transplant. Organ transplant becomes an essential mode of treatment when there is an end stage organ failure in a patient [1]. Transplantation provides benefits to society as a whole as well as to the individuals who receive transplants. It is often the most cost-effective form of treatment for end-stage disease patients and offers the opportunity for patients disabled by illness to play a fuller and more active role in society, thus reducing the costs of health care and social care. The success of clinical transplantation as a therapy for end-stage organ failure is limited by the availability of suitable organs for transplant [1–3]. Organ donation can be done in two ways. The first is live donation in which the person donates as he is alive. Kidney and blood can be donated in this way. The second way of organ donation is deceased
donation. This type is called cadaveric organ donation (COD). After death, several organs such as heart, lungs, kidneys, liver, small bowel, pancreas, corneas, tissue, bone marrow and others can be donated and transplanted to the patient seeking transplantation [1,4–7]. In general, acquired or developmental damage of any organ due to any reason leaves the victim crippled. In such circumstances, to overcome the problems organ transplant becomes an essential mode of treatment [2,6,7]. The good results have led to a more general application of this procedure to save the lives of the patients. Despite the fact that organ transplantation is saving the lives of several people all over the world, there is an increasing discrepancy between the number of potential donors and recipients [8-10]. Organ trafficking; the sale and purchase of human organs for transplantation; is a widespread crime. One reason for this criminal is shortage of donated organs. Estimates put the worldwide number of commercial transplantations; transplantations that involve payment for
∗
Corresponding author. Department of Biomedical sciences, Faculty of medical sciences, Institute of health, Jimma University, P.O.Box: 378, Jimma, Ethiopia. E-mail addresses: [email protected] (A. Gerbi), [email protected] (M. Bekele), [email protected] (S. Tesfaye), [email protected] (G. Chane), [email protected] (Y. Markos). https://doi.org/10.1016/j.tria.2019.100056 Received 24 August 2019; Received in revised form 23 October 2019; Accepted 14 November 2019 Available online 20 November 2019 2214-854X/ © 2019 The Authors. Published by Elsevier GmbH. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/BY-NC-ND/4.0/).
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level of 50%; 95% CI and 5% margin of error. Based on this, the sample size became 384. But a correction formula was used as indicated by Kotrlik JW et al. [25] and because the total source population was less than 10,000. As a result, two hundred and sixty nine health care professionals were selected. A 10% non-response rate (27 people) was also calculated and allocated. This finally enabled us to include 296 health care professionals into the study. Systematic sampling technique was used to recruit the study participants. First document containing permanently employed healthcare professionals was reviewed from the statistics office of the hospital. Then, the total study population size (N; which was 896) was divided by the calculated sample size (nf; which was 296) to find sample interval (k; which was calculated to be 3). After the first participant was randomly selected from the professionals listed from one to three; every third healthcare professional was recruited until we found 296 individuals.
the organ; at about 10,000 annually, roughly 10% of all transplantations. Organ trafficking is an illegal means of meeting the shortage of transplants. It is a stateless crimes, legitimacy, and international criminal. The activity also flourishes for several interacting reasons, such as medical needs, poverty and criminality [11]. Organ steal and trafficking is commonly seen in human trafficking. Ethiopia is one of the major countries in which humans are trafficked. Reports indicate that many people in the world were killed by traffickers for their organs. Developing donation practice is essential to control organ trafficking [12–15]. Public awareness and attitude are critical for the development of donation program. Organ donation and transplant rates vary widely across the globe, but there remains an almost universal shortage of deceased donors. The unmet need for transplants has resulted in many systematic approaches to increase donor rates [16]. In Germany approximately 3000 organs are transplanted annually [17]. Yet, in the Netherlands, like in many other European countries, there is a considerable shortage of vital organs (hearts, kidneys etc … for transplantation purposes [18]. In countries where donation practice is highly developed, organ donors prefer deceased donation to live donation. This is confirmed by a study conducted in China which reported 60.1% of study participants approved deceased donation where as only 48.5% approved living donation [19]. According to a study from Nigeria, the attitude of health care workers towards organ donation is cardinal to the successful implementation and sustainability of transplant programs [20]. To achieve COD, it is necessary to act at two levels: the general public and healthcare workers [10and21]. Specifically, the attitudes of healthcare workers about organ donation and transplantation are fundamental to obtaining organs. This is because the medical profession plays a central role in raising public awareness of both living and postmortem organ donation. Healthcare professionals are the critical link in augmenting public awareness about organ donation [21]. Many developed countries have designed programs specifically to allow medical professionals to promote better public understanding and awareness of organ and body donation. The approach of health care workers influences not only potential donors but also donor families. In Ethiopia, there are studies that assessed knowledge, attitude, and practice towards blood donation and their associated factors among health care providers [22,23]. Unfortunately, there is no any study conducted on knowledge, attitude and willingness regarding COD among health care workers in Ethiopia.
2.4. Data collection Data were collected by a structured and pre-tested questionnaire. The questionnaire had four sections: Part one which contained questions that assessed socio-demographic factors, Part two which contained questions that assessed knowledge (9 questions), Part three which contained questions that assessed attitude (11 questions) and Part four which contained questions that assessed willingness (4 questions) regarding COD. Three B.Sc. nurses were recruited as data collectors and the researchers supervised the data collection process. 2.5. Data quality control The quality of data was assured by proper designing of the questionnaire and pre-testing of the questionnaire in healthcare professionals working in Shenen Gibe hospital which is a public hospital in the same town. Training was given for the data collectors. The completed questionnaires were reviewed and cross-checked. 2.6. Data processing and analysis Data were entered into EPI data version 3.0, and transferred to SPSS version 20.0 for analysis. Frequencies, proportions, and measures of central tendency and variation were used for descriptive analysis. PValue < 0.05 was employed to declare the statistically significance. Chi-squared test is used to determine whether there is a significant difference between the expected and observed frequencies. Finally, Hosmer and Lemshow test at p-value > 0.05 was applied to test model fitness.
2. Methods 2.1. Study design and setting This is an institution based cross-sectional study which was conducted in JUMC. JUMC is found in Jimma town; 378 km to Southwest of Addis Ababa, Ethiopia. The hospital is a university hospital where 896 permanently employed health care professionals give 24 h service in all aspects of health. The study period was from March to June 2018.
2.7. Ethical consideration Ethical approval was done by Jimma University Institute of Health Research Review Board and letter of permission for data collection was obtained from medical director of the hospital. The purpose of the study was explained and written consent was obtained from the study subjects.
2.2. Source and study population All healthcare professionals who were permanent employee of JUMC were the source population. Meanwhile, healthcare professionals who were selected by systematic sampling technique from employees’ list and worked in JUMC for at least six months were included. The professionals in annual leave and those who were not willing to participate in the study were excluded from the study.
3. Result 3.1. Socio-demographic characteristics A total of 296 health care professionals responded to the survey out of whom 153 (51.7%) were male and 143 (48.3%) were female. The mean age of the respondents was 28.03 ± 4.56 years and they ranged in age from 21years to 60years. About 184 (62.2%) of the professionals had bachelor degree (98males and 86 females); 40 (13.5%) had medical doctorate degree (20 male and 20 female); 18 (6.1%) had masters
2.3. Sample size determination and sampling procedure The sample size was calculated using single population proportion formula as indicated by Daniel, 1999 [24] by taking the knowledge 2
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Table 1 Socio-demographic (n = 296). Variables
characteristics
of
study
participants,
Frequency (n)
Sex Male 153 Female 143 Age 21–25 76 26 - 30 173 31–35 28 36 - 40 13 41–45 4 46 - 50 1 51–55 0 56 - 60 1 Level of education you currently achieved Diploma 53 Bachelor 184 Master 18 Doctor 40 Specialty certificate 1 Category of profession Nurses 125 Clinical Lab 54 Pharmacists 28 Anesthesiologists 15 Radiologists 4 Gen doctors 40 Special doctors 1 Others 29 Year of service as healthcare professional (years) 1-5 192 6 - 10 85 11-15 9 16-20 9 21-25 0 26-30 0 31-35 0 36-40 0 ≥41 1 Marital status Single 137 Married 158 Divorced 1 Widowed 0 Married but live in separated place 0 Religion Orthodox 153 Muslim 62 Protestant 61 Catholic 6 Others 14 Ethnicity Oromo 135 Amhara 61 Tigre 3 Kefa 9 Others 88 Self-perceived health status Excellent 147 Very Good 135 Good 14 Poor 0
JUMC,
Table 2 Knowledge of study participants regarding cadaveric organ donation, JUMC, 2018 (n = 296).
2018
Percentage (%)
Knowledge variable Have you ever heard of organ donation from dead body?
51.7 48.3
Organ donation can be done in which way?
25.8 58.5 9.6 4.4 1.3 0.3 0 0.3
From which of the following sources did you hear about cadaveric organ donation?
17.9 62.2 6.1 13.5 .3 42.2 18.2 9.5 5.1 1.4 12.8 0.3 9.8
Had you taken part in some training courses or lectures about cadaveric organ donation in Ethiopia or abroad? Do you know the shortage status of organ? Do you know the purpose of cadaveric organ donation?
64.9 28.7 3.0 3.0 0 0 0 0 0.3
Do you know the time with in which the organ is taken from a dead body and reserved? The reason for organ shortage in health and education is?
46.3 53.4 .3 0 0
Which diseases are donated organs screened for?
51.7 20.9 20.6 2.0 4.7
What is the clinical reasonable criterion to judge death?
45.6 20.6 1.0 3.0 29.7
Who determines whether a patient in your hospital is dead or not?
49.7 45.6 4.7 0
Frequency
Percent
Yes No Total From A Living Person Only After Death Of A Person Both Not Sure Total From Doc Internet TV Radio News Paper Friends Other Total
233 63 296 30
78.7 21.3 100.0 12.9
74
31.8
116 13 233 41 57 68 39 4 15 9 233
49.8 5.6 100.0 17.6 24.5 29.2 16.7 1.7 6.4 3.9 100.0
Yes No Total
35 261 296
11.8 88.2 100.0
Yes No Total Study And Research Transplantation Both No Idea Total Yes No Total Tradition Economy No System Mistrust No Compensation Luck Of Knowledge Total HIV Hepatitis TB Spore Total Cardiopulmonary Brain Not Sure Total Anesthesiologist Neurologist Cardiologist Not Sure Other Total
136 160 296 41 75 131 49 296 111 185 296 94 11 70 21 22 69 296 193 85 17 1 296 171 59 66 296 18 13 70 105 90 296
45.9 54.1 100.0 13.9 25.3 44.3 16.6 100.0 37.5 62.5 100.0 31.8 3.7 23.6 7.1 7.4 23.3 100.0 65.2 28.7 5.7 .3 100.0 57.8 19.9 22.3 100.0 6.1 4.4 23.6 35.5 30.4 100.0
3.2. Knowledge of JUMC health care professionals about cadaveric organ donation
degree (12 male and 6 female); and 1 (0.3%) had specialty certificate in ophthalmology. Nurses, clinical laboratory technologists, pharmacists, anesthesiologists, radiologists, generic doctors, ophthalmologist, and others were included into the study. The mean year of service was 5.4 ± 4.17. Data regarding socio-demographic variables are indicated in Table 1.
Table 2 indicates the finding from the analysis of questions assessing knowledge of the professionals about COD. The proportion of the participants who had heard of COD was 233 (78.7%). Out of the total health care professionals who had heard of COD, about 88 (37.7%) were nurses, 40 (17.2%) were clinical laboratory technologists, 36 (15.4%) were generic doctors, 27 (11.7%) were clinical pharmacists, 13 (5.5%) were anesthesiologists, 3 (1.2%) were radiologists, 1 (0.4%) was special doctor, and 26 (11.2%) were others. When knowledge about COD is cross tabulated to the level of 3
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education, it was found that out of the total health care professionals who had heard of COD, about 145 (62.3%) were bachelor degree holders, 37 (15.9%) were medical doctorate degree holders, 34 (14.9%) were diploma holders, 16 (6.8%) were masters degree holders, and 1 (0.4%) had specialty certificate in ophthalmology. Out of the nurses, about 88 (70.4%) had heard of but out of generic doctors 37 (92.5%) had heard of COD. There was no a significant difference between males and females regarding knowledge of COD (p = 0.195). Regarding the source of knowledge about COD, about 68 (29.2%) had got the knowledge from television; 57 (24.5%) had got it from internet; 41 (17.6%) had got from medical doctors; 39 (16.7%) had got from radio; 15 (6.4%) had got from friends; 4 (1.7%) had got from newspaper; and 9 (3.9%) had got it from other sources. Despite this, the proportion of health care professionals who took training on COD was only 35 (11.8%). The result of the study also indicated that more than half of the respondents (54.1%) know the shortage status donated organs for patients with end stage organ failure. In similar manner, the professionals knowledge regarding the purpose of organ donation indicated that about 75 (25.3%) of the them know that organs are donated for transplantation purpose only, 41 (13.9%) know that organs are donated for research and education, 131 (44.3%) know that organs are donated for both but 49 (16.6%) had no idea about the purpose of organ donation. Moreover, about 185 (62.5%) of them do not know the time with in which an organ is taken from a dead body and reserved for transplantation or study. Yet, about 69 (23.3%)of them argued that it is because of absence of knowledge among the whole community in the country regarding COD that is responsible for shortage of donated organs.
Table 3 Attitude of JUMC health care professionals towards Cadaveric Organ Donation, 2018 (n = 296). Attitude variable Cadaveric organs are donated for medical science, research and transplantation in developed countries. Should it be encouraged in Ethiopia (belief in the usefulness of body donation)? As a medical professional, what is your attitude towards the possibility of your organs being used for donation after you die? Is cadaveric organ donation acceptable from a religious point of view in Ethiopia? Would your personal decision be in favor of cadaveric organ donation if you hear/see that a known person had donated his/her organs? If you know/see someone near by you (eg professional colleague) donating his/her body, would it affect your decision to donate?
Frequency
Percent
Yes No Total
199 97 296
67.2 32.8 100.0
Strongly Agree Agree Not Sure Disagree Strongly Disagree Total Yes No Not Sure Total Yes No Not Sure Total
40 124 92 24 16 296 44 77 175 296 67 86 143 296
13.5 41.9 31.1 8.1 5.4 100.0 14.9 26.0 59.1 100.0 22.6 29.1 48.3 100.0
Strongly Agree
Yes No Not Sure Total
19 6 15 32 43 49 15 25 52 1 9 14 0 3 13 97 123 76 296
47.5 15.0 37.5 25.8 34.6 39.5 16.3 27.1 56.5 4.1 37.5 58.3 0.00 18.7 81.2 32.8 41.6 25.7 100.0
Yes No Not Sure Total
180 30 86 296
60.8 10.1 29.1 100.0
Strongly Agree Agree Not Sure Disagree Strongly Disagree Total Strongly Agree Agree Not Sure Disagree Strongly Disagree Total Strongly Agree Agree Not Sure Disagree Strongly Disagree Total No One Family Spouse Doc Other Don't Know Total
7 43 109 73 64 296 61 151 65 10 9 296 22 124 100 36 14 296 30 191 17 5 40 13 296
2.4 14.5 36.8 24.7 21.6 100.0 20.6 51.0 22.0 3.4 3.0 100.0 7.4 41.9 33.8 12.2 4.7 100.0 10.1 64.5 5.7 1.7 13.5 4.4 100.0
Agree
Not Sure
3.3. Attitude of JUMC health care professionals towards cadaveric organ donation
Disagree
The findings of the study regarding the attitude towards COD indicate that about 164 (55.4%) of the professionals had good attitude towards COD; of these, only 40 (13.5%) showed strong agreement. Likewise, about two-third or 199 (67.2%) of the professionals encouraged it to be done in Ethiopia. The respondents who did not have good attitude towards COD were asked whether or not their personal decision regarding the attitude to donate cadaveric organ would be changed if a known person donates his/her organ. Accordingly, the finding indicated that only 1 (2.5%) of the respondents said he will be in favor of donating cadaveric organ if he sees a known person donating cadaveric organ. Similarly, they were asked what their attitude would be if they meet/see someone who was their friend is donating cadaveric body. According to the result, none of them would change their decision if they would see someone who was their friend donating cadaveric organ. In the similar manner, they were asked whether or not they would believe that donated organs are misused. Consequently, about 50 (16.9%) believe that donated organs are misused. Questions were also raised for the health care professionals whether or not they would recommend the general public/community to donate their cadaveric organs. The result indicated that about 211 (71.6%) of them recommend the general public to do so. Please see Table 3 about the details of this part.
Strongly Disagree Is the thought of your body being cut, following donation, affecting your decision regarding donating your cadaveric organs? If you donate cadaveric organs, do you feel that you are helping patients with end stage organ failure and the medical profession? As a health professional, do you believe that donated organs are misused?
Do you recommend the general public to donate cadaveric organs for patients suffering from organ failure and medical science education? Is it good to give incentives for people who are willing to donate their organs after death (opinions on incentive based organ donation)?
3.4. Willingness of JUMC health care professionals to donate cadaveric organ
Following the death of the donor, who do you think has the authority to give consent for cadaveric organ donation?
The willingness to donate cadaveric organs among the participants of the study was found to be 117 (39.5%) of whom 72 (61.5%) are male and 45 (38.5%) are female. Their major reason for their willingness is because they want to save the lives of patients with end stage organ failure (About 59.1% responded in this way). The respondents who said ‘to avoid unnecessary wastage of organs’ were 24.6%; those who said ‘to facilitate medical teaching and research’ were 8.9% and those who 4
Yes No Not Yes No Not Yes No Not Yes No Not Yes No Not
Sure
Sure
Sure
Sure
Sure
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Fig. 1. Pie graph indicating the willingness of health care professionals to donate their body; 2018.
said ‘to be lived by other people's life’ were 7.4%. Respondents who were unwilling to donate their cadaveric organs were also asked what their reasons were for their unwillingness. According to the findings of the study, about 22.4% said that they feel psychological anxiety when they think of it; 18.0% said that their families do not like it, 17.3 said that they do not like to be cut into pieces, 12.9% said that they did not have any reason, 9.2% said religious barrier, 8.5% said that organs could be wasted, 8.2% said that organs could be wasted, and 3.4% said that they have their own reason which they do not like to reveal (see Figs. 1 and 2) (see Fig. 3).
of knowledge about living organ donation and 0.3% level of knowledge about COD among its study participants [2]. The findings of these two studies are lower than we found. This might be because these studies were conducted among medical, nursing, and general science students. The findings of the present study regarding the attitude towards COD indicate that about 55.4% of the professionals had good attitude towards COD. Similarly, good attitude has been reported in many studies around the world. For instance, in a study conducted among 263 health care professionals who had been participating in transplantation activity, it was found that about 68% of the professionals had good attitude towards deceased organ donation [28]. The same study also indicates that the attitude towards deceased organ donation among the general population is 63% which is slightly lower than the data of health care professionals. Still a higher level of good attitude was seen in a study conducted in Ahwaz, Egypt in which 75% of the participants were pro organ donation, while 22% were against it and the remaining 3% had no specific idea [29]. Concerning the willingness to donate cadaveric organs, the present study found that about 39.5% of the professionals were willing to donate their cadaveric organs. In contrary to the finding of the present study, a study conducted among anatomy department staff at Autonomous University of Nuevo Leon, Monterrey, Mexico, reported that the willingness among technical assistants, anatomy research students and professors were 94.7%, 73.9%, and 93.7% [30]. In comparison to our study, the level of willingness that was found in this study is very high. The difference could be resulted from the difference in the socio-demographic characteristics of the study subjects and the better level of awareness that was seen among the participants of the study conducted in Mexico.
4. Discussion Health care professionals can play great potential role in maximizing the limited organ supply for patients with end stage organ failure in Ethiopia which is essential and deserves several studies. Despite this, there is no data in the literature regarding the knowledge, attitudes, and willingness of Ethiopian health care professionals toward COD. For this reason, an attempt has been made in the current study to assess the problem. The finding of the present study has showed that about 78.7% JUMC health care workers had heard of COD. This finding is lower than the finding of a study conducted among medical residents in St John medical college hospital in South India which reported which reported 97% [26]. The differences in the findings might be resulted from the differences in the study subjects. In contrast to the finding of our study, a study conducted among medical students in Faculty of Medicine, Mansoura University, Egypt, found a knowledge level of 11.7% [27]. But, another study from Southern Odisha, India, reported 63.7% level
Fig. 2. Bar graph indicating the reasons of health care professionals for willingness to donate their cadaveric organs; 2018. 5
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Fig. 3. Bar graph indicating the reasons of health care professionals for unwillingness to donate their cadaveric organs; 2018.
Ethics approval and consent to participate
Similarly, in a study conducted in USA it was found that out of 385 participants, 254 (66%) were extremely willing to donate to a sibling but only 179 (47%) had designated themselves a cadaveric donor on their drivers' licenses [31]. In another study conducted in China, 60.1% of the participants of the study approved deceased donation; however, only 48.5% approved living donation [19] which indicates that deceased donation is preferred to living donation. When the above two studies are compared to the present study, their findings are higher than our study. The difference might be resulted because the countries have developed live and deceased organ donation programs which are results of well developed awarenesses among their communities. The awareness that is created is the most responsible factor to increase willingness. This has been confirmed by a study conducted by Shaheen FA [32]. Some studies have come with a low level of willingness as compared to the present study. For example, a study from Turkey indicated that only 34.4% showed willingness [33]. Similarly, according to the report of a study conducted in Kuala Lumpur, Malaysia, less than a third of the participants of the study pledged to donate their organs upon death with women (35.6%) showing a higher incidence compared with men (33.2%). The probable reason that made the findings of these studies lower than the present study might be the differences in the study sample population. The study conducted in Kuala Lampur was conducted in the general community [34]. This study could not take into consideration of the knowledge and attitude, and willingness of general population. Moreover, the present study could not establish a cause-effect relationship between the explanatory variables and outcome variables because of the cross-sectional nature of the study. These are the limitations of the current study. Nevertheless, as the first study of Ethiopian health professional knowledge, attitudes, and willingness toward COD, it provides a somewhat important perspective on COD and it paves a way for further studies in the country.
The study was approved by the Institutional Review Board of Jimma University. The study respected freedom to participate and adhered to research principles pertaining to privacy and confidentiality and written consent was sought from all the study participants. Financial disclosure The proposal of this research was reviewed by IRB of Jimma University. Yet, it was funded by the authors. Declaration of competing interests The authors declare that they have no competing interests. Acknowledgements Not Applicable. Abbreviations COD CI
Cadaveric organ donation Confidence interval
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5. Conclusion Majority of health care professionals in JUMC were well aware of COD. But, their attitude toward COD is not as much as their knowledge. In addition, their willingness to COD is highly lower than the willingness levels reported by similar studies. Hence, intensive education is required to up raise their attitude and willingness in order to meet the need of donated organs.
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