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Reluctance to Donate Organs: A Survey Among Medical Students
Reluctance to Donate Organs: A Survey Among Medical Students H. Jung ABSTRACT Background. The organ shortage is a major obstacle in the development of the modern surgical life-saving techniques of transplantation. Romanians seem to be more reluctant toward deceased organ donation than most Europeans. A significant percentage of respondents from an European survey (31%) were unable to give a reason for their unwillingness to donate. Aim of our study was to assess medical students’ perception of deceased donation for transplantation and to identify sources of unwillingness to donate organs from a deceased next of kin. Materials and methods. I performed a cross-sectional study involving 140 randomly selected medical students of mean age 20 years. The self-administered questionnaire contained 22 items; informed consent was obtained prior to completion. Results. The percentage of unwillingness or hesitancy to donate an organ from a deceased close relative was 38.6%, without significant differences in gender or living area. Desire for body integrity preservation and respect toward the deceased person were the most often indicated reasons to excuse the donation denial. Religious motives were indicated by only tbree subjects; church attendance was irrelevant in relation to willingness to donate. Conclusions. Emotional and moral factors were most frequently invoked by medical students as justification for indecision or refusal of organ donation for transplantation. RGAN transplantation is synonymous with modern medicine. Tissue donation has become recently a preoccupation of forensic pathologists as well. Organ and tissue shortages are a consequence of donation refusals by family members in some cases. Nevertheless, autopsy and organ donation acceptance have proved to be more frequent than donation of the whole body for dissection.1 Lack of knowledge and misconceptions about health care professionals have been identified as factors that impact the decision to donate among some minority groups.2 Investigation of medical students’ opinions may provide evidence for educational strategies to improve people’s perceptions of the donation act.
O
MATERIALS AND METHODS A cross-sectional study by interviewing 140 second and third year medical students from the University of Medicine and Pharmacy Tîrgu Mures¸, Romania was performed. The questionnaire contained 22 items and included questions concerning: ● ●
Socio-demographic features: age, gender, place of living (urban/ rural) legislative knowledge about autopsy and organ donation
● ● ● ●
discussions within the family about the issue of donating an organ after death willingness to donate one’s own organ after death willingness to donate a close relative’s organ after death exploration of the reasons to not donate organs or tissues from a deceased person (family member).
Data were processed using descriptive statistical parameters and multivariate frequency distribution. We performed tests of goodness to fit with a significance level of 0.05.
From the University of Medicine and Pharmacy Tirgu Mures, Romania, Institute of Legal Medicine, Tirgu Mures, Romania. Partly supported by the Sectorial Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU 60782. Address correspondence to Harald Jung, University of Medicine and Pharmacy Tirgu Mures, Institute of Legal Medicine, Str. Ghe. Marinescu 38, Tirgu Mures, RO-540142, Romania. E-mail: [email protected]
© 2013 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
0041-1345/–see front matter http://dx.doi.org/10.1016/j.transproceed.2013.02.037
Transplantation Proceedings, 45, 1303–1304 (2013)
1303
1304
JUNG Table 1. Family Discussions and Availability to Donate Organs Among Medical Students MALE STUDENTS
Family discussions Own organ donation Close relative’s organ donation
FEMALE STUDENTS
YES
NO
Undecided
YES
NO
Undecided
YES
NO
Undecided
24 (57.1%) 34 (81.0%) 26 (61.9%)
18 (42.9%) 2 (4.80%) 1 (2.4%)
0 6 (14.3%) 15 (35.7%)
65 (66.3%) 80 (81.6%) 60 (61.2%)
33 (33.7%) 3 (3.1%) 8 (8.2%)
0 15 (15.3%) 30 (30.6%)
89 (63.6%) 114 (81.4%) 86 (61.4%)
51 (36.4%) 5 (3.6%) 9 (6.4%)
0 21 (15.0%) 45 (32.1%)
RESULTS
The mean age of the group was 20.5 years and gender distribution, 30% male and 70% female students. Most of the respondents declared they lived in urban areas (110 – 78.6%). 89 students (63.6%), that they had already discussed organ donation within their families. The number of female students having talked about organ donation was almost double that of those who did not while the difference was less for male students. Overall 81.4% agreed to donate their own organs after deaths; there was no significant gender-difference. Only 61.4% expressed willingness to donate a close relative’s organs in the eventuality of braindeath. The other 54 students (38.6%) were either undecided or opposed to organ donation from a deceased next of kin (Table 1). We identified the following reasons to not donate a close relative’s organ after death: ● ● ● ●
TOTAL
desire of next of kin’s body integrity preserved for emotional reasons (n ⫽ 28 including 25 female students) “respect towards the deceased person” (n ⫽ 19, majority by female students) religious motives (n ⫽ 3) — church attendance was irrelevant in relation to the willingness to donate Distrust in the health system or in the transplantation procedure (n ⫽ 4) times
Seven students (5%) did not choose any of the questionnaire’s alternatives, indicating not “know” as an answer. DISCUSSION
The Eurobarometer survey (released in 2010) concerning organ donation revealed that 31% of the Europeans unwilling to donate were unable to give a reason for their decision while only 7% indicated a religious basis3. Within our group distrust in the health system and fear of improper body manipulation were less significant than in the European survey, possible due to the specificity of our medical student group. We managed to overcome the psychological barrier of the respondents4,5 obtaining emotional and moral indications of the reasons not to donate. Education is essential to stress younger generations’ responsibility and altruistic behavior concerning organ donation to develop well-considered choices for their family and society.6 – 8 We noticed a large percentage of undecided students (32.1%) when asked about willing to donate organs from a deceased next of kin. A change of mind might be possible through appropriate education. Awareness of organ donation is
correlated with education and socioeconomic status, while motivation to donate is in turn associated with the awareness of organ donation.4 Communication strategies are even more required for ethnic groups with deep religious roots and faith-based views.9 Development of altruistic behaviors is the final goal of any educational project to increase organ donation and decrease opposition.7 The present-day younger generation of medical students will shortly be a major influence to change the mentality of general population. Thus it is important to evaluate their attitudes and knowledge in order to develop educational tools on the topic of transplantation. In conclusion, reluctance to donate a close relative’s organ after death was greater than that to donate one’s own organs after death. Social and religious affiliation did not seem to influence the dicision. Instead, emotional and moral factors were most frequently invoked by medical students in our survey group as justification for indecision about or refusal of organ donation. Educational strategies should focus to remove these emotional and moral barriers. REFERENCES 1. Sanner M. A comparison of public attitudes toward autopsy, organ donation and anatomic dissection - a Swedish survey. JAMA. 1994;271(4):284 –288. 2. Clarke-Swaby S, Sharp C, Randhawa G. Attitudes towards organ donation and kidney disease among black African, black Caribbean and asian populations in Lambeth, Southwark and Lewisham, London, United Kingdom. Organ, Tissue & Cells. 2012; 15(1):17–20. 3. Europeans and organ donation. Eurobarometer 2009. Available from http://ec.europa.eu/public_opinion/archives/ebs/ebs_333a_ en.pdf. 4. Saleem T, Ishaque S, Habib N, et al. Knowledge, attitudes and practices survey on organ donation among a selected adult population of Pakistan. BMC Medical Ethics. 2009;10(5):1–12. 5. Radunz S, Hertel S, et al. Attitude of health care professionals to organ donation: two surveys among the staff of a German University Hospital. Transplant Proc. 2010;42:126 –129. 6. Cantarovich F, Cantarovich D. Education and organ donation: “the unfinished symphony”. Letter to the Editors. Transplant International 2012;25:eS3– eS4. 7. Milaniak I, Przybylowski P, Wierbiczki K, Sadowski J. Organ transplantation education: the way to form altruistic behaviors among secondary school students toward organ donation. Transplant Proc. 2010;42:130 –133. 8. Milaniak I, Przybylowski P, Wilczek Ruzyczka E, Wierzbicki K, Sadowski J. The opinions of young people on paid organ donation. Organ, Tissue & Cells. 2012;15(1):32–38. 9. Randhawa G, Brocklehurst A, Pateman R, Kinsella S, Parry V. Islam and organ donation: perspectives from the United Kingdom. Organ, Tissue & Cells. 2012;15(1):27–31.
O
MATERIALS AND METHODS A cross-sectional study by interviewing 140 second and third year medical students from the University of Medicine and Pharmacy Tîrgu Mures¸, Romania was performed. The questionnaire contained 22 items and included questions concerning: ● ●
Socio-demographic features: age, gender, place of living (urban/ rural) legislative knowledge about autopsy and organ donation
● ● ● ●
discussions within the family about the issue of donating an organ after death willingness to donate one’s own organ after death willingness to donate a close relative’s organ after death exploration of the reasons to not donate organs or tissues from a deceased person (family member).
Data were processed using descriptive statistical parameters and multivariate frequency distribution. We performed tests of goodness to fit with a significance level of 0.05.
From the University of Medicine and Pharmacy Tirgu Mures, Romania, Institute of Legal Medicine, Tirgu Mures, Romania. Partly supported by the Sectorial Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU 60782. Address correspondence to Harald Jung, University of Medicine and Pharmacy Tirgu Mures, Institute of Legal Medicine, Str. Ghe. Marinescu 38, Tirgu Mures, RO-540142, Romania. E-mail: [email protected]
© 2013 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
0041-1345/–see front matter http://dx.doi.org/10.1016/j.transproceed.2013.02.037
Transplantation Proceedings, 45, 1303–1304 (2013)
1303
1304
JUNG Table 1. Family Discussions and Availability to Donate Organs Among Medical Students MALE STUDENTS
Family discussions Own organ donation Close relative’s organ donation
FEMALE STUDENTS
YES
NO
Undecided
YES
NO
Undecided
YES
NO
Undecided
24 (57.1%) 34 (81.0%) 26 (61.9%)
18 (42.9%) 2 (4.80%) 1 (2.4%)
0 6 (14.3%) 15 (35.7%)
65 (66.3%) 80 (81.6%) 60 (61.2%)
33 (33.7%) 3 (3.1%) 8 (8.2%)
0 15 (15.3%) 30 (30.6%)
89 (63.6%) 114 (81.4%) 86 (61.4%)
51 (36.4%) 5 (3.6%) 9 (6.4%)
0 21 (15.0%) 45 (32.1%)
RESULTS
The mean age of the group was 20.5 years and gender distribution, 30% male and 70% female students. Most of the respondents declared they lived in urban areas (110 – 78.6%). 89 students (63.6%), that they had already discussed organ donation within their families. The number of female students having talked about organ donation was almost double that of those who did not while the difference was less for male students. Overall 81.4% agreed to donate their own organs after deaths; there was no significant gender-difference. Only 61.4% expressed willingness to donate a close relative’s organs in the eventuality of braindeath. The other 54 students (38.6%) were either undecided or opposed to organ donation from a deceased next of kin (Table 1). We identified the following reasons to not donate a close relative’s organ after death: ● ● ● ●
TOTAL
desire of next of kin’s body integrity preserved for emotional reasons (n ⫽ 28 including 25 female students) “respect towards the deceased person” (n ⫽ 19, majority by female students) religious motives (n ⫽ 3) — church attendance was irrelevant in relation to the willingness to donate Distrust in the health system or in the transplantation procedure (n ⫽ 4) times
Seven students (5%) did not choose any of the questionnaire’s alternatives, indicating not “know” as an answer. DISCUSSION
The Eurobarometer survey (released in 2010) concerning organ donation revealed that 31% of the Europeans unwilling to donate were unable to give a reason for their decision while only 7% indicated a religious basis3. Within our group distrust in the health system and fear of improper body manipulation were less significant than in the European survey, possible due to the specificity of our medical student group. We managed to overcome the psychological barrier of the respondents4,5 obtaining emotional and moral indications of the reasons not to donate. Education is essential to stress younger generations’ responsibility and altruistic behavior concerning organ donation to develop well-considered choices for their family and society.6 – 8 We noticed a large percentage of undecided students (32.1%) when asked about willing to donate organs from a deceased next of kin. A change of mind might be possible through appropriate education. Awareness of organ donation is
correlated with education and socioeconomic status, while motivation to donate is in turn associated with the awareness of organ donation.4 Communication strategies are even more required for ethnic groups with deep religious roots and faith-based views.9 Development of altruistic behaviors is the final goal of any educational project to increase organ donation and decrease opposition.7 The present-day younger generation of medical students will shortly be a major influence to change the mentality of general population. Thus it is important to evaluate their attitudes and knowledge in order to develop educational tools on the topic of transplantation. In conclusion, reluctance to donate a close relative’s organ after death was greater than that to donate one’s own organs after death. Social and religious affiliation did not seem to influence the dicision. Instead, emotional and moral factors were most frequently invoked by medical students in our survey group as justification for indecision about or refusal of organ donation. Educational strategies should focus to remove these emotional and moral barriers. REFERENCES 1. Sanner M. A comparison of public attitudes toward autopsy, organ donation and anatomic dissection - a Swedish survey. JAMA. 1994;271(4):284 –288. 2. Clarke-Swaby S, Sharp C, Randhawa G. Attitudes towards organ donation and kidney disease among black African, black Caribbean and asian populations in Lambeth, Southwark and Lewisham, London, United Kingdom. Organ, Tissue & Cells. 2012; 15(1):17–20. 3. Europeans and organ donation. Eurobarometer 2009. Available from http://ec.europa.eu/public_opinion/archives/ebs/ebs_333a_ en.pdf. 4. Saleem T, Ishaque S, Habib N, et al. Knowledge, attitudes and practices survey on organ donation among a selected adult population of Pakistan. BMC Medical Ethics. 2009;10(5):1–12. 5. Radunz S, Hertel S, et al. Attitude of health care professionals to organ donation: two surveys among the staff of a German University Hospital. Transplant Proc. 2010;42:126 –129. 6. Cantarovich F, Cantarovich D. Education and organ donation: “the unfinished symphony”. Letter to the Editors. Transplant International 2012;25:eS3– eS4. 7. Milaniak I, Przybylowski P, Wierbiczki K, Sadowski J. Organ transplantation education: the way to form altruistic behaviors among secondary school students toward organ donation. Transplant Proc. 2010;42:130 –133. 8. Milaniak I, Przybylowski P, Wilczek Ruzyczka E, Wierzbicki K, Sadowski J. The opinions of young people on paid organ donation. Organ, Tissue & Cells. 2012;15(1):32–38. 9. Randhawa G, Brocklehurst A, Pateman R, Kinsella S, Parry V. Islam and organ donation: perspectives from the United Kingdom. Organ, Tissue & Cells. 2012;15(1):27–31.