A study to assess the knowledge of medical students regarding organ donation in a selected college of Western Maharashtra
Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/MJDRDYPU.MJDRDYPU_258_16
Context: As per United Network for Organ Sharing, there are over 71,000 people on organ transplant waiting list in the United States. The only way to increase organ donations is to educate the health-care professionals and public about the importance of becoming an organ donor. One of the ways to start this is to promote the awareness of the college students, especially those in the medical field, toward organ donation as they are the most suitable persons to carry the message to the community. Aims: This study aims to determine the knowledge of medical students regarding organ donation. Settings and Design: Cross-sectional study conducted in a medical college of Western Maharashtra. Subjects and Methods: A questionnaire adapted to the study requirements from the published research was designed to capture the knowledge toward organ donation. Final year MBBS students who gave verbal consent to the study were included. Statistical Analysis Used: Microsoft Excel and SPSS version 20. Results: 87% of the students had correct knowledge regarding brain death occurring after road traffic accident. Fifty-four percent (54.45%) of students were not aware that an individual suffering from infectious disease cannot donate organs. 61% of the students were not aware that a National network for organ donation exists in their city. 48.5% of students did not know how to register oneself as an organ donor. Conclusions: The results of the study revealed that there exists a knowledge gap among the medical students regarding organ donation and there is an urgent need for addressing this knowledge gap which will help in improving the organ donation rate in our country. Keywords: Knowledge, medical students, organ donation
Organ transplantation is the process of replacing diseased organs, parts of organs, or tissues by healthy organs or tissues. The transplanted organ or tissue can be obtained from the patient himself (autograft), from another human donor (allograft), or from an animal (xenograft). Transplanted organs may be artificial or natural, whole (such as kidney, heart, and liver) or partial (such as heart valves, skin, and bone).[1] Approximately, 25 different organs and tissues can be transplanted such as heart, kidney, liver, pancreas, cornea, bone marrow, blood, skin, and ligaments.[2] The organ supply for transplantation does not match the increasing demand in most of the countries. In the USA and UK, the organ donation rate is 26 and 14 per million, whereas in India, it is only 0.34 per million population.[3] In India, almost 500,000 people die every year due to non-availability of organs. Annually, 175,000 kidney patients, 50,000 heart patients, 50,000 liver patients, and 1 lakh corneal blind patients await transplant, but only 5000, 30, 700, and 25,000 donors are available, respectively.[4] It is estimated that 1.5 lakh brain death occurs due to road traffic accidents (RTA) and if even 20% of them were to donate, all the requirements for organ transplantation in our country would be fulfilled.[5] Organ donation and transplantation is an important aspect of treatment of chronic organ failures in today's era of medicine. Formal education on the topic has been recently added in the medical curriculum. Since medical students are the future doctors of the country, their positive attitude and high level of knowledge can create a positive environment and promote organ donation. Hence, this study was carried out to determine the present level of knowledge of medical students toward organ donation and to identify the areas where the knowledge was lacking and to further suggest remedial measures to augment the knowledge in those areas.
A descriptive, cross-sectional study was done in undergraduate medical students of a selected college in Western Maharashtra. All students who gave oral consent and were willing to participate by filling the questionnaire were enrolled into the study. A questionnaire adapted to the study requirements from the published [6] research was designed to capture the knowledge toward organ donation. The questionnaires were pre-tested on a sample of ten undergraduate students and finalized. These questionnaires were not included in the final analysis. The questionnaire consists of structured questions with two sections: Section A: This section included demographic information such as age, gender, monthly family income, and history of organ donation in the family. Section B: This section assessed the level of knowledge toward organ donation among study participants. Only final year MBBS students were included in the study. Students were briefed about the background and purpose of the study and questionnaires were issued in the classrooms. Students were asked to indicate their responses either as right/wrong/do not know. They were instructed to give their own answers and consultation was not permitted. After answering, the answer sheets were collected for evaluation. Statistical analysis was done using Microsoft Excel and SPSS version 20 (IBM Corp, Armonk, NY).
The study population consisted of 169 respondents. All questions were answered by all the participants. About 95% of the participants were in the age group of 22–25 years. The sample included 118 (69.8%) male students and 51 (30.2%) female students. There was no significant difference between sociodemographic characteristics or knowledge regarding organ donation between the two genders. 56.2% of the students had a family income of more than 2 lakhs while only 1.2% of the students had a family income of <15,000. When students were asked if brain death can occur after RTA, 87% of the participants gave correct answer stating that brain death can occur after RTA while 3.6% gave the wrong answer and 9.5% were not aware. When participants were asked whether brain death is considered as legal death in India, the majority were aware about this fact [Figure 1].
The predominant source of their knowledge was television (37.9%) followed by the internet (21.3%), newspaper (16.6%), and only 10.1% of the students reported that they got the information from their medical schools [Figure 2].
Only 28.4% of students knew someone who had undergone transplant surgery. 13.1% of the students were not aware that brain death can occur after RTA. 37.2% of the students believed that brain death is not legal death in India. About 8.98% were ignorant of brain death facts like vital organ are alive after brain death and organs are fit for donation after brain death. Fifty-four percent (54.45%) of students were not aware that an individual suffering from infectious disease cannot donate organs. Only 41.1% of the students were aware of the time interval between harvesting and transplanting the organ. The knowledge regarding the method of storage of harvested organs was correct in 68.65% students. Students exhibited sound knowledge about compatibility to be checked between donors and recipient with 86.4% of students saying blood group compatibility is a must. Knowledge regarding transplantation to be done between whom to whom scored below 30.75%. Knowledge regarding before and after care of recipient was fairly good at 60.56%. Knowledge regarding registration, identification and portal of access as an organ donor was quite low with only 40.97% giving correct answers, 20.87% giving wrong answers, and 38.1% individuals being ignorant about the topic [Figure 3]. Knowledge about various organs that can or cannot be donated by a living donor and a cadaver are as given in the [Table 1] and [Table 2], respectively.
Organ donation and transplantation is an important treatment modality of many end organ diseases.[7] The gap between demand and supply is quite high. As per United Network for Organ Sharing, there are over 71,000 people on organ transplant waiting list in the United States.[8] One of the important reasons behind this is a lack of knowledge among the entire population and many myths and beliefs accepted by people with respect to organ donation. It has been shown in previous studies as well that health professionals can positively influence the opinions and attitudes of patients and their relatives, leading to higher rates of organ procurement.[9] The present study gives in-depth knowledge on selected factors related to organ donation among medical students. The medical students were keen on the subject, and none of them refused to participate in the study. Major source of information for our study participants regarding organ donation was media. This was similar to various studies conducted in India and abroad.[10],[11] In this study, 86% students knew that blood group compatibility is necessary for organ donation. This was found to be higher as compared to a study conducted in the USA where only 69.1% of students knew this fact.[12] The knowledge on legal issues related to organ donation was found to be at lower levels as compared to studies conducted in Austria.[13] Knowledge regarding consideration of brain death as legal death in India was comparatively lower (62%) as compared to a study conducted in Karnataka.[14] There could be several reasons for this; one of them may be due to the recent introduction of the topic on organ donation in Maharashtra University of Health Sciences. This offers a hope of an increase in the level of knowledge in future. Further, when students were asked about the organs that can/cannot be donated by a living donor, about 90% of the students correctly knew that organs such as brain, spinal cord, and heart valves cannot be donated by a living donor. However, 40% of the students wrongly said that bone cannot be donated by a living donor. Similarly, when asked about the organs that can/cannot be donated by a cadaveric donor, about 60% of the students correctly answered that heart, heart valve, and lungs can be donated by a dead person. This was similar to the previous studies being conducted in various regions of the country.[15],[16] The current study thus reinforces the need for stress on the knowledge of organs available for donation to be included in the medical curriculum. A similar need for change in undergraduate organ donation and transplantation curriculum was suggested by a study done in the United Kingdom.[17] However, the knowledge of medical students regarding registration, identification, and portal of access for organ donation was found to be lacking in a high percentage of students. 61% of the students were not aware that a National Network for Organ Sharing exists in their city. Knowledge about these Non-governmental Organizations (NGOs) is important to guide the individuals willing to donate organs. 48.5% of students did not know how to register oneself as an organ donor. This was similar to a study conducted in India, which shows that only 42% of the individuals had knowledge about donor card.[18] Medical students can guide an individual to register oneself as an organ donor if he/she knows how to it himself. Only 39.1% of the students were aware of the NGOs working for the noble task of organ donation. There could be several reasons for this, one of them is the lack of inclusion of organ donation and transplantation as a part of the medical curriculum till last revision of the curricula by the university, perceived difficulty in signing up the organ donor register and lack of knowledge of the procedure to sign up as an organ donor or that signing up is not a priority. Similar difficulty in registering oneself as an organ donor was seen in a study done in Puerto Rico due to the lack of awareness.[19] An interesting observation made was that 47.9% considered that religious beliefs were a limiting factor for organ donation. This observation was similar to a study done in Pakistan.[20] This highlights the importance of involvement of social scientists along with health-care professionals in the country as well as similar regions and developing countries across the globe to increase awareness as well as acceptance of organ donation in the society.[21] The study undertaken also brought forward use of mass media as an effective tool in the planning of IEC campaigns as the majority of the study participants had received information on the topic from mass media communication channels. Mass media is an important channel for spreading awareness as identified by various other studies as well.[22],[23] Furthermore, the study highlights the need for professional endeavor among health professionals to promote awareness among medical students.
The present study highlights specific areas related to organ donation to be included in medical curricula to increase the overall competence of medical graduates in the country regarding organ donation. This will help to fill the gaps and lack of knowledge regarding the need of organ donation currently existing in the country. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]
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