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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE Table of Contents   
Year : 2006  |  Volume : 17  |  Issue : 4  |  Page : 491-496
Knowledge and Attitudes of High School Students Related to Organ Donation and Transplantation: A Cross-Sectional Survey in Turkey


1 Transplant Coordinator at Transplant Coordination Unit, Ankara, Turkey
2 Baskent University, Faculty of Medicine, Ankara, Turkey
3 Assoc. Prof., Baskent University Faculty of Medicine, Department of General Surgery, Ankara, Turkey
4 Prof., General Coordinator at Transplant Coordination Unit, Department of Family Medicine, Ankara, Turkey
5 Prof., President, Baskent University Faculty of Medicine, Department of General Surgery, Ankara, Turkey

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   Abstract 

We have very little information about the knowledge and attitude of high school students towards organ donation and transplantation. The aim of this study was to identify student-related factors that might affect organ donation, and then use this information to develop some essential strategies and policies. Two hundred students from one urban high school were surveyed with a questionnaire. After completing the first interview, the students underwent a training program on organ donation and transplantation. Once this was complete, the students filled out the same questionnaire in a second interview session. We then analyzed the changes from before to after the educational program in order to assess the program's effectiveness. Concerning brain-death, 66.1% of the respondents identified the correct definition of this concept before training, and 92% did so after training (p<0.001). The correct definition of transplantation was chosen by 68.3% of the respondents before training, and by 90.6% after training (p<0.001). It is clear that this educational program greatly enhanced the students' level of knowledge related to many aspects of organ donation and transplantation and significantly expanded awareness. By leading to changes in opinion, such training programs will significantly increase the number of donors and the rate of transplantation in Turkey.

Keywords: Knowledge, Attitude, Organ Donation, Transplantation, High School Student, Turkey.

How to cite this article:
Tokalak I, Kut A, Moray G, Emiroglu R, Erdal R, Karakayali H, Haberal M. Knowledge and Attitudes of High School Students Related to Organ Donation and Transplantation: A Cross-Sectional Survey in Turkey. Saudi J Kidney Dis Transpl 2006;17:491-6

How to cite this URL:
Tokalak I, Kut A, Moray G, Emiroglu R, Erdal R, Karakayali H, Haberal M. Knowledge and Attitudes of High School Students Related to Organ Donation and Transplantation: A Cross-Sectional Survey in Turkey. Saudi J Kidney Dis Transpl [serial online] 2006 [cited 2019 Oct 23];17:491-6. Available from: http://www.sjkdt.org/text.asp?2006/17/4/491/32485

   Introduction Top


In all countries, organ donation and transplant­ation activities are dependent on legislation, attitudes of the general public and health­care professionals, as well as levels of organi­zation and coordination of transplantation units. Attitudes toward organ donation in the general public can be influenced by factors such as level of related knowledge, level of education, and religion. Ethnicity, gender, and traditional values have also been identified as predictors of donation practice. [1],[2],[3],[4]

One report from Spain revealed that the most common reason for refusal to donate was misunderstanding of the term "brain­death". [5] The second most frequent reason was lack of knowledge of the donor's wishes. Other reasons for refusal were social issues, religious beliefs, suspicion about premature withdrawal of life support, suspicion about inappropriate use of organs/tissues, and concern about disfigurement of the body. [1],[5] The limited information that has been published concerning reasons for refusing donation in various coun­tries worldwide reveals a low level of related knowledge and low numbers of actual donors, particularly in developing nations. Many factors contribute to this insufficient knowledge and to people's attitudes and behavior regarding organ donation and transplantation. Research in various Islamic countries has shown that organ donation during life and after death is well accepted by Muslims; however, the concept of brain-death is not well understood. [1],[5],[6],[7]

Different programs have been developed to tackle the problem of organ-donor shortage. Public education is important for expanding organ donation. Studies have shown significant causal relationships between knowledge about organ donation and attitudes about this practice, between attitudes toward organ donation and willingness to donate, and between willing­ness to donate and the decision to request or carry an organ donor card. [3],[8]

High school students are key actors in the organ donation process. The knowledge and attitudes of this group are of great importance, because these individuals can influence their families in all aspects of organ donation and transplantation. In many countries, including Turkey, a citizen can indicate his or her willing­ness to donate organ(s) on his/her driving license. Accordingly, people often make their first decisions regarding organ donation as teenagers, when they obtain their driving licenses. This decision can be difficult for individuals who are not informed about organ donation, or for those who have not discussed organ donation with their families. Research indicates that knowledge about organ procure­ment is positively correlated with signing an organ donor card. [2],[8][9]

Clearly, it is important to provide good infor­mation at the youngest age possible. Educa­tional programs that focus specifically on high school students are needed, because the current sources of donation-related information for this group are inadequate.

Evaluation of any such health education program should address two main questions: [9]

a) Did this program increase knowledge about organ donation and transplant­ation?

b) Did it change the opinion of high school students about organ donation if they had negative opinions previously?

Little research has been done on knowledge and opinion of high school students about organ donation and transplantation. One study from Sweden showed that youth were more posi­tively inclined towards organ donation and transplantation than older respondents. [10] Similarly, a survey of high school students in India and Hong Kong revealed widespread acceptance of organ donation; more than 60% of survey respondents between the ages of 15 and 19 years expressed a willingness to donate organs after death. [11] As in most parts of the globe, in Turkey we have minimal in­formation about knowledge and attitudes of high school students towards organ donation and transplantation, or about the dynamics of family discussions related to these topics. [1],[11]


   Objectives Top


This study had three main goals:

a) To gather baseline data about levels of related knowledge in a cross-sectional sample of Turkish high school students and identify factors that limit organ donation.

b) To use these data to develop essential strategies, policies, and educational program curricula connected to basic health sciences.

c) To develop a new high school health curri­culum that will provide an appropriate way for students to receive accurate in­formation and make informed decisions about organ donation.


   Materials and Methods Top


Two hundred students from one urban Turkish high school were surveyed. All students in the school were included, and the ages ranged from 15 to 18 years. Initially, each student answered a questionnaire comprised of multiple-choice and fill-in-the-blank items. This was done in a face-to-face interview with an investigator who assisted with any problems or questions the student had. The questionnaire consisted of 25 items (11 questions about demographics and 14 specific questions about the research topic). The subjects addressed in the document were socio-cultural status, willingness to donate organs after death, ability to identify major organs and tissues currently being transplanted, knowledge of the defi­nition of brain-death, and knowledge of how information about organ donation and trans­plantation is gathered.

One hundred and eighty-nine (95%) of the 200 students completed the first interview/ questionnaire. After the initial questionnaire was submitted, the students underwent a training program on organ donation and trans­plantation. Once this was complete, 138 of the 189 students who responded to the first questionnaire filled in the same questionnaire in a second interview session. We then analyzed the changes from before to after the educational program in order to assess the program's effectiveness. Survey results before and after the training program were compared using frequency analysis and the independent t-test. All analyses were done using the Statistical Package for Social Sciences, version 11.0.


   Results Top


The response rate for the two-part survey was 69% (138/200 total students). The survey questions about parental education levels were aimed at learning the socio-cultural status of the students' families. The results from the 189 pre-training questionnaires that were completed showed that 65.9% of the fathers and 50% of the mothers had a university degree. Twenty-six of the fathers (13.8%) and 18 of the mothers (9.5%) had a chronic disease in the 189 students in the pre-training group. In the 138 students in the post-training group, four (2.4%) knew someone who had under­gone transplantation, all the grafts being kidneys; three (2.2%) knew someone who had been on the waiting list for kidney transplant­ation, and eleven (8%) of the students had family members who had donated organs.

The survey results related to willingness to donate are shown in [Table - 1]. Prior to the training program, 24.9% of the 189 respond­ents stated that they were willing to donate their organs after death, whereas after training 38.4% of the 138 respondents said they would do so (p<0.001). Before training, 14.3% of the respondents said they were absolutely opposed to organ donation, and this rate fell significantly to 7.2% after the program was completed (p<0.001).

When asked about approval for organ donation from a brain-dead relative, 56.1% of the students, before the training, said they would approve of this, and the rate rose to 68.8% after the training program. Before training, the main reason given for opposing organ donation and transplantation was fear of the procure­ment process (6.3%). After training, the frequencies for all the reasons initially cited for opposing donation were lower. The rate for "lack of information about donation" dropped from 3.7% to 0% (p<0.01), and the rate for "fear of procurement" fell from 6.3% to 1.4% (p<0.05) [Table - 2].

When we assessed the students' knowledge of the major organs and tissues that can cur­rently be transplanted, the level of knowledge for each tissue/organ we asked about was significantly higher after the training (p<0.001) [Table - 3]. Prior to training, 11.6% of the students said they had no idea about any of types of transplants mentioned in the survey, but this proportion dropped significantly to 3.6% after the program (p=0.005).

Concerning the concept of brain-death, 66.1% of the respondents identified the correct defi­nition before training, and 92% did so after training (p<0.001). The correct definition of transplantation was chosen by 68.3% of the respondents before training, and by 90.6% after training (p<0.001).


   Discussion Top


In Turkey, as in the rest of the world, the major barrier to transplantation is the shortage of donor organs. This shortage is a result of insufficient public awareness about organ/ tissue donation and procurement. Our survey examined knowledge levels and attitudes related to organ donation and transplantation in a group of Turkish high school students. As emphasized, informing youth can play a key role in guiding the knowledge, attitudes, and behavior of the general public in this area.

The high school that participated in this survey was one of the most reputed schools in Ankara, Turkey's capital city. The socio­cultural level of the study population was high, as most of the students' parents had university degrees. Education is associated with more positive views about organ donation and transplantation. After the students finished our training program, we found that a signi­ficantly higher proportion said they would consent to donate their own organs. Also, a lower proportion said that they absolutely opposed donation. Additionally, after the program, a significantly higher percentage of students said they would approve donating an organ from a brain-dead relative. Prior to training, the main reasons for refusing personal donation were religious beliefs, suspicion about inappropriate use of harvested organs, disfigurement of the body, fear of the actual procurement process, and lack of information about the donation process. After training, we observed lower frequencies of all of these responses. The students' knowledge of the major organs and tissues that can currently be transplanted was also significantly better after the educational program. Significantly, more respondents picked the correct answer for the definitions of brain-death and trans­plantation after the training.

It is clear that this educational program greatly enhanced the students' level of knowledge related to many aspects of organ donation and transplantation. Our results suggest that school­based interventions, such as this type of training program, can significantly expand awareness in this area and lead to changes in opinion.


   Conclusion Top


In conclusion, in order to foster positive attitudes toward organ tissue donation in all Turkish citizens, we need to have good strategies and creative elements in a strong educational campaign. Such educational policies could help to motivate the general public to decide in favor of donation and acquire legal donor cards. Our analysis shows that knowing more about donation increases the likelihood that a teenage student will have positive opinions about this process. The study indicates that adolescents' opinions about donation and transplantation are still open to change, and the amount of change we ob­served emphasizes the potential importance of education on this subject at the high school level or earlier.


   Practice Implications Top


Based on the results from this survey, we propose to implement health education programs on donation and transplantation in Turkish public high schools. One of the goals of teachers and principals at this level should be to educate students about organ donation and discuss this issue in order to help them to for­mulate opinions and make informed personal decisions relatively early in life. We recom­mend that public programs on organ donation and transplantation should be developed for all age-groups in Turkey. In addition to con­veying information about organ donation, these educational programs should include other elements, such as encouragement to engage in family discussions on the subject. School-based health education curricula on organ donation and transplantation provide a base of valuable information, but these health education messages must be culturally sensitive and should incorporate an emphasis on family discussions.

The findings in this survey indicate that efforts towards implementing this type of educational campaign could significantly increase the number of donors and the rate of transplantation in Turkey. It is essential to focus on special training for high school students, because these individuals play an important role in guiding public attitudes and behavior in this area. Such programs would promote transfer of accurate infor­mation by the students, and would therefore help to raise awareness about organ donation in the general public.

 
   References Top

1.Akgun S, Tokalak I, Erdal R. Attitudes and behavior related to organ donation and transplantation: a survey of university students. Transplant Proc 2002;34:2009-11.   Back to cited text no. 1    
2.Akgun HS, Bilgin N, Tokalak I, Kut A, Haberal M. Organ donation: a cross­ sectional survey of the knowledge and personal views of Turkish health care pro­fessionals. Transplant Proc 2003;35:1273-5.  Back to cited text no. 2    
3.Tokalak I, Basaran O, Emiroglu R, et al. Health care professionals' knowledge of procedural issues in transplantation: the need for continuing education programs. Transplant Proc 2004;36:14-6.  Back to cited text no. 3    
4.Anantachoti P, Gross CR, Gunderson S. Promoting organ donation among high school students: an educational inter­vention. Prog Transplant 2001;11:201-7.  Back to cited text no. 4    
5.Santiago C, Gomez P. Asking for the family consent: analyses and refusals. Transplant Proc 1997;29:1629-30.  Back to cited text no. 5    
6.Santiago C. Family and personal consent to donation. Transplant Proc 1997;29:1625-8.  Back to cited text no. 6    
7.Wig N, Aggarwal P, Kailash S, Handa R, Wali JP. Awareness of brain death and organ transplantation among high school children. Indian J Pediatr 1999;66:189-92.  Back to cited text no. 7    
8.Weaver M, Spigner C, Pineda M, Rabun KG, Allen MD. Knowledge and opinions about organ donation among urban high school students: pilot test of a health education program. Clin Transplant 2000;14:292-303.  Back to cited text no. 8    
9.Weaver M, Spigner C, Pineda M, et al. Impact of school-based teaching on students' opinions of organ donation and transplantation. Transplant Proc 1999;31: 1086-7.  Back to cited text no. 9    
10.Sanner MA. Giving and taking-to whom and from whom? People's attitudes toward transplantation of organs and tissues from different sources. Clin Transplant 1998;12: 530-7.  Back to cited text no. 10    
11.Spigner C, Weaver M, Cardenas V, Allen MD. Organ donation and transplantation: ethnic differences in knowledge and opinions among urban high school students. Ethn Health 2002;7:87-101.  Back to cited text no. 11    

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Correspondence Address:
Mehmet Haberal
President of Baskent University, Fevzi Xakmak Cd. 10. Sok. No. 45 06490, Bahcelievler - Ankara
Turkey
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    Tables

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