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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 1  |  Page : 23-30
Knowledge and attitudes toward organ donation: a community-based study comparing rural and urban populations


Health and Hospital Administration Program, College of Business Administration, King Saud University, Riyadh, Saudi Arabia

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Date of Web Publication8-Jan-2010
 

   Abstract 

The study was set to determine whether knowledge and attitudes toward organ dona­tion differ according to geographical location. Self-administered questionnaires were employed to collect data such as demographic characteristics, basic knowledge, attitudes and source of information about organ donation from subjects in rural and urban areas. The questionnaires were distributed randomly to 1,000 individuals in both areas during 2008. The data were analyzed in a descriptive fashion. Despite similarities in knowledge and attitudes of respondents in both areas, rural res­pondents were less likely to have information about organ donation, to report willingness to donate organs, and to have knowledge about "brain death" or the "organ donation card" than their counter­parts in urban areas. The study identified that the principle respondents' source of information about organ donation was the television. More than 90% of respondents in rural and urban areas reported that the contribution of health care providers in providing them with knowledge about organ dona­tion and transplantation was "none" or "little". Respondents identified several reasons, which may influence their decisions to donate organs. In conclusion, the deficit in knowledge and attitudes of rural respondents about organ donation may be justified by the lack of information about this signi­ficant issue. Accordingly, health facilities, local mass media and educational institutions should provide intensive educational programs to encourage the public donate organs.

How to cite this article:
Alghanim SA. Knowledge and attitudes toward organ donation: a community-based study comparing rural and urban populations. Saudi J Kidney Dis Transpl 2010;21:23-30

How to cite this URL:
Alghanim SA. Knowledge and attitudes toward organ donation: a community-based study comparing rural and urban populations. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2014 Oct 25];21:23-30. Available from: http://www.sjkdt.org/text.asp?2010/21/1/23/58703

   Introduction Top


The Saudi Center for Organ Transplantation (SCOT), previously known as the National Kid­ney Foundation, was established in 1984 with an objective to supervise activities of organ dona­tion and transplantation in Saudi Arabia. SCOT adopted strategies that included research con­duction, distribution of donation cards, public awareness and health professionals' education. [1],[2],[3],[4] Despite efforts to educate and encourage the public about donation and transplantation, the number of organ donors has not paralleled the growing waiting list, [5],[6],[7] and inadequate organ donation in Saudi Arabia remains a major limi­ting factor for transplantation.

Providing the general public by relevant information and correcting some of the misconcep­tions are likely to increase the number of indi­viduals willing to donate organs. Several stra­tegies have been adopted in order to maximize the number of donors in many countries, inclu­ding increasing the number of organs transplan­ted from living donors, legislation [8] and making the deceased's persons wishes expressed on an organ donor card (e.g. driver's license) legally binding. [9]

Studies on factors associated with knowledge and attitudes towards organ donation have shown contradicting results and have indicated that it is not clear which factors are most significantly related to decision-making for donation. [4],[10],[11],[12],[13]

Some studies identified that the place of public residence may influence the knowledge, attitudes and the willingness for organ donation. [14],[15] This may stem from the fact that people living in rural or remote areas may have poorer know­ledge due to difficulty in accessing health in­formation resources. [15] No studies have been carried out in Saudi Arabia to assess the general public knowledge, attitudes, and sources of in­formation regarding organ donation among ru­ral populations.

The main objective of this study is to deter­mine whether knowledge, attitudes and sources of information about organ donation and trans­plantation differ according to geographical lo­cation.


   Materials and Methods Top


In this cross-sectional study, 1000 subjects were selected using a stratified random sam­pling technique in order to represent respon­dents from both rural and urban areas. Forty­four males and 59 females from both areas were excluded from the study due to incomplete questionnaires, refusal to give their consent to participate, or failure to complete the questio­nnaire due to lack of time. A total of 897 par­ticipants successfully completed the questio­nnaires; a response rate of 89.7%.

The study was conducted in a randomly se­lected primary health care (PHC) centers during 2008. PHC centers are considered the first point of contact between the general public and the health care system in Saudi Arabia, and it is therefore an ideal location to obtain a more re­presentative sample from people with different socio-demographic and cultural characteristics.

The survey instrument was a standardized self­administered questionnaire and was designed to capture information relevant to the study. The questionnaire was divided into four sections with a total of 30 items. Section I included ques­tions on demographic characteristics (6 items). Section II consisted of questions on knowledge about organ donation (8 items). Section III con­sisted of statements regarding respondents' atti­tude towards organ donation and transplantation (10 items). In section IV, respondents were asked about their sources of information con­cerning organ donation (6 items). The responses for items on knowledge and attitudes were in "yes" and "no" form. Items on respondents' source of information about organ donation were scored on a 5-point Likert scale ranging from "none" to "very much".

A number of steps were taken to increase the content validity of the questionnaire. Firstly, a review of the relevant literature was carried out in order to select some statements pertaining to respondents' knowledge and attitudes. Secondly, two academic staff reviewed the questionnaire and their suggestions were incorporated into the final questionnaire. Finally, a pilot survey of 20 adult persons in each geographical area (10 males and 10 females) was conducted. On the basis of the outcome of the pilot survey, a few questions were reformed and some were either added or excluded. The pilot survey results were not included in the main survey. The covering letter of the questionnaire outlined the title and the purpose of the study and the identity of the researcher. The participants were informed about the importance of the study and were encou­raged to participate and were informed on the issue of anonymity; no identifying information was included on the questionnaire.


   Statistical Analysis Top


The data for this study were collected by a group of health services administration students and were analyzed in a descriptive fashion using the Statistical Package for Social Sciences (SPSS). In making comparison between rural and urban areas, the mean values of continuous variables were compared using student's t-tests and the proportions of categorical variables were com­pared using chi-square analysis. The level P< 0.05 was considered as the cutoff value for significance.


   Results Top


Profile of respondents

[Table 1] shows the general profile of the 897 respondents included in the study. Respondents from the urban areas comprised 57.3% of the study sample. Demographic variables indicated that respondents in both the rural and urban areas were well matched with respect to their age, nationality, educational level, employment status and marital status. The differences bet­ween the respondents from the rural and urban areas with respect to the demographic variables were not statistically significant. However, a significantly higher percentage of males than females in rural areas were represented in the study sample compared with that in the urban areas (P< 0.0001).

Knowledge about organ donation

[Table 2] shows that the respondents in the rural areas had a significantly lower percentage of knowledge about organ donation and transplan­tation than the respondents in the urban ones. For example, respondents in rural areas repor­ted having less information about organ dona­tion than their counterparts in urban areas (P< 0.0001). When the respondents were asked whether they knew who should be contacted if they wished to donate an organ, a significantly lower percentage of those in the rural than the urban areas answered in an affirmative (P< 0.0001). Similarly, a significantly lower percen­tage of respondents in the rural areas reported less knowledge about the requirements and pro­cedures for organ donation than respondents in the urban areas (P< 0.001). Only about one-third of respondents in the rural areas and one-half of respondents in the urban areas knew the types of organs that can be donated (P< 0.0001). Res­pondents in the urban areas were more know­ledgeable about the brain death concept (P< 0.0001) and the donation card (P< 0.0001) than respondents in the rural areas. A significantly higher percentage of respondents in the rural areas believed more than their counterparts in the urban areas that "only organs of young people can be donated" (P< 0.01).

Attitudes towards organ donation

[Table 3] shows the attitudes of subjects toward organ donation according to place of residence, which indicates that the rural respondents differed significantly from their counterparts in the ur­ban areas in a number of attitudinal aspects. For instance, a significantly higher percentage of res­pondents in the urban areas 343 (66.7%) ex­pressed willingness to donate an organ than those in the rural areas 164 (42.8%) (P< 0.0001). Those who were willing to donate, in both the rural and urban areas, did not differ significantly in the timing of donation. The vast majority of respondents in the rural and urban areas were willing to donate after their death only (51.8% and 58.0%, respectively). However, a higher per­centage (34.8%) of respondents in the rural areas was willing to donate during life time than respondents in urban areas (26.2%). The per­centage of the respondents who were willing to donate at anytime (either during life or after death) was similar in the rural and urban areas (13.4% and 15.7% respectively).

The respondents in the rural and urban areas provided different reasons inhibiting them from organ donation. The respondents in the rural areas were more likely to report "worries about receiving inadequate health care after donation" (P< 0.0001), "lack of family support" (P< 0.0001) and "lack of information about organ donation" (P<0.0001) than those in the urban areas. On the contrary, the respondents in the urban areas were more likely to report "lack incentives" (P< 0.0001) and "other reasons" (P< 0.0001) than those in the rural areas. Despite a higher per­centage of respondents in the rural areas had expressed "fear of complications after donation" and "religious reasons" than those in the urban areas as reasons for not donating, the difference was not statistically significant.

Source of information

[Table 4] shows that respondents in the rural and urban areas differ significantly according to the source of information about organ donation. The respondents in the urban areas had a sig­nificantly higher mean score (3.95) than those in the rural areas (3.01) about receiving infor­mation from television (P< 0.001). Moreover, the respondents in the urban areas had a sig­nificantly higher mean score (2.54) than those in the rural areas (2.12) regarding newspapers as a source of information (P< 0.001). Similarly, respondents in the urban areas had significantly higher mean scores in receiving information from posters and health care providers (1.66 and 1.36 respectively) than those in the rural areas (1.36 and 1.20 respectively) (P< 0.001). The res­pondents in both the rural and urban areas had similar mean scores in receiving information from families (1.13 and 1.14 respectively) and from "other sources" (2.28 and 2.31 respectively). The difference between the rural and urban areas in receiving information about organ do­nation from these sources was not statistically significant.


   Discussion Top


The results of our study demonstrate several characteristics of the respondents. In general, those who live in the rural areas were less likely to have information about organ donation than their counterparts in urban areas. For instance, they were less likely to know "whom should be contacted" for organ donation, to know the "types of organs that can be donated" and more likely to believe that "only organs of young people can be donated". The vast majority of respon­dents in rural areas had never before heard either about "brain death" or the "organ donation card".

Our results indicate that more than half of the rural respondents and more than forty percent of the respondents living in the urban areas were not willing to donate organs. Similarly, the vast majority of respondents in both geo­graphical areas were not willing to sign the donation card. These results demonstrate that the level of knowledge about organ donation in both the rural and urban areas is not optimal. In fact, the rural respondents from the areas were less likely to report willingness to donate or­gans than respondents in urban areas. Interven­tional programs to improve the awareness of the general public, particularly those living in re­mote areas, is required. Once these programs are established, they need to be evaluated in order to assess the progress of the attitudes to­ward organ donation.

Our study identified that the principle respon­dents' source of information about organ dona­tion was the television (TV). The contribution of other sources of information in providing respondents with knowledge about organ dona­tion was minimal. Generally, studies had shown the importance of visual media in increasing the awareness of the public about organ donation. [16],[17]

Our study also identified several reasons that may influence the decision-making of the pub­lic toward organ donation. Many of these rea­sons can be manipulated. For example, the vast majority of respondents in rural areas were con­cerned about not receiving adequate health care after donation. Therefore, it is possible that es­tablishing legislations that will guarantee the donors better health care and easy access to health facilities might encourage people to do­nate organs during their life times. Similarly, respondents in urban areas were more likely to report "lack of incentives" as one of the main reasons for not willing to donate. Accordingly, financial and non-financial incentives should be considered to encourage the public to donate organs.

The results of this study showed that res­pondents in both the rural and urban areas re­ported that lack of family support was one of the limiting factors for donating organs. Efforts should be made to increase discussions about organ donations among the family members. Previous research had reported direct correla­tion between willingness to donate and family support [18] and indicated that appropriate public exposure to knowledge about organ donation would result in more family discussions and more frequent declaration of one's wishes to donate, decreasing uncertainty at critical times (brain death of a loved one) and would likely to increase organ donation.

Moreover, our results surprisingly indicated that more than 90% of respondents in the rural and urban areas reported that the contribution of health care providers in providing them with knowledge about organ donation and transplan­tation was "none" or "little". This may question health education activities held in health care facilities such as primary health care centers, where health education is considered one of their principles.

The majority of the respondents in both areas reported "lack of information" about organ do­nation and transplantation. These findings are comparable with those reported from neighbo­ring countries [13],[18] as well as studies conducted in the West [19],[20] and Saudi Arabia; [1],[21],[22],[23] all in­dicate the importance of public education about the importance of organ donation.

One major limitation of this study is that it did not examine the relationship between respon­dents' willingness to donate and their socio-de­mographic characteristics, their knowledge and attitudes about organ donation. This could be an important topic for future research. Second, this study does not claim to be comprehensive be­cause the study took place in Riyadh region only. Accordingly, the results may have limited applicability to other regions in the Kingdom. Third, the results reported here were based on information collected by questionnaires and were subjected to the disadvantages of using this data collection tool. However, the questio­nnaire was anonymous, which should have en­couraged accurate and honest self-disclosure. Future research should attempt to address some of the concerns indicated in the limitations.

In conclusion, the negative attitudes of respon­dents towards organ donation reported by this study are justified by the inadequate informa­tion acquired by the public about this signi­ficant issue. Accordingly, the general public should not be held alone responsible for the unwillingness to donate organs; other parties such as local mass media, health care providers, and educational institutions are responsible too for this result.


   Acknowledgement Top


The author of this study would like to thank the Research Center in the College of Business Administration for the financial support of the study.

 
   References Top

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2.Shaheen F, Souqiyyeh M, Abdullah A. Strategies and obstacles in an organ donation program in developing countries: Saudi Arabian experience. Transplant Proc 2000;32:1470-2.  Back to cited text no. 2      
3.Aswad S, Souqiyyeh M, Huraib S, El-Shihabi R. Public attitudes toward organ donation in Saudi Arabia. Transplant Proc 1992;24:2056-8.  Back to cited text no. 3      
4.El-Shoubaki H, Bener A. Public knowledge and attitudes toward organ donation and transplan­tation: a cross-cultural study. Transplant Proc 2005;37:1993-7.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]  
5.Shaheen F. Organ transplantation in the King­dom of Saudi Arabia: new strategies. Saudi J Kidney Dis Transpl 1994;5:3-5.  Back to cited text no. 5  [PUBMED]  Medknow Journal  
6.Al-Shehri S, Shaeen F, Al-Khader A. Organ donations from deceased persons in the Saudi Arabian population. Exp Clin Transplant 2005; 3:301-5.  Back to cited text no. 6      
7.Aldawood A, Al Qahtani S, Dabbagh O, Al­Sayyari A. Organ donation after brain death: experience over five-years in a tertiary hospital. Saudi J Kidney Dis Transpl 2007;18:60-4.  Back to cited text no. 7  [PUBMED]  Medknow Journal  
8.Terasaki P, Cecka J, Gjertson D, Takemoto S. High survival rates of kidney transplants from spousal and living unrelated donors. N Engl J Med 1995;333:333-6.  Back to cited text no. 8      
9.Haustein S, Sellers M. Factors associated with (un)willingness to be an organ donor: impor­tance of public exposure and knowledge. Clin Transplant 2004;18:193-200.  Back to cited text no. 9      
10.Light J, Kowalski W, Ritchie W, et al. New profile of cadaveric donors: what are the kidney donor limits? Transplant Proc 1996;28:17-20.  Back to cited text no. 10      
11.Shaheen F, Souqiyyeh M. Factors influencing organ donation and transplantation in the Middle East. Transplant Proc 2000;32:645-6.  Back to cited text no. 11      
12.Jasper J, Nickerson C, Hershey J, Asch D. The public's attitude toward incentives for organ donation. Transplant Proc 1999;31:2181-4.  Back to cited text no. 12      
13.El-Shoubaki H, Bener A, Al-Mosalamani Y. Factors influencing organ donation and trans­plantation in the state of Qatar. Transplant Med 2006;18:97-103.  Back to cited text no. 13      
14.Conesa C, Rios A, Ramirez A, Canteras M, Rodriguez M, Parrilla P. Attitudes toward organ donation in rural areas of Southeastern Spain. Transplant Proc 2006;38:866-8.  Back to cited text no. 14      
15.Conesa C, Rios A, Ramirez P, et al. Rural pri­mary care centers as a source of information about organ donation. Transplant Proc 2005;37: 3609-13.  Back to cited text no. 15      
16.Matesanz R, Miranda B. Organ donation the role of the media and of public opinion. Nephrol Dial Transplant 1996;11:2127-8.  Back to cited text no. 16  [PUBMED]  [FULLTEXT]  
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18.Bilgel H, Sadikoglu G, Goktas O, Bilgel N. A survey of the public attitudes towards organ donation in a Turkish community and of the changes that have taken place in the last 12 years. Transpl Int 2004;17:126-30.  Back to cited text no. 18  [PUBMED]  [FULLTEXT]  
19.Schauenburg H, Hildebrandt A. Public knowledge and attitudes on organ donation do not differ in Germany and Spain. Transplant Proc 2006;38:1218-20.  Back to cited text no. 19  [PUBMED]  [FULLTEXT]  
20.Sandera S, Miller B. Public knowledge and attitudes regarding organ and tissue donation: an analysis of the northwest Ohio community. Patient Educ Couns 2005;58:154-63.  Back to cited text no. 20      
21.Al-Sebayel M, Al-Enazi A, Al-Sofayan M, et al. Improving organ donation in Central Saudi Arabia. Saudi Med J 2004;25:1366-8.  Back to cited text no. 21      
22.Al-Attar B, Shaheen F, Souquiyyeh M, Babiker A, Ahmed H. Brain death and organ donation in Saudi Arabia. Transplant Proc 2001;33:2629-31.  Back to cited text no. 22      
23.Al-Sebayel M. The status of cadaveric organ donation for liver transplantation in Saudi Arabia. Saudi Med J 2002;23:509-12  Back to cited text no. 23      

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Correspondence Address:
Saad Abdullah Alghanim
Health and Hospital Administration Program, King Saud University, P.O. Box 271373, Riyadh
Saudi Arabia
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    Abstract
    Introduction
    Materials and Me...
    Statistical Analysis
    Results
    Discussion
    Acknowledgement
    References
    Article Tables
 

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