| Abstract|| |
The growing demand for organs continues to outpace the supply. The aim of our study was to evaluate the knowledge, attitude and awareness of organ donation procedures among the health-care providers in the Intensive Care Units (ICUs) at a tertiary hospital. This was a questionnaire-based study conducted in December 2011 among the health-care providers at five ICUs in a tertiary teaching hospital in Riyadh, Saudi Arabia. A total of 154 participants completed the questionnaire. Eighty percent of the participants acknowledged that organ donation is a legal practice in Saudi Arabia, but only 73% knew that the hospital had an organ donation policy. However, only 34% were willing to participate in a training program for organ donation. Interestingly, only 57% were willing to donate their organs. Our results suggest that more measures should be taken to educate the health-care providers regarding the concept of organ donation and the ethical and religious beliefs. Also, the policy of the hospital and the Saudi Center for Organ Transplantation regarding the process of organ donation should be strongly emphasized.
|How to cite this article:|
Alsultan M. The perception of organ donation among health-care providers in the intensive care units at a tertiary center. Saudi J Kidney Dis Transpl 2012;23:724-8
|How to cite this URL:|
Alsultan M. The perception of organ donation among health-care providers in the intensive care units at a tertiary center. Saudi J Kidney Dis Transpl [serial online] 2012 [cited 2014 Aug 1];23:724-8. Available from: http://www.sjkdt.org/text.asp?2012/23/4/724/98147
| Introduction|| |
The recent advances made in immunosuppressant drugs have made transplantation a common treatment option for those in need.  Transplantation offers a better quality of life and better long-term survival.  The waiting list for organ transplantation continues to grow as the number of available organs remains relatively constant.  The growing demand for organs continues to outpace the supply.  According to the United Networks for Organ Sharing (UNOS), there are over 112,000 people in the United States in the appropriate waiting lists in need of an organ. The shortage of available organs for transplantation is a worldwide concern,  but this problem is even more glaring in developing countries. In Saudi Arabia, there are more than 4200 patients presently on the waiting list for kidney transplantation.  Because of the high incidence of motor vehicle accidents in this country, the cadaveric organs prove to be a viable source for meeting the current demand.  However, this pool of potential organs has not been properly utilized due to the debate in the medical field and in the public regarding the intricacies of organ donation. , The medical staff in the Intensive Care Units (ICUs) represents many cultures and, in general, the prevalence of knowledge about organ donation ranges from 60 to 85% globally. This range varies proportionately with the development status of the country.  There is a significant correlation between the impetus to donate and the knowledge and awareness of organ donations.  In our ICUs, organs were procured from only 17% of the confirmed brain-dead patients. Certain cultural facets encourage the acceptance of organ donation. The variation in the acceptance of such policies can be explained in part by regional differences in culture.  The objective of our study was to evaluate the knowledge, attitude and awareness of organ donation procedures among the healthcare providers in the ICUs at a tertiary hospital in Saudi Arabia.
| Method|| |
Questionnaires were distributed among the health-care providers at five ICUs in a tertiary teaching hospital in Riyadh, Saudi Arabia, in December 2011. These ICUs, which are managed by board-certified intensivists, are closed units with more than 3000 admissions per year. The health-care workers in these units represent approximately 52 nationalities, including North American, Australian, European and South-East Asian.
A trained organ donation co-ordinator conducted the survey. The questionnaire was pilot tested to screen for potential flaws in the evaluation process. After it was appropriately modified, the questionnaire was distributed among all health-care providers. The questionnaire was divided into three sections. The first section was used to gather the sociodemographic information. The second and third sections assessed the knowledge of the actual transplantation procedure and the attitudes toward organ donation.
| Statistical Analysis|| |
The descriptive statistics, including frequencies, percentages and mean (±SD), were estimated appropriately. The categorical variables were compared using the Chi-squared test. Results with a P <0.05 were considered statistically significant. The statistical analysis was performed using Minitab for Windows (release 13.1).
| Results|| |
The questionnaires were distributed to 200 health-care providers; 154 participants (77%) completed the same. The mean age of the providers was 32.0 ± 10.7 years. Fifty-seven percent of the participants were female and 27% had 10 years or more of experience in the ICU. The majority of respondents were Saudi (40%), followed by Indian/Pakistani (25%) and Middle Eastern (20%) nationalities. Nurses comprised 53% of the respondents. Physicians and respiratory therapists comprised 28% and 12% of the participants, respectively [Table 1].
Knowledge of organ donation
Eighty percent of the participants acknowledged that organ donation is a legal practice in Saudi Arabia, but only 73% knew that the hospital had an organ donation policy. The majority of the participants (97%) believed that the "population should be aware of the organ donation concept." However, only 34% were willing to participate in a training program for organ donation. Additionally, most of the respondents (81%) supported the concept of "allowance for organ donation." Interestingly, only 57% were willing to donate their organs [Table 2]. There were no significant differences between the two sexes or among the groups with varying ICU experience (P-values of 0.3 and 0.7, respectively) regarding the inclination to donate organs [Table 3].
|Table 3: Stratification of willingness to donate organs according to gender and experience in the Intensive|
Click here to view
| Discussion|| |
Our findings demonstrate that the health-care providers in the ICU possessed inadequate knowledge regarding organ donation and the actual procedures involved. Only 80% of the participants were aware of legalization of organ donation in Saudi Arabia, and only 73% were aware of the current organ donation policy of our hospital. This variation in knowledge may be explained in part by the different cultures represented by the respondents.
In our study, 57% of the health workers were willing to donate an organ. In contrast, 96% of participants expressed favorable attitudes toward donation in a similar study performed in Ohio.  However, our findings were similar to the observation made in a Canadian study of a comparable design. In this report, 62-69% of the survey respondents were willing to donate an organ.  Our percentage of willing organ donors greatly exceeded what was observed in a Turkish study in which only 23% of the physicians and 11% of the nurses were willing to donate an organ.  The percentage of healthcare providers willing to become organ donors correlates with the workers' knowledge and attitude toward the transplantation process.  In accordance with our observation, the studies from Pakistan  and from Nigeria  demonstrated no significant association between the gender and the inclination to donate.
Many of the health-care providers are reluctant to participate in the organ donation due to the moral distress and inner conflict imposed by the actual practice.  A study in Belgium demonstrated that formal training is associated with improved attitudes toward organ donation.  Another study from Taiwan found that effective training of ICU nurses resulted in a marked improvement in their knowledge, attitude and motivation.  The attitude of health-care providers toward donation is essential to the success of the organ donation program.  The transplantation process is facilitated by the co-operation of many persons involved with the patient care, including the family members, physicians, nurses and government officials [Saudi Center for Organ Transplantation (SCOT)]. 
The religious acceptance of organ donation augmented the motivation to become a donor.  Our study has several limitations. First, we used the convenience sampling to draw our sample for this study. This practice is inferior to the probability sampling as the latter represents a more appropriate distribution of participants. Secondly, it is not clear if the prompts included in the questionnaire were fully understood by the respondents. Lastly, the study was conducted in one center. Nevertheless, our study establishes a significant standard for future analysis. We conclude that public education should focus on all the areas of deficient knowledge to eventually dismiss the pervasive misconceptions that have served as barriers to transplantation. The knowledge and awareness of organ donation is inadequate but growing both in Saudi Arabia and globally.  The health-care providers can play a critical role in educating patients about donation. Measures should be taken to educate the health-care provider regarding the concept of organ donation and the ethical and religious beliefs as well as the policy of the hospital and SCOT regarding the process of organ donation. The gap between the health-care providers and the concept of organ donation should be bridged by a more favorable attitude and adequate knowledge, which should be endorsed by educational programs.
| References|| |
|1.||Reddy AV, Guleria S, Khazanchi RK, Bhardwaj M, Aggarwal S, Mandal S. Attitude of patients, the public, doctors, and nurses toward organ donation. Transplant Proc 2003;35:18. |
|2.||Bapat U, Kedlaya PG, Gokulnath. Organ donation, awareness, attitudes and beliefs among post graduate medical students. Saudi J Kidney Dis Transpl 2010; 21:174-80. |
|3.||Essman C, Thornton J. Assessing medical student knowledge, attitudes, and behaviors regarding organ donation. Transplant Proc 2006;38:2745-50. |
|4.||Salim A, Schulman D, Ley EJ, Berry C, Navarro S, Chan LS. Contributing factors for the willingness to donate organs in the Hispanic American population. Arch Surg 2010; 145:684-9. |
|5.||Aldawood A, Al Qahtani S, Dabbagh O, Al-Sayyari AA. Organ donation after brain-death: experience over five-years in a tertiary hospital. Saudi J Kidney Dis Transpl 2007; 18:60-4. |
|6.||Al Shehri S, Shaheen FA, Al-Khader AA. Organ donations from deceased persons in the Saudi Arabian population. Exp Clin Transplant 2005;3:301-5. |
|7.||Al-Naami MY, Arafah MA, Al-Ibrahim FS. Trauma care systems in Saudi Arabia: an agenda for action. Ann Saudi Med 2010;30:50-8. |
|8.||Shaheen FA. Organ donation in the Middle East countries. Ethn Dis 2009;19:S1-16-7. |
|9.||Saleem T, Ishaque S, Habib N, et al. Knowledge, attitudes and practices survey on organ donation among a selected adult population of Pakistan. BMC Med Ethics 2009;10:5. |
|10.||Al-Khader AA, Shaheen FA, Al-Jondeby MS. important social factors that affect organ transplantation in Islamic countries. Exp Clin Transplant 2003;1:96-101. |
|11.||Sander SL, Miller BK. Public knowledge and attitudes regarding organ and tissue donation: an analysis of the northwest Ohio community. Patient Educ Couns 2005;58:154-63. |
|12.||Molzahn AE. Knowledge and attitudes of physicians regarding organ donation. Ann R Coll Physicians Surg Can 1997;30:29-32. |
|13.||Bilgin N, Akgun HS. A focus on health care professionals in organ donation: A cross-sectional survey. Transplant Proc 2002;34:2445-7. |
|14.||Topbas M, Turkyilmaz S, Can G, et al. Information, attitude, and behavior toward organ transplantation and donation among health workers in the eastern Black Sea region of Turkey. Transplant Proc 2011; 43:773-7. |
|15.||Odusanya OO, Ladipo CO. Organ donation: knowledge, attitudes, and practice in Lagos, Nigeria. Artif Organs 2006;30:626-9. |
|16.||Mandell MS, Zamudio S, Seem D, et al. National evaluation of healthcare provider attitudes toward organ donation after cardiac death. Crit Care Med 2006;34:2952-8. |
|17.||Pelleriaux B, Roels L, Van Deynse D, Smits J, Cornu O, Delloye C. An analysis of critical care staff's attitudes to donation in a country with presumed-consent legislation. Prog Transplant 2008;18:173-8. |
|18.||Lin LM, Lin CC, Lam HD, Chen CL. Increasing the participation of intensive care unit nurses to promote deceased donor organ donation. Transplant Proc 2010;42:716-8. |
|19.||Agaba EI, Ocheke IE, Agaba PA, et al. Willingness of Nigerian healthcare workers to donate kidneys. Int J Artif Organs 2008;31:329-32. |
Consultant, Intensive Care Medicine and Emergency Medicine, Associate Professor, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh
[Table 1], [Table 2], [Table 3]