|Year : 2016 | Volume
| Issue : 6 | Page : 1129-1138
|Attitudes, knowledge, and willingness to donate organs among Indian nursing students
Vijayalakshmi Poreddi1, BV Katyayani1, Sailaxmi Gandhi2, Rohini Thimmaiah3, Suresh Badamath4
1 College of Nursing, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
2 Department of Nursing, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
3 Toowoomba Base Hospital, Toowoomba, Queensland, Australia
4 Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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|Date of Web Publication||28-Nov-2016|
| Abstract|| |
Globally, there is an acute shortage of organs for transplantation. Health professionals play an important role in raising awareness, motivating, and subsequently increasing the organ donation rates. Research related to nursing students' attitudes toward organ donation is limited from India. We aimed to assess undergraduate nursing students' knowledge, attitudes, and willingness to donate organs. This was a cross-sectional descriptive study carried out among conveniently selected undergraduate nursing students (n = 271) using self-reported questionnaires. All the participants were aware of organ donation. A majority (n = 251, 94%) of them were unaware of organ donation law. The mean score indicates that 66.7% of the participants had adequate level of knowledge [mean ± standard deviation (SD), 7.34 ± 1.61] and 72.3% hold positive attitudes (mean ± SD, 83.9 ± 1.01) toward organ donation. Statistically significant correlation (r = 0.265, P <0.001) was observed between knowledge and attitudes of the participants toward organ donation. The findings suggest the need for revising the nursing curricula to prepare the future nurses' competent in encountering the issues related to organ donation and fostering.
|How to cite this article:|
Poreddi V, Katyayani B V, Gandhi S, Thimmaiah R, Badamath S. Attitudes, knowledge, and willingness to donate organs among Indian nursing students. Saudi J Kidney Dis Transpl 2016;27:1129-38
|How to cite this URL:|
Poreddi V, Katyayani B V, Gandhi S, Thimmaiah R, Badamath S. Attitudes, knowledge, and willingness to donate organs among Indian nursing students. Saudi J Kidney Dis Transpl [serial online] 2016 [cited 2020 Jan 26];27:1129-38. Available from: http://www.sjkdt.org/text.asp?2016/27/6/1129/194595
| Introduction|| |
Organ shortage for transplantation is a crucial problem worldwide.  Although organ donation is a very personal issue, the organ donation process involves medical, legal, ethical, organizational, and social factors. , In India, "The Transplantation of Human Organs Act" was legalized in 1994.  Yet, organ donation rate in India is very poor (0.34 per million) compared to developed countries. 
Earlier studies clearly indicate that knowledge, attitudes, and behaviors are the major factors that positively influence the organ donation rates. ,, Similarly, health-care providers' attitudes and beliefs can influence public willingness to donate an organ for transplantation.  A recent study among Indian and Pakistan students identified that religion, awareness of the importance of donation, impact of medical education, culture-specific factors, treatment of donors and their organs, and influence of family were the key factors that influence attitudes toward organ donation.  Published research also acknowledged university students' willingness to sign on organ donation card. , Further, a meta-analysis carried out by Feeley in 2007 revealed that students were more receptive of new knowledge and information related to health and human services issues.  Nurses being major group among health professionals, they play a major role in the process of organ donation and transplantation. ,, However, a number of published studies found lack of knowledge and inadequate experience among nurses in dealing with issues related to organ donation and transplantation. ,, Similar to other countries, even in India, undergraduate nursing curricula do not discuss issues with regard to organ donation (only 1 h is allotted for discussion about organ donation and role of nurse in organ donation process).  Reviewed literature reveals a paucity of knowledge among medical and nursing students related to initiating discussion with family members about organ donation.  Nonetheless, research has been demonstrated that formal training about organ donation can influence nursing students' attitudes, knowledge, communication, and registration behaviors related to organ donation. , In India, only a few studies have focused about organ donation among healthcare workers,  patients,  and college students.  However, no published studies exist related to students nurses' knowledge and attitudes toward organ donation. Thus, the present study was aimed to assess Indian undergraduate nursing students' attitudes, knowledge, and willingness to donate organs.
| Materials and Methods|| |
This was a cross-sectional descriptive survey carried out among undergraduate nursing students at a College of Nursing, Bengaluru, South India.
A non-probability convenience sample with a quantitative descriptive design was adopted for the present study. Students currently studying the undergraduate nursing course and who were willing to participate were included in the study. Nursing students who had family members/relatives in need of organs for transplantation were excluded from the study. A total of 278 students were eligible to participate in the study. However, seven questionnaires were discarded because of incomplete responses and few were absent during data collection (n = 4). Hence, final sample comprised 267 undergraduate nursing students with high response rate (94%).
Data collection instruments
The questionnaire included four sections:
- Section A: This part consisted of items about sociodemographic details of the participants such as age, gender, year of education, religion, and residence. In addition, five questions regarding participants' awareness about organ donation, brain death, legislation, opinion on promotion of organ donation, and sources of information about organ donation were inquired
- Section B: This part of items intended to measure knowledge level of participants about organ donation.  This scale consisted of 11 items with true/false response options in five subscales, namely, general donation-related statistics (2 items), knowledge of the donation process (3 items), knowledge of what signing a donor card means (3 items), knowledge of medical suitability for donation (2 items), and knowledge of religious institutions' objections to donation (1 item). One mark awarded for every correct response, 0 otherwise. Hence, the total number of marks in the knowledge section ranged from "0" to "11"
- Section C: This part consisted of 22 items with 5-point Likert scale that ranged from "strongly disagree" to "strongly agree" to assess participants' attitudes toward organ donation.  Points ranging from 1 to 5 were given to each response such that the more positive the response, the higher the score. The total possible scores for this scale range from 22 to 110
- Section D: This part of the questionnaire measured participants' willingness to donate the organs. Intent to sign the card was measured on a 5-point scale developed by Skumanich and Kintsfather (1996)  (1 = "I will definitely sign the card," 2 = "I will probably sign the card," 3 = "I am unsure as to whether or not I will sign it," 4 = "I will probably not sign it," and 5 = "I will definitely not sign it."). A sixth item was added to identify the participants who had already signed an organ donation card. 
Data collection procedure
The questionnaire was piloted among group (n = 20) of participants and found that the study was feasible. Necessary modifications were made. The finalized questionnaires (English version) were administered to the participants batch wise after completion of their regular lectures. It took approximately 20-30 min to complete all the questionnaires.
After obtaining the permission from the administrators of the nursing college, the researchers approached the participants and explained briefly about purposes of the present study. Verbal consent was obtained from the volunteered participants, and they were given freedom to quit the study. Participants' confidentiality was respected with coded numbers. To keep their participation anonymous, no identification details were not asked, and coded numbers were used for each respondent.
| Statistical Analysis|| |
Before analysis, negatively worded items were reverse coded. Data were analyzed using R 3.23 version software (codename "Wooden Christmas Tree").  Descriptive statistics (frequency, percentage, mean, and standard deviation) were used to interpret the data. The Pearson's correlation coefficient test was used to examine the relationship between knowledge and attitudes of the participants toward organ donation. Statistical significance was assumed at P = 0.05.
| Results|| |
The sample of the present study consisted of 267 individuals of whom 99.3% (n = 265) were women. The mean age of the participants was [mean ± standard deviation (SD)] 19.20 ± 1.23 years. Majority of the participants were Christians (n = 207, 77.5%). All of them heard about organ donation and were in favor of organ donation. However, only 51.3% (n = 137) of them were aware of brain death. A vast majority of the participants were unaware of organ donation law (n = 251, 94%). A great majority also acknowledged that newspapers (61%) and television (58%) were the main sources of information about organ donation [Table 1].
With regard to knowledge regarding donationrelated statistics, 91.4% (n = 244) of the participants agreed that the demand for transplants is higher than availability. Majority of the participants felt that "organ and tissue donation does not disfigure the body, so an open casket funeral is possible" (n = 239, 89.5%) and 80.9% (n = 216) agreed that once a person has signed a donor card, they can still change their mind about organ donation. The mean score on knowledge scale indicates that 66.7% (mean ± SD, 7.34 ± 1.61) of the participants had adequate knowledge about organ donation [Table 2].
|Table 2: Participants' knowledge about important aspects of the organ donation.|
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[Table 3] describes participants' responses to organ donation attitude questionnaire. A large number of the participants were in favor of organ donation (n = 252, 94.4%) and were willing to donate organs after their death (n = 220, 82.4%). Similarly, a majority of the participants expressed that doctors would try hard to save their life whether or not they plan to be an organ donor (n = 193, 72.3%). The mean score of the attitude toward organ donation scale (mean ± SD, 83.9 ± 1.01) suggests that 76.2% of the participants hold positive attitudes toward organ donation.
With regard to intention to sign on the organ donation card, 79.4% (n = 212) of the participants were willing to sign on the organ donation card. However, merely 5.6% (n = 15) had already signed on organ donation card. On correlational analysis, it was observed there was a positive correlation between knowledge and attitudes of the students toward organ donation (P <0.001).
| Discussion|| |
This was the first descriptive study from India that attempted to assess nursing students' knowledge and attitudes toward organ donation. To facilitate and regulate the organ donation, the Government of India enacted the new legislation titled as the Human Organs Transplantation (Amendment) Act, 2011. This legislation amended the Transplantation of Human Organs Act, 1994. This new piece of legislation now includes standards for transplantation of tissues such as bones, skin, heart valve, and cornea besides organs such as heart, liver, pancreas, and kidneys. Further in 2014, the Ministry of Health and Family Welfare, Government of India notified the new rules on how to implement the Transplantation of Human Organ Act. All these actions clearly state the intention of the legislation. There are two aspects of the legislation; one is to ensure that the commercial angle to organ donation is curtailed in India and the second is to promote organ donation after brain death. The present study showed that a majority of the students had adequate levels of knowledge and hold positive attitudes toward organ donation. However, in consistent with several studies, only a lesser number of the students were willing to sign on organ donation card.
In this study, all of them were aware of "organ donation" and were in support of an Indian study carried out among college students.  Further, everyone in the sample was in favor of promoting organ donation. This number was higher compared to the studies that showed 75%  and 87%  and 97.5%  of the participants those who supported organ donation. In line with previous research, merely 6% of students were aware of legislation regarding organ donation. Unfortunately, this number was lower than the studies that observed 13.9% or more were aware of legislation regarding organ donation. ,, On the other hand, these findings were contrary to a recent study that revealed 52.7% of the nurses were conscious of national and international legislation regarding organ donation.  Earlier research indicates that lack of information on the legal and procedural details of organ donation in the general population including health professionals could be an important factor that contributes to shortage of organ donors.  Hence, it is crucial for the health-care providers to be aware of existing laws and procedures pertaining to organ donation.
For the health professionals, it is important to understand the term "brain death" so that they can clear family members/relatives misconceptions about brain death and can help them in making end-of-life decisions.  Several studies also indicate that the concept of brain death was frequently misunderstood by the healthcare professionals. , Similarly, 51.3% of the students in the present study were aware of brain death. These findings could be due to lack of content about brain death in the nursing curricula in India. However, research indicates that important issues related to brain death were continued to be neglected.  In line with previous research, television and newspapers were the main sources of information regarding organ donation in the present study and similar to previous studies. ,,,,
According to the current statistics in India, every year nearly 500,000 people die because of non-availability of organs. Majority of the participants (65.9%) agreed that Indians wait longer for kidney transplants. Similar to these findings, studies showed that thousands of patients are waiting for getting organ, while many of them die during their expectations. , The present study found that 67% of the students had adequate knowledge on organ donation that supports earlier research carried out among health professionals ,, and college students.  Nonetheless, studies proved that nursing students' knowledge of organ donation got substantially improved after educational programs. ,, Furthermore, Kim et al acknowledge the necessary to have an effective educational program for nurses to improve their knowledge of brain death and organ donation. 
In India, family is an important social agency that meets the various needs of its members.  In this context, individual decision whether to donate or not, in most of the cases final decision regarding organ donation will be taken by the family members.  Thus, it is very important to communicate individuals' decisions about organ donation after death with their families. In agreement with this statement, a majority (79.2%) had discussed their wishes after death with families. Religion is an important force in India and visible in many aspects of life.  However, with regard to organ donation, majority of the participants opposed that they have been taught organ donation is against their religion. Similarly, in a recent study from India, a vast majority (94.54%) of the participants endorsed that religion was not the criteria for organ donation.  On the contrary, a survey among medical students in Turkey found that 42.7% of the respondents indicated that their religion restricts organ donation.  Similarly, in a recent qualitative study, nurses perceived religion as an important factor that may interfere in the process of organ donation.  These differences could be due to religious and cultural beliefs imbibed among the participants. In the present study, nearly half of the participants opined that "It is important for a person's body to have all of its parts" (47.7%), "it is not possible to have regular funeral service after organ donation" (50.2%) and "organs for transplant can be bought and sold on the black market" (48.7%). In support of these findings, earlier research among nursing personnel proved that lack of correct perception of brain death content, fear of cutting organ of the body, and fear of mutilation of the body after death were the reasons of disagreement with organ donation.  Despite these concerns, majority of the participants (79.4%) in the present study were willing to sign on the organ donation card. However, in line with previous research, ,,, merely 5.6% of them signed on organ donation card. Similar to previous studies,  positive correlation was found in the present sample between knowledge and attitudes of the students toward organ donation (P <0.001).
| Limitations|| |
The present study has limitations such as convenience sampling, restricted to a single university, and cross-sectional survey made difficult to generalize the findings. Further, our sample is overrepresented with women. Hence, we could not analyze the gender differences. Despite these limitations, our findings may provide an insight about nursing students' knowledge, attitudes, and behaviors related to organ donation. Thus, the findings can be useful for nurse educators to identify and rectify the lacunas in the undergraduate nursing curriculum.
| Conclusions|| |
The study concludes that though majority of the students had an adequate level of knowledge and favorable attitudes toward organ donation, very few had signed organ donation card. Further, nursing students' knowledge and perceptions were still deficient in areas such as whether or to have all body parts, regular funeral service after organ donation, and impact of religion on organ donation. Thus, the study suggests the need for revising the nursing curricula to prepare the future nurses' competence in dealing the issues related to organ donation. ,,
| Acknowledgments|| |
The researchers sincerely thank the participants for their valuable contribution.
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College of Nursing, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka
[Table 1], [Table 2], [Table 3]
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