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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
ORIGINAL ARTICLE  
Year : 2018  |  Volume : 29  |  Issue : 6  |  Page : 1326-1332
Assessment of knowledge and attitude toward organ donation among the Saudi population in Riyadh City


1 Department of Basic Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
2 Department of Basic Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia; Department of Microbiology and Immunology, Faculty of Medicine, Cairo University, Giza, Egypt

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Date of Submission06-Nov-2017
Date of Acceptance21-Dec-2017
Date of Web Publication27-Dec-2018
 

   Abstract 

We aimed to assess the knowledge and attitude of the Saudi population and students of health science colleges as well as healthcare workers in Riyadh city about organ donation (OD). Data of this study were collected from 648 Saudi residents of Riyadh city using interviewer-administered questionnaires and online surveys. The participants included 503 from the general population and 145 health science professionals. The subjects included 252 males and 396 females with mean age of 27.09 ± 9 years. Majority of the participants (60%) were aware of OD from media as the main source of information, while only 30% had knowledge about Saudi center for organ transplantation (SCOT). It was found that 47.7% of the population agreed to donate both organs and tissue and 26% of them accepted the idea of OD to please Allah. The most important barrier (13%) was the belief that their bodies should be kept intact after death followed by ignorance about OD. Among health science professionals, 63% thought that everyone should be automatically registered as an organ donor while 15% believed that the donated organs could be misused. The majority of Riyadh’s population knew the concept and procedure of OD; however, there was a lack of awareness of the presence of SCOT. Religion is not a barrier for OD in the Saudi population. Awareness programs are urgently needed to emphasize the importance of donation as well as clarification of wrong beliefs.

How to cite this article:
Alsharidah DS, Al-Dossari FS, AlMahmoud N, Alanzan BA, Binkhulaif RJ, Bakhsh EM, Alkhalaf AA, Bin Huzim BA, Sarhan NT, Sulayem LM, ElFeky DS, Syed S. Assessment of knowledge and attitude toward organ donation among the Saudi population in Riyadh City. Saudi J Kidney Dis Transpl 2018;29:1326-32

How to cite this URL:
Alsharidah DS, Al-Dossari FS, AlMahmoud N, Alanzan BA, Binkhulaif RJ, Bakhsh EM, Alkhalaf AA, Bin Huzim BA, Sarhan NT, Sulayem LM, ElFeky DS, Syed S. Assessment of knowledge and attitude toward organ donation among the Saudi population in Riyadh City. Saudi J Kidney Dis Transpl [serial online] 2018 [cited 2019 Jan 17];29:1326-32. Available from: http://www.sjkdt.org/text.asp?2018/29/6/1326/248304

   Introduction Top


Organ donation (OD) means the donation of biological tissue or an organ of the human body, from a living or a dead person to a living recipient in need of a transplantation. Organ transplantation is the preferred mode of replacement therapy and can be the last recourse of lifesaving or for life-improving treatments. It has been documented that the organs from a single donor can save or help up to as many as 50 people.[1]

There are three types of organ donors; the living donor, donors after circulatory death (DCDs) [also known as nonheart-beating donors (NHBDs)] and donors after brain-death. There are three conditions where OD is ruled out completely; the donor diagnosed with cancer, untreated infection, or a condition that affects the nervous system.[2]

Many countries are adopting strategies to increase OD rates.[3] The World Health Organization requested the member countries to provide the relevant data for “The International Registry in Organ Donation and Transplantation” in 2010 and up till now, it has collected the data of approximately 80 countries. The countries with higher rates of OD are USA, China, Brazil, and France. Among the Arab countries in the Middle Eastern area, Kuwait is a leading country in organ transplantation.[4]

In 1982, the first resolution of the Islamic Council in Saudi Arabia about OD and transplantation was issued, which permitted the usage of tissue and organ transplantation from both living and cadaveric donors. This resolution marked a new era in organ transplantation in Saudi Arabia, leading to the establishment of the National Kidney Foundation in 1984, which was renamed Saudi Center of Organ Transplantation (SCOT) in 1993. A study reported the various organs that had been transplanted by SCOT and included 3759 kidneys (1267 cadaver, and 2492 living); 279 livers (225 cadaver, and 54 living); 92 hearts; 421 cornea; eight lungs, and five combined kidneys and pancreas transplants. In addition, there have been many tissue donations of bone marrow, heart valves (264 hearts), skin, and bone tissue.[5]

Availability of a suitable organ is the major challenge for transplantation. To improve organ supply, continued efforts and strategic planning are required. Awareness of general public, especially healthcare students, plays an important role in increasing organ donor pool; in view of this, a study was planned to assess the general trends in the Saudi population. The aim of the study was to assess the knowledge and attitude of Saudi population, students of health science college, and healthcare workers in Riyadh city about OD.


   Materials and Methods Top


This cross-sectional study was conducted on 648 adult Saudis aged 18 years and above, excluding non-Saudis and those below 18 years of age. The study settings included shopping malls, parks, hospitals, coffee shops, online, in addition to health science colleges and hospitals in Riyadh city.

Assuming a significant level of 5% and precision of 20%, a sample size of 489 subjects was estimated using stratified quota sampling. Informed consent was taken from all participants before participation in the study. The study was approved by the Institutional Review Board of the College of Medicine, Princess Nourah Bint Abdulrahman University.

The study was based on two close-ended, structured, interviewer-administered questionnaires; one for the general population consisting of two aspects; (a) knowledge about OD, (b) attitude and barriers toward OD with a total of 22 questions; while the other was for Health Science students and Health-Care workers consisting of an additional aspect i.e., their opinion on the idea of OD, with a total of 32 questions. Both questionnaires were initially validated through a pilot test of five participants from the general population and five from the students and healthcare workers before administration. The questionnaires were then distributed using quota sampling by the research team to the corresponding study group. Based on prior research studies, the expected positive attitude toward OD was 64.7%.[6] All statistical analyses were conducted with the Statistical Package for the Social Science software version 16.0 (SPSS Inc., Chicago, IL, USA). The descriptive statistics of studied sample were analyzed regarding mean, standard deviations, frequency, and percentage. Analysis of quantitative data by t-test and association of qualitative variables by Chi-square test were conducted. P <0.05 was considered as statistically significant.


   Results Top


A total of 648 questionnaires were collected from Riyadh population using online survey and interviewer-administered questionnaires; 503 from general population and 145 from health-related subjects. The general population represented 77.6% of the total study participants; (183 males and 320 females), whereas health sciences students represented 22.4% of the total study participants (70 males and 75 females).

[Table 1] demonstrates the mean knowledge score of OD according to the independent variables. The overall mean age of the participants was 27.09 ± 9 years, [252 males (38.8%) and 396 females (60.7%)]. The level of education was insignificantly related to knowledge of OD; the source of knowledge was mainly media (60%), internet (20%), friends (17%) and from schools (12%).
Table 1: Demographic data and knowledge score about organ donation.

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[Table 2] shows the knowledge about SCOT among Riyadh citizens; 30% of the general population knew about this center, 24% knew where to register to become an organ donor in Riyadh and 61% considered SCOT a place to sign up an organ donor card.
Table 2: General knowledge about the Saudi Center for Organ Transplantation among Riyadh population (affirmative answer).

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Circumstances, acceptance, and barriers influencing the decisions of organ donors are shown in [Table 3]. Most people agreed to donate both organs and tissues with a percentage of 47.7% while 53.8% wanted to donate after death, and 19.3% liked to specify their organ recipient. The current study showed that 47% participants from general population accept the idea of OD for three reasons; to please Allah, for the sake of helping a person after death and finally, because they believed that there is no use of their organs after they die. The most common barrier (13%) was the belief of the participants that their bodies should be kept intact after death. While the least common barrier (5%) was that they had religious beliefs preventing them from donating their organs.
Table 3: Circumstances, acceptances and barriers influencing the decision of organ donors.

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Among the health science professionals and students, 63% of participants had positive response to the suggestion of automatic Registration as an organ donor with the choice of withdrawal from it. Further, 91% believed that it is important to determine the brain-death of the donor to declare the patient as a potential donor, while 76% mentioned that they knew the criteria of brain-death [Table 4].
Table 4: Opinions of Health Science professionals and students.

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   Discussion Top


The study assessed the knowledge, acceptance, and barriers of OD among the general Saudi population and health science professionals to increase awareness and willingness to donate organs. The results showed significant variation among male and female knowledge scores (P = 0.0001); however, the total number of females was more than males. The education level did not have any impact on the level of knowledge of OD. In contrast, a study conducted in Pakistan to determine the knowledge regarding OD in selected adult population, revealed a direct correlation between education level and the knowledge of OD. About 42.6% of precollege students and 52.2% from college and higher education institutes had higher level of knowledge about OD.[7]

Regarding the source of knowledge about OD, our data revealed that media was the most effective source of information and schools as the least effective. Our finding is consistent with a study done in India where about 21% of participants became aware through mass media.[8] A media campaign can thus significantly influence awareness on OD and beliefs, as confirmed by a study in which the post-media surveys demonstrated significant improvements in OD awareness (P <0.0001).[9]

Despite the successful performance of SCOT for almost all types of organ transplantations since its establishment, the current study showed low level of awareness about this center. Only 24% of the study population knew about the existence of a center to register as an organ donor in Riyadh, 30% of participants were familiar with the functions of SCOT and 61% considered signing an organ donor card.

Although a great majority of the population in Saudi Arabia is Muslim, however, this study revealed that only 5% of population considered religious beliefs as a barrier for OD and refused to donate on this basis. Similarly, a study conducted in Dhahran Military Hospital showed that 68.6% of the participants considered it legal to donate organs versus 26.2%, who considered it illegal in Islam.[6] Another study performed in Kuala Lumpur showed that only 10% of the respondents refused OD because of religion.[10] Thus, as people get more educated, religious barrier is no longer a real barrier. On the contrary, it is considered as saving thousands of lives and helping others, which is a principle rule in Islam.

Among the barriers, the highest percentage of participants (13%) believed that their bodies should be kept intact after death. This is consistent with a study which documented that 16.7% of contributors wanted their bodies to remain intact after death.[10] In this study, many participants were against OD due to multiple other reasons as, for example, 6% did not consider themselves healthy enough to donate. A study conducted mainly on Catholic Christians regarding the hindrances related to OD revealed that 17% of the respondents refused to donate based on traditional Godly beliefs, whereas 10% had no religious affiliations. Other six hindering factors reported in this study included, limited information about OD, healthy organ not available to donate, fear about lack of forgiveness by ancestors and tribal elders who might not accept the concept of OD, intact bodies required during rituals and for earth burials, bad-shaped bodies due to accidental deaths and worry about possession by the donor’s spirit.[11]

Although the Saudi Islamic Council had permitted tissue and organ transplantation from both living and cadaveric donors since 1980’s,[5] the majority of our population was not willing to donate. Only 47% of the participants had willingness to donate organs and tissues, 6% wanted to donate while alive, whereas 53% were willing to donate after death. On the contrary, a study conducted in Poland reported that 83% of citizens agreed to donate their organs after death.[12]

The most common reason for people to donate organs in our study was to please Allah (26%) and not for financial benefits. Similar results were reported from the study conducted in Dhahran, where a great majority (82.1%) was in favor of OD for the same reason; however, 14.5% asked for a reward from the government and 3.4% believed that the reward should come from the donor.[6]

The current study documented that 63% of health professionals were in favor of automatic registration as an organ donor. A study determining the knowledge, attitudes, and practices regarding OD in India displayed that 81% participants were of the opinion that consent for OD after death should be given only by family members. Both studies demonstrated a favorable inclination toward OD; however, preference in approval-holders of donation varied and each had their pros and cons, which might be due to the difference in understanding the concept of OD and its importance.[8]

The quality of care for donated organs is as important as saving people’s lives. Our study revealed that 15% of Saudi Health Science students thought that donated organs could be misused, which is consistent with another study showing that about 59% of people believed that there is a potential danger of donated organs being misused, abused, or misappropriated.[8] With differences in cultures, variation in opinions among people belonging to different cultural and religious beliefs exists on OD. Our study showed that 76% of healthcare participants were familiar with the brain-death criteria whereas a study conducted in 21 Latin American countries showed that all health-care workers were aware of brain-death criteria, proving the higher level of education among physicians in these countries and the importance of identification of criteria to determine brain death.[13] Regarding the ability to identify possible organ donors, our study demonstrated that 46% of Saudi healthcare workers could do that. A study conducted on American healthcare population reported that 66% of the hospital administrators, 55% of directors of nursing, 49% of the Intensive Care Unit nurses and 96% of neurosurgeons were aware of the criteria for identifying possible organ donors.[9] This indicates that we need to increase the knowledge among Saudi health workers.

Regular programs, lectures, and campaigns are urgently needed to improve the awareness regarding OD among general population, to increase the number of organ donors, to improve efficiency of donation process as well as to expand the living donor pool in Riyadh city. There is a strong relationship between educational level and knowledge of OD, as shown by a study performed on 70 students who responded a pretest and posttest questionnaire after the classroom teaching. The awareness about OD increased from 27% to 80%.[14]

Interpretation of the definition of a healthy organ, and screening stages before accepting donation is also imperative since some people believe that they are not healthy enough to donate organs. People should know the specific cases where OD is contraindicated as in nervous system infections, positive human immunodeficiency virus, cancer, or diseased organ. Explaining the importance and clarifying the wrong beliefs of possible donors will be useful to the family of critically ill patients.


   Conclusion Top


The study recognized that public awareness and knowledge holds the key to acceptance and willingness to donate. Most of Riyadh’s population knew the concept and procedure of OD, although only 30% were aware of the presence of SCOT. Majority of Riyadh residents agreed signing up for a donation card by reasons of faith, good deed, importance of OD, and belief that their organs will not be beneficial to them after death. It was concluded that religion is not a barrier as was previously suggested. Effective actions should be taken to educate people with the contribution of health-care providers, media, and religious scholars.

Conflict of interest: None declared.

 
   References Top

1.
Manara AR, Murphy PG, O’ Callaghan G. Donation after circulatory death. BJA 2012; 108:i108-21.  Back to cited text no. 1
    
2.
Oxford Transplant Foundation; 2013. Available from: http://www.oxfordtransplant.org.uk/patients-donors/faqs. ([Last accessed on 2018 May 14]  Back to cited text no. 2
    
3.
Gridelli B, Remuzzi G. Strategies for making more organs available for transplantation. N Engl J Med 2000;343:404-10.  Back to cited text no. 3
    
4.
Gómez MP, Pérez B, Manyalich M. International registry in organ donation and transplantation-2013. Transplant Proc 2014;46: 1044-8.  Back to cited text no. 4
    
5.
Shaheen FA, Souqiyyeh MZ. Increasing organ donation rates from Muslim donors: Lessons from a successful model. Transplant Proc 2004;36:1878-80.  Back to cited text no. 5
    
6.
Mohamed E, Guella A. Public awareness survey about organ donation and transplantation. Transplant Proc 2013;45:3469-71.  Back to cited text no. 6
    
7.
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.  Back to cited text no. 7
    
8.
Balwani MR, Gumber MR, Shah PR, et al. Attitude and awareness towards organ donation in Western India. Ren Fail 2015;37: 582-8.  Back to cited text no. 8
    
9.
Salim A, Berry C, Ley EJ, Schulman D, Navarro S, Chan LS. Utilizing the media to help increase organ donation in the Hispanic American population. Clin Transplant 2011; 25:E622-8.  Back to cited text no. 9
    
10.
Tumin M, Noh A, Jajri I, Chong CS, Manikam R, Abdullah N. Factors that hinder organ donation: Religio-cultural or lack of information and trust. Exp Clin Transplant 2013; 11:207-10.  Back to cited text no. 10
    
11.
Chen AN, Chen KF, Chang PC, et al. Hindering factors and suggestions related to organ donation decisions: Perspective of the Taiwan Ali-Shan Tsou aboriginal tribe. Transplant Proc 2014;46:1041-3.  Back to cited text no. 11
    
12.
Kobus G, Poplawska W, Zbroch E, Malyszko J, Bachórzewska-Gajewska H, Malyszko J. Opinions of town residents on organ transplantation. Transplant Proc 2014;46:2492-5.  Back to cited text no. 12
    
13.
Prottas J, Batten HL. Health professionals and hospital administrators in organ procurement: Attitudes, reservations, and their resolutions. Am J Public Health 1988;78:642-5.  Back to cited text no. 13
    
14.
Ramadurg UY, Gupta A. Impact of an educational intervention on increasing the knowledge and changing the attitude and beliefs towards organ donation among medical students. J Clin Diagn Res 2014;8:JC05-7.  Back to cited text no. 14
    

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Correspondence Address:
Prof. Sadiqa Syed
College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh
Saudi Arabia
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DOI: 10.4103/1319-2442.248304

PMID: 30588963

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