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Saudi Journal of Kidney Diseases and Transplantation
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RENAL DATA FROM THE ARAB WORLD  
Year : 2020  |  Volume : 31  |  Issue : 4  |  Page : 821-825
Attitudes, Knowledge, and Social Perceptions toward Organ Donation and Transplantation in Eastern Morocco


1 Department of Nephrology, Faculty of Medicine and Pharmacy of Oujda; Laboratory of Epidemiology, Clinical Research and Public Health, University Mohamed Premier, Oujda, Morocco
2 Department of Education Sciences, Laboratory of Management, Environnement, Education and Social Responsibility of Organisations, Faculty of Education Sciences, University Mohamed V, Rabat, Morocco

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Date of Submission16-Jul-2019
Date of Acceptance05-Sep-2019
Date of Web Publication15-Aug-2020
 

   Abstract 


The study is aimed to assess attitudes, knowledge, and social perceptions toward organ donation and transplantation in Eastern Morocco and therefore understand what sets back this activity’s expansion and progression. We conducted a cross-sectional study involving three groups of persons that are theoretically involved in the process of organ donation (medical students, law students, and nurses). Data were collected using an anonymous questionnaire related to the cultural, religious, medical, and legal aspects of organ donation and transplantation. Six hundred questionnaires were distributed. The participation rate in the study was 71%, with female predominance and participants were mainly from an average socioeconomic level. Fifty- one percent of the participants were medical students. About 87.1% had already heard about organ transplantation in Morocco, but most of them felt that they were not sufficiently informed. 57.9% of the participants were favorable with some reluctance to organ donation, 28.7% were unconditionally favorable, and 5.9% were totally unfavorable. Only 46% of the participants accepted living organ donation, whereas 47.1% did not. Moreover, 64.7% of the participants accepted organ donation after their death, evoking the desire to help others and save lives. According to our survey, 55.1% of our participants considered that the decision to donate their organs after death belongs to them. About 44.9% think they should discuss this decision with their relatives and 50% said their culture and religion influence their decisions. Our work did reveal an insufficient level of awareness about various aspects of the topic. Moreover, a high pro-portion of the participants did not have positive attitudes toward donating, mainly driven by religious, cultural beliefs and perceived risks to the donor. The reasons of refusal should be analyzed carefully to improve acceptability toward organ donation and transplantation.

How to cite this article:
Haddiya I, El Meghraoui H, Bentata Y, Guedira M. Attitudes, Knowledge, and Social Perceptions toward Organ Donation and Transplantation in Eastern Morocco. Saudi J Kidney Dis Transpl 2020;31:821-5

How to cite this URL:
Haddiya I, El Meghraoui H, Bentata Y, Guedira M. Attitudes, Knowledge, and Social Perceptions toward Organ Donation and Transplantation in Eastern Morocco. Saudi J Kidney Dis Transpl [serial online] 2020 [cited 2020 Sep 28];31:821-5. Available from: http://www.sjkdt.org/text.asp?2020/31/4/821/292316



   Introduction Top


Organ transplantation is considered the best treatment for vital organ failure as it offers a better survival and quality of life to the patients.[1],[2] In our country, where related living donors are by far the primary source of transplants, several difficulties hinder the transplantation process such as the lack of financial support, noncompliance of patients and their relatives, as well as the shortage of brain-dead donors.[2],[3],[4]

Research suggests that attitudes, knowledge, and social perceptions of people towards organ donation have a significant impact on their willingness to donate and to register in the organ donor registry.[1] However, we often observe that our transplantation program faces, as the main barrier, the nonadherence of both potential living donors and brain dead patients’ families, often for sociocultural considerations.[5]

The aim of this study was to assess attitudes, knowledge, and social perceptions toward organ donation and transplantation in Eastern Morocco and therefore understand what sets back this activity’s expansion and progression.


   Methods Top


We performed a cross-sectional study in 2017, involving three groups of persons that are theoretically involved in the process of organ donation (medical students, law students, and nurses), those nonwilling to participate were excluded from the study.

Data were collected using an anonymous self-administered questionnaire related to the cultural, religious, medical, and legal aspects of organ donation and transplantation to assess attitudes, knowledge, and perceptions regarding this topic.

Data were analyzed using IBM SPSS Statistics version 20.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics are presented as frequencies and percentages for the categorical variables and mean ± standard deviation for numerical variables.

Ethical considerations: no name or identification was collected, and accepting to fill of the questionnaire was taken as consent.


   Results Top


Four hundred and twenty-eight questionnaires were completed out of 600 that were initially distributed to participants who fulfilled the study criteria, which corresponds to a response rate of 71%. The mean age of the participants was 24.66 ± 3.862 (18–40) years, with a sex ratio M/F of 1.3. Eighty-nine percent of them were from an average socioeconomic level. Fifty-one percent were medical students, whereas 29% and 20% were nurses and law students, respectively.

Donation and transplantation-related knowledge

87.1% of the participants already knew about organ donation and transplantation, while 12.4% only heard about it for the first time during our survey. Fifty-two percent of law students have never heard of it, and only 12% among them considered themselves informed enough about the subject. Whereas 84% of the nurses knew about the subject, but only 16% of them considered themselves sufficiently informed about it. Interestingly, 4% of Medical students have never heard of it and 60% revealed not being sufficiently informed.

Furthermore, 90% of our participants knew that donation could be performed from both living and brain dead donors. Half of the participants knew about the existence of a national law on donation and transplantation, mainly through the media. However, 60% of respondents were unaware of the existence of a national registry of acceptance and refusal of organ donation (50% of law students did not know the existence of this registry versus 27% of medical students). Besides, 67% of the participants were aware of being alleged donors if their families do not object after their death.

Attitudes toward donation and organ transplantation

57.9% of the participants were favorable with some reluctance to organ donation for transplantation, 28.7% were unconditionally favorable, and 5.9% were totally unfavorable. Noteworthy that 65% of the nursing staff and 63% of medical students were favorable with some reluctance versus 35% of law students. Furthermore, 46.7% of the participants were favorable but with some restrictions to organ removal from a close relative.

Only 46% of the participants accepted living organ donation, while 47.1% were not (17.5% were afraid of abuse or organ trafficking, 7.2% considered themselves too young to take such a decision, 2.6% mentioned a health problem, 6.3% feared complications, 5.1% lacked of confidence in the medico-surgical teams skills and 8.4% were opposed unless the recipient is a family member).

About 64.7% of the participants accepted organ donation after their death, evoking the desire to help others and save lives. On the other hand, 13.6% were opposed to it (6.3% had doubts as to the honesty of the distribution, 5.4% wanted their body to remain intact according to a religious belief, 1.9% were opposed to it unless the recipient is a family member).

Nineteen percent selected at least one organ or tissue that they would not donate (mainly the heart in 8%, followed by the cornea in 6%, then the skin in 3%). It is noteworthy that 51.6% of our participants reported being blood donors.

Donation and organ transplantation perceptions

According to our survey, 55.1% of our participants considered that the decision to donate their organs after death belonged to them. 44.9% think they should discuss this decision with their relatives. Besides, in our survey, 68% have never considered donating an organ, whereas 50% of the participants said their culture and religion do influence their choices and decisions.


   Discussion Top


The participation rate in our study was 71%, with female predominance and mainly from an average socioeconomic level. Fifty-one percent of the participants were medical students. About 87.1% of our participants had already heard about organ transplantation in Morocco, but most of them felt that they were not sufficiently informed. This joins data of both another Moroccan and a Tunisian study but remains inferior to French results, in which > 97% of participants have already heard about organ donation.[3],[6],[7],[8] On another hand, our percentage was higher than that reported by Ackoundou-N’Guessan et al, where only 45% of the surveyed population knew about trans- plantation.[9] 57.9% of the participants had a favorable opinion but were reluctant about organ donation. Forty-six percent agreed to donate their organs during their lifetime and 64.7% after their death. In addition, half of the responders know about the law governing organ donation and transplantation in Morocco mainly through the media. What’s more, 50% indicated that their culture and religion influenced their choice.

These data are similar to the results of another national study performed earlier.[3] In our survey, the majority (90%) of our participants knew that organ donation can be made from living or brain dead donors which are far superior to data from a Tunisian study where only 30.8% claimed this fact.[7]

We also noticed that medical students and nurses were the most aware of the subject and that 67% of our participants knew they were alleged donors if their families did not object after their death.

In addition, 51% of our population knew the existence of the Moroccan law regulating donation and transplantation. It should be noted that 40% of the French population ignored that such a law existed in their country.[10] Moreover, our results are far superior to both a Pakistani study where only 13.3% of the assessed students were aware of the existence of transplantation legislation,[11] as well as data from a Swiss study where only 44% of students knew about that law.[12] It has also been found that 60% of the people questioned knew the existence of a national registry of acceptance and refusal of organ donation, which is similar to Tunisian data.[7] Nonetheless, half of the law students did not know the existence of this registry versus 27% of medical students. Thus, there seems to be a lack of information in the law curriculum regarding the legislative aspect of the subject.

Attitudes and social perceptions on donation and organ transplantation

57.9% of the participants were favorable, but with some reluctance, to organ donation and transplantation. This percentage is inferior to that of the French biomedical agency, as this topic is part of their health priorities.[13] Comparing the responses of our three study groups, it should be noted that 65% of the nursing staff and 63% of medical students were favorable with some reluctance versus 35% of law students. It should be noted that doctors in training and nurses have a more favorable position than law students. Furthermore, 46.7% of our participants are favorable but with some conditions to organ removal from first-degree relatives, our results are lower than those of some European countries such as Sweden (73%), Finland (72%), England (64%) and the Netherlands 62%, but seems superior to that of Turkish (45%), and Austrian study (35%).[14]

Comparing the responses of our three groups, we, therefore, note that medical students and nurses have a more favorable attitude toward donation and transplantation. This is similar to a Turkish study in which nurses and students in medicine were more favorable to organ removal from a close family member after death than students in theology.[15] In addition, 47.1% were unfavorable to donation (2.6% mention a health problem, 6.3% fear complications, 5.1% lack confidence in the skills of the medical team, and 8.4% are opposed unless the recipient is a family member). This is unlike a French survey where only 9.4% were opposed to donation.[16]

Regarding brain-dead donation, 64.7% of our participants are unconditionally favorable to organ removal after death. These results are consistent with those of a Senegalese study in which 71.5% of the participants would agree to donate a kidney after death.[17] This result is similar to that of other studies conducted in Lebanon, Turkey, and Tunisia.[71518] In a French survey of young people aged 16–25, 70% agreed that their organs would be donated in the event of death.[13]

A Tunisian study also concluded that the older the person is and the higher the level of education they possess, the more they tend to be reluctant about organ donation following death,[7] but these characteristics have not been explored in the present study.

Furthermore, 13.6% of our participants were opposed to brain-death organ donation. The wish that their body remains intact and the doubts regarding the distribution’s equity are the main justifications of refusal. This is similar to data from a Tunisian study where damage to body integrity ranks at the top reasons of donation refusal.[7] According to our survey, 44.9% think that their family should have a role in their decision to harvest their organs after death. Fifty percent said that their culture and religion influence their choice. In Lebanon, the National Committee for Organ and Tissue Donation and Transplantation cited religion as a major reason for refusal (46.7%).[18] In Asia, an Indian study involving students revealed the impact of religious beliefs and the difficulty of changing them, since only 4.3% of those who were surveyed said their religion would allow organ donation, and this percentage decreased only by 3% after a training on organ donation and transplantation program.[19] In a Lebanese study, a significant number of participants revealed their fear of body mutilation during organ harvesting, suggesting an additional obstacle in the organ donation process.[18] However, a study conducted in Saudi Arabia found that the Islamic vision, Supporting the Concepts of Transplantation, provided the strongest positive influence to organ donation.[20]


   Conclusion Top


Our work is one of the few that have been performed so far in our region to assess attitudes, knowledge, and social perceptions of organ donation and transplantation in medical students, nurses, and law students. It did reveal a thoroughly insufficient level of awareness about various aspects of the topic. Moreover, a high proportion of the participants did not have positive attitudes toward donating, mainly driven by religious, cultural beliefs, and perceived risks to the donor. The reasons of refusal should be analyzed carefully to improve acceptability towards organ donation. Therefore, there is a need for culturally adapted communication approaches to overcome the main misconceptions regarding organ donation.

Conflict of interest: None declared.



 
   References Top

1.
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Ackoundou-N’guessan C, Gnionsahe A, Kouame E, et al. Characteristics of potential living kidney donors in Ivory Coast: A survey prior to a project of kidney transplantation in French Black Africa. Nephrol Ther 2007;3: 456-60.  Back to cited text no. 9
    
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Bazin C, Koissy S, Malet J. Contribution à la Réflexion sur le Don D’organes en France. Recherche et Solidarite; 2009. Available from: http://www.france-adot.org/images/pj/283p1_Synthese-Contribution-R&S-DondOrganes.pdf. Last accessed date 15 July 2019.  Back to cited text no. 10
    
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Correspondence Address:
Intissar Haddiya
Department of Nephrology, Faculty of Medicine and Pharmacy of Oujda, Oujda
Morocco
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DOI: 10.4103/1319-2442.292316

PMID: 32801243

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