Year : 2010 | Volume
: 21 | Issue : 1 | Page : 23--30
Knowledge and attitudes toward organ donation: a community-based study comparing rural and urban populations
Saad Abdullah Alghanim
Health and Hospital Administration Program, College of Business Administration, King Saud University, Riyadh, Saudi Arabia
Saad Abdullah Alghanim
Health and Hospital Administration Program, King Saud University, P.O. Box 271373, Riyadh
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 «DQ»brain death«DQ» or the «DQ»organ donation card«DQ» than their counterparts in urban areas. The study identified that the principle respondents«SQ» 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 «DQ»none«DQ» or «DQ»little«DQ». 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 2019 Dec 7 ];21:23-30
Available from: http://www.sjkdt.org/text.asp?2010/21/1/23/58703
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. ,,, Despite efforts to educate and encourage the public about donation and transplantation, the number of organ donors has not paralleled the growing waiting list, ,, 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  and making the deceased's persons wishes expressed on an organ donor card (e.g. driver's license) legally binding. 
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. ,,,,
Some studies identified that the place of public residence may influence the knowledge, attitudes and the willingness for organ donation. , 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.  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
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.
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 PProfile 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 (PKnowledge 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 (PAttitudes 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%) (PSource 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 ,
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  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 , as well as studies conducted in the West , and Saudi Arabia; ,,, 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.
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.
|1||Alam A. Public opinion on organ donation in Saudi Arabia. Saudi J Kidney Dis Transpl 2007;18:54-9.|
|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.|
|3||Aswad S, Souqiyyeh M, Huraib S, El-Shihabi R. Public attitudes toward organ donation in Saudi Arabia. Transplant Proc 1992;24:2056-8.|
|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.|
|5||Shaheen F. Organ transplantation in the Kingdom of Saudi Arabia: new strategies. Saudi J Kidney Dis Transpl 1994;5:3-5.|
|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.|
|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.|
|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.|
|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.|
|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.|
|11||Shaheen F, Souqiyyeh M. Factors influencing organ donation and transplantation in the Middle East. Transplant Proc 2000;32:645-6.|
|12||Jasper J, Nickerson C, Hershey J, Asch D. The public's attitude toward incentives for organ donation. Transplant Proc 1999;31:2181-4.|
|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.|
|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.|
|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.|
|16||Matesanz R, Miranda B. Organ donation the role of the media and of public opinion. Nephrol Dial Transplant 1996;11:2127-8.|
|17||Garcia V, Goldani J, Neumann J. Mass media and organ donation. Transplant Proc 1997;29: 1618-21.|
|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.|
|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.|
|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.|
|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.|
|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.|
|23||Al-Sebayel M. The status of cadaveric organ donation for liver transplantation in Saudi Arabia. Saudi Med J 2002;23:509-12|