Saudi Journal of Kidney Diseases and Transplantation

RENAL DATA FROM THE ARAB WORLD
Year
: 2012  |  Volume : 23  |  Issue : 6  |  Page : 1304--1310

Knowledge and attitudes of health care professionals toward organ donation and transplantation


Osama Alsaied1, Abdulbari Bener2, Yousuf Al-Mosalamani3, Bakr Nour1,  
1 Weill Cornell Medical College, Doha, Qatar
2 Weill Cornell Medical College; Department of Medical Statistics and Epidemiology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; Department of Evidence for Population Health Unit, School of Epidemiology and Health Sciences, University of Manchester, Manchester, UK
3 Department of Organ Transplantation, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar

Correspondence Address:
Abdulbari Bener
Department of Public Health, Weill Cornell Medical College, Consultant and Head, Department of Medical Statistics and Epidemiology, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar

Abstract

To identify and assess the level of knowledge and attitudes of health care professionals (HCP) in Qatar toward organ donation and transplantation, this cross-sectional study was carried out from October 2007 to February 2008 in the Accident and Emergency Departments and Intensive Care Units of the hospitals of the Hamad Medical Corporation (HMC). A representative sample of 585 HCP working in the hospitals of the HMC was approached and 418 staff gave consent to participate in the study (71.5%). 36.8% were physicians, 48.6% nurses and 14.6% Emergency Medical Service (EMS) technicians. Of the surveyed HCP, 40.7% were males and 59.3% were females. Majority of the staff were in the age group of 30-39 years (58.6%). More than half of the physicians (59.7%) and technicians (57.4%) assumed that organs can be bought and sold in the State of Qatar. Most of the physicians (76.6%) and nurses (75.9%) knew that brain-dead persons are eligible for organ donation, whereas only 57.4% of the EMS technicians thought so. Majority of the HCP supported organ donation; physicians (89.0%), nurses (82.3%) and technicians (70.5%). The attitude of the physicians (24.0%) and nurses (20.2%) to donate a kidney to a family member was very poor compared with the attitude of the technicians (44.3%). Although the HCP support organ donation (83%), more than half of the physicians (51.3%), nurses (61.6%) and technicians (54.1%) wanted to be buried with all their organs intact. The findings, although they give cause for hope, suggest that there is much work yet to be done before organ donation and transplantation can become fully accepted by the medical community in Qatar.



How to cite this article:
Alsaied O, Bener A, Al-Mosalamani Y, Nour B. Knowledge and attitudes of health care professionals toward organ donation and transplantation.Saudi J Kidney Dis Transpl 2012;23:1304-1310


How to cite this URL:
Alsaied O, Bener A, Al-Mosalamani Y, Nour B. Knowledge and attitudes of health care professionals toward organ donation and transplantation. Saudi J Kidney Dis Transpl [serial online] 2012 [cited 2019 Nov 14 ];23:1304-1310
Available from: http://www.sjkdt.org/text.asp?2012/23/6/1304/103585


Full Text

 Introduction



Organ transplantation is considered as the definitive and the most cost-effective treatment for end-stage organ disease among the kidney, liver, lung and heart patients. The improvement of long-term outcomes in the last 25 years paved the way for more acceptances among health care professionals (HCP) and the public. [1] In 2007, 28,356 donors (including 6308 live donors) were available for transplantation in the United States. [2] Here, in the middle east, and specifically in Qatar, the rate of organ donation (live and deceased) lags behind the US and European organ donations. [3] In 2005, El-Shoubaki et al showed that (31-39%) of the general population of Qatar were willing to donate their organs after death, while only half of them expressed their willingness to donate an organ while they are still alive. [1]

Successful organ donation depends on multiple factors, such as legislation, which helps to develop the process, and agencies that further put the guidelines into practice. However, whatever the system, HCP beliefs and attitudes play a major role in helping to make this happen. To date, little research has been done on the knowledge and attitude of HCP about organ donation and transplantation in Qatar. HCP help in identifying donors and initiating the appropriate process, and it is their attitudes that directly influence the decision of potential donor families and next of kin. Therefore, we have conducted a cross-sectional survey among HCP with the aim of assessing their level of knowledge and attitude toward organ donation and transplantation.

 Subjects and Methods



This is a cross-sectional study to determine the level of knowledge and attitudes of HCP toward organ donation in Qatar. The survey was carried out from October 2007 to February 2008 in the Accident and Emergency Departments and Intensive Care Units of the hospitals of the Hamad Medical Corporation (HMC). A cluster sampling design was used and a representative sample of 585 HCP in HMC were approached after approval from HMC's Institutional Review Board committee. After providing appropriate information about the purposes of the study and to their right of refusal, 418 (71.5%) health care staff gave consent to participate. The remaining 167 surveys (28.5%) were excluded as being incomeplete or did not return the questionnaire. Of the completed surveys, 36.8% (n = 154) were from physicians (P), 48.6% (n = 203) from nurses (N) and 14.6% (n = 61) from Emergency Medical Service (EMS) technicians (T). The questionnaire used on the study was adopted and modified from the original form devised by Dr. Mary Stoeckle. [4] The instrument was initially tested on 50 staff as a pilot study. That questionnaire included variables on socio-demographic characteristics, knowledge, attitude and current opinions toward organ donation and transplantation

 Statistical Analysis



The data were analyzed by using the Statistical Package for Social Sciences (SPSS), Windows Version # 15. Student's t-test was used to ascertain the significance of differences between mean values of two continuous variables and the Mann-Whitney test was used for non-parametric comparisons. Chi-square analysis was performed to test for differences in proportions of categorical variables between two or more groups. Spearman's correlation coefficient was used to evaluate the strength of concordance between variables. The level P <0.05 was considered as the cut-off value for significance.

 Results



The questionnaire analysis was divided into three sections. The first section focused on the socio-demographic characteristics of the 418 respondents. 36.8% were physicians while nurses and technicians comprised 48.6% and 14.6%, respectively. Gender, educational level, place of living, religion and marital status are given in [Table 1]. Most of the physicians and EMS technicians (95.5% and 72.1%, respectively) were Muslim, while 62.6% of the nurses were Christian.{Table 1}

The level of knowledge was assessed in the second section of the questionnaire. [Table 2] reveals that when the knowledge level of physicians, nurses and EMS technicians were compared, significantly fewer nurses believed that brain death matched their personal definition of death, while significantly fewer EMS technicians thought it was acceptable to harvest organs from cardiac arrest victims. Significantly more physicians thought that the hospital involvement was influenced by state law and that brain death was the acceptable criteria for the diagnosis of death. EMS technicians were significantly less likely to know which organs were appropriate for living donation and that brain dead individuals were eligible for organ donation. Nurses, on the other hand, were significantly less likely to understand the rules about being a designated donor, thought that everyone who needed a transplant received one, that the cost of donation is paid by the donor's family and that organs can be bought and sold in Qatar. The myth that there is no organ shortage was supported by physicians (68.8%), nurses (48.3%) and EMS technicians (63.9%). Also, most of the HCP (physicians 68.8%, nurses 64.5% and EMS technicians 70.5%) felt that past history of alcohol and IV drug abuse precludes candidates from transplantation. Additionally, it was remarkable that physicians (59.7%), nurses (42.9%) and EMS technicians (57.4%) thought falsely that those organs can be bought and sold in the state of Qatar, and that the cost of organ donation is paid by the donor family.{Table 2}

[Table 3] shows accumulation of attitudes and Pre-formed opinions of HCP toward organ donation. The majority of the HCP supported organ donation, were willing to donate a kidney to a family member in need and were receptive to the notion of receiving an organ transplant if needed, while only a limited number of them were open to the idea of donating a kidney to a stranger. Nurses were less likely to consider donating an organ and discuss the issue with a family member, and thought that they needed more time to think about it. Physicians were significantly more likely to know someone who had received a transplant and were willing to receive an organ transplant, if needed.{Table 3}

When compared on the basis of pre-formed opinions, physicians were significantly less likely to believe that organ donation conflicted with their religious views, with fewer moral objections, and had a fear of disfigurement. They were significantly more likely to that by designating himself/herself to be an organ donor would lead to inadequate medical care.

Nurses' pre-formed opinions suggested that they were significantly more likely to admit that they did not have sufficient information regarding organ donation, wanted to designate the potential donor and wanted physicians to have more information in their offices about organ donation.

 Discussion



In spite of the fact that 31-39% of the general population of Qatar showed previously their willingness to donate their organs after death, [1] the number of cadaveric kidneys donated remained low. That fact motivated us to explore other factors influencing organ donation.

The majority of physicians and EMS technicians were Muslim, while 62.6% of nurses were Christian. The impact of religion on the attitude toward organ donation was not seen in the current study. Kececioglu et al [5] reported in 2000 that the attitudes of Turkish religious and Muslim scholars concluded that organ donation is consistent with Islamic beliefs and values. Notably, almost 10% of the people in the Kingdom of Saudi Arabia (KSA) carry an organ donation card. [6],[7] Additionally, Bilgel et al. noted a change in public attitude in Turkey 12 years after establishing a successful transplant program. [8] This denotes that education is an ongoing process in every community. Ashraf et al [9] confirmed the same findings in Pakistan, where 59.9% of the educated public were willing to donate their organs.

The impact of education was further investigated in an international opinion poll carried out in France, Argentina, Brazil, Austria and Italy. [10] An important finding in the study was the importance of early education programs in schools.

Essman and Lebovitz [11] went one step further to study the value of educating medical students. By proposing a medical school elective course, they felt that it would enhance the link between physicians and procurement professionals.

In our study, 46.8% of physicians compared with 18.2% of nurses believed in brain death. Jones-Riffell and Stoeckle [4] studied the attitude of nursing students. Nurses in our study expressed their need for more information about organ donation. In our study, most of the HCP felt that there is no organ shortage. This is not supported by the number of kidney transplants compared with the dialyzed patients in Qatar.

The financial incentives are still a controversial issue. It was surprising to see that 59.7% of physicians, 42.9% of nurses and 57.4% of EMS technicians believed that organs are sold and bought in the state of Qatar.

Boulware et al and Jasper et al [12],[13] addressed the issue in the USA and in Canada, respectively. In the USA, there was a disparity about public attitudes toward monetary incentives for organ donation across the racial, ethnic and socioeconomic groups. The results of the Canadian study cast doubt on the validity of claims of those who oppose incentives for organ donation.

Those authors believe that value of altruism could not be undermined by monetary incentives. Our belief is that a community cooperative agency and social charity program should be developed to support families of deceased donors if they require so, especially that many of those expatriate victims leave behind children and family members with limited, if any, support.

In this study, similar to others, [14],[15] the results validated our perception that HCP attitudes influence the potential donor family members. It highlights the importance of more education as early as middle and high school, all through nursing, technical and medical schools.

Additionally, being in a Middle Eastern country with a predominately Muslim population but with the existence of a multicultural, diverse ethnic and different religions within the expatriate population, the recruitment of religious, ethnic and community leadership in the education process is of utmost importance. [16],[17]

Our survey revealed that, in general, HCP have an acceptable level of knowledge and fairly positive attitudes toward organ donation and transplantation, similar to what has been reported earlier from this area. [17],[18] Among the health care staff, it was found that the level of knowledge about organ donation and the willingness to donate an organ was higher in physicians, whereas the nurses had better view points about organ donation. The study supports the need to establish an education program and discussion among HCP about organ donation and procurement.

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