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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2017  |  Volume : 28  |  Issue : 3  |  Page : 599-608
Gender differences in perceptions and attitudes of general population towards organ donation: An Indian perspective

1 College of Nursing, National Institute of Mental Health and Neuro Sciences (Institute of National Importance), Bengaluru, Karnataka, India
2 Toowoomba Base Hospital, Toowoomba, Queensland, Australia
3 Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (Institute of National Importance), Bengaluru, Karnataka, India

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Date of Web Publication18-May-2017


Globally, shortage of organs available for organ transplantation is a major problem. Studies assessing awareness and attitudes towards organ donation are limited from India. The aim of this study is to assess gender differences in the perceptions and attitude of general population toward organ donation. A cross-sectional descriptive study was carried out among randomly selected patient relatives (n = 193) at the outpatient department of a tertiary care center. Data were collected through face-to-face interview using a structured questionnaire. Our findings revealed that majority of men than women were aware and in favor of promoting organ donation (χ2 = 10.428, P < 0.001). Best part of men (70.9%) compared to 52.3% of women were willing to donate their organs after death (χ2 = 18.080, P <0.001). Similarly, more number of (48.5%) men were willing to sign on the organ donation card. There is an urgent need to uncover the myths and misconceptions of the general population toward organ donation. Further, healthcare providers and governmental and nongovernmental agencies should take active initiation in motivating the public to give their consent for organ donation.

How to cite this article:
Poreddi V, Sunitha T S, Thimmaiah R, Math SB. Gender differences in perceptions and attitudes of general population towards organ donation: An Indian perspective. Saudi J Kidney Dis Transpl 2017;28:599-608

How to cite this URL:
Poreddi V, Sunitha T S, Thimmaiah R, Math SB. Gender differences in perceptions and attitudes of general population towards organ donation: An Indian perspective. Saudi J Kidney Dis Transpl [serial online] 2017 [cited 2020 Oct 24];28:599-608. Available from: https://www.sjkdt.org/text.asp?2017/28/3/599/206460

   Introduction Top

The shortage of organs available for organ transplantation is a global concern.[1] Organ donation is defined as an act of giving one or more organs, without compensation, for transplantation to another person.[2] India is one of the lowest organ donating countries in the world. In India, “The transplantation of Human Organs Act” was legalized in 1994,[3] yet organ donation rate in India is very poor (0.16/ million) compared to developed countries (35/million in Spain).[4]

Public awareness of organ donation primarily affects the organ transplantation programs.[5] Previous research showed that knowledge and perceptions about organ donation were positively associated with donation attitudes, willingness, and donor registration.[6],[7],[8] However, numerous studies have shown positive attitude among general population toward organ donation and transplantation.[9],[10] Further, a recent review literature based on 33 studies confirmed that young age, women, high socio economic status, education, knowledge and awareness of organ donation, experiential knowledge about organ donation, and family positive attitudes were found to be the most influencing factors for organ donation.[11]

In general, organs’ donors come from brain dead and nonheart-beating donors.[12] Brain death was explained as definite death of the brain despite other live organs without any hope for improvement and the impending change into complete death (death of the brain and other organs) within few hours, days, or months.[13] According to a nongovernmental organization, in India, there were 1.4 lakhs accident victims diagnosed as brain dead annually. Yet, organs from only about 120 were retrieved. This shows the magnitude of organ shortage problem in India despite having adequate organs available. Hence, it is crucial to assess general population attitudes toward organ donation. In India, there is a dearth of information available on this topic. In India, only a few studies had been conducted on this topic among health-care workers,[14] patients,[15] college students,[16] and public[17] and rural population.[18] However, studies that focused gender differences in their attitudes toward organ donation were not found. Thus, the present study was aimed to assess gender differences in perceptions and attitude of general population toward organ donation.

   Materials and Methods Top

This was a cross-sectional descriptive survey carried out among the relatives of the patients attending the outpatient department (OPD) at a tertiary care center in Bangalore, South India.

The study sample was selected through random sampling technique (lottery method) based on the OPD registry. The study criteria included individuals aged 18 years and above and those were willing to participate. Persons with cognitive impairment and relatives of the patients those were waiting for organ transplants were excluded from the study. Overall 275 individuals were approached to participate in our study, 82 (30%) declined to participate due to lack of interest and time. Hence, our final sample comprised 193 participants with 70% response rate.

Data collection instruments

The questionnaire included three sections.

  1. Section A: this part consisted of items about sociodemographic details of the participants such as age, gender, education, religion, economic status, marital status, 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
  2. Section B: this part consisted of 22 items with a 5-point Likert scale that ranged from “strongly disagree” to “strongly agree” to assess perceptions and attitudes of participants toward organ donation.[19] 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
  3. Section C: 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[20] (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.[21]

Data collection procedure

The questionnaire was piloted among group (n = 20) of participants and found the study was feasible. Necessary modifications were made. The primary author through face-to-face interview collected the data, in a private room at the treatment facilities where the participants were recruited. It took approximately 45 min to complete the structured questionnaire.

Ethical consideration

The Ethics Committee of the concerned hospital approved the study protocol. The researchers approached the participants and explained briefly about purposes of the present study. Written consent was obtained from the volunteered participants and they were given freedom to quit the study. Participants’ confidentiality was respected.

   Statistical Analysis Top

Before analysis, negatively worded items were reverse coded. Data were analyzed using appropriate statistical software. Descriptive and inferential statistics used to determine significant differences between the participants regarding their mean knowledge and attitudes’ scores. Statistical significance considered at P <0.05.

   Results Top

The present study sample consisted of 193 participants, of whom 53% were men. The mean age for the men was 43.21 ± 15.56 [M ± standard deviation (SD)] and for the women was 45.18 ± 15.47 (m ± SD). The number of women who were illiterate (26.7%) was little higher than men (17.5%). Majority of the participants were Hindus and were married. More number of men (99%) were aware and approved to promote organ donation than women (χ2 = 10.428, P <0.001) [Table 1]. More number of men than women received information about organ donation through television (39.9%), followed by newspapers (19.6%) and friends (19.1%) [Figure 1].
Table 1: Characteristics of the respondents.

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Figure 1: Sources of information about organ donation.

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[Table 2] illustrates gender differences related to attitudes toward organ donation. Best part of men (70.9%) comparing to 52.3% of women were willing to donate their organs after death (χ2 = 18.080, P<0.001). Although the majority of the participants from both groups felt that it is important to discuss with family about their “after death” wishes, 17.5% of men were unsure about it (χ2 = 19.383, P <0.001). However, 85.4% of men discussed their “after death” wishes with their families (χ = 10.502, P <0.03). Similarly, majority of men (92.3% and 77.8%) than women agreed to receive (χ = 9.520, P <0.04) and donate (χ2 = 9.941, P <0.04) to a person of a different race. While 46.6% of men were unsure, 60% of women approved that organ donation is a safe and effective practice (χ2 = 12.076, P <0.01). A majority of men (56.3% and 58.3%) opined that it was important for a person’s body to have all its parts when buried (χ = 7.688, P <0.05) and impossible to have a regular funeral service after organ donation (χ = 17.594, P<0.001). Despite the fact that 17.8% of women disapproved, majority (76.7%) of men agreed that organs for transplant can be bought and sold on the black market in India (χ2 = 12.253, P <0.01). Majority of women (60%) than men opined that poor persons also have an equal opportunity for organ transplantation (χ2= 11.756, P <0.01). Further, a significant association was found between men and women whether they were willing to sign on the organ donation card or not (χ2 = 6.885, P <0.03). Whereas 66.7% of women were unsure, 48.5% of men were willing to sign on the organ donation card [Table 3].
Table 2: Gender differences of the participants toward organ donation attitude questionnaire.

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Table 3: Participants' intentions to sign the organ donation card.

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   Discussion Top

This was the first innovative study that examined gender differences related to their attitudes toward organ donation from India. The present study was unique in nature as it was conducted among general population who attended OPD at a tertiary care center. Hence, we were able to collect the representative sample from various backgrounds. Our study also demonstrated positive attitudes toward organ donation among men compared to women.

In the current study, more of men were familiar about organ donation and were in favor of promoting organ donation than women. These findings could be because literacy rate among men than women is higher in India. Hence, men may follow newspapers and television more often than women. The present study also demonstrated that majority (59%) of men and (44.5%) women received information about organ donation through television and newspapers. These findings reflect the findings of the previous research.[22] Similar to a recent study, more number of men than women were willing to donate their organs after death. On the contrary, other studies have shown that women have more willingness to donate organs.[23],[24],[25],[26]

In India, family plays a crucial role in organ donation process. Thus, it is important to discuss with family members regarding donation of organs after the death of the potential organ donor. Majority of women in this study disagreed to discuss their wishes related organ donation while 85.4% of men discussed their wishes about organ donation with their families. These findings were contradictory to a recent national survey that found 81% of women than men (68.3%) discussed their wishes to be a donor with family members.[27] Same way, in a study from Ireland, observed that 67% of women have discussed organ donation with their family at some point in their lives, whereas only 41% of men felt the issue important enough to speak about with their families. This could lead us to think that discussing the topic and having the right information about it makes a person more prone to make a decision about organ dona- tion.[28] Earlier studies also indicate that persons those discussed organ donation with family members may be more willing to donate organs.[29],[30] Further, family’s knowledge of the individual wish about organ donation influence on decision-making by family to provide consent for organ donation.[31] In a recent study from Australia, majority of donors opined that organ donation would not create distress, and family supported the idea of organ donation would respect their wishes if they were recorded on the register. Hence, organ donation needs to be considered as a family decision.[32] Thus, it is important to encourage people to discuss organ donation with their family members. Men in the present study were more willing to donate and receive organs from a different race than women. These findings indicate positive attitudes among men participants.

Review literature clearly indicates that stigma and cultural beliefs such as the importance of being buried intact were the common barriers to organ donation.[33],[34] Although majority of men were in favor of organ donation, they also believed that it is important for a person to have all parts when buried and it is impossible to have regular funeral services after organ donation. These findings were comparable to a study that found more often men refused to donate as postmortem donors than do women.[24] In a study, it was found that men were more concerned with maintaining their bodies’ integrity to maintain personal dignity and believed that body desecration will bring bad luck.[35] Further, a study found that fear of a lack of body wholeness strongly influences peoples’ beliefs toward organ donation.[36] In addition, studies also provided evidence that participants felt that organ donation creates inconvenience to burial arrangements.[37]

Recently, organ trade has become an important issue that should be tackled with an appropriate legislation.[38] According to the Health Organization, it was estimated that organ trafficking may be accounting for up to 5%- 10% of the kidney transplants performed annually.[39] More number of men opined that organs for transplant can be bought and sold on the black market in India. In fact, it was true that before the commencement of the Transplantation of Human Organs Act in 1994, India had a successful legal market in organ trading. Low cost and availability brought in business from around the globe and transformed India into one of the largest kidney transplant centers in the world.[40] Nonetheless, ethical issues in organ trade pushed the Indian government to pass legislation banning the sale of organs.[41] However, illegal organ donation and misuse of organs was a main reason for low for organ donation rate in India.[3]

In line with previous research, our study also observed that men were more willing to sign on organ donation card than women. These findings were in parallel with a study from Libya that demonstrated significantly stronger willingness among men than women.[25] On the contrary, in few studies, it was found that females were more willing to donate organs.[24],[42] [44] Although majority of the participants in the present study were in favor of organ donation, only 0.5% had organ donation card. However, majority of the participants from both groups were unsure about signing in organ donation cards. Hence, public education campaigns should focus on motivating public to sign on organ donation cards.

   Limitations Top

There were certain limitations in the present study such as cross-sectional design; small sample restricted to one tertiary care center that made difficult to generalize the findings. Therefore, future studies that include a larger sample and qualitative studies with focus on group discussions may be helpful to understand this issue in-depth. However, the strength of the present study is that it include a random sample at a tertiary care center that comprises of participants with various backgrounds and represents the varied Indian population. The findings of the present study may be helpful in planning the public education programs.

   Conclusion Top

The present study was successful in demonstrating gender differences in their attitudes toward organ donation. Men found to be hold more positive attitudes toward organ donation than women. However, cultural beliefs such as body integrity while burying and it is not possible to have regular funeral service after organ donation were still exist among majority of the participants. Hence, there is an urgent need to uncover the myths and misconceptions of the general population toward organ donation. However, these points to be taken into consideration while planning public awareness programs about organ donation. Further, health-care providers and governmental and non-governmental agencies should take active initiation in motivating the public to give their consent for organ donation.

   Acknowledgments Top

We thank all the participants for their valuable contribution.

Conflict of interest: None declared.

   References Top

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Correspondence Address:
Vijayalakshmi Poreddi
College of Nursing, National Institute of Mental Health and Neuro Sciences (Institute of National Importance), Bengaluru - 560 029, Karnataka
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DOI: 10.4103/1319-2442.206460

PMID: 28540899

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