Saudi Journal of Kidney Diseases and Transplantation

: 2019  |  Volume : 30  |  Issue : 6  |  Page : 1375--1380

Determinants of medical students for intention to organ donation: Application of theory of planned behavior

Mohtasham Ghaffari1, Sakineh Rakhshanderou1, Katayoun Najafizadeh2, Ali Ramezankhani1, Marzieh Latifi1,  
1 Department of Health Education and Health Promotion, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Correspondence Address:
Marzieh Latifi
Department of Health Education and Health Promotion, School of Public Health, Shahid Beheshti University of Medical Sciences, P. O. Box 19835-35511, Tehran


Organ donation and transplantation save thousands of lives in the world. The aim of this study was identifying determinants of organ donation intention based on the Theory of Planned Behavior (TPB) among Iranian Medical Students. This cross-sectional study was performed during 2017 in Shahid Beheshti University of Medical Sciences. A sample of 438 students of Shahid Beheshti University of Medical Sciences was selected using multi-stage sampling method including stratified and random sampling. Data were collected by using a reliable and valid TPB-based questionnaire. All the participants filled the questionnaires and the data were extracted according to the previously described method. Data were analyzed by using the Statistical Package for the Social Sciences version 16.0 software. Descriptive statistic and Spearman correlation and Logistic regression were used for analyzing the data. Mean age of the participants was 20.92 ± 1.98 years. There was a significant linear positive correlation between behavioral intention and attitude, subjective norms, and perceived behavior control. Logistic regression analysis for assessing relation of TPB variables with behavioral intention showed that perceived behavioral control was more correlate with students’ intention for getting organ donation card (odds ratio: 1.049, confidence interval: 1.062, P <0.000) perceived behavioral control, explain student’s willingness to register as an organ donor. We must provide facilities so that students could register for organ donation easily.

How to cite this article:
Ghaffari M, Rakhshanderou S, Najafizadeh K, Ramezankhani A, Latifi M. Determinants of medical students for intention to organ donation: Application of theory of planned behavior.Saudi J Kidney Dis Transpl 2019;30:1375-1380

How to cite this URL:
Ghaffari M, Rakhshanderou S, Najafizadeh K, Ramezankhani A, Latifi M. Determinants of medical students for intention to organ donation: Application of theory of planned behavior. Saudi J Kidney Dis Transpl [serial online] 2019 [cited 2021 Jun 22 ];30:1375-1380
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Organ donation and transplantation save thousands of lives in the world.[1],[2] Clearly, one of the most important challenges for the healthcare system in Iran and other countries are the death of thousands of people who need to get an organ.[3] Based on 2009 statistics in Germany, the rate of organ donation was 15.9 per million population (pmp) compared to 21.9 pmp in the United States or 34.4 pmp in Spain.[4] The participants of this study were medical students for the reason that these people are the first to face a brain death case in the hospital and based on prior studies, they lack knowledge and proper awareness toward brain death and the way to inform the family of the cases.[2],[3] They have an important role to improve rate of organ donation. As future staff, medical students have to take the role of promoting organ donations.[4] Increase in organ donation of a country depends on the improvement in awareness and mindset of its medical science activists toward organ donation and the way they react to a case when it happens and the way they communicate with the brain death’ families.[5]

According to the results of the study by Feeley, although most Americans have a positive attitude toward organ donation, donated behavior among American people was unde-sirable.[6] Overall, there have been studies in Muslims country of Saudi Arabia, 66% of the studied population were be familiar with organ donation[7] and 37.8% of the Qatari population were willing to donate their organs.[8]

Theatrical model

Theory of planned behavior (TPB) has been established in social and health behavior studies by Ajzen and Fishbein.[9] TPB is often used to study health-related decision-making behavior in adult.[10] This theory suggests that intention is directly driven by attitude (positive or negative evaluations), subjective norms (the degree of perceived social pressure from significant others to do the behavior), perceived behavioral control and intention.[11] According to this theory, behavior is the best predicted by intention. Intention is, in turn, determined by attitude toward the behavior, subjective norms, and perceived behavioral control.[12]

TPB has used in some organ donation-related studies. Designing and planning interventions are the first step for increase the acceptance of organ donation, it is necessary to determine the influencing factors on organ donation. There is not any TPB-based study in our region that measured intention toward organ donation and transplantation. The aim of our study was identifying determinants of organ donation intention based on TPB among Iranian Medical Sciences students in Shahid Beheshti University of Medical Sciences (SBMU).


This was a cross-sectional study being performed in health, medicine, nursing, and midwifery faculties from December 2016 to February 2017.

Four hundred and thirty-eight students of SBMU were selected using multi-stage sampling method. According to the students’ number of each school, sample size in every school was calculated and then by using random sampling method. The participants were selected in each school. Students who had donor card and unwillingness to participate in this study were excluded.

The Student Research Committee in SBMU approved the study protocol. The ethics code was IR.SBMU.PHNS.1395.92. All the participants gave their informed consents and confidentially before inclusion in the study.

Data were collected using a questionnaire being designed according to the TPB. The validity of the questionnaire was evaluated by experts’ viewpoints. Seven health educators and promoters, two epidemiologists, three-organ donation experts were selected by convenience sampling. The face and content validity of the questionnaire was measured.

Then, the Content Validity Ratio (CVR) was calculated. To determine the cutoff point for CVR, Lawshe’s table was used.[13] Content validity index (CVI) (CVR) was used based on Waltz and Basel CVI.[14] The CVI and CVR for each item were calculated (CVR: 0.93 and CVI: 0.90). The reliability of the questionnaire was evaluated (Cronbach’s alpha: 0.893 and ICC: 0.93).

The questionnaire included demographic characteristics gender, age, ethnicity, occupation, religion etc, (26 questions), attitude (14 questions), subjective norms (16 questions), perceived behavioral control (10 questions), and intention is determined by two questions.

Attitude, subjective norms, perceived behavior control, and intention questions were developed on the basis of five-point Likert scale (strongly agree, agree, neutral, disagree, strongly disagree), so scores were between 1 and 5.

Two behavior questions were developed as two answer choices (yes, no) that one and zero score were used for yes and no response, respectively. Thus, the total score was calculated based on the percentage of each option question.

The questionnaires were distributed to four hundred and fifty students during break time of their classes. Investigator gave appropriate instructions about the study. Then, the questionnaires were completed without name and were collected by investigator.

All the information was entered into a computer database. Data were analyzed by the Statistical Package for the Social Sciences version 16 Software (SPSS Inc., Chicago, IL, USA). Data were reported as a mean ± standard deviation and proportions as appropriate. Spearman correlation test was used for assessing the linear correlation between the corresponding variables and the correlation coefficients were calculated. For all statistical tests, the alpha level for all statistical tests was P <0.05.


Thirteen questionnaires did not suitable and unfilled for the analysis and questionnaires of 438 medical students were analyzed. Of the respondents, 40.6% were male and 59.4% was female. The respondents had a mean age of 22.30 ± 4.761 years (18-49 years). All of the students were Muslim and 94.3% were Shia. We showed result of demographic variables in [Table 1].{Table 1}

Participants announced their families 65.8%, friends 30.6%, doctors and medical staff 29.5%, religious leaders 22.8%, and teachers 18.5% as the most influential people in their decision-making for getting organ donation card.

According to [Table 2], There was significant linear positive correlation between behavior intention and attitude (r = 0.103; P <0.031), subjective norms (r = 0.152; P <0.001) and perceived behavior intention (r = 0. 394; P <0.000) [Table 2].{Table 2}

[Table 3] shows that there was significant linear positive correlation between behavior intention and behavior beliefs (r = 0.2; P <0.000) and normative beliefs (r = 0.238; P <0.000) and control beliefs (r = 0.301; P <0.000) and perceived power (r = 0.412; P <0.000).{Table 3}

In the same way, we did not find any significant linear correlation between behavior intention and outcome evaluations (r = -0.014; P = 0.777) and motivation to comply (r = 0.063; P = 0.187).

In same way, application of the logistic regression analysis and backward stepwise method was used to assess the relation of TPB variables on behavioral intention. Attitude toward organ donation used with odds ratio estimate of 0.996 (95% confidence interval: 0.986, 1.006), no influential predictor of organ donation intention. According to [Table 3], regression analysis of the variables indicated that subjective norms and perceived behavioral control can be used as predictors of behavioral intention, between them perceived behavioral control was influential.


Based on the TPB, this study investigated how attitude, social norms, and perceived behavioral control influenced in the behavioral intention to register as an organ donor for medical students in SBMU.

According to the results, attitude is not predictive for organ donation among participants. Bresnahan et al[15] investigated attitude toward organ donation was the highest predictors of organ donation for those in the United States, Japan, and Korea.

As the same way, the result of Hyde et al[16] showed that attitude as a significant predictor of intentions to register for organ donation, same another research (Morgan,[17] Smith et al,[18] and Park and Smith,[13]) they also announced attitude as a strong predictor in these participants. Wu[14] found that attitude was not a significant predictor of talking with family. Discuss with family can promote the understanding of family member’s donation decisions, and must prepare effective facilitate such as education and use social networks and promote family discussion.[19],[20]

Because of contradictory, this finding with previous studies might be high mean score of attitude among participants about organ donation.

In addition, this study showed that Subjective norms predicted intention to become a donor among medical students. The findings of current study are consistent with those of Hyde et al[16] who found that subjective norms as significant predictors for intention to become an organ donor.

According to Alvaro et al,[21] having family discussion was significant predictors for organ donation and willing to be an organ donor was predictive of family discussion.

In this study, family has the most important influence for participant decision-making. More than 65% participants announced family as the most influential people in their decision for getting organ donation card. In general, in Iran the consent of family is required by law to enable the actual organ donation, we could inform family about organ donation and improve their knowledge about this. Among studies, some of them announced that people willing to talk with family were more willing to became potential organ donation.[15],[18]

Our results support the conclusion that the perceived behavior control as the most important predictor for intention to organ donation, according to this result only provide a facilities so that students could register for donor card and can significantly increase positively influence attitude to organ donation among students. Moreover, other results showed that knowledge and attitude do not make behavior change alone, but the most important factors in this study for changing behavior were providing facilities and families and friend’s opinion about organ donation.

This study has several strengths including the use of large sample size, a strong theoretical framework using standardized measures.

The limitation of this study which is needed to be taken into consideration when making generalizations about the findings. One of them is unwilling some students for participate because they never thought about organ donation and some schools did not allow us to do this study at their schools. Totally, health promoters must be able to manage more effecttive interventions for promoting several behaviors.[22]

Moreover, the results lead us to the conclusion that, perceived Behavior control affect participants’ donation decision making and appear to impact on their decisions. To facilitate decision-making it is needed to prepare tools and equipment to get the organ donation card at the schools. Also, we need to prepare families with organ donation awareness due to their influencing on approve or disapprove donation of their members and perception of the decision-making process. The result of this study has important implications for the further community based education program for encouraging student to register as organ donors.


This study is related to the project from the Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran. We also appreciate the “Student Research Committee” and “Research and Technology Chancellor” in Shahid Beheshti University of Medical Sciences for their financial support of this study.

Conflict of Interests: None declared.


1Azmandian J, Shokouhi M, Poorhoseini SS, Mirzaei M. Study of education effect on nurses’ knowledge and attitudes. Iran J Crit Care Nurs 2013;6:11-20.
2Anker AE, Feeley TH, Friedman E, Kruegler J. Teaching organ and tissue donation in medical and nursing education: A needs assessment. Prog Transplant 2009;19:343-8.
3Gupta N, Garonzik-Wang JM, Passarella RJ, et al. Assessment of resident and fellow knowledge of the organ donor referral process. Clin Transplant 2014;28:443-9.
4Chung CK, Ng CW, Li JY, et al. Attitudes, knowledge, and actions with regard to organ donation among Hong Kong medical students. Hong Kong Med J 2008;14:278-85.
5Radunz S, Juntermanns B, Heuer M, Frühauf NR, Paul A, Kaiser GM. The effect of education on the attitude of medical students towards organ donation. Ann Transplant 2012;17:140-4.
6Feeley TH, Servoss TJ. Examining college students’ intentions to become organ donors. J Health Commun 2005;10:237-49.
7Aswad S, Souqiyyeh MZ, Huraib S, el-Shihabi R. Public attitudes toward organ donation in Saudi Arabia. Transplant Proc 1992;24:2056-8.
8El-Shoubaki H, Bener A. Public knowledge and attitudes toward organ donation and transplantation: A cross-cultural study. Transplant Proc 2005;37:1993-7.
9Godin G, Kok G. The theory of planned behavior: A review of its applications to health-related behaviors. Am J Health Promot 1996;11:87-98.
10Lien N, Lytle LA, Komro KA. Applying theory of planned behavior to fruit and vegetable consumption of young adolescents. Am J Health Promot 2002;16:189-97.
11Ajzen I. Attitudes, Personality, and Behavior. Milton Keynes: Open University Press Google Scholar; 1988.
12Courneya KS, McAuley E. Cognitive mediators of the social influence-exercise adherence relationship: A test of the theory of planned behavior. J Behav Med 1995;18:499-515.
13Park HS, Smith SW. Distinctiveness and influence of subjective norms, personal descriptive and injunctive norms, and societal descriptive and injunctive norms on behavioral intent: A case of two behaviors critical to organ donation. Hum Commun Res 2007;33: 194-218.
14Wu AM. Discussion of posthumous organ donation in Chinese families. Psychol Health Med 2008;13:48-54.
15Bresnahan M, Lee SY, Smith SW, et al. A theory of planned behavior study of college students’ intention to register as organ donors in Japan, Korea, and the United States. Health Commun 2007;21:201-11.
16Hyde MK, White KM. To be a donor or not to be? Applying an extended theory of planned behavior to predict posthumous organ donation intentions. J Appl Soc Psychol 2009;39:880-900.
17Morgan SE, Miller JK. Beyond the organ donor card: The effect of knowledge, attitudes, and values on willingness to communicate about organ donation to family members. Health Commun 2002;14:121-34.
18Smith SW, Kopfman JE, Lindsey LL, Yoo J, Morrison K. Encouraging family discussion on the decision to donate organs: The role of the willingness to communicate scale. Health Commun 2004;16:333-46.
19DeJong W, Drachman J, Gortmaker SL. Options for increasing organ donation: The potential role of financial incentives, standardized hospital procedures, and public education to promote family discussion. Milbank Q 1995;73:463-79.
20Waldrop DP, Tamburlin JA, Thompson SJ, Simon M. Life and death decisions: Using school-based health education to facilitate family discussion about organ and tissue donation. Death Stud 2004;28:643-57.
21Alvaro EM, Jones SP, Robles AS, Siegel JT. Predictors of organ donation behavior among hispanic Americans. Prog Transplant 2005;15: 149-56.
22Ghaffari M, Latifi M, Rocheleau C.A, Najafizadeh K, Rakhshanderou S, Ramezankhani A. Using the theory of planned behavior framework for designing interventions related to organ donation. Ir J Med Sci 2018;187:609-13.