Knowledge and Attitude towards Organ Donation in Rural Kerala

KK Manojan,a Ramiz Raja A,b Vincy Nelson,b Nazeema Beevi,b Regi Joseb

a. Department of Internal Medicine, Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram; b. Department of Community Medicine, Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram.

Abstract

Transplantation is the preferred treatment for many end-stage solid organ diseases.  Organ shortage has become a public health crisis due to increased demand which continues to surpass supply.   Knowledge gap and misunderstandings about organ donation have generated fear and mistrust in people’s mind thereby preventing them from coming forward.

A cross sectional study was conducted in rural settings of Kerala among above-18-years age population to assess their knowledge and attitude towards organ donation.  Interviews were conducted using a semi-structured questionnaire and data were analyzed using SPSS v20.

Majority (97%) of the participants had heard about organ donation but only 53% had a good knowledge. 48% had poor attitude towards being an organ donor.  50% thought that live organ donation can cause severe health problems. Organ specific willingness for donation among participants was highest for eye, followed by kidney and liver.

Keywords: , , , ,

Introduction

Organ transplantation has become the preferred treatment for many terminal solid organ diseases1.  Very often the best solution is to replace the damaged organ with a healthy one.  Most commonly transplanted organs are cornea, kidney, and liver.  The gap between demand and supply of transplant organs is getting wider and wider, and the number of patients waiting for transplantation has increased globally.2 

Existing studies have shown wide  knowledge and attitude gaps about organ donation among general public, which is worsened by religious attitudes and superstitious beliefs, generating fear and mistrust about organ donation.

Kerala is a state known for its high educational and healthcare standards.  This study attempts to find out whether the knowledge and attitude towards organ donation is any different among a rural population in Kerala.3,4

Objectives

  1. To assess the knowledge and attitude of  a rural community regarding organ donation
  2. To assess the common barriers which prevent people from volunteering for organ donation

Methods

A community based cross sectional study was conducted in a rural population of south Kerala.  The data was collected through face to face interview using a semi structured questionnaire which had categories for assessing knowledge, individual perceptions, willingness and barriers. Sample size for the study was estimated to be 100; by considering the high literacy rate in Kerala  and assuming knowledge about organ donation among general public  at 50%, with relative precision of  20%.

The study commenced after obtaining the clearance from Institutional Ethics Committee (IEC) of Sree Gokulam Medical College and Research Foundation, Venjaramoodu.  The study area was Mudackkal Panchayath, which was selected randomly from the rural field practice area of the institution.  The study population included individuals above 18 years of age who were present in the house during the survey, out of which one person from each house was randomly interviewed.  Data collection was done for two months from 1st August to 30th September 2013. The collected data was analyzed using Statistical Package for Social Sciences (SPSS) version 20. All qualitative variables are described with frequencies and percentages.

Results

62% of the participants were women.  81% had educational qualification above high school.  The mean age in the study group was 43.6 years for men and 48.5 years for women.  79% were Hindus and 21% were Muslims.

Knowledge

Figure 1.  Knowledge about organ donation

Figure 1. Knowledge about organ donation

97% of the participants had heard about organ donation. Each knowledge question was given a weighted score and the total score was 20.  Scores below 8 were considered as poor, 8 – 14 as moderate and above 14 as good. 53% of the participants had a good knowledge regarding organ donation and only 4% had poor knowledge (Figure 1).

Figure 2. Knowledge regarding organs that can be donated while alive

Figure 2. Knowledge regarding organs that can be donated while alive

Among those who had good knowledge regarding organ donation most of them  (90%) knew that eye can be donated after death but  26% thought that eye can be donated while alive also (Figure 2).

Attitude

A scoring system similar to that for knowledge was used for attitude questions as well. Only 26% of the participants had good attitude towards organ donation, whereas 48% showed poor attitude (Figure 3).

Figure 3. Attitude towards organ donation

Figure 3. Attitude towards organ donation

As far as individual organs of donation are concerned, willingness levels were found to be roughly half that of knowledge levels (Figure 4).

Common Barriers in Organ Donation

50% of the participants thought that live organ donation can cause severe health problems.  In general, the barriers against organ donation were religious perceptions (17%), lack of family support (25%) and fear of loss of earning potential (25%).

Figure 4. Comparison of knowledge and willingness regarding organ donation

Figure 4. Comparison of knowledge and willingness regarding organ donation

62% of the participants showed willingness to support their family members with cadaveric organ donation.  Only 5% had at least one family member involved in organ donation.

Discussion

97% of the participants had heard about organ donation which can be attributed to high literacy status of the population and this finding was similar to a study done in Mangalore.5  Better awareness regarding cornea donation could be a result of awareness campaigns in the media and by various NGOs.

Regarding attitude towards organ donation, 47% of the participants expressed their willingness to donate at least one organ (eye).  This observation is similar to a previous study, where 53% participants were willing for organ donation6

Organ specific willingness for donation was highest for eye, followed by kidney and liver; and similar findings were noted in studies done elsewhere3.  However, there has been only limited acceptance of donation of other organs.  Lack of accurate information about the after effects of organ donation was found to be the most important barrier against volunteering for organ donation.

Conclusion

Majority of people has heard about organ donation (97%). In spite of good knowledge about organ donation only less than 50% were willing to donate.  The negative attitude towards organ donation was driven by religious beliefs, lack of family support and perceived health risks and financial insecurity.  The reasons for unwillingness should be looked into more carefully and awareness campaigns planned to increase acceptability of organ donation.

References

  1. Abbud-Filho M, Ramalho H, Pires HS, Silveira JA. Attitudes and awareness regarding organ donation in the western region of Sao Paulo, Brazil. Transplant Proc. 1995 Apr;27(2):1835.
  2. UNOS. Waiting list data: United Network for Organ Sharing. 2010.  Available from: www.unos.org
  3. Reddy AVR, Guleria S, Khazanchi RK, Bhardwaj M, Aggarwal S, Mandal S. Attitude of patients, the public, doctors, and nurses toward organ donation. Transplant Proc. 2003 Feb;35(1):18.
  4. Spencer M. The barriers to organ and tissue donation in palliative care. End Life J. 2012;2:1–11.
  5. Mithra P, Ravindra P, Unnikrishnan B, Rekha T, Kanchan T, Kumar N, et al. Perceptions and Attitudes Towards Organ Donation Among People Seeking Healthcare in Tertiary Care Centers of Coastal South India. Indian J Palliat Care. 2013;19(2):83–7.
  6. Mishra PH, Aarti V, Sarma RK. A Knowledge, Attitude and Practice Study of Organ Donation and its Problems in the Metropolitan City of Delhi. JA cad Hosp Adm  2004;16:11.

Author Information

  1. K K Manojan – Associate Professor, Department of Internal Medicine, Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram.
  2. Ramiz Raja A – Postgraduate Student, Department of Community Medicine, Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram.
  3. Vincy Nelson – Postgraduate Student, Department of Community Medicine, Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram.
  4. Nazeema Beevi – Assistant Professor, Department of Community Medicine, Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram.
  5. Regi Jose – Professor, Department of Community Medicine, Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram.

Acknowledgment

  1. Prof. Dr. Jeesha C Haran, Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram.
  2. Thulasi M, Shakir K I, Thanseena AH, Sidharth B Venu, Vishnu KS, Zulekha Najeeb – 4th Semester MBBS students, Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram.

Conflicts of Interest: None declared

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