|Year : 2020 | Volume
| Issue : 2 | Page : 112-119
Perspectives of clinical students toward organ donation and transplantation: A cross-sectional descriptive study in a Nigerian tertiary hospital
Vivian Uzoamaka Muoneke1, Dorathy Chinwe Obu2, Samuel Nkachukwu Uwaezuoke1, Uzoma Vivian Asiegbu2, Azubike A Anya2, Alfred Friday Una3
1 Department of Paediatrics, College of Medical Sciences, University of Nigeria Nsukka, Enugu State, Nigeria
2 Department of Paediatrics, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
3 Department of Community Medicine, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
|Date of Submission||24-Mar-2020|
|Date of Decision||03-Apr-2020|
|Date of Acceptance||29-Apr-2020|
|Date of Web Publication||29-Jul-2020|
Vivian Uzoamaka Muoneke
Department of Paediatrics, College of Medical Sciences, University of Nigeria, Nsukka, Enugu State.
Source of Support: None, Conflict of Interest: None
Background: The terminal stages of most chronic organ-related diseases are often characterized by end-stage organ failure. Organ donation with subsequent transplantation represents the best clinical practice. Although several studies on the knowledge and attitudes of medical students toward organ donation and transplantation have been conducted elsewhere, similar reports are few in Nigeria. Aim: This study aimed to determine the knowledge and attitudes of clinical students in a Nigerian tertiary hospital on organ donation and transplantation. Materials and Methods: A cross-sectional study was conducted among clinical students of Ebonyi State Univesity (EBSU) Abakaliki at the Federal Teaching Hospital Abakaliki (FETHA) southeast Nigeria between January and July 2019, using standardized self-administered organ donation questionnaires. These questionnaires were self-administered to 204 medical students selected by systematic random sampling. The data were analyzed on descriptive statistics using the Statistical Package for the Social Sciences (SPSS) version 20.0. The differences in proportions were tested for statistical significance with the chi-square test. Statistical significance was based on P value <0.05. Results: Majority (99.0%) of the students knew about organ donation and its indications and the common transplantable organs but believed the kidneys were the most commonly transplanted organs. Sixty four (31.4%) of the total students were willing to serve as donors because of “the need to save a life.” Students’ age (P = 0.78), year of study (P = 0.10), marital status (P = 0.15), and religion (P = 0.69) did not significantly influence their perspectives about organ donation and transplantation. However, gender (P < 0.001) and residential status (P = 0.02) had a significant influence. Conclusion: A substantial number of clinical students in this clime have the correct perspectives on organ donation and transplantation, irrespective of their sociodemographic characteristics.
Keywords: Clinical students, knowledge, organ donation, transplantation
|How to cite this article:|
Muoneke VU, Obu DC, Uwaezuoke SN, Asiegbu UV, Anya AA, Una AF. Perspectives of clinical students toward organ donation and transplantation: A cross-sectional descriptive study in a Nigerian tertiary hospital. Int J Med Health Dev 2020;25:112-9
|How to cite this URL:|
Muoneke VU, Obu DC, Uwaezuoke SN, Asiegbu UV, Anya AA, Una AF. Perspectives of clinical students toward organ donation and transplantation: A cross-sectional descriptive study in a Nigerian tertiary hospital. Int J Med Health Dev [serial online] 2020 [cited 2020 Oct 22];25:112-9. Available from: https://www.ijmhdev.com/text.asp?2020/25/2/112/291055
| Introduction|| |
Organ donation is the process of removing an organ from one person and surgically placing it in another person’s body. Organ donation and transplantation are now the preferred method of treating end-stage organ failure. For instance, in patients with end-stage renal disease (ESRD), kidney transplantation represents not only the best clinical practice but also the most cost-effective care when compared with alternative available treatments. Moreover, organ transplantation potentially increases life expectancy and improves the recipient’s quality of life.
Specifically, organs that can be donated by living or deceased individuals include the liver, kidneys, pancreas, and heart, and these organs can be donated by individuals while alive or after death. The transplanted organ or tissue can also be obtained from the patient himself (autograft), from another human donor (allograft), or from an animal (xenograft). Transplanted organs may be artificial or natural, whole (such as the kidneys, heart, and liver) or partial (such as heart valves, skin, and bone). Currently, approximately 25 different organs and tissues can be transplanted such as the heart, kidneys, liver, pancreas, cornea, bone marrow, blood, skin, and ligaments.
The basic material needed for any transplant is a healthy organ, which can be procured from both living and deceased donors.
The demand for organs for transplantation continues to exceed the inadequate supply capacity all over the world. Regrettably, lack of awareness and correct knowledge coupled with myths and misconceptions regarding organ donation, which are driven by sociocultural factors,,, contribute to the low percentage of organ donation.,
In developed nations such as the United States, 95% of adults support organ donation, whereas only 54% are actual registered donors. The challenge is even more obvious in most developing countries, including sub-Saharan Africa, where there is paucity of data and records concerning organ donation and transplantation. On the contrary, from the developed countries of the world in 2015, data obtained from the Global Observatory on Donation and Transplantation though reported an increase in the trend of organ donation of approximately 5.8% since 2014, were however still less than the 10% of the global needs.
Organ donation during the early days of organ transplantation had been restricted to only cadavers but as these could not meet up with the growing need for organs, donation was thus extended to donations from living donors. This on its own creates some ethical concerns as physicians must risk the life of a healthy person to save or improve the life of a patient.
Awareness of organ donation is still poor due to the ignorance of laymen about the importance, procedures, benefits, and legal issues of organ donation. There is a direct relationship between the awareness of organ donation and the level of education. However, a study showed that even the medical fraternity lacks clarity with regard to rules and procedures to organ transplantation. Hence, it is imperative to provide adequate knowledge regarding organ donation in the community by promoting the awareness of college students in the medical field. Besides, health-care professionals are the most critical link in the organ procurement process. Their knowledge and attitude are essential factors in the creation and promotion of an environment that has a positive influence on organ donation rates. In Nigeria, organ donation is gradually gaining momentum, although very few studies have been conducted on this subject. However, organ yield is still significantly low, leading to significant concerns about organ shortage.
This shortage has been linked to some sociodemographic and cultural factors of individuals., Although several studies on the knowledge and attitudes of medical students toward organ donation and transplantation have been conducted elsewhere, similar reports are few in Nigeria.
This study was therefore initiated to determine the knowledge and attitudes of clinical students in a Nigerian tertiary hospital on organ donation and transplantation. Their knowledge and attitude on this subject may have implications for clinical practice in future.
| Materials and Methods|| |
Study design and sampling
It was a hospital-based, cross-sectional study, which was conducted with a self-administered questionnaire distributed to medical students of EBSU on clinical posting at the Federal Teaching Hospital Abakaliki, Ebonyi State, irrespective of their departmental attachment. About 204 students were enrolled into the study using the systematic random sampling method.
The questionnaire design and data collection
A structured open-ended questionnaire adapted from a standardized questionnaire on Organ Donation and Transplantation was used. The questionnaire was divided into three sections. Section I included questions on demographic characteristics. Section II consisted of questions on knowledge and sources of information about organ donation, whereas Section III had statements regarding respondents’ perception and attitude toward organ donation and transplantation. The responses for items on knowledge and attitude of organ donation were in the format of “yes,” “no,” and “not sure.” Before distribution, this questionnaire was pretested on 10 medical students to resolve any ambiguity in the questions and obtain comments from the responders. Two academic staff then reviewed the questionnaire, and the students’ suggestions were incorporated into the final questionnaire to strengthening its face validity. Written permission was obtained from the ethics committee of the hospital before commencement of the study. Verbal consent was obtained from each respondent before administering the questionnaire. Data were collected anonymously.
The data were analyzed on descriptive statistics using Statistical Package for Social Sciences (SPSS) software, version 20.0 (SPSS Inc., Chicago, IL, USA). The differences in proportions were tested for statistical significance with the chi-square test. Statistical significance was based on a P value <0.05.
| Results|| |
Sociodemographic characteristics of the students
Of the 204 medical students who participated in the study, majority 151 (74%) were females with a male:female ratio of 1.0:2.9. A substantial number (43.1%) were mostly in the 400 level. Their age range was between 20 and 34 years with a mean of 24.7 ± 2.4 years. Ninety-nine percent of these students were Christians, 95.6% were single (marital status), whereas 44.6% were resident in the school hostels [Table 1].
Perspectives of the students on organ donation and transplantation
Majority (99.0%) of the students knew about organ donation and its indications and the common transplantable organs but believed the kidneys were the most commonly transplanted organs. As shown in [Table 2], 200 (98.0%) of the respondents thought that the kidneys were the most common organs that were usually transplanted, whereas 3 (1.5%) of them believed that all the body organs could be transplanted. Concerning eligibility and decision to donate organs, 192 (94.3%) noted that only living subjects should be donors, whereas 87 (42.8%) believed that only subjects with brain death should donate their organs. One hundred and eighty five (91.0%) of the students indicated that the decision to donate should be that of the donors, whereas 58 (28.6%) maintained that the decision should rest with the doctors [Table 3].
|Table 2: Knowledge of organs to be donated and transplanted among the study population|
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In [Table 4], 122 (60.0%) of the respondents obtained information concerning organ transplantation from the media (especially from the television), whereas only 9 (4.6%) obtained their information from faith-based sources. When prompted on the motivation for possible organ donation, 64 (31.4%) of the students mentioned “the need to save a life,” whereas 19 (9.3%) of them would be motivated to donate an organ on account of their faith-based convictions. On the contrary, 106 (52.2%) of the students would be unwilling to donate organs because of the complications they envisaged.
|Table 4: Source of information and reasons for organ donation and transplantation|
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Effect of sociodemographic variables on students’ perspectives
The age of the students (P = 0.78), year of study (P = 0.10), marital status (P = 0.15), and religion (P = 0.69) did not significantly influence their perspectives about organ donation and transplantation. However, gender (P < 0.001) and residential status (P = 0.02) had a significant influence [Table 5]. Also, these sociodemographic variables did not significantly affect the perception of the students on organ donation and transplantation (age [P = 0.44], gender [P = 0.08], year of study [P = 0.48], marital status [P = 0.63], religion [P = 0.28], and residential status [P = 0.22]) [Table 6], as well as on their attitudes to the practice (age [P = 0.60], gender [P = 0.70], marital status [P = 0.69], year of study [P = 0.08], and religion [P = 1.00]) [Table 7]. Interestingly, only residential status (P = 0.005) had a significant influence on the students’ attitudes to organ donation and transplantation.
|Table 5: Levels of statistical significance among the variables on perception|
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|Table 6: Levels of statistical significance among the variables on knowledge|
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|Table 7: Levels of statistical significance among the variables on attitude|
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| Discussion|| |
In this study, almost all the students (99.0%) had a pre-survey awareness about organ donation and transplantation. However, for those aged above 25 years, only 44.6% had knowledge of organ donation adjudged as correct. This number of students with the right perspectives on the subject is comparable to the percentage reported by Agrawal et al. (45.5%) and Gomez et al. (58%) but is higher than the percentage of respondents documented by Eziyi et al. (28%) and Hamed et al. (36%). As was reported in previous studies,, some of the reasons advanced for the substantial number of students with poor pre-survey knowledge include insufficient information in the students’ curriculum regarding organ-donor recruitment, lack of public awareness campaigns on large-scale organ donation, as well as lack of exposure and understanding about the entire transplantation process.
Interestingly, female medical students in our study significantly appeared to have a better understanding of organ donation and transplantation compared to their male counterparts, as was similarly observed by Adithyan et al. in their study. In contrast, this finding differs from the report by Agrawal et al., who noted that male adult respondents appeared to possess better knowledge than their female counterparts. No reason was given for this gender disparity on knowledge. Cognitive learning is determined by natural and environmental factors. The influence of gender on cognition is not clear cut as both males and females can equally show exceptionally high intelligence quotient (IQ) in learning.
Remarkably, this study found that 60.1% of the students mentioned the electronic media as a common source of knowledge on organ donation and transplantation. This figure is comparable to 78%, 65.4%, and 37.9% of the respondents reported by other studies. This is an unexpected finding knowing that these students should possess better knowledge and attitude judging from their exposure to both the classroom and clinics, unfortunately, the reverse is the case. This probably suggests that didactic lectures on the subject may be lacking in the curriculum of most medical schools and so should be addressed.
Concerning the students’ knowledge on the commonly donated and transplanted organs, a significant majority (99.0%) mentioned the kidneys. This response agrees with the findings of Sobnach et al., Zhang et al., and Agrawal et al., who documented 88.0%, 94.1%, and 95.2% of the students, respectively, as giving the same response. It, however, contrasts with 45.6% of students noted by Srinivas et al., who reported that a higher percentage of them believed that the eye with its components was the more commonly donated organ. Perhaps, the predominant specialty practice in the area of study and the ophthalmology specialty of the investigators could have introduced some bias in the students’ response.
On the students’ willingness to serve as organ donors, majority (85.3%) would do so, based on volunteerism and faith-based convictions. Again, these findings are comparable with those reported by Zhang et al., who noted that 85.3% of their respondents were willing to donate their organs in contrast to El-Agroudy et al. who had only 58% of their study participants willing to donate. Obviously, the faith-based convictions on organ donation and transplantation may be a major determinant of the willingness of respondents in this study to serve as donors if the need arose.
For the majority of the students who were not willing to donate (55.4%), the following reasons were given for their unwillingness; phobia for donation-related complications (52.2%), phobia for possible threat to life (50.7%), phobia for bodily disfigurement (29.0%), and phobia for surgery (27.5%). Interestingly, other investigators had reported similar reasons.,, Other reasons given include loss of traditional values, family decision against donation,, and religious beliefs.
Although this study has not established the effect of sociodemographic variables (except residential status) on the students’ attitude toward organ donation and transplantation, other researchers have shown a positive relationship between attitude and family support., For instance, Bilgel et al. showed a direct link stemming from appropriate public exposure to knowledge about organ donation resulting in more family discussions, more frequent declaration of one’s wishes to donate, and decreasing uncertainty at a critical time, which would eventually result in an increase in organ donation.
| Conclusion|| |
Although a substantial number of the clinical students in this study have the correct perspectives on organ donation and transplantation irrespective of their sociodemographic characteristics, their overall knowledge on the subject appears modest. On the basis of the possible implications for clinical practice in future, the school curriculum should be modified to include comprehensive didactic lectures on organ donation and transplantation. Given the medical advances in this field and the increasing global acceptability of transplantation, similar studies are advocated in other parts of this country to extensively establish the knowledge and attitude of medical trainees on the subject.
Regarding the study design, the cross-sectional nature of the study did not allow for a follow-up investigation on the respondents to document any change in their perspectives on the subject. Second, the small sample size of the study may have precluded valid inferences on students’ knowledge and attitude toward organ donation and transplantation in this clime. Third, the questionnaires were not interviewer administered, thus leading to the likelihood of respondents’ responses emanating from poor understanding of the questionnaire items.
We wish to acknowledge one of us, Late Dr. Obu S. U. M., one of those who conceived and designed this study but succumbed to death even before the study could be carried out.
Financial support and sponsorship
This study was supported by funding from all the authors.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ulasi II, Ijoma CK Organ transplantation in Nigeria. Transplantation 2016;100:695-7.
Saidi RF, Hejazii Kenari SK Challenges of organ shortage for transplantation: Solutions and opportunities. Int J Organ Transplant Med 2014;5:87-96.
Watson CJ, Dark JH Organ transplantation: Historical perspective and current practice. Br J Anaesth 2012;108:i29-42.
Steinberg A Organ transplantation and definition of the moment of death—Jewish perspective. Encyclopedia Hilchatit-Refuit, s.v. Rega Ha’mavet 1998;6:39-44.
Lifepoint I What can be donated. 2007. Available from: http://www.lifepoint-sc.org/facts_what.html. [Last accessed on 2017 Dec 05; last edited on 2018 Mar 08].
Ghorbani F, Khoddami-Vishteh HR, Ghobadi O, Shafaghi S, Louyeh AR, Najafizadeh K Causes of family refusal for organ donation. Transplant Proc 2011;43:405-6.
Sulania A, Sachdeva S, Jha D, Kaur G, Sachdeva R Organ donation and transplantation: An updated overview. MAMC J Med Sci 2016;2:18-27.
Mani G Perceptions and practices related to organ donation among a rural population of Kancheepuram district, Tamil Nadu, India. J Compr Health 2016;4:72.
Annadurai K, Mani K, Ramasamy J A study on knowledge, attitude and practices about organ donation among college students in Chennai, Tamil Nadu. Prog Health Sci 2013;3:59-65.
Kaur S, Ghai S, Krishnn N, Rana D, Kathania D, Kaur G, et al
. Knowledge, attitude and perception regarding organ donation among the nursing students. J Postgrad Med Edu Res 2015;49:105-10.
Donate Life America. 2019 501 (c) (3). Available from: https://www.donatelife.net/. [Last cited 2015 Oct 19; last edited on 2020 Apr 14].
Mahillo B, Carmona M, Álvarez M, Noel L, Matesanz R. Organ donation and transplantation activities. Global Observatory on Donation and Transplantation (GODT). Transpl Rev 2013;27:57-60.
Truog RD The ethics of organ donation by living donors. N Engl J Med 2005;353:444-6.
Saraswathi I, Usha MN, Manikandan S, Prema S Awareness of organ donation among fresh students in medical field. Int J Med Sci Clin Invent 2014;1:274-83.
Saleem T, Ishaque S, Habib N, Hussain SS, Jawed A, Khan AA, et al
. Knowledge, attitudes and practices survey on organ donation among a selected adult population of Pakistan. BMC Med Ethics 2009;10:5.
Jothula KY, Sreeharshika D Study to assess knowledge, attitude and practice regarding organ donation among interns of a medical college in Telangana, India. IJCMPH 2018;5:1339-45.
Gomez M, Castañeda E, Cruzalegui C, Bazan G, Nakachi A, Soto H, et al
. Knowledge and attitude towards organ donation among medical residents. Lima-Peru. Transplantation 2018;102:664.
Eziyi AK, Osho PO, Ajao KO, Ojo OE, Badmus TA, Salako AA Determinants of acceptance of organ donation among medical students, Nigeria. Int J Med Med Sci 2014;1:116-21.
Sucharitha ST, Siriki R, Dugyala RR, Mullai , Priyadarshini Kaavya, et al
. Organ donation: Awareness, attitudes and beliefs among undergraduate medical students in South India. Natl J Res Community Med 2013;2:79-148.
Agrawal S, Binsaleem S, Al-Homrani M, Al-Juhayim A, Al-Harbi A Knowledge and attitude towards organ donation among adult population in Al-Kharj, Saudi Arabia. Saudi J Kidney Dis Transpl 2017;28:81-9.
Hamed H, Awad ME, Youssef KN, Fouda B, Nakeeb AE Knowledge and attitudes about organ donation among medical students in Egypt: A questionnaire. J Transplant Technol Res 2016;6:155.
Adithyan GS, Mariappan M, Nayana KB A study on knowledge and attitude about organ donation among medical students in Kerala. Indian J Transplant 2017;11:133-7.
Sebastián-Ruiz MJ, Guerra-Sáenz EK, Vargas-Yamanaka AK, Barboza-Quintana O, Ríos-Zambudio A, García-Cabello R, et al
. Knowledge and attitude toward organ donation of medicine students of a Northeastern Mexico Public University. Gaceta Médica de México2017;153:430-40.
Srinivas RG, Kiran P, Lakshmi Prasad KK Knowledge and attitude regarding organ donation and transplantation among undergraduate medical students in North coastal Andhra Pradesh. Int J Community Med Public Health 2018;5: 1064-8.
Sindhu A, Ramakrishnan TS, Khera A, Singh G A study to assess the knowledge of medical students regarding organ donation in a selected college of Western Maharashtra. Med J DY Patil Univ 2017;10:349-53.
Sobnach S, Borkum M, Hoffman R, Muller E, McCurdie F, Millar A, et al
. Medical students’ knowledge about organ transplantation: A South African perspective. Transplant Proc 2010;42:3368-71.
Zhang W, Shi X, Chen J, Jing X, Dong Y, Chen Y, et al
. Medical students’ knowledge, attitudes and willingness of organ donation: A cross-sectional study. Transplantation 2017;101:S24.
El-Agroudy AE, Jaradat A, Arekat M, Hamdan RM, AlQarawi N, AlSenan ZK, et al
. Survey of medical students to assess their knowledge and attitudes toward organ transplantation and donation. Saudi J Kidney Dis Transpl 2019;30:83-96.
] [Full text]
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.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]