Public Awareness Survey About Organ Donation and Transplantation E. Mohamed and A. Guella ABSTRACT Background. This survey was conducted to assess the public perception on organ donation and transplantation. Methods. A random sample of the population attending the outpatient clinics in Dhahran Military Hospital, Saudi Arabia, from December 1, 2011, to January 31, 2012, answered a questionnaire related to the above aim. Results. From 582 subjects who answered the questionnaire, 85 were excluded for incoherent answers. From the remaining 497, 77.7% were males and 22.3% females with the age ranging from 18 to 65 years, and the majority was at a secondary or university level of education. More than 90% were aware organ transplantation and donation. From a religious point of view, 68.6% considered it legal to donate organs versus 26.2%. Those who disagreed with the concept of donation believed that one kidney is not enough to survive (50%), and that the remaining kidney may be affected (25.8%), whereas 15.2% expressed fear of the operation. Kidney transplantation was the preferred treatment for 73.2% of respondents and 12.75% were in favor of dialysis. Regarding financial incentive, 14.5% asked for reward from the government, 3.4% believed that the reward should come from the donor, and the majority (82.1%) stated that organ donation should be for the sake of God. Finally, there was a 61.2% willingness of respondents to donate relatives’ organs after brain death. Conclusion. The level of awareness about donation and transplantation in our population was found to be satisfactory. Religion was not a bar for organ donation; moreover, financial incentive was not found to be a positive stimulus toward donation because the majority was willing to donate for the sake of God.
T
HE DISCREPANCY between the demand and supply of organs is a great obstacle precluding the progress of transplantation programs. Although public opinion surveys showed that more than 95% of respondents were aware of organ donation1 and that 60% to 70% of them were willing to donate,2 organ shortages still prevail worldwide. This public enthusiasm toward donation is not translated into an increase in donors. Still, we believe that these surveys are useful because they will allow us to identify the modifiable attitudes and behaviors toward organ donation. Therefore, we performed this cross-sectional survey to scrutinize the attitude, behavior, and knowledge of our local population regarding organ donation and to identify any causes of negative attitudes regarding donation. MATERIALS AND METHODS A total of 13 questions were constructed based on the literature. In this questionnaire the different issues addressed were related to
awareness and willingness to donate organs, also the risks, legality, and the motivation of organ donation. A random sample of the population attending the outpatient clinics in King Fahd Military Medical Complex, Dhahran (Eastern Province of Saudi Arabia), from December 1, 2011, to January 31, 2012, answered the questionnaire in a face-to-face approach with the transplantation coordinators.
RESULTS
From a total of 582 respondents, 85 were excluded because of incoherent answers. The remaining 497 respondents
From the King Fahd Military Medical Complex (E.M., A.G.), Dhahran, Kingdom of Saudi Arabia. Address reprint requests to Dr Eltayeb Mohamed, PO Box 946, 31932 Dhahran, Kingdom of Saudi Arabia. E-mail: tayebgom@ hotmail.com
ª 2013 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
0041-1345/13/$esee front matter http://dx.doi.org/10.1016/j.transproceed.2013.08.095
Transplantation Proceedings, 45, 3469e3471 (2013)
3469
3470
MOHAMED AND GUELLA
Fig 1. Graph showing reasons disagreement with organ donation.
for
included 386 males (77.7%) and 111females (22.3%).Their ages ranged between 18 and 65 years. All levels of education were present, with the majority (84.5%) at the secondary or university level. Awareness of organ donation and transplantation was perceived by 95.6% and 93.9%, respectively. Agreement to donate a kidney was found in 73.4%. Those who averse to donation expressed the following reasons: 1) one kidney is not enough (50%), 2) the remaining kidney may be affected (25.8%), and 3) a fear of the operation (15.2%) (Fig 1). However, 68.6% considered organ donation to be a legal act from the Islamic point of view versus 26.2%. Kidney transplantation was the preferred treatment modality for end-stage renal disease in 73.2% (with 39.2% in favor of living-related, 17.1% commercial, and 16.9% cadaveric donation), whereas 12.75% were in favor of dialysis. Regarding financial incentive for organ donation, 14.5% asked for a reward from the government, 3.4% believed that the reward should come from the donor, and the majority (82.1%) stated that organ donation should be for the sake of God (Fig 2). Finally, willingness to donate the organs of close relatives after brain death was accepted by 61.2%.
DISCUSSION
Our results show that the willingness to donate organs (73.4%) exceeds those reported by other studies performed in the Middle East; with 62.3% willingness in Pakistan,3 47% in Iran,4 and 37.8% in Qatar.5 The high rate of willingness to donate in our population could be explained by the high education level of the random sample examined and is quite different from the results obtained in Riyadh
Fig 2. Pie chart depicting the source of reward.
either in urban or rural areas where the willingness to donate did not exceed 35%.6 Interestingly, we found that the majority of potential donors (82.1%) are willing to do so for the sake of God, which is a peculiar concept in Muslim belief that includes altruism. As far as we know, this finding has not been addressed in any study performed in Muslim communities. Surprisingly, our study did not find financial incentive to play a significant role in stimulating donation. The main reason for unwillingness to donate a kidney in our population was the fear of potential risks related to the remnant solitary kidney (75.8%). Interestingly, a Pakistani study showed that body weakness, pain, and infection were the main causes for their refusal (more than 50%).7 However, the intention to donate an organ from a close relative (61.2%) is almost equal to or exceeding some European results (eg, Sweden 73%, Finland 72%, United Kingdom 64%, Netherland 62%, Turkey 45%, and Austria 35%).8 The availability of a fatwa (religious ruling) since 1988 by the Saudi Islamic Jurisprudence Assembly Council allowing deceased and live organ donation may explain why 68.8% of our respondents consider donation to be legal from an Islamic point of view. This coincides with another Saudi report revealing that religious belief has a negative impact on organ donation in 27.5% only of the subjects studied.9 However, the gap is still wide between this positive attitude toward deceased organ donation and the reality of organ shortage. A considerable number of respondents (17%) prefer commercial transplantation as a source of organs. In conclusion, our study showed that the level of awareness of transplantation and organ donation is comparable to western data. It also revealed that the main obstacle to organ donation is not religious but rather related to the general concept that having one kidney only may expose the donor to potential medical problems. Unfortunately, the literature showing that there is excellent long-term prognosis for donors is mainly available to the medical transplantation community but not to the public. Therefore, these favorable reports must be emphasized in any public health education program.
PUBLIC AWARENESS SURVEY
REFERENCES 1. Manninen DL, Evans RW. Public attitudes and behavior regarding organ donation. JAMA. 1985;253(21):3111e3115. 2. National Survey of Organ and Tissue Donation Attitudes and Behavior. Washington, DC: Gallop Organization; 2005. 3. Saleem T, Ishaque S, Habib N, et al. Knowledge, attitudes and practices survey on organ donation among a selected adult population of Pakistan. BMC Med Ethics. 2009;10(5): 1e12. 4. Afshar R, Sanavi S, Rajabi MR. Attitude and willingness of high school students towards organ donation. Saudi J Kidney Dis Transpl. 2012;23(5):929e933.
3471 5. Elshoubaki H, Benar A. Public knowledge and attitudes towards organ donation and transplantation, a cross cultural study. Transplant Proc. 2005;37(5):1993e1997. 6. Alghanim SA. Knowledge and attitudes toward organ donation: a community based study comparing rural and urban population. Saudi J Kidney Dis Transpl. 2010;21(1):23e30. 7. Khan N, Masoud Z, Tufail N, et al. Knowledge and attitudes of people towards organ donation. JUMDC. 2011;2(2):15e21. 8. European Commission. Organ donation and Transplantation, In Special Eurobarometer. Brussels, Belgium: TNS Opinion & Social; 2010. 9. Alam AA. Public opinion on organ donation in Saudi Arabia. Saudi J Kidney Dis Transpl. 2007;18(1):54e59.
T
HE DISCREPANCY between the demand and supply of organs is a great obstacle precluding the progress of transplantation programs. Although public opinion surveys showed that more than 95% of respondents were aware of organ donation1 and that 60% to 70% of them were willing to donate,2 organ shortages still prevail worldwide. This public enthusiasm toward donation is not translated into an increase in donors. Still, we believe that these surveys are useful because they will allow us to identify the modifiable attitudes and behaviors toward organ donation. Therefore, we performed this cross-sectional survey to scrutinize the attitude, behavior, and knowledge of our local population regarding organ donation and to identify any causes of negative attitudes regarding donation. MATERIALS AND METHODS A total of 13 questions were constructed based on the literature. In this questionnaire the different issues addressed were related to
awareness and willingness to donate organs, also the risks, legality, and the motivation of organ donation. A random sample of the population attending the outpatient clinics in King Fahd Military Medical Complex, Dhahran (Eastern Province of Saudi Arabia), from December 1, 2011, to January 31, 2012, answered the questionnaire in a face-to-face approach with the transplantation coordinators.
RESULTS
From a total of 582 respondents, 85 were excluded because of incoherent answers. The remaining 497 respondents
From the King Fahd Military Medical Complex (E.M., A.G.), Dhahran, Kingdom of Saudi Arabia. Address reprint requests to Dr Eltayeb Mohamed, PO Box 946, 31932 Dhahran, Kingdom of Saudi Arabia. E-mail: tayebgom@ hotmail.com
ª 2013 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
0041-1345/13/$esee front matter http://dx.doi.org/10.1016/j.transproceed.2013.08.095
Transplantation Proceedings, 45, 3469e3471 (2013)
3469
3470
MOHAMED AND GUELLA
Fig 1. Graph showing reasons disagreement with organ donation.
for
included 386 males (77.7%) and 111females (22.3%).Their ages ranged between 18 and 65 years. All levels of education were present, with the majority (84.5%) at the secondary or university level. Awareness of organ donation and transplantation was perceived by 95.6% and 93.9%, respectively. Agreement to donate a kidney was found in 73.4%. Those who averse to donation expressed the following reasons: 1) one kidney is not enough (50%), 2) the remaining kidney may be affected (25.8%), and 3) a fear of the operation (15.2%) (Fig 1). However, 68.6% considered organ donation to be a legal act from the Islamic point of view versus 26.2%. Kidney transplantation was the preferred treatment modality for end-stage renal disease in 73.2% (with 39.2% in favor of living-related, 17.1% commercial, and 16.9% cadaveric donation), whereas 12.75% were in favor of dialysis. Regarding financial incentive for organ donation, 14.5% asked for a reward from the government, 3.4% believed that the reward should come from the donor, and the majority (82.1%) stated that organ donation should be for the sake of God (Fig 2). Finally, willingness to donate the organs of close relatives after brain death was accepted by 61.2%.
DISCUSSION
Our results show that the willingness to donate organs (73.4%) exceeds those reported by other studies performed in the Middle East; with 62.3% willingness in Pakistan,3 47% in Iran,4 and 37.8% in Qatar.5 The high rate of willingness to donate in our population could be explained by the high education level of the random sample examined and is quite different from the results obtained in Riyadh
Fig 2. Pie chart depicting the source of reward.
either in urban or rural areas where the willingness to donate did not exceed 35%.6 Interestingly, we found that the majority of potential donors (82.1%) are willing to do so for the sake of God, which is a peculiar concept in Muslim belief that includes altruism. As far as we know, this finding has not been addressed in any study performed in Muslim communities. Surprisingly, our study did not find financial incentive to play a significant role in stimulating donation. The main reason for unwillingness to donate a kidney in our population was the fear of potential risks related to the remnant solitary kidney (75.8%). Interestingly, a Pakistani study showed that body weakness, pain, and infection were the main causes for their refusal (more than 50%).7 However, the intention to donate an organ from a close relative (61.2%) is almost equal to or exceeding some European results (eg, Sweden 73%, Finland 72%, United Kingdom 64%, Netherland 62%, Turkey 45%, and Austria 35%).8 The availability of a fatwa (religious ruling) since 1988 by the Saudi Islamic Jurisprudence Assembly Council allowing deceased and live organ donation may explain why 68.8% of our respondents consider donation to be legal from an Islamic point of view. This coincides with another Saudi report revealing that religious belief has a negative impact on organ donation in 27.5% only of the subjects studied.9 However, the gap is still wide between this positive attitude toward deceased organ donation and the reality of organ shortage. A considerable number of respondents (17%) prefer commercial transplantation as a source of organs. In conclusion, our study showed that the level of awareness of transplantation and organ donation is comparable to western data. It also revealed that the main obstacle to organ donation is not religious but rather related to the general concept that having one kidney only may expose the donor to potential medical problems. Unfortunately, the literature showing that there is excellent long-term prognosis for donors is mainly available to the medical transplantation community but not to the public. Therefore, these favorable reports must be emphasized in any public health education program.
PUBLIC AWARENESS SURVEY
REFERENCES 1. Manninen DL, Evans RW. Public attitudes and behavior regarding organ donation. JAMA. 1985;253(21):3111e3115. 2. National Survey of Organ and Tissue Donation Attitudes and Behavior. Washington, DC: Gallop Organization; 2005. 3. Saleem T, Ishaque S, Habib N, et al. Knowledge, attitudes and practices survey on organ donation among a selected adult population of Pakistan. BMC Med Ethics. 2009;10(5): 1e12. 4. Afshar R, Sanavi S, Rajabi MR. Attitude and willingness of high school students towards organ donation. Saudi J Kidney Dis Transpl. 2012;23(5):929e933.
3471 5. Elshoubaki H, Benar A. Public knowledge and attitudes towards organ donation and transplantation, a cross cultural study. Transplant Proc. 2005;37(5):1993e1997. 6. Alghanim SA. Knowledge and attitudes toward organ donation: a community based study comparing rural and urban population. Saudi J Kidney Dis Transpl. 2010;21(1):23e30. 7. Khan N, Masoud Z, Tufail N, et al. Knowledge and attitudes of people towards organ donation. JUMDC. 2011;2(2):15e21. 8. European Commission. Organ donation and Transplantation, In Special Eurobarometer. Brussels, Belgium: TNS Opinion & Social; 2010. 9. Alam AA. Public opinion on organ donation in Saudi Arabia. Saudi J Kidney Dis Transpl. 2007;18(1):54e59.
