Knowledge, Attitudes And Willingness Of Hospital Staff, Medical Students And General Public Towards Organ Donation

Background and aimThe rapid development of organ transplant technology and inadequate number of organ donors caused the imbalance between organ supply and demand. The status quo of the organ shortage in our country is more serious than other countries. Organ donation is the most effective way to solve the present situation of organs shortage. Organ donation work around the world has made some achievements and experience. In China, however, there are some problems to be solved such as the current legal system of organ donation construction relative lag, low "brain death" recognition, lack of proper incentive mechanism and so on. It is a social problem in front of us to be solved that how to make the public recognized organ donation, understand the importance of organ donation and actively become a donor. Health professionals and medical students contact with the patients frequently, their knowledge about organ donation and their attitude and willingness toward organ donation will directly affect the donation willingness of patients and their families. At the same time, their knowledge about organ donation and their attitude and willingness will affect their ability to discover the potential organ donor. Therefore, understanding of health professionals and medical students’knowledge, attitude and willingness of organ donation is more important. At present, the researches about organ donation attitude and willingness are only for single population, such as health professionals, medical students, as well as general public, but no research on the comparison among health staff, medical students and general public. Most of the researches analyzed the influence factors of organ donation willingness using simple factor analysis but using logistic regression.The purpose of this study:(1) to know the knowledge of health professionals and general public towards to organ donation and compare the difference among the different groups; (2) to know the attitudes of health professionals, medical students and general public towards to organ donation and comparing the difference among the different groups of organ donation attitude; (3) to know the willingness of health professionals, medical students and the public towards to organ donation and comparing the difference among the different groups of organ donation willingness. Analyze the influence factors of organ donation willingness by univariate analysis and multivariate analysis so that we can put forward the practical measures improving donation willingness, which can improve our country’s organ donation work.MethodsBetween January 2013 and January 2014, a random sample including 600 medical students which came from two medical universities in China,400 health professionals which came from eight hospitals at Dalian and Chaozhou in China and 700 general public came from Dalian, Wafangdian, Pulandian, Dandong, Yingkou in Liaoning province, Anyang in Henan province and Tianshui in Gansu province were investigated by self-designed questionnaire, including 30 items about basic information, knowledge, attitude and willingness towards organ. The investigators distributed and taken back the questionnaires and did not give any suggestion to the respondents. To ensure respondents’ privacy the study was voluntary and anonymous, we did not collect the content forms. Returning a completed questionnaire indicated informed consent for study participation.All statistical calculations were performed using SPSS13.0 (SPSS, Inc., Chicago, IL). Measurement data were presented with mean values ± standard deviations (x±s) after testing for normal distribution. Categorical data were summarized as counts and percentages (%). Mann-Whitney test was used for two ordinal variables comparisons and Kruskal-Wallis H test was used for three ordinal variables comparisons. Chi-square analysis was performed to test for differences in proportions of categorical variables between two or more groups. The influence factors of organ donation willingness were analyzed by binary logistic regression analysis.Results1. General demographic information:A total of 1607 questionnaires were returned including 565 men (35.2%) and 1042 women (64.8%). The mean age was 29.3±10.0 years. Of all study participants,62.7% were unmarried. Most respondents (78.9%) had a specialist qualification or above. The month income of most respondents (85.3%) was less than 5000 RMB.25.1% of respondents are communist party members and 17.7% of the respondents have religious beliefs. Over half of the respondents (67.1%) were in good or very good health status.2. The knowledge of respondents regarding organ donation:(1) 93.7% of the respondents knew about organ donation, but were not very familiar with organ donation. Only 19.0% of people knew the donation department and 9.8% of people knew the organ donation program. In all respondents,9.0% knew someone donated organs and 12.1% knew someone received the donor organs.60.5% of the respondents knew the status of the organ shortage. The respondents believed that the main reasons caused the organ shortage was "the influence of traditional idea" (72.2%) and "low information level of the public towards organ donation" (58.1%). Regarding to brain death,77.8% of respondents said they knew or understood a little, 8.6% of respondents knew about brain death very well, but there were 13.6% of the public had never heard of brain death. More than half (59.3%) of respondents believed that brain death was the reasonable criteria to judge death. (2) The comparisons on the knowledge regarding organ donation in different populations: health professionals and medical students’knew more about organ donation than the public (H= 130.010, P< 0.001); there were no statistical differences among different population about knowing the organ donation department (χ2= 0.621, P= 0.733) and knowing the organ donation program (χ2= 5.680, P=0.058). Health professionals and medical students knew more about organ shortage status than the public (χ2=144.427, P< 0.001); Health professionals and medical students knew more about "brain death" than the public (H= 422.973, P< 0.001); The ration that health professionals and medical students took "brain death" as a reasonable criteria to judge death was higher than the public (χ2= 381.584, P<0.001).3. The attitudes of the respondents towards organ donation:(1) 77.2%of respondents believed that it was a noble thing to save critically ill patients with their own organs,45.6% of respondents supported living organ donation,61.6% of respondents supported cadaveric organ donation. In all respondents,60.4% agreed to register the donation willingness when applying the ID card or driver’s license for organ donation willingness. More than half (55.5%) of respondents were afraid that the doctor would not try his best to save life in order to obtain the organs. Regarding to compensation,60.9% of respondents believed that the donors should be given compensation. The top two favorite compensation ways were " enjoy the right of priority treatment when transplanted organs", which accounted for 66.3% and "the reduction of hospitalization medical expenses" (40.0%). Cash compensation was third acceptable compensation way (36.9%).48.8%of the respondents believed that compensation would increase the rate of organ donation and 59.3% of the respondents thought that compensation would not tarnish donors.32.4% of respondents believed that cash compensation would lead to commercialization and more than half of the respondents (50.5%) thought that the compensation would increase the number of potential of living-organ donation. (2) Comparisons on the attitudes of different population towards organ donation. More medical students and more health professionals believed that use their organs to save critically ill patients is a noble thing than the public (χ2= 37.612, P<0.001). Medical students and health professionals showed a higher support attitude towards living organ donation than the public (H-9.148 P< 0.001). Medical students and health professionals showed a higher support attitude towards cadaveric organ donation than the public (H= 92.679, P< 0.001). There was no difference on attitudes of medical students, health professionals and the public towards register the organ donation willingness when applying for a driver’s license or ID card (χ2= 5.042, P-0.080). Regarding to "if you afraid that the doctor would not try his best to save life in order to obtain the organs", the public showed more afraid than health professionals and medical students (H= 138.273, P< 0.001). Regarding to compensation, the ratio of medical students who support was higher than health professionals and the public(χ2= 61.244, P< 0.001). When the respondents were asked that "if you get some compensation, whether or not it could increase your willingness to donate", medical students gave more positive answers than health professionals and the public (χ2= 49.503, P< 0.001). Medical students were more favorite to "enjoying the priority in transplantation waiting list" (79.1% vs.61.4%,57.3%, P< 0.001), "reduction of hospitalization medical expenses" (50.0% vs.34.3%,34.2%, P< 0.001) than the health professionals and the public. More than half of the health professionals (54.2%) and medical students (60.5%) believed that the compensation would increase organ donation rate, but more public (48.4%) were not quite sure about this (χ2= 92.119, P< 0.001). Most of the health professionals and medical students did not believe compensation will tarnish the donors, which was different to the public (χ2= 24.357, P< 0.001). The ratio that believed economic compensation would not cause the commercialization of medical students was higher than health professionals and the public (χ2=36.729, P<0.001). The ratio that medical students believed compensation will increase the potential of living-organ donation was higher than health professionals and the public (χ2=173.308, P<0.001).4. Willingness towards organ donation:(1) The survey showed that in all respondents,651 people (40.5%) were willing to donate their organs after death, 83.9% of respondents were willing to donate part of organs to their parents, spouses or children,43.8% of respondents were willing to donate part of their organs to relatives or friends, while only 12.6% of respondents were willing to donate part of organs to those unknown. The 956 respondents whose answer were "unwilling to donate organs after the death" or "not sure" were asked to give the reasons that unwilling to donate, the top three reasons were disfigured corpse (54.4%), distrusted the medical institutions (42.9%) and incomplete laws (36.8%). In the respondents who were willing to donate, the top organ willing to donate was cornea which account for 51.6%, the second organ was kidney (42.5%) and liver (36.7%) was in the third. Only 9.8% of the respondents were willing to donate their family’s organs after death, most of the respondents (68.8%) choose "according to the choice of the relatives ". Other 344 respondents (21.4%) who were unwilling to donate their family’s organs after death were asked to give the reasons and the top three reasons were " can’t accept in emotion and hope the family can be buried" (79.1%), "worry about disfigured corpse " (38.4%) and "mistrust of medical institutions (29.4%). (2) The organ donation willingness of different population was compared as followed. The willingness of medical students (93.3%) to donate part of their organs to the parents, children or spouse was stronger than health professionals (82.8%) and the public (75.8%) (χ2= 76.163, P< 0.001). The willingness of the public (52.3%) to donate part of the organ to relatives or friends was stronger than health professionals (42.1%) and medical students (35.6%) (χ2= 72.540, P< 0.001). The willingness of the public (17.2%) and health professionals (15.0%) to donate part of the organ to the stranger were stronger than medical students (6.1%) (χ2= 45.396, P< 0.001). The willingness of health professionals (48.8%) and medical students (43.7%) to donate their organs after death were stronger than the public (32.8%) (χ2=35.279, P < 0.001). The reasons unwilling to donate organs after death were different among health professionals, medical students and the public (P< 0.001). Cornea is the most like organ that medical students and the public were willing to donate, but the health professionals were willing to donate kidney firstly. The willingness of different people to donate their family’s cadaveric organs was different (χ2=93.582, P< 0.001) and the public showed the highest willingness (15.1%), but medical willingness of students was the lowest (3.0%). There was no difference about the reasons that unwilling to donate their family’s organs after the death among different population (P>0.05). (3) The results of univariate analysis in cadaveric organ donation influence factors were showed as followed. Female showed a higher willingness towards cadaveric organ donation than males (χ2=4.302, P=0.038). The donation willingness of respondents between the ages of 20 to 29 was highest (χ2=13.133, P =0.011). There was no statistical difference in the willingness of respondents in different income population (χ2=7.647, P=0.160), in different birth place population (χ2=3.312, P=0.069), in different religion population (χ2=1.265, P=0.261) and in different marital status population (χ2=5.511, P=0.064). The willingness to donate of respondents with different educational level was different (χ2= 42.781, P<0.001) and the willingness of respondents with master or doctor degree was the highest (84.3%). There was no statistical difference according to the politics status of respondents (χ2=6.283, P=0.099) and health status (χ2=6.272, P=0.151). The univariate analysis showed that donation willingness of respondents correlated to the knowledge level of organ donation (χ2=17.875, P<0.001), whether or not knew the organ shortage status (χ2=11.045, P<0.001), the knowledge level of brain death (χ2=32.094, P< 0.001) and belivede that it was noble to save others lives with their own organs (χ2=105.592, P<0.001). The respondents with more support on living organ donation (χ2=62.247, P<0.001) and cadevaric organ donation (χ2=320.613, P<0.001) had more willingness to donate. The degree of afraid that the doctor would not try his best to save life to obtain the organs was negatively correlate to the donation willingness (χ2=56.053, P<0.001).The main factors influencing the willingness towards organ donation were found by multivariate analysis, which were educational level (Waldχ2=9.705, P=0.008), believing organ donation is a noble thing (Waldχ2=13.967, P<0.001) and the attitude towards cadaveric organ donation (Waldχ2=127.005, P<0.001). The potential donors with higher educational level, believing organ donation is a noble, owing positive attitude towards cadaveric organ donation had more willingness to donate than the others.Conclusions1. The awareness of respondents towards organ donation is higher, but knowledge toward organ donation is little, especially the public’s knowledge regarding "brain death"2. The attitudes of respondents toward organ donation and compensation for the donation are relatively positive, but low faith in the doctor3. The willingness of the respondents towards cadaveric organ donation is higher and most of the respondents are willing to donate their living organs to their family numbers4. The potential donors with higher educational level, believing organ donation is a noble thing, owing positive attitude towards cadaveric organ donation had more willingness towards cadaveric organ donation5. The knowledge, attitudes and willingness towards organ donation of health professionals and medical students are more positive than the public...