|Year : 2015 | Volume
| Issue : 1 | Page : 58-62
Beliefs and barriers for organ donation and influence of educational intervention on dental students: A questionnaire study
Basavaraj Patthi, Swati Jain, Ashish Singla, Shilpi Singh, Hansa Kundu, Khushboo Singh
Department of Public Health Dentistry, DJ College of Dental Sciences and Research, Modinagar, Uttar Pradesh, India
|Date of Web Publication||19-Mar-2015|
Dr. Basavaraj Patthi
Department of Public Health Dentistry, DJ College of Dental Sciences and Research, Modinagar, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: Many developmental disorders or accidents leave the victims crippled resulting in vision loss and fatal damages to the vital organs. At such point of time, organ donation remains the only ray of hope. However, there exists very little awareness among the masses regarding the same. Aim: To assess the knowledge, attitude and, belief on/toward organ donation and the impact of an educational intervention among the Dental undergraduate students of a Dental College of Modinagar, India. Materials and Methods: A questionnaire and intervention based survey was carried out. All the students from B.D.S 1 st year to internship and patients who attended screening/treatment camps organized by the Department of Public Health Dentistry were included for the study. A 11-item structured questionnaire to assess the knowledge, attitude, and beliefs regarding organ donation was used. This was followed by an educational intervention for the college students. Immediately after this session, the same questionnaire was again distributed and collected. Chi-square test was used to analyze the statistical difference. Results: The overall level of knowledge and beliefs about the concept of organ donation in the two groups was similar before the intervention was provided. After the intervention for B.D.S students, a significant improvement in the level of knowledge and attitude was observed. About 74.6% of students in contrast to 42.3% of the patients realized the significance of organ (P < 0.0001) and 72.4% of the patients and 63.4% of students considered organ donation against their religious beliefs. About 65.6% of the students post interventions were willing to educate the masses about significance of organ donation. Conclusion: A significant knowledge gap exists amongst the dental undergraduates and the general population for organ donation. The positive influence of educational intervention emphasizes the need of an intervention to bring positive changes thereby highlighting the significance of health education.
Keywords: Dental undergraduates, educational intervention, knowledge, organ donation, patients
|How to cite this article:|
Patthi B, Jain S, Singla A, Singh S, Kundu H, Singh K. Beliefs and barriers for organ donation and influence of educational intervention on dental students: A questionnaire study. J Indian Assoc Public Health Dent 2015;13:58-62
|How to cite this URL:|
Patthi B, Jain S, Singla A, Singh S, Kundu H, Singh K. Beliefs and barriers for organ donation and influence of educational intervention on dental students: A questionnaire study. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2020 Sep 20];13:58-62. Available from: http://www.jiaphd.org/text.asp?2015/13/1/58/153588
| Introduction|| |
The greatest of all creations is man himself, the marvelous machine - precise and efficient. The human body has a dynamic framework of multifunctional organs making it susceptible to many diseases. Road traffic accidents and birth defects may result in functional and physical loss of important organs of the body leading to various kinds of handicap. In such circumstances, organ donation is the ideal treatment option. However; this opportunity only becomes available, when someone donates their organs or tissues upon their death. 
Organ donation is the surgical removal of an organ or tissues from one person (the donor) and placing it in another person (the recipient). Most donated organs and tissues are from people who have died. Organs and tissues that can be transplanted include Liver, Kidneys, Pancreas, Heart, Lung, Intestine, and Cornea, Middle ear, Skin, Bone, Bone marrow, Heart valves and Connective tissue. But, a living person can also donate some organs like Blood, stem cells, and platelets.  It has been legalized in India, under the "Transplantation of Organ Act, 1994." ,,
Still in India, every year nearly 500,000 people die because of nonavailability of organs, 200,000 people die of liver disease and 50,000 people die from heart disease. The figures reveal that around 150,000 people await for a kidney transplant, but only 5000 get one. About 1,000,000 people suffer from corneal blindness and await transplant. Surprisingly, nationally, with a population of over 1.2 billion people, the statistics stands at only 0.08 persons as organ donors per million population. This is an incredibly small and insignificant number compared to the statistics around the world. 
Globally, the prevalence of knowledge about the legislations and need for organ donation was found to range from 60% to 85%, on using different knowledge variables.  Medical and Dental students constitute a special group which can have tremendous influence the on the masses as a whole. They have different opinions that are governed by socio cultural factors such as traditional customs, the practice of preservation of the intact body after death, uneasiness in discussing death related issues and family objections.  However, many students lack relevant basic knowledge and are influenced by personal attitudes and biases which are held by the general public, which impinge on health care professionalism. There is also a discrepancy between their attitudes and actions. While a majority of healthcare professionals support organ donations, only a small proportion make actual commitments through signing of organ donor cards or registering to become organ donors.  Knowledge, attitude, and actions are interrelated, and previous studies have shown that culture and religion were important external influences that affected the decision-making process. 
In a study done by Annadurai et al.,  among college students, the knowledge about different aspects of organ donation was found to be low. While 86.1% of the students were not aware of legislation, 75% of respondents were in favor of organ donation. However, only 2% were registered for organ donation. Similar findings were also reported by Sucharitha et al.  and Chung et al.  Limited literature is available assessing the knowledge, attitude and beliefs about organ donation among dental undergraduate students.
Thus, the present study aims to assess the knowledge, attitude and belief on/toward organ donation and the impact of an educational intervention among the Dental undergraduate students of a Dental College of Modinagar, India.
| Materials and Methods|| |
A questionnaire and intervention based survey was carried out at a Dental College, Uttar Pradesh during the time period of May 2014 to June. 2014. All the students from B.D.S 1 st year to internship (500 students) and patients who attended screening/treatment camps organized by the college from May 2014 to June 2014 (530 patients) were considered for the study. Only those students and patients who gave consent were included for the study while patients with reported intellectual disability were excluded.
Prior to the survey, the study design was reviewed and approved by the Institutional Ethical Committee. Written informed consent was obtained from all the study subjects after explaining them the purpose and methodology of the study.
The survey instrument was a structured questionnaire, which was finalized after pretesting and pilot study [Table 1]. The questionnaire was distributed and collected from all the B.D.S students on a single working day of May 2014. The 11-item questionnaire was translated in the local language-Hindi and was validated and checked for internal consistency by test-retest method (Cronbach's alpha value = 0.89). It was then distributed and collected from the patients during the camps held by the Department of Public Health Dentistry. A total of 465 students (out of 500, response rate 93%) and 450 patients (out of 530; response rate 84.9%) agreed to participate in the study and returned the filled questionnaire. This was followed by an educational intervention for the college students, with interactive sessions being held on organ donation by a senior faculty member of a Medical College in June 2014. The educational part included material that highlighted the concept and statistics of organ donations, types of organ donations, legal issues and motivational messages that inspired students for organ donations. Immediately after this session, the same questionnaire was again distributed and collected.
All the responses were entered in the Microsoft Excel spreadsheet (2007) and processed using the software SPSS - version 21.0 (SPSS Inc., Chicago, IL, U.S.A). The proportions (% of responses-Yes or No) were calculated for each Question. Chi-square test was used to analyze the difference between the individual responses before and after the intervention.
| Results|| |
A total of 465 undergraduate students pursuing B.D.S and 450 patients who attended dental treatment camps were included for the study. Student group consisted of 270 males (58.06%) and 195 females (41.94%). Among the patients, 252 (56%) were males and 198 were females (44%). About 89.9% of the students (418) and 82.8% (373) of the patients were Hindus while remaining were Muslims. Among the 450 patients; 390 (86.7%) had completed a minimum of primary education while the remaining were illiterate. None of the patients had studied till graduation or above.
[Table 1] highlights the responses of the questionnaire before the intervention was provided. The overall level of knowledge and perceptions about the concept of organ donation in the two groups was similar before the intervention was provided (Question 1, 4, 6, 7, 9, 10 and 11), the difference being statistically nonsignificant. However, when the students were asked about the need for organ donation, 74.6% of them realized the significance of organ donation in contrast 42.3% the treatment camp patients (Question no. 2, P < 0.0001). 72.4% of the patients and 63.4% of students considered organ donation against their religious beliefs (Question no. 5, P < 0.0001).
When the same was compared after the intervention [Table 2] for B.D.S students, a significant improvement in the level of knowledge was observed (Question no. 2, 3, 4, 7, and 10). About 96.8% of them realized the significance of organ donation to the society as compared to 74.6% pre intervention group (Question no. 2, P < 0.001). Also a positive change in the attitude of students concerning the religious barrier and family support was observed following the educational intervention (Question no. 5, P < 0.001 and Question no. 8, P = 0.04 respectively) after the educational intervention. For remaining responses, the assessed difference between the pre and post intervention data was statistically nonsignificant (Question no. 1, 4, 6, 7, 9, 10, 11).
| Discussion|| |
Organ donation saves lives in patients affected by terminal organ failures and improves quality of life. It has gradually ameliorated in the last two decades and usually provides excellent results in children and young adults, and is increasingly challenged by the growing proportion of the elderly transplant patients with co-morbidities. Solid organ transplant programs activity has been steadily growing but is still far from global needs, with great differences among countries. Although progress in medical science and technology has vastly improved success rates for organ transplantations, severe organ shortages continue preventing these medical advances from being realized for all potential patients. Efforts to expand the available organ supply have become more crucial for meeting transplant demand. 
The present study attempted to compare the awareness level regarding the concept of organ donation among dental undergraduate students with that of general masses at the baseline so as to give an insight into the existent knowledge gap among the students and masses as a whole irrespective of their educational background and to then analyze the influence of educational intervention on the knowledge, attitudes and beliefs of the dental undergraduate students. The results of the present study demonstrated several characteristics of the respondents concerning their knowledge, attitude and beliefs on organ donation before the educational intervention.
In general, the awareness level about the concept of organ donation among the dental students was marginally better than the patients [Question no. 1, [Table 1], which reflects the suboptimal level of knowledge about organ donation prevalent among the patients attending the dental camps which in turn reflected the attitude of the masses. This was less than the reported results of previous studies conducted by Sucharitha et al.  and Ramadurg and Gupta  Possible reasons for this may be due to insufficient emphasis on organ donor recruitment in the curriculum, lack of exposure and understanding about the entire transplantation process, and paucity of any large-scale organ donation public awareness campaigns in the community. Hence, it is necessary that educational measures in the form of change in dental and medical curriculum, regular workshops/seminars are recommended to improve the present scenario. When the health education intervention was provided to the dental students the level of awareness raised to 100% which was quite similar to the findings of Ramadurg and Gupta  This shows that Health Education forms an essential component of action to promote health and raise the awareness level.
The response to the Question no. 2 assessed the self-realization of the role and usefulness of organ donation for the society as a whole. Majority of the patients (57.7%) did not consider organ donation essential compared to a mere 25.37% of the camp patients, (P = 0.001); again emphasizing the existent knowledge gap especially among the general population which might be attributed to their educational status. However, a statistically improved positive response was seen post intervention amongst the student group.
More number of the students (70.7%) as compared to patients (68.2%) found organ donation a difficult and complicated procedure [Question no. 3, [Table 1]. Similar response was seen when enquired for the legislations concerning the same [Question no. 4, [Table 1]. This was similar to the results of Annadurai et al.,  but contrary to the findings from Wig et al.  This again describes that the organ donation is not a familiar concept among the Indian public. Knowledge about organ donation policy and the organ donation process can play a pivotal role in increasing individuals' willingness to donate their own organs and those of a relative. , Thereafter, issues related to donor recruitment as well as supply and demand of cadaveric organs should be more emphasized in the medical and dental curriculum. A special elective course for medical and dental students covering aspects of organ donation might be rather helpful. ,
About 72.4% of the patients in contrast to 63.4% of the students [Question no. 5, [Table 1] considered organ donation against their religious beliefs. This was in agreement to the findings of Oliver et al.  This highlights the role of religious barrier specially in the rural areas observed in our patient sample and shows that religious concerns play a significant role much more often than clinicians and transplant teams believe. Only few patients came forward with their religious concerns when asked in detail about the religious constraints for organ donation by the chief investigator [Question no. 5, [Table 1]. Various misbeliefs and psychosocial barriers existed such as belief in the preservation of an intact body after death, family objections to organ donation, and discomfort discussing death related issues, which "negatively" influenced attitude. However, post intervention results showed statistically increased religious acceptance amongst the students which again emphasizes the pivotal role of education in information dissemination to break sociocultural barriers.
Most of the study subjects (55.3% of students and 52.4% of patients) wanted to donate their organs only to their close relatives [Question no. 6, [Table 1] and a similar trend was seen post intervention also [Question no. 6, [Table 2]. Also, study subjects were less aware of the various organs that can be donated [Question no. 7, [Table 1]. Similar findings were reported by Chung et al.  Post intervention results showed improved knowledge regarding the various organs that can be donated; however, majority of students still wanted to donate organs to their close relatives only, signifying the existent psychological roadblocks in the society.
About 80.6% of the students agreed that their family will support their decision of organ donation in contrast to 23.3% of the patients that could be attributed to the lower education level of the patients [Question no. 8, [Table 1]. There was only a marginal improvement in the positive response post intervention [Question no. 8, [Table 2]. Continuous health education programs might improve this situation.
Majority of study subjects, both students, and patients, agreed that there is a lack of information regarding organ donation and were reluctant to educate the society about the same [Questions 9 and 10, [Table 1]. This is in agreement to the findings of Sucharitha et al.  It is mainly due to the paucity of information and hence lack of interest. But, post intervention a significantly higher students were willing to educate the masses [Question no. 10, [Table 2] highlighting the significance of health education again.
Both the students and patients were anxious regarding the misuse of their donated organs [Question no. 11, [Table 1]. The same trend was seen even after intervention [Question no. 11, [Table 2]. This needs to be addressed adequately by continuing dental education to achieve an optimal awareness level.
The limitation of the present study was that the intervention was applicable only to students who were within the dental college, which puts reservations for the mass. Further longitudinal interventional studies are, therefore, recommended to assess the influence of educational intervention on the general population. It is thus recommended to conduct awareness sessions in dental colleges and in community outreach programs. Educated health care providers can then play a critical role in motivating the public for the cause of promotion of organ donation.
| Conclusion|| |
The present study revealed a significant knowledge gap amongst the dental undergraduates and the general population for organ donation. There exist many misbeliefs and psychosocial barriers regarding the same which needs to be dealt at an urgent basis. The positive influence of educational intervention emphasizes the need of an intervention which incorporates knowledge, motivational messages, facts and figures, to bring necessary changes in the perceptions and intentions of the students regarding organ donations thereby highlighting the significance of health education on health promotion. Organ donation is the need of the hour, and immediate steps are required to disseminate the information regarding the same to save thousands of life.
| References|| |
Mudur G. Indian doctors debate incentives for organ donors. BMJ 2004;329:938.
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.
Annadurai K, Mani K, Ramasamy J. A study on knowledge, attitude and practices about organ donation among college students in Chennai, Tamil Nadu-2012. Prog Health Sci 2013;3:59-65.
Sucharitha ST, Siriki R, Dugyala RR, Mullai, Priyadarshini, Kaavya. Organ donation: Awareness, attitudes and beliefs among undergraduate medical students in South India. Natl J Res Community Med. 2013;2:79-148.
Chung CK, Ng CW, Li JY, Sum KC, Man AH, Chan SP, et al.
Attitudes, knowledge, and actions with regard to organ donation among Hong Kong medical students. Hong Kong Med J 2008;14:278-85.
Grinyó JM. Why is organ transplantation clinically important? Cold Spring Harb Perspect Med 2013;3. pii: a014985.
Ramadurg UY, Gupta A. Impact of an Educational Intervention on Increasing the Knowledge and Changing the Attitude and Beliefs towards Organ Donation among Medical Students. J Clin Diagn Res 2014;8:JC05-7.
Wig N, Gupta P, Kailash S. Awareness of brain death and organ transplantation among select Indian population. J Assoc Physicians India 2003;51:455-8.
Mossialos E, Costa-Font J, Rudisill C. Does organ donation legislation affect individuals′ willingness to donate their own or their relative′s organs? Evidence from European Union survey data. BMC Health Serv Res 2008 27;8:48.
Edwards AG, Newman A, Morgan JD. Exposure to the field of renal transplantation during undergraduate medical education in the UK. BMC Med Educ 2005;5:32.
Edwards AG, Weale AR, Morgan JD. A survey of medical students to assess their exposure to and knowledge of renal transplantation. BMC Med Educ 2004;4:32.
Oliver M, Woywodt A, Ahmed A, Saif I. Organ donation, transplantation and religion. Nephrol Dial Transplant 2011;26:437-44.
[Table 1], [Table 2]