actitudes de turco médica y estudiantes de derecho hacia la donación de Órganos (1)

7/25/2019 Actitudes de Turco Mdica y Estudiantes de Derecho Hacia La Donacin de rganos (1)

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International Journal of Organ Transplantation Medicine

*Correspondence:Prof. Dr. Osman GnayErciyes University Medical Faculty Department of PublicHealth, Kayseri, Turkey

Tel:+90-352-207-6666/23727Fax:+90-352-437-5285

E mail:[email protected]

Attitudes of Turkish Medical and Law Students towardsthe Organ Donation

M. Sairolu, O. Gnay*,E. Balci

Erciyes University Medical Faculty Department ofPublic Health, Kayseri, Turkey

ABSTRACT

Background:Attitudes of medical and law personnel towards organ donation are very important.

Objective:To compare the attitudes of the medical and law students towards organ donation.

Methods:498 students in the 1stand 4thgrades of the medical and law faculties of Erciyes University,Kayseri, Turkey, in 201112 academic year, were included in this study. A questionnaire consisting of 31

questions on socio-demographic characteristics of the students and their attitudes towards organ dona-

tion and transplantation was administered to the participants.

Results:The percentage of the students who donated organs was 1%. Approximately, 48% of the medicalstudents and 34% of the law students stated that they think to donate organs. The percentage of the stu-

dents with a positive attitude towards organ donation was found signiicantly higher among the medical

students than the law students, and higher among the 4th grade compared to the 1stgrade.

Conclusion:The percentages of the students who have donated organs and think to donate are rather low.Medical students attitude towards organ donation was more positive than the law students.

KEYWORDS:Faculty, medical; Law faculty; Student; Tissue and organ procurement; Transplantation;

Attitudes

INTRODUCTION

Organ failure is one of the importantworldwide public health problems.Transplantation is an effective thera-peutic modality for irreversible organ failure[1]. Organs and tissues that are necessaryfor transplantation can be achieved from thelive donors or from cadaver [2, 3]. Nowadays,transplantation can be performed for many or-gans and tissues, such as heart, liver, kidney,

pancreas, bone marrow, blood, skin and cor-nea [4].

In Turkey, transplantation is practiced ac-cording to a law the so-called The Law onOrgan Donation, ratified in 1979 and revisedin 1982. In this law, it has been stated that or-

gans or tissues can be taken from a cadaver ifthere is a written testament of the deceased orwith the consent of the relatives. Organs andtissues cannot be taken if there is a statementof the deceased, indicating he or she was op-posed to organ donation [5].

Insufficiency of organ donation is a commonproblem all over the world. Waiting lists fororgans are getting longer every day. In con-trast, organ supply remains relatively con-

stant. In Turkey, like other countries, forlack of transplants, many patients in need oftransplant wait for a long period and many dieevery year [6, 7]. The legal and health carestaffs should be responsive and knowledge-able about organ donation because of the le-gal and medical aspects of the problem. In themeantime, the society as a whole should havesufficient knowledge about and positive atti-tudes towards organ donation. In the medicalliterature, there are a lot of articles related tothe knowledge, attitudes and practices of the

health professionals and health-related school

Original Article


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2 Int J Org Transplant Med 2015; Vol. 6 (1) www.ijotm.com

students [816]. Most of these articles are onthe physicians and medical students. Howev-er, we could not find any study related to theknowledge, attitude and practices of the lawstudents on this subject in the internationalmedical literature.

We therefore conducted this study to com-pare the knowledge, attitudes, and practices ofmedical and law students of Erciyes Univer-sity, Kayseri, Turkey, towards organ donationand transplantation.

MATERIAL AND METHODS

This cross-sectional study was conducted inmedical and law faculties of Erciyes Universi-ty, Kayseri, Turkey in 2011. Erciyes Universityis a state university in the provincial centre ofKayseri, which is located in the central partof Turkey. It was planned to include all 694students who studied at the first and fourthacademic years of medical and law faculties.The study was approved by the ethical com-mittee of Erciyes University Medical Faculty.The administrative permissions were taken

from the deaneries of the faculties.The obtained data were collected through aquestionnaire consisting of 31 questions. Thequestionnaire was prepared by the research-ers in the light of related literature. The ques-tions in the questionnaire were related tosocio-demographic characteristics (eg, age,sex, school, grade, residence) of the studentsand their knowledge, attitudes and practicestowards organ donation and transplantation.Most of the questions were structured with

23 response options. The response optionsfor the structured questions were yes/no andundecided, if necessary. There was only oneopen-ended question, about transplantable or-gans. The answers to this question were eval-uated as know or do not know for sometransplantable organs.

The students in the study group were visitedin their classrooms, informed about the studyand their verbal consents were taken. All stu-

dents who were in the classroom accepted to

participate in the study. The anonymous ques-tionnaires were distributed to the students.The students filled the questionnaire underthe supervision of the researchers.

The data were analyzed by SPSS for Win-dowsver 15.0. 2test, Students ttest for in-dependent data, and binary logistic regressionanalysis were used for statistical analyses. Ap value


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www.ijotm.com Int J Org Transplant Med 2015; Vol. 6 (1) 3

The percentage of the students who knewtransplantable organs among the fourth grademedical students was significantly higherthan that in the first grade. However, no sig-nificant difference was found between the firstand fourth grade students of the law faculty.

In the whole study group, 88% of the studentsknew that transplantation can be performedfrom the cadaver. This percentage was 85.6%for the medical students and 93.6 % for the lawstudents; 13.5% of the medical students and

29.6% of the law students stated that verbalconsent of the individual is sufficient for organdonation. About half of the medical studentsand 70% of the law students knew where theycan apply for organ donation.

The attitudes of the medical and law studentstowards organ donation are shown in Table 2.Only 1.4% of the medical students mentionedthey had donation card, of whom, 48% thoughtto donate. On the other hand, none of the law

students had donation card; 33.8% of themthought to donate. The difference between theattitudes of the medical and law students to-wards organ donation was significant.

Those students who had donation card andthought to donate were evaluated togetherand their attitude was interpreted as positivetowards organ donation. The students whodid neither want nor decide to donate organswere also evaluated together and their attitudewas interpreted as negative towards organ

donation. It was found that 45% of the studygroup had a positive attitude towards organdonation. On the other hand, 81.9% of the stu-dents indicated that they would ask for organfrom someone, in case they need. The rate was82.3% for the medical students and 81.0% forthe law students (p=0.201).

The effects of various factors on the attitudesof the students towards organ donation wereanalyzed through binary logistic regression

Attitudes of medical and law students towards organ donation

Table 1:Comparison of the medical and law students knowledge about transplantableorgans and tissues.

Organ/tissueMedical faculty (n=356)n (%)

Law faculty (n=142)n (%)

p value

Kidney 318 (89.3) 114 (80.3) 0.007

Hearth 292 (82.0) 93 (65.5)


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analysis (Table 3). The percentage of the posi-tive attitude toward organ donation was sig-nificantly higher among the medical studentsthan the law students (Table 3); the rate wassignificantly higher among the fourth gradethan the first grade students. Students gen-

der, family residence, having a relative waitingfor transplantation or transplant recipient didnot have any significant effect on his or herattitude.

The reasons why students had negative atti-tude towards organ donation are shown in Ta-

ble 4; 21.3% of the medical students, and 12.7%of the law students stated that their knowl-edge about medical aspects of organ donationand transplantation was sufficient. However,the percentage of students who knew legalaspects of organ donation and transplantation

was 14.3%, and 54.9% respectively. The dif-ference between medical and law students interms of their self-evaluations was significant.Of studied students, 85.1% of medical studentsand 84.5% of law students stated they wantedmore information about organ donation andtransplantation.

Table 3:Factors influencing the attitudes of studied students towards organ donation

Independent variables Group nPositive attituden (%)

OR (95% CI)

Faculty Law 142 48 (33.8) 1.00Medicine 356 176 (49.4) 1.81 (1.182.78)

School grade1stgrade 334 128 (38.3) 1.00

4thgrade 164 96 (58.5) 2.15 (1.463.19)

GenderMale 241 99 (41.1) 1.00

Female 257 125 (48.6) 1.41 (0.972.05)

Family residenceRural 152 59 (38.8) 1.00

Urban 346 165 (47.7) 1.33 (0.882.00)

A relative waiting for transplantationNo 460 199 (43.3) 1.00

Yes 38 25 (65.8) 2.13 (1.004.54)

A relative who is transplant recipientNo 410 174 (42.4) 1.00

Yes 88 50 (56.8) 1.51 (0.912.52)

Total 498 224 (45.0)

Table 4:Comparison of the study groups according the reasons of the students who did not want or wereuncertain to donate organs.

Reasons for not donating organMedical faculty(n=356) n (%)

Law faculty(n=142) n (%)

Organ donation is not appropriate religiously 29 (16.3) 12 (12.8)

Afraid of taking organs before the death 42 (23.3) 29 (30.9)

Does not want disruption of body integrity after the death 37 (20.6) 19 (20.2)

Fear that their organs will be given to those who do not want 12 (6.7) 4 (4.3)

Fear of commercial exploitation of organs 26 (14.4) 15 (16.0)

Others 34 (18.9) 15 (16.0)

Total 180 (100.0) 94 (100.0)

2=2.818, p=0.728

M. Sairolu, O. Gnay, E. Balci


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DISCUSSION

Necessary organs for transplantation can beobtained from cadaver or live donor. In mostwestern countries, organ transplantations aremainly performed from cadavers. However, inTurkey, the situation is different and trans-plantations are mostly performed from livedonors [17, 18].

The most well-known transplantable organsare kidney, heart, and liver. The order of themost well-known transplantable organs bythe students in this study was similar to otherstudies earlier performed in Turkey and inother countries [3, 10, 13, 14, 19, 20]. This

situation might depend on the fact that kid-ney transplantation is the most commonlyperformed organ transplantation in Turkey, inparticular, and in the world, at large.

We found that the percentage of students whoknew each of the transplantable organs wassignificantly higher among medical studentscompared to the law students. When the firstand fourth grade students were evaluatedseparately in terms of their knowledge about

transplantable organs, we found there wasno difference between the first year medicaland law students, whereas the knowledge ofthe fourth year medical students was signifi-cantly higher than that of the fourth year lawstudents. These differences may be due to thepresence of topics in the third and fourth yearsof medical curriculum and the higher likeli-hood that a fourth year medical student meetsa patient with organ failure or transplant. In astudy conducted on medical students in Brazil,it was found that knowledge of the students

about transplantable organs was higher dur-ing the later years of the study [10].

Of the medical students studied, 1.4% statedthey had donation card, of whom, 49.4% werewilling to donate. On the other hand, amongthe law students, there was no one who haddonation card and the percentage of thosewho were willing to donation was 33.8%. Thepercentage of the students who had donationcard and those who were willing to donate

varies from study to study. While the percent-

age of the students who had donor card wasquite high in some countries, it was very lowin Turkey. The percentage of medical studentswith donor card was 80% in the USA, 69.2%in Brazil, 43% in the UK, 31.9% in Germany,22% in Iran, 8.7% in Greece, and 8% in SouthAfrica [8, 10, 11, 14, 16, 20, 21]. According toprevious studies conducted in Turkey, the pro-portion of people who had donation card var-ied between 1.8% and 13.4% [2224].

The percentages of having donor card weregenerally higher in among medical studentsthan in other students. In a study conductedin Germany, 31.0% of medical students oweddonor card; the rate was 11.3% among other

students [20]. In a study conducted in Greece,the percentages were 8.7%, and for medicalstudents, 3.6% for nursing students, and 3.1%for medical laboratory students [14]. In con-trast, in a study in England, 74% of nursingstudents and 43% of medical students had do-nation card [21].

The proportion of people who were willingorgan donation mentioned differently between30% and 91%, in various studies. [3, 19, 22,

23, 25]. The percentage of potential organ do-nors was lower among law students comparedto medical students. This difference may bedue to the fact that medical students encoun-ter more frequently with patients in need oforgan transplantation than law students. Onthe other hand, there are some issues about or-gan donation and transplantation in the thirdand fourth years of the curriculum of medicalfaculty.

Organ donation can be done in provincial

health directorates, security directorates, hos-pitals, organ transplantation centers, founda-tions related to organ donation, etc. Accord-ing to a study held by Naar, et al[19], 48.5%of medical students knew where to apply fororgan donation. In our study, 50.8% of medi-cal students and 69.0% of law students knewwhere to apply. These data show that law stu-dents are better informed than medical stu-dents on legal aspects of donation.

Almost half of the medical students and one-



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third of law students stated that they consid-ered organ donation. On the other hand, 82.3%of medical students and 81.0% of law studentsexpressed their willingness to receive organor tissue from another person, if they need. Ina study held by Baykan, et al[26], on the firstyear of medical students, similar results werefound. These data show that organ transplan-tation is acknowledged by the majority of thepeople as a therapeutic method, but participa-tion to organ donation has not yet reached thedesired level.

In our study, when the reasons of the studentswho did not want to donate or who were un-certain about the matter were asked, it was

found that 27.7% of the students were afraid ofremoving their organs before death, 21.9% didnot want their physical integrity to be disrupt-ed after the death, 16.0% found organ dona-tion religiously inappropriate, and 16.0% wereanxious about being commercially abused.Almost 18% of medical students and 13.3% oflaw students were those who supposed organdonation was not comply with their religion.According to a study carried out by zmen,et al[3], on health college students, 38.2% of

the students who did not consider donation,stated that they did not want their physicalintegrity to be disrupted, 41.2% was conscien-tiously uncomfortable, 17.6% thought that do-nated organs would be abused commercially,and 29.4% found organ donation religiouslyimproper.

The percentage of the students who foundtheir knowledge on medical aspects of organtransplantation sufficient was higher amongmedical students; however, more law students

thought their knowledge on legal aspectsof the matter is sufficient. Majority of bothgroups found their knowledge on both aspectswas insufficient. Approximately 85% of thestudents in both groups indicated that theywanted to learn more about organ donationand organ/tissue transplantation.

This investigation is one of the first studies tocompare the knowledge, attitudes and practic-es of medical and law students toward organ

donation. The study has some limitations. The

study was performed in a single university andthus, the results may not be generalized to allmedical and law students in Turkey.

In conclusion, we found that medical and lawstudents have insufficient information abouttransplantation and organ donation. Theneeds for organ donation have been increas-ing in all communities. Education programs,which provide information about transplanta-tion and organ donation for all sectors of thecommunity, should be prepared; these pro-grams should be applied regularly in all edu-cational institutions from elementary schools.Programs about organ donation should beprepared and shown in the media, especially

on television and on the Internet.

To raise awareness among students, educationrelated to organ donation should be enhancedand sustained. Education programs can be car-ried out to motivate those who are uncertainabout donation. For example, a documentaryabout the patients who are waiting for organscan be shown to all students.

ACKNOWLEDGEMENTS: The authors wishto thank to deaneries of the Medical Facultyand Law Faculty of Erciyes University fortheir permission and to Dr. Hmeyra Aslanerfor her help during data collection.

FOUNDING: The authors declared that nofinancial support was taken for this study.

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actitudes de turco médica y estudiantes de derecho hacia la donación de Órganos (1)

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