Knowledge, Attitudes and Intention to Donate Organs among the Public, Health Sciences Students and Health Personnel: A Scoping Review with a Systematic Review of Malaysian Studies

Background

Various barriers lead to a shortage of organs for transplantation in Malaysia. One drive to improve the organ donation rate operates through future healthcare practitioners and practitioner advocacy. This scoping review was carried out to establish and summarise findings about organ donation-related articles among the public, health sciences students and health personnel. A further aim was to synthesise the latest data on knowledge and attitudes towards organ donation in the Malaysian population.

Methods

PubMed, Scopus, Google Scholar and the Malaysian Medical Repository (MyMedR) were used for a search conducted up to May 2022. Relevant search terms included 'Organ donation' and 'Malaysia'. Journal articles related to knowledge, attitudes and intention were grouped under the general public and health science. Students and health personnel were included. Eligible studies were reviewed by two independent reviewers. Any disagreements were resolved by consensus with a third reviewer.

Results

The 31 included articles revealed an increased level of awareness among the public regarding organ donation. The analysis identified that nonrecognition of brainstem death (38.5%), no knowledge of how to contact the Organ Transplant Coordinator (82.3%) and never approaching the families of a potential donor (63.9%) led to a lack of confidence among healthcare practitioners to promote organ donation.

Conclusion

The shortage of organ donors is the result of the failure to identify the expected donor, obtain consent and procure the organs due to the passivity of Malaysian health professionals in promoting the organ donation process.

Barriers and facilitators of deceased organ donation among Muslims living globally: protocol for an integrative systematic review using narrative synthesis

INTRODUCTION

Muslims have been shown to have less favourable attitudes towards organ donation and are less likely to consent to donate their organs. While several studies have been undertaken globally to identify the barriers and facilitators of organ donation, no systematic review has synthesised this evidence to date. Therefore, this systematic review aims to identify the barriers and facilitators of organ donation among Muslims living globally.

METHODS AND ANALYSIS

This systematic review will include cross-sectional surveys and qualitative studies published between 30 April 2008 and 30 June 2023. Evidence will be restricted only to studies reported in English. An extensive search strategy will be used in PubMed, CINAHL, Medline, Scopus, PsycINFO, Global Health and Web of Science, as well as specific relevant journals that may not be indexed in these databases. A quality appraisal will be undertaken using Joanna Briggs Institute quality appraisal tool. An integrative narrative synthesis will be used to synthesise the evidence.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Institute for Health Research Ethics Committee (IHREC) (IHREC987), University of Bedfordshire. The findings of this review will be disseminated widely through peer-reviewed journal articles and leading international conferences.

PROSPERO REGISTRATION NUMBER

CRD42022345100.

Knowledge and Attitude Toward Organ Donation Among the Adult Population in Jazan, Saudi Arabia

Background

Organ transplantation is recognized as a life-saving procedure for patients with potentially terminal illnesses. However, the population's awareness of organ donation and related issues is variable throughout the world.

Objectives

The study purposes to evaluate the knowledge and attitude toward organ donation among the adult population in the Jazan region, Saudi Arabia.

Methods

We conducted a cross-sectional questionnaire-based study on the general population in Jazan using the convenient sampling method. The questionnaire was composed of 21 items distributed over demographic characteristics, knowledge, and attitude domains. The knowledge and attitude domain levels were categorized into low, moderate, and high based on the scoring of its items. The data had been analyzed using SPSS software version 23 (IBM Corp., Armonk, NY). Frequency and percentages were used to display categorical variables. Mean and standard deviation was used to present numerical variables. The independent t-test and analysis of variance (ANOVA) test were both used to test for factors associated with knowledge score and attitude score toward organ donation.

Results

A total of 1019 participants were included in the study. The majority were between the ages of 18 and 30 years and 3.4% of them were older than 50 years. Eighty percent of participants had a university level of education or higher and 48% were students. This survey showed that 493 (48.4%) had a moderate knowledge level of organ donation (total score between 50% and 75%) with younger age, being a student, and residence status associated with a higher level of knowledge while gender and the education levels were not. Five hundred one (49.2%) of the participants reported being in agreement with organ donation and 56 (5.5%) of them reported disagreement. Most of the participants exhibited a low positive attitude toward organ donation, with 592 (58.1%) of the participants (a total score less than 50%) (score of 4 and less). Young age and being a student were the factors associated with a positive attitude while gender, education levels, residence status, and monthly status were having no significant associations with the positive attitude toward organ donation.

Conclusion

This study concluded that study participants had a moderate level of knowledge and a low positive attitude toward organ donation. The advocacy in promoting organ donation should be increased through the use of appropriate mediums to change the attitudes and enhance the willingness of people.

Barriers towards deceased organ donation among Indians living globally: an integrative systematic review using narrative synthesis

OBJECTIVES

To understand the barriers towards deceased organ donation among Indians living globally.

DESIGN

Integrative systematic review using narrative synthesis.

DATA SOURCES

CINAHL, Medline full-text, PsycInfo, Scopus, Global Health, Web of Science, and PubMed Central, Indian Journal of Transplantation and Google Scholar.

TIME PERIOD

1 January 1994 to 31 December 2021.

PARTICIPANTS

Individuals of Indian origin living globally.

RESULTS

Eighty-nine studies were included with more than 29 000 participants and quality of the studies were assessed using Joanna Briggs Institute's critical appraisal tool. Though majority of the participants had knowledge toward organ donation with a positive influence on willingness, the gap between knowledge and willingness was huge, with minimal registration influenced by the complex sociocultural constructs. Various sociocultural constructs such as family, fear and mistrust, religion, and bodily issues play a vital role. Differences were identified in willingness to donate and register between southern and other regions of India. Indian's organ donation behaviour in other geographical locations differed based on the socioreligious background of the country they lived in such as in Malaysia, Canada and the UK. However, they were collective in decision-making and had complex sociocultural interference irrespective of the country the individual lived which differed only in their next generations.

CONCLUSION

Though this study showed the complex relationship, and its influences on organ donation behaviour, lacunae were identified to further understand how such complex interactions determine or inform the behaviour. Also, methodological issues were identified, where this particular population outside India were collectively studied with their neighbouring population which are not homogenous. Studies in India majorly addressed a similar aim using similar methods which produced repetition of studies leading to lack of diversified, wider and in-depth research. Therefore, while this systematic review addressed the barriers toward organ donation among Indians living globally, it also informs various gaps in research and also methodological issues.

PROSPERO REGISTRATION NUMBER

CRD42019155274.

Can financial rewards complement altruism to raise deceased organ donation rates?

BACKGROUND

Organ supply-demand in developing countries worldwide has continued to widen. Hence, using a large survey (n ¼ 10,412), this study seeks to investigate whether human psychology could be used to inculcate philanthropy to raise deceased organ donation rates.

METHODS

Three models were constructed to examine multidimensional relationships among the variables. Structural equation modeling was applied to estimate the direct and indirect influence of altruism, financial incentives, donation perception, and socioeconomic status simultaneously on willingness to donate deceased organs.

ETHICAL CONSIDERATIONS

The study was approved by the University of Malaya ethics committee.

RESULTS

The results show that altruism amplifies the impact of socioeconomic status and donation perception on willingness to donate. Also, the results show that financial incentives cannot complement altruism to raise organ donation rates. Hence, investing in education and public awareness enhances altruism in people, which then increases the propensity to donate.

CONCLUSION

Evidence suggests that governments should allocate resources to increase public awareness about organ donation. Awareness programs about the importance of philanthropic donations and the participation of medical consultants at hospitals in the processes form the foundation of such a presumptive approach.

Knowledge and attitudes of healthcare professionals and the impact on willingness to donate organs: a tertiary hospital survey

INTRODUCTION

Healthcare professionals (HCPs) working in critical care areas play an important role in the organ donation (OD) process. We studied HCPs' own willingness to be organ donors and its association with sociodemographic factors as well as their knowledge and attitudes about OD and transplantation.

METHODS

A cross-sectional survey of HCPs working in four critical care units in a major transplant centre in Malaysia was undertaken using a validated structured questionnaire. Responses were analysed using multivariable analysis with willingness to donate as the dependent variable.

RESULTS

Of the 412 respondents (response rate 98.1%), the majority were nurses (60.4%), Malay (71.1%) and female (77.2%). Overall, 68.0% were willing to donate. The independent predictors of willingness to donate were profession (p < 0.001) and the Hindu religion (p = 0.001). Ethnicity (p = 0.003), religious belief (p < 0.001), knowledge (p = 0.016), belief in brain death (p = 0.018) and confidence in transplantation (p < 0.001) also independently correlated with willingness to donate, while attitudes to OD did not. Of those willing to donate, only 37.3% were carrying a donor card and only 63.1% had informed their family of their intention to donate.

CONCLUSION

Although willingness to donate was higher in critical care HCPs than HCPs in general, significant knowledge gaps as well as certain beliefs and perceptions that could pose a barrier to OD were identified in this group. Measures to improve OD rates in Malaysia should include targeted educational programmes for HCPs working in critical care areas.

A Mosque-Based Qualitative Study on American Muslim Women's Organ Donation Beliefs

INTRODUCTION

Detailed studies on the associations between religious beliefs and organ donation attitudes among religious minorities remain wanting. Although Muslims appear to have low rates of support for donation, how these behaviors relate to religious frameworks requires further investigation.

METHODS

We sought to explore the relationship between religious beliefs (Islam) and organ donation attitudes through focus groups with 43 Muslim women from 5 Chicago-area mosques. Purposive selection of mosques generated near-equal representation of Arabs, South Asians, and African Americans, as well as diversity in education and income. Using the theory of planned behavior as our conceptual framework, we expanded the traditional normative domain to include religiously informed beliefs.

FINDINGS

We found that the relationship between religious beliefs and Muslim attitudes toward organ donation is more complex than commonly perceived. Regarding the Islamic ethicolegal permissibility of organ donation, participants expressed a range of normative beliefs. Furthermore, participants voiced concerns beyond religious permissibility, including anxieties over modesty violations during the donation process, as well as concerns about purported black market organ trade and medical risks to donors.

DISCUSSION

Given that participants raised religious, societal, and biomedical concerns regarding organ donation, our findings suggest that effective educational programs should involve nuanced curricula that teach to the plurality of Islamic ethicolegal opinions and discuss transplantation processes within the United States.

Willingness toward organ and body donation among anatomy professors and students in Mexico

Most anatomists agree that cadaver dissection serves as a superior teaching tool in human anatomy education. However, attitudes toward body donation vary widely between different individuals. A questionnaire was developed to determine the attitudes toward body and organ donation among those who learn the most from cadavers: medical students, medical student teaching assistants, medical students involved in research, and anatomy professors. A cross-sectional, prospective study was designed in which the questionnaire was distributed among first-year human anatomy students before undertaking cadaver dissection at the beginning of the semester, and then again after a commemoration service at the end of the course. The questionnaire items included demographic data, as well as questions designed to characterize participants' attitudes regarding body/organ donation from strangers, family members, and whether participants would consider such practices with their own bodies. Out of a total of 517 students enrolled in the Human Anatomy course in the Medical School at the Universidad Autónoma de Nuevo León, Mexico during January to June 2016, 95% responded to the first (491) and second (490) surveys. Participants' opinions on their own organ donation was similar before and after exposure to cadaver dissection, with between 87% and 81% in favor of such practices, and only 3% against it, in both surveys. Participants' willingness to donate their own bodies, as well as those of family members, increased, while reluctance regarding such practices decreased by half (P < 0.0001 and P < 0.05). Professors had the highest rates of positive opinions regarding their own body donation (74.9%), with 18.8% undecided. Low opposition toward organ and body donation remains prevalent among both anatomists and physicians in training in Mexico. Anat Sci Educ 10: 589-597. © 2017 American Association of Anatomists.

A Comprehensive Analysis of the Current Status and Unmet Needs in Kidney Transplantation in Southeast Asia

To address the unmet needs in the face of a growing demand for end-stage renal failure management and kidney transplantation in Asia, we have conducted a critical analysis of published literature and national registries to evaluate clinical outcomes and the rates of organ donation in Southeast Asia and the challenges facing these regions with regards to regulation, choice of donor source, and funding. Based on the available data, suggestions are proposed for an advancement of rates of organ donation and access, with emphasis on improved regulation and public education.

Factors Associated With Medical and Nursing Students' Willingness to Donate Organs

Malaysia suffers from a chronic shortage of human organs for transplantation. Medical and nursing students (MaNS) are future health professionals and thus their attitude toward organ donation is vital for driving national donation rates. This study investigates MaNS' willingness to donate organs upon death and the factors influencing their willingness. A cross-sectional design was used with a sample of 500 students (264 medical and 236 nursing) at the University of Malaya. A self-administrated questionnaire was used. The responses were analyzed by using descriptive statistics and multiple logistic regression. Of all respondents, 278 (55.6%) were willing to donate organs upon death, while the remaining 222 (44.4%) were unwilling to donate. Only 44 (8.8%) had donor cards. The multiple logistic regression revealed that the minorities ethnic group was more willing to donate organs than Malay respondents (adjusted odds ratio [aOR] = 1.98, P = 0.010). In addition, medical students were more willing to donate than nursing students (aOR = 2.53, P = 0.000). Respondents who have a family member with a donor card were more willing to donate than respondents who do not (aOR = 3.48, P = 0.006). MaNS who believed that their religion permits deceased donation were more willing to donate than their counterparts (aOR = 4.96, P = 0.000). Household income and sex were not significant predictors of MaNS' willingness to donate organs upon death. MaNS have moderate willingness, but low commitment toward deceased organ donation. Strategies for improving MaNS' attitude should better educate them on organ donation, targeting the most the Malay and nursing students, and should consider the influence of family attitude and religious permissibility on MaNS' willingness.

Demographic and Socioeconomic Factors Influencing Public Attitudes Toward a Presumed Consent System for Organ Donation Without and With a Priority Allocation Scheme

The influence of demographic and socioeconomic factors on the public's attitude towards a presumed consent system (PCS) of organ donation was estimated in 2 scenarios: without and with a priority allocation scheme (PAS). Self-administered questionnaires were completed by 775 respondents. Using multiple logistic regressions, respondents' objections to donating organs in both scenarios were estimated. In total, 63.9% of respondents would object to donating under a PCS, whereas 54.6% would object under a PCS with a PAS. Respondents with pretertiary education were more likely to object than were respondents with tertiary education, in both the first (adjusted odds ratio [AOR] = 1.615) and second (AOR = 1.728) scenarios. Young respondents were less likely to object than were middle-aged respondents, in both the first (AOR = 0.648) and second (AOR = 0.572) scenarios. Respondents with mid-ranged personal monthly income were more likely to object than were respondents with low income, in both the first (AOR = 1.994) and second (AOR = 1.519) scenarios. It does not seem that Malaysia is ready to implement a PCS. The educational level, age, and income of the broader public should be considered if a PCS, without or with a PAS, is planned for implementation in Malaysia.

Relationships between Islamic religiosity and attitude toward deceased organ donation among American Muslims: a pilot study

BACKGROUND

Religion-rooted beliefs and values are often cited as barriers to organ donation among Muslims. Yet how Islamic religiosity relates to organ donation attitude among Muslims is less studied.

METHODS

Using a community based participatory research approach, we recruited adults from mosque communities to self-administer a questionnaire assessing levels of Islamic religiosity, attitude toward deceased organ donation, and sociodemographic descriptors.

RESULTS

Of the 97 respondents, there were nearly equal numbers of men and women. Over a third were Arab American (n=36), and nearly a quarter were either South Asian (n=23) or African American (n=25). Respondents viewing difficulties in life as punishment from God had a decreased odds of believing deceased organ donation to be justified (OR 0.85, P<0.05). Other measures of Islamic religiosity, such as intrinsic religiosity, positive religious coping and one related to following Islamic ethical guidelines, were not associated with organ donation attitude. Arab Muslims were more likely to believe deceased organ donation to be justified than South Asian or African Americans (OR 7.06, P<0.05). Sociodemographic descriptors including age, sex, and country of origin, as well as self-reported health and trust of the American health-care system, were not significantly associated with attitude toward deceased organ donation.

CONCLUSION

Higher levels of intrinsic religiosity or adherence to Islamic ethics do not appear to associate with negative attitudes toward deceased organ donation. Negative religious coping appears, however, to be related to lower rates of believing deceased organ donation to be justified. Future studies with larger samples that incorporate additional measures of religiosity can further clarify relationships between religiosity and organ donation attitude among Muslim communities.

Knowledge and ethical perception regarding organ donation among medical students

BACKGROUND

To determine the knowledge and ethical perception regarding organ donation amongst medical students in Karachi- Pakistan.

METHODS

Data of this cross sectional study was collected by self administered questionnaire from MBBS students of Ziauddin University from 2010 to 2011. Sample size of 158 (83 First years and 75 Fourth years) were selected by convenient sampling and those students who were present and gave consent were included in the study. The data was analyzed by SPSS version 20.

RESULTS

A total of 158 participants from Ziauddin Medical University filled out the questionnaire out of which 83(52.5%) were first years and 75(47.5%) were fourth year medical students. Mean age of sample was 20 ± 1.7. Majority of students were aware about organ donation with print and electronic media as the main source of information. 81.6% agreed that it was ethically correct to donate an organ. In the students' opinion, most commonly donated organs and tissues were kidney, cornea, blood and platelet. Ideal candidates for donating organ were parents (81%). Regarding list of options for preference to receive an organ, most of the students agreed on young age group patients and persons with family. Willingness to donate was significantly associated with knowledge of allowance of organ donation in religion (P = 0.000).

CONCLUSION

Both 1st year and 4th year students are aware of Organ Donation, but there is a significant lack of knowledge regarding the topic.

Islamic bioethics: between sacred law, lived experiences, and state authority

There is burgeoning interest in the field of "Islamic" bioethics within public and professional circles, and both healthcare practitioners and academic scholars deploy their respective expertise in attempts to cohere a discipline of inquiry that addresses the needs of contemporary bioethics stakeholders while using resources from within the Islamic ethico-legal tradition. This manuscript serves as an introduction to the present thematic issue dedicated to Islamic bioethics. Using the collection of papers as a guide the paper outlines several critical questions that a comprehensive and cohesive Islamic bioethical theory must address: (i) What are the relationships between Islamic law (Sharī'ah), moral theology (uṣūl al-Fiqh), and Islamic bioethics? (ii) What is the relationship between an Islamic bioethics and the lived experiences of Muslims? and (iii) What is the relationship between Islamic bioethics and the state? This manuscript, and the papers in this special collection, provides insight into how Islamic bioethicists and Muslim communities are addressing some of these questions, and aims to spur further dialogue around these overaching questions as Islamic bioethics coalesces into a true field of scholarly and practical inquiry.