THE KNOWLEDGE, PERCEPTION AND ATTITUDES TOWARDS ORGAN DONATION AMONG GENERAL POPULATION-JEDDAH, SAUDI ARABIA

Layan Khushaim 1 , Roaa Al Ghamdi 1 , Faisal Al-Husayni 2 , Abdulaziz Al-Zahrani 2 , Arshadullah Khan 3 and Ahmed Al Zahrani 3 . 1. College of Medicine, Ibn Sina National College for Health Science, National Guard Hospital, Jeddah, Saudi Arabia. 2. College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, National Guard Hospital, Jeddah, Saudi Arabia. 3. Department of Surgery, King Saud Bin Abdulaziz University for Health Sciences, National Guard Hospital, Jeddah, Saudi Arabia. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


ISSN: 2320-5407
Int. J. Adv. Res. 6(1), 1255-1269 1257 Data management and analysis plan:-Data were analyzed using statistical package for social sciences (SPSS) software version 20. Qualitative variables were presented as numbers and percentages in brackets, while quantitative variables were represented as median and interquartile range. Chi-square test was used to determine the association between two variables and Fisher's Exact test was used when >20% of cells had expected count less than 5. P value <0.05 was considered statistically significant.

Results:-
A total of 375 respondents were surveyed, their age ranged from 17 to 70 years with a median age of 30 years (IQR= 240-40). Females outnumbered males (54.7% versus 45.3% respectively). More than half of study population were married and employed (51.55% and 58.4% respectively) Majority (58.9%) of them were at university education and above while, elementary and middle school education represented only .8% and 2.4% respectively. The family income in most of them (38.4%) ranged from 3000 to10000 RS. Additionally, greatest numbers (78.7%) of the participants were healthy with no chronic diseases (table 1).
Out of the total respondents, 361 (96.3%) and 359 (95.7%) have heard of the terms organ donation and transplantation respectively whereas, the majority (83.5%) did not know where to get organ donation card. About two-thirds (66.9%) agree that brain dead persons are eligible to donate organs, and the majority (76.8%) of the participants stated that the family is the entitled to consent for this process. In cases of organ donation from living persons, the majority (91.7%) recognized that the subject himself is the authorized to give consent. Most of the participants believed that organ donation save someone's life while, only view it as a source of money or a social responsibility (86.4%, 7.5% and 6.2% respectively).Except for the significant association between the level of education and the number of participants have heard about organ donation (p=.001), there was no significant relation between each of educational level, gender, or the family income and perceptions towards organ donation as shown in tables (2,3 and 4).
Tables (5, 6 and 7) demonstrate the knowledge of the study participants about types of organs that could be donated. Before death, the majority answered kidney (78.4%), followed by liver (47.7%), blood (47.5%), bone marrow (32.5%), heart (25.6%) and cornea (21.3%). Alternatively, heart, kidney, liver and cornea were the most frequently reported organs to be donated after death (52.5%, 49.9%, 40.5% and 39.5% respectively). Significantly higher percentages of university education participants reported kidney as an organ that could be donated before death (p=.016). Furthermore, lack of knowledge about organs that could be donated before and after death was significantly higher among those at the level of elementary, middle, diploma and high school education compared to university education ( p<.05). Table (6) shows that females reported donation of blood, skin and bone marrow before death, and lung and cornea after death significantly more than males. Additionally, there was significant lack of knowledge in males than females (32.4% versus 20.5% respectively). Furthermore, family income did not show significant impact on the level of knowledge of the study population ( Table 7).
The respondent's attitude toward organ donation revealed that 107 (28.5%) were not ready to donate while, 24.5%were willing for organ donation and46.9% were ready to donate only after death. Those showed positive attitude towards organ donation were ready to donate to anyone (53.1%) but, only 16.5% preferred donation to one of their family members. Actually, most of them did not donate before or have an approval card for organ donation after death (98.1% and 97.3% respectively). Fear of surgeries (21.9%), family disapproval (12.3%) and religion (5.9%) were the common reasons for the refusal of organ donation. There was significant association between education level and the reasons that prevent organ donation (.012). Fear of surgeries increased with increase of level of education and it was the most frequent (26.2%) cause among university education and above. On the other hand, family disapproval was the most frequent (33.3%) cause among elementary and middle school education (Table 8). Additionally, fear of surgeries and family disapproval were significantly higher among females than males. While religion and medical condition of the recipient were significantly higher among males (p=.016) as shown in table (9). Alternatively, there was no significant association between the family income and attitude of the study population towards organ donation (Table 10).
Most of the participants suggested media (38.4%), campaigns (36.0%), and clinics (17.6%) as methods to increase awareness of the public about organ donation as shown in fig (1). Additionally, they suggested free medical insurance (65.6%), money (26.7%) or awards (7.7%) as a motivation of people towards organ donation (Fig 2).      .025 *      There is a global shortage of donor organs in comparison to patients awaiting transplantation (14).Public knowledge and attitude is crucial to overcome the shortage of donor organs (15). So, their evaluation is essential to develop educational programs to raise the public commitment to OD. Accordingly, this study assessed various factors affecting the knowledge and attitude of the general population towards OD in Jeddah city, Saudi Arabia.
In this study, most of the study populations have heard about OD, transplantation and they believed that it saves someone's life. However, the majority did not know where to get organ donation card. This observed lack of knowledge about SCOT and how to get the donation card was also seen among the medical staff in Saudi Arabia as less than one-third of intensivists in a study knew the role of SCOT in organ donation (16). Moreover, this study showed considerable lack of knowledge about organ donation from brain dead persons where only two-thirds stated that brain dead persons are eligible to donate organs. Similar poor knowledge was reported in Pakistan where only 23% of participants knew that organs can come from both living and cadaver bodies (17). Actually, inadequate knowledge and vague conception of brainstem death always had a negative effect on OD (15). A survey on Sweden ICU nurses highlighted that they didn't trust brain death diagnosis (18).The current study also revealed that the overall perceptions about OD did not differ significantly by educational level, gender, or the family income. In contrast, a study in Korea has shown a high level of knowledge among health-care professionals which is influenced significantly by educational level of the respondents (19).
Knowledge about types of organs that could be donated before and after death was assessed in this study. Before death, the majority answered kidney (78.4%), followed by liver (47.7%), blood (47.5%), bone marrow (32.5%), heart (25.6%) and cornea (21.3%). Alternatively, heart, kidney, liver and cornea were the most frequently reported organs to be donated after death (52.5%, 49.9%, 40.5% and 39.5% respectively). It also explored considerable lack of this knowledge among participants with low education and among males. This should be considered and welldirected interventions are needed to educate them about the topic of organ donation.
In this study, about seventy percent showed positive attitude towards organ donation and they were willing to donate either before or after death. On the other hand, 28.5% showed negative attitude and refused organ donation. More negative attitude and refusal of organ donation was reported among Saudi population in Taif (59.3%) and Al-Kharg (75%) by Al-Harthi and Alzahrany (20) and Agrawal et al. (21). In west countries, a public survey in the United States revealed that 75% are more likely to donate their organs, and similarly, in the United Kingdom, a crosssectional study included 119 respondents has shown two-thirds of them were in favor of donating their organs and participants who knew someone who had donated or received an organ are having a more positive attitude (22,23). Furthermore, many studies evaluated knowledge and attitude of medical students in different countries such as Saudi Arabia, Ireland, India, and Nigeria revealed adequate level of knowledge, and the majority are willing to donate with a positive correlation between the level of knowledge and the willing toward donation (24)(25)(26).Positive attitude of our study participants was also detected in their preference of who to donate where more than half of them were ready to donate to anyone. This agrees with Majeed (26), and it shows their optimistic attitude toward other human being.
In this survey, there was no significant association between the participant's attitudes towards OD and their education, gender or income. In agreement with this Hamed et al. (15) reported absence of association between gender and attitude of medical students toward OD. In contrast, many reports concluded that female gender was significantly associated with positive attitude towards OD (27)(28)(29). Another study by Boulware et al. (30) reported that young males with higher education showed better attitude towards OD.
Despite our study participants' positive attitude toward organ donation, only 2.7% of them are holders of donor card. This contribution is much lower than reported among Saudi nursing (28.3%) and medical students (17.5%) at University of Dammam by Majeed (26). Other Asian studies like Korean, Chinese and Japanese, and other American and European studies reported much higher rate of card holders (31)(32)(33)(34)(35).This is attributed to the observed lack of knowledge among our study participants about how to get the donor card. This needs to be addressed and it necessitates more efforts by SCOT in order to compensate organ shortage in Saudi Arabia.
Fear of surgeries, family disapproval, and religion were the common reasons for the refusal of organ donation in our study. Additionally, religious causes were more reported by males. In agreement with this, fear of body mutilation, 1267 health complications, lack of proper information, and religious reasons were the most common reasons for a significant proportion of unwillingness for organ donation among Saudi population in Al-Kharj (21). In different studies, health concerns were the main causes to oppose donation including fear of living with one kidney, fear of operation, and other medical reasons, in addition to inadequate information on organ donation (36,37).Despite many Islamic scholars and organizations had issued Fatwas in favor of organ donation (38,39). Additionally, Deceased and living donor organ donation is allowed and practiced in many Islamic countries as Saudi Arabia and Pakistan (38).One of the reported issues behind refusal of OD among the study participants are religious causes. Other Saudi studies reported a similar result (37,40). In Malaysia, an overwhelming majority of the respondents (98.5%) are against donating their organs, despite receiving information on organ donation (41).
Most of the studied participants suggested media, campaigns, and clinics as methods to increase awareness of the public about organ donation. Additionally, they suggested free medical insurance, money or awards as a motivation of people towards organ donation. This shows that the media plays a key role in raising awareness of organ donation. Moreover, more awareness campaigns sponsored by SCOT are to be held throughout the kingdom to improve the population knowledge. Such awareness programs will definitely promote the Public attitude toward organ donation.

Conclusion:-
These results suggest considerable lack in information regarding OD among general population in Jeddah, especially the concept of brain death and types of organs eligible for donation before and after death. Likewise, they showed positive attitude and willingness towards organ donation to anyone, but actually they did not have the knowledge about the responsible governmental institution and how to get the donation card. Moreover, health concerns and religious reasons were reported as important barriers against OD. All these issues should be highlighted and focused on while preparing educational programs to improve the public knowledge and attitude towards OD. Maximum use of all possible approaches including mass media, lectures, campaigns, advertisements exhibitions and medical curriculum should be done. Also, motivation of the public can be increased by some legislation like free medical insurance or awards.

Study limitations:-
Limitation of this study is partly due to the small sample size and being confined to only one city.

Potential conflicts of interest:-
The authors declare that there are no conflicts of interest.
Financial support:-This study received no specific funding.