https://doi.org/10.33698/NRF0231-Neha Handa, Neena Vir Singh ,R K Dhiman,Sandhya Ghai, Meenakshi Agnihotri
Abstract : Background: Each year thousands of individuals wait for organs to be donated for transplantation. Nurses have a major role to play in tackling organ shortage. Hence, their knowledge is extremely important to the success of organ donation. Objective: To assess the knowledge regarding organ donation among the nurses. Methods: A descriptive study was conducted on 149 nurses working in 6 purposively selected general wards of a tertiary care institute of North India. All the nurses working in selected wards were enrolled in the study.A questionnaire consisting of socio- demographic data, knowledge assessment questions regarding organ donation was administered to nurses for data collection.The maximum attainable score was 28.Data collected was analyzed using descriptive and inferential statistics.Results: The results of the study revealed that 59.7% nurses had good knowledge, 12.1% had very good knowledge, 28.2% had average knowledge regarding organ donation. The mean knowledge score of the nurses was 16.73 ± 3.58 with the range of 9-26. Conclusion & Recommendation: Nearly two-third nurses had good and very good knowledge about organ donation.They can play a pivotal role in organ donation awareness and can disseminate knowledge in public about importance of organ donation. Hence it is recommended to organize in- service education program on organ donation for nurses.
Keywords
Knowledge; Nurses; Organ Donation
Correspondence at
Neha Handa
Nursing Officer,
156 A, Nivedita Hostel, PGIMER, Chandigarh
Introduction
Organ donation is the process of giving an organ or a part of an organ for the purpose of its transplantation into another person.1 There is a wide gap between the number of organs donated and the number of people waiting for a transplant.2 Nationally, with a population of 1.2 billion people, the statistic stands at 0.08 persons as organ donors per million populations (PMP).3 Of a total of 9.5 million deaths annually in India, nearly 1,00,000 are due to organ failure. To save and extend lives, organ donation and organ transplantation have become the only hope.4 Randhawa suggests that nurses should be trained regarding the process of
Research Methodology
A descriptive study was conducted on 149 nurses working in 6 purposively selected general wards (Male and Female Surgical wards, Male and Female Medical wards, Gastroenterology ward, Special Male organ donation.5 Babaie suggested that Surgical ward) of a tertiary care institute of educational curriculum and facilities should be applied to enhance favorable change in behavior of health personnel towards organ donation.6 Oluyombo reported that there is disparity in knowledge of organ donation and willingness to donate among health care workers. Efforts should be intensified to give comprehensive and appropriate education to them about organ donation to bridge this gap.7 Aghayan HR suggested that the educational programs can enhance nurses’ knowledge and commitment to the organ donation process and, ultimately, increase the donation rate. Consequently, it is of great importance for organ procurement units to focus on regular training programs for all their healthcare staff.8
Nurses while providing routine care to the patients can disseminate the information to educate the patients and their caregivers, motivate and encourage them regarding organ donation. It is important that they should be well equipped with the knowledge regarding organ donation. Hence the present study was conducted to assess the knowledge of nurses regarding organ donation.
North India during July – September, 2016. A questionnaire consisting of socio- demographic data, knowledge assessment questions regarding organ donation was used for data collection. There were 28 questions, each correct answer was given one score, with maximum knowledge score of 28. Total knowledge score was categorized as poor (0-7), average (7-14), good (15-21) and very good (22-28). The ethical clearance for study was taken from Institute Ethics Committee. Permission was obtained from Medical Superintendent and heads of all concerned departments. Informed written consent was sought from each individual participants. Ward-wise data was collected from the nurses using questionnaire. Participants were asked to fill the questionnaire under supervision and at the same time, filled questionnaires were collected back. Collected data was analyzed using descriptive and inferential statistics by SPSS version 20.0.
Results
Table 1depicts the socio-demographic data of nurses. Around 80% of the nurses were between 23-40 years of age. Mean age ±SD was 31.16 ± 7.79 with the range of 23-52 years. Majority(78.5%)were females. More than half (53.0%) were B.Sc. Nursing. Nearly half of the nurses (43.6%)were from rural background, 63.7% were Hindu by religion and 69.8% belonged to nuclear family.
Table 1 : Socio-Demographic Data of the Nurses
N=149
| Socio-demographic Variables | n (%) |
| Age(years)* | |
| 21-40 | 123 (82.6) |
| 41-60 | 26 (17.4) |
| Sex | |
| Male | 32 (21.5) |
| Female | 117 (78.5) |
| Educational Status | |
| GNM | 67 (45.0) |
| B.Sc. Nursing | 79 (53.0) |
| M. Sc. Nursing | 03 (2.0) |
| Background | |
| Rural | 60 (40.3) |
| Urban | 65 (43.6) |
| Suburban | 24 (16.1) |
| Religion | |
| Hindu | 95 (63.7) |
| Sikh | 36 (24.2) |
| Others (Muslim/Christian/Buddhism) | 18 (12.1) |
| Type of family | |
| Nuclear | 104 (69.8) |
| Joint/ Extended | 45 (30.2) |
*Mean age ± SD (years) 31.16 ± 7.79, Range 23 – 52
GNM: General Nursing Midwifery, B.Sc Nursing: Bachelor of Science in Nursing, M.Sc Nursing: Masters of Science in Nursing
Table 2 shows the work profile of nurses. Designation of majority of nurses (79.2%) was Nursing Officer. Study included nurses from Male Medical ward (40.5%), Female medical ward (26.7%), Male surgical ward (40.0%),Female surgical ward (28.4%) Gastroenterology ward (33.3%)and Special male surgical ward (31.1%). Work experience of most of the nurses (76.5%) was 1-10 years with the mean ± SD (years) of 7.28± 6.80, range1– 27
Table 2: Work Profile of the Nurses
N=149
| Work Profile | n (%) |
| Designation | |
| Senior Nursing Officer | 31 (20.8) |
| Nursing Officer | 118 (79.2) |
| Area of Posting | |
| MMW | 30 (40.5) |
| FMW | 20 (26.7) |
| MSW | 30 (40.0) |
| FSW | 21 (28.4) |
| GE Ward | 25 (33.3) |
| Special MSW | 23 (31.1) |
| Total work experience* (years) | |
| 1-10 | 114 (76.5) |
| 11-20 | 30 (20.1) |
| 21-30 | 05 (3.4) |
*Mean Working experience± SD (years) 7.28 ± 6.80, Range 1 – 27
MMW: Male medical ward, FMW: Female medical ward, MSW: Male surgical ward, FSW: Female surgical ward, GE ward: Gastroenterology ward, Special MSW: Special male surgical ward
Table 3 reveals the awareness regarding organ donation among nurses. All the nurses were aware about the term ‘Organ Donation’. Source of information was other healthcare professional for 69.1% of nurses. Few nurses (9.4%)had already attended some educational program (Camp/ Eye donation awareness day / Seminar on Kidney transplant).
Table 3 : Awareness Regarding Organ Donation among Nurses
N=149
| Variable | n (%) |
|
Awareness about the term “Organ Donation” |
149 (100.0) |
| Source of information
Other healthcare professional Mass media Curriculum Friends |
103 (69.1) 50 (33.5) 41 (27.5) 32 (21.5) |
|
Attended any educational program (Camp/ Eye donation awareness day/ Seminar on Kidney transplant ) |
14(9.4) |
Table 4 shows the knowledge of nurses regarding organ donation. More than 80% of nurses were aware about WHO definition of organ donation, organs can be donated after brain stem death, circulatory death as well as living organ donor, term brain death, suspecting brain death by Glasgow Coma Scale, informing transplant coordinator for organ donation counseling in a brain dead patient, mandatory license for any hospital to carry out organ transplantation, available methods for pledging organs, options for promotion of organ donation in the study centre.
Two-third were aware about body donation, organizations involved in organ donation. Nearly half of the subjects were aware about green corridor, Organ donation day and no age criteria for organ donation in brain dead. Only one-fourth of the nurses were aware that how many people can be benefited from one brain dead donor, organ donation rate of India, members of brain death declaration committee.
Nurses showed lack of knowledge in certain areas, such as organs that can be donated by living donor and after brain death, absolute contraindication for organ donation, consent system followed for organ donation in India.
Table 4: Knowledge of Nurses Regarding Organ Donation
N=149
| Knowledge of nurses regarding Organ Donation | Correct Response n (%) |
| WHO defines Organ donation as donating human cells, tissues or organs intended for human applications | 121 (81.2) |
| Organs can be donated after brain stem death, circulatory death and living organ donor | 122 (81.8) |
| Organs that can be donated by living donor includes kidney and liver | 27 (18.1) |
| Organs that can be donated after brain death includes liver, pancreas and heart | 15 (10.1) |
| Malignancy is not an absolute contraindication for organ donation | 30 (20.1) |
| Opt in consent system is followed for organ donation in India | 22 (14.7) |
| Key reasons for shortage of organ donors in India are ignorance and lack of know- ledge about organ donation, myths & beliefs and lack of motivation to pledge organs | 135 (90.6) |
| More than 10 people can be benefited from one brain dead donor | 40 (26.8) |
| Organ donation rate of India is 0.5 per million populations | 45 (30.2) |
| Body donation refers to donating body for medical research and education | 115 (77.1) |
| Term Brain death is a stage at which functions of brain stem get permanently ceased, heart continue to beat | 130 (87.2) |
| If GCS is 3, brain death can be suspected | 133 (89.2) |
| Radiologist is NOT a member of Brain death declaration committee | 35 (23.5) |
| If a brain dead patient is suspected, Transplant Coordinator should be informed first for organ donation counseling | 127 (85.2) |
| PGIMER has transplant coordinators | 127 (85.2) |
| A license is mandatory for any hospital to carry out organ transplantation | 142 (95.3) |
| Already pledged organs cannot be retrieved without consent of family | 94 (63.0) |
| If organs are already pledged, Then consent for organ retrieval can be given by grandparents, First degree relative, grandchildren (> 18 yrs) | 59 (35.6) |
| Decision about organ donation in unclaimed dead bodies can be made by Medical Superintendent | 35 (16.7) |
| Organization involved in organ donation are National Organ and Tissue Transplant Organization (NOTTO), Regional Organ & Tissue Transplant Organization (ROTTO), State Organ& Tissue Transplant Organisation (SOTTO) | 117 (78.5) |
| Regional centre for organ donation in northern region of India is PGIMER, Chandigarh | 88 (59.0) |
| Lung transplant has not been done yet in PGIMER, Chandigarh | 104 (69.8) |
| Regional centre for organ donation in northern region of India is PGIMER, Chandigarh | 88 (59.0) |
| Lung transplant has not been done yet in PGIMER, Chandigarh | 104 (69.8) |
| Lung transplant has not been done yet in PGIMER, Chandigarh | 104 (69.8) |
| Available methods for pledging organs in PGIMER are filling donor cards, online registration, contact organ donation team | 134 (89.9) |
| Available options for promotion of organ donation in PGIMER, Chandigarh are Organ donor option in ID – card, Online information available on website, Organ donation posters at various sites at PGI | 128(85.9) |
| There are no age criteria for organ donation in brain dead | 84(56.4) |
| Awareness about Green corridor | 74(49.7) |
| Green corridor is a special route to effectively transfer donated organs | 73(48.9) |
| Organ donation day is celebrated on 13 August each year | 83(55.7) |
Graph 1 depicts the category-wise knowledge score of nurses regarding organ donation. Nearly half of nurses (59.7%) have good knowledge,12.1% have very good and 28.2% have average knowledge.Their mean knowledge score was 16.73 ± 3.58 with the range of 9-26. Mean percent score was 59.75 ± 12.78 with the range of 32.14 – 92.85.
Graph 1: Knowledge Score of Nurses Regarding Organ Donation
N=149
Discussion
A healthy organ can replace a damaged organ. Organ transplantation improves health status of a person that can change the entire life span and give him quality life. Good knowledge of nurses regarding organ donation can improve public awareness. This descriptive study was conducted among nurses to assess their knowledge regarding organ donation. The present study revealed that 71.8% nurses had good and very good knowledge regarding organ donation, 28.2% had average knowledge. A similar study showed that having adequate information and knowledge about organ donation was found to be just 25%.9 In another study, 80% of nurses had knowledge about their roles in the organ donation process, 82% agreed with their roles in this process. Masoumian et al concluded that nurses did not have adequate knowledge regarding their role in organ donation process. 10
In the present study, more than 80% of subjects were aware about WHO definition of organ donation, organs can be donated after brain stem death, circulatory death as well as living organ donor, term brain death, suspecting brain death by Glasgow Coma Scale score. Other aspects like informing transplant coordinator for organ donation counseling in a brain dead patient, mandatory license for any hospital to carry out organ transplantation, available methods for pledging organs and options for promotion of organ donation in study centre were also known to majority of nurses.
Body donation refers to donating body for medical research and education. There are organizations involved in organ donation such as National Organ and Tissue Transplant Organization (NOTTO), Regional Organ and Tissue Transplant Organization (ROTTO) and State Organ and Tissue Transplant Organization (SOTTO). About two-third of the subjects were aware about body donation and organizations involved in organ donation.
Nearly half of the subjects were aware that Green corridor is a special route to effectively transfer donated organs, organ donation day is celebrated on 13 August each year and there is no age criteria for organ donation in brain dead. There are few other important aspects of organ donation like the number of people who can be benefited from one brain dead donor, organ donation rate in India and members of brain death declaration committee. Only one-fourth of the subjects were aware about these aspects. Subjects showed lack of knowledge in certain areas, such as organs that can be donated by living donor and after brain death, absolute contraindication for organ donation, consent system followed for organ donation in India. Another study pertaining to cadaver organ donation transplantation showed that organs being currently transplanted were known to 75% of nurses .11 Knowledge regarding organ donation among nurses can help to promote organ donation by improving public awareness and ultimately increase the donation rate. We recommend that there should be frequent CNE programs and other informative programs for nurses so that their knowledge can be updated and improved. Similar study can be replicated in other healthcare professionals.
References
- Saleem T, Ishaque S, Habib N, Hussain SS, Jawed A, Aamir Ali Khanet al. Knowledge, attitude and practices survey on organ donationamong a selected adult population of BMC Medical Ethics. 2009; 10(5).
- Mayoclinic staff. Organ donation: Don’t let these myths confuse you [Online]. May 03, 2013 [cited 2016 March 16]; Available from: URL: http://www. org/healthy-lifestyle/consumer- health/in-depth/organ-donation/art- 20047529?reDate=31012016
- Organ donation in India[Online]. 1 April 2013 [cited 2016 Mar ch 16];A vail-able from: URL:http://donatelifeindia.org/about-organ- donation/organ-donation-in-india/
- Chakradhar K, Doshi D, Reddy BS, Kulkarni S, Reddy Knowledge, Attitude and Practice Regarding Organ Donation among Indian Dental Students. Int J Organ Transplantation Med. 2016; 7(1):28-35.
- Randhawa Specialist nurse training programme: dealing with asking for organ donation. Journal of Advanced Nursing.1998;28(4):405-08
- Babaie M, Hosseini M, Hamissi J, Hamissi Knowledge, Attitude and Practice of Nurses Regarding Organ Donation. Global Journal of Health Science. 2015;7(6).
- Oluyombo R, Fawale MB, Ojewola RW, Busari OA, Ogunmola OJ, Olanrewaju TO, et. al. Knowledge Regarding Organ Donation and Willingness to Donate among Health Workers in South-West Nigeria. – PubMed – NCBI [Internet]. Ncbi.nlm.nih.gov. 2017 [cited
3 1 J a n u a r y 2 0 1 7 ] . A v a i l a b l e from:https://www.ncbi.nlm.nih.gov/pubmed/ 26889370
- Aghayan HR 1, Arjmand B, Emami-Razavi SH, Jafarian A, Shabanzadeh AR, JalaliF. Organ donation workshop – a survey on nurses’ knowledge and attitudes toward organ and tissue donation in Int J Artif Organs. 2009 Oct;32(10):739-44
- Awareness Of Organ Donation And Transplantation Among Health Care Professionals: A Prospective Study: 10.5005/jp-journals-10056- 0016
- Masoumian Hoseini ST, Manzari Z, Khaleghi ICU Nurses’ Knowledge, Attitude, and Practice Towards their Role in the Organ Donation Process from Brain-Dead Patients and Factors Influencing it in Iran.Int J Organ Transplant Med. 2015;6(3):105-13.
- Zhang L, Liu W, Xie S, Wang X, Mu-Lian Woo S, Miller A et Factors Behind Negative Attitudes Toward Cadaveric Organ Donation. Transplantation. 2014;1.