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Original Article

Knowledge, Attitude, and Practices Regarding Organ Donation


among Adult Visitors in a Public Hospital in Delhi, India
Sandeep Sachdeva*, Anika Sulania, Nidhi Dwivedi
Department of Community Medicine, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India

Abstract
Objective: To assess knowledge, attitude, and practices regarding organ/tissue donation. Materials and Methods: A cross‑sectional descriptive
study was conducted among ambulatory, consenting adult (>18 years) visitors of a mid‑level government hospital using a predesigned,
pretested, semistructured interview schedule. Data were analyzed by calculating proportion, Chi‑square test, and odds ratio (OR). Results: Of
450 respondents, 271 (60.2%) were aged more than 31 years, 264 (58.7%) were male, 345 (76.7%) were married, 374 (83.1%) were Hindu,
304 (67.6%) had studied up to 10th class, 278 (61.8%) were working, 217 (48.2%) had 0–2 previous visit to this hospital, and 142 (31.6%)
reported history of hospitalization. Majority (337, 74.9%) of the respondents had heard the term organ donation (OD). On probing further, nearly
87.3% and 82.4% of respondents had ever heard of eye and kidney donation, respectively. Encouragingly, more than half of respondents, i.e.,
261 (58.0%), showed willingness for OD. Statistically (P < 0.001) higher odds for OD willingness was found among participants who were
aware of the term OD (unadjusted OR [UOR] = 2.8, 95% confidence interval [CI]: 1.82–4.39), eye donation (UOR = 3.2, 95% CI: 1.78–5.76),
and kidney donation (UOR = 4.0, 9.5% CI: 2.40–6.84). Similarly, higher willingness was found among single/separated participant and with
higher level of education (P < 0.05). About one‑fourth (120, 26.7%) of respondents had donated blood in the past, but this practice had no
statistical bearing on the willingness for OD (P = 0.61). Nearly half of the respondents, i.e., 239 (53.1%), were aware that organs could be
removed from both living and dead person; 373 (82.9%) of respondents were aware that organs cannot be removed from the body without
authorized permission (UOR = 2.7, 95% CI: 1.57–4.88 and adjusted OR [AOR] = 2.6, 95% CI: 1.27–5.66). However, only 119 (26.4%)
respondents consented to sign a pledge card for OD. Higher odds (AOR = 12.8, 95% CI: 5.02–32.75) for OD willingness was found among
those who consented to sign a pledge card. A high of 364 (80.9%) respondents had no misconception that a person will be born with missing
organ following donation of organ/tissue in this life. Conclusion: A high awareness but low level of positive attitude and practices was noticed
among sampled metropolitan respondents toward organ/tissue donation.

Keywords: Awareness, cornea, developing country, kidney, legislation, organ, perception, program, tissue, training, transplantation

Introduction No country in the world till date collects sufficient organs to


meet the needs of its citizens. It is estimated that currently organ
Organ transplantation is a successful medical intervention
transplantation covers <10% of the global needs. Spain, Austria,
available for end‑stage organ failure. For the last couple of
Croatia, USA, Norway, Portugal, Belgium, and France stand out
decades, it has assumed public health significance due to
as countries with high rates of deceased organ donors.[3‑5] Spain
shortage of high‑quality human organs. In conjunction with
has consistently recorded highest deceased organ donation (OD)
other needs, it is one of the drivers of medical, reproductive,
rate of 33–35 donors per million population and many countries
and transplant tourism across the globe.[1,2] Currently, organ
across the world have been following Spanish model for OD.[6,7]
donors are broadly classified into two types: donor after
Contrary to general perception, the long‑term cost of renal
brain death and donor after cardiac death with removal
of organs/tissue possible during both living and deceased
Corresponding Author: Dr. Sandeep Sachdeva,
state. Organ and tissue transplantation is expensive medical Department of Community Medicine, North Delhi Municipal Corporation
intervention, primarily driven by private sectors in the country, Medical College and Hindu Rao Hospital, New Delhi ‑ 110 007, India.
and young deaths due to road traffic accident or cardiovascular E‑mail: sachdevadr@yahoo.in
event provide a best option for high‑quality organ yield.
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DOI: How to cite this article: Sachdeva S, Sulania A, Dwivedi N. Knowledge,


10.4103/ijot.ijot_35_17 attitude, and practices regarding organ donation among adult visitors in a
public hospital in Delhi, India. Indian J Transplant 2017;11:127-32.

© 2017 Indian Journal of Transplantation | Published by Wolters Kluwer - Medknow 127


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Sachdeva, et al.: Organ donation and transplantation

transplantation is lower compared to hemodialysis or peritoneal proportion, Chi‑square test, odds ratio (OR) to assess the
dialysis. Even the quality of life and survival are reportedly association with covariates and considered significant at
better among renal transplant recipients.[8,9] P < 0.05.
India needs at least 260,000 organs every year, i.e., 180,000
kidneys, 30,000 livers, and 50,000 hearts whereas only Results
6000 kidneys, 1200 livers, and 15 hearts are transplanted Of 450 respondents, 271 (60.2%) were aged more than
annually (National Organ Transplant Program). Unfortunately, 31 years, 264 (58.7%) were males, 345 (76.7%) were married,
India with a 1.2 billion population is lagging in OD with a 374 (83.1%) were Hindu, 304 (67.6%) had studied up to
national deceased donation rate of <1 per million population.[10] 10th class, 278 (61.8%) were working, 217 (48.2%) had 0–2
Country has well‑developed corneal donation and transplant previous visit to this hospital, and 142 (31.6%) reported “ever”
program; however, even eye donation after death has been history of hospitalization. Sociodemographic profile of study
relatively slow to take off.[11‑14] In the backdrop of annual respondents is shown in Table 1.
requirement of 100,000 corneas, around 50,000 were collected
during the past few years and yet 40% could be transplanted Encouragingly, more than half of respondents, i.e., 261 (58.0%),
due to quality issues (personal communication). showed willingness for their organ/tissue donation.
Higher willingness was found in participants who were
The government has initiated specific sustained actions for the single/separated (P < 0.05) and those having higher level of
promotion of organ and tissue donation, but it has not been able education (P  <  0.05). There was no statistically significant
to come to a stage of full realization. The myriad reason for this difference noticed with regard to age, gender, religion, working
state of affair could be due to individual, community, and health status, and previous visits to this institution or hospitalization
system issues. With this background, a study was conducted to toward willingness for OD.
assess the knowledge, attitude, and practice (KAP) regarding
organ/tissue donation and transplantation among adult visitors Majority (337 of 450 respondents, i.e., 74.9%) had heard the
of a government hospital in Delhi, India. term OD (ang daan). Details are shown in Table 2. However,
on probing further, nearly 87.3% and 82.4% of respondents
had ever heard of eye and kidney donation, respectively.
Materials and Methods Statistically (P  <  0.001) higher odds for OD willingness
A cross‑sectional descriptive study was conducted among was found among respondents who were aware of the term
ambulatory, coherent, consenting adults (>18 years) visiting OD (unadjusted OR [UOR] =2.8, 95% CI: 1.82–4.39), eye
a mid‑level municipal teaching hospital of Delhi using a
predesigned, pretested, semistructured interview schedule
during the period of February–March 2016 after obtaining Table 1: Sociodemographic profile of study respondents
clearance from the institutional ethics committee. A sample Variables Total (n=450), n (%)
size of 400 was calculated assuming the prevalence of OD Age (years)
awareness at 50%, relative error of 10%, and 95% confidence 18‑30 179 (39.8)
interval (CI). However, we were able to mobilize and interview ≥31 271 (60.2)
450 respondents visiting the outpatient department (OPD). Sex
Male 264 (58.7)
Study respondents either a patient or accompanying attendant
Female 186 (41.3)
were contacted based on convenience by the researchers
Marital status
after obtaining informed verbal consent in hospital premises, Married 345 (76.7)
galleries, patient waiting area, garden, cafeteria, and snack Single/separated 105 (23.3)
corner in a comfortable, nonjudgmental, and confidential Religion
manner. On completion of successful interaction, participants Hindu 374 (83.1)
were thanked for their cooperation and all related doubts Others 76 (16.9)
cleared followed by prompt additional help, if any, was Level of education
extended. Studied till 10th class 304 (67.6)
>10th class 146 (32.4)
The study instruments consisted of two sections: Part‑I
Occupation status
which is sociodemographic background and Part II which
Working 278 (61.8)
captured specific items related to knowledge, perception,
Students/house wife/nonworking 172 (38.2)
attitude, practices, and willingness of organ/tissue donation.
Previous visits to this hospital
The responses of some of the questions were categorized into 0‑2 217 (48.2)
Likert‑based scale of agree, neutral, and disagree. ≥3 233 (51.8)
There were no missing values and data were entered into a History of at least 24 h hospitalization
Microsoft Excel sheet and analyzed using SPSS software Yes 142 (31.6)
version 16 (IBM Inc, Armonk, New York, USA) by calculating No 308 (68.4)

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Sachdeva, et al.: Organ donation and transplantation

Table 2: Knowledge and perception of organ/tissue donation


Factors Willingness for organ donation P UOR (95% Cl) AOR (95% Cl)
Total (%) Yes (%) No (%)
Ever heard about organ donation?
Yes 337 (74.9) 217 (83.1) 120 (63.5) <0.001 2.8 (1.82‑4.39) 1.3 (0.67‑2.70)
No 113 (25.1) 44 (16.9) 69 (36.5)
Ever heard about eye donation?
Yes 393 (87.3) 242 (92.7) 151 (79.9) <0.001 3.2 (1.78‑5.76) 1.0 (0.39‑2.98)
No 57 (12.7) 19 (7.3) 38 (20.1)
Ever heard about kidney donation?
Yes 371 (82.4) 237 (90.8) 134 (70.9) <0.001 4.0 (2.40‑6.84) 2.0 (0.83‑4.80)
No 79 (17.6) 24 (9.2) 55 (29.1)
Organ donation means removal of organs from
Both living and dead person 239 (53.1) 162 (62.1) 77 (40.7) <0.001 1.7 (1.35‑2.16) 0.8 (0.58‑1.21)
Dead person only 108 (24) 55 (21.1) 53 (28)
Don’t know 103 (22.9) 44 (16.9) 59 (31.2)
Can organs be removed without permission of patient or
family member?
Yes 77 (17.1) 59 (22.6) 18 (9.5) <0.001 2.7 (1.57‑4.88) 2.6* (1.27‑5.66)
No 373 (82.9) 202 (77.4) 171 (90.5)
Awareness regarding legislation on organ donation and
transplantation?
Yes 129 (28.7) 89 (34.1) 40 (21.2) 0.002 1.9 (1.25‑2.97) 1.2 (0.67‑2.21)
No 321 (71.3) 172 (65.9) 149 (78.8)
In general do people in society donate organs
Yes 195 (43.3) 129 (49.4) 66 (34.9) 0.001 1.9 (1.29‑2.81) 1.2 (0.74‑2.09)
No 255 (56.7) 132 (50.6) 123 (65.1)
Do you know that some people die because of
nonavailability of organs?
Yes 356 (79.1) 215 (82.4) 141 (74.6) 0.030 1.5 (1.00‑2.51) 0.9 (0.50‑1.83)
No 94 (20.9) 46 (17.6) 48 (25.4)
Does your religion allow organ donation?
Yes 328 (72.9) 214 (82.0) 114 (60.3) <0.001 2.7 (1.83‑3.97) 1.1 (0.69‑1.92)
No 122 (27.1) 47 (18.0) 75 (39.7)
Only rich and VIPs are provided organs for transplantation
Agree 203 (45.1) 110 (42.1) 93 (49.2) 0.057 0.7 (0.64‑0.98) 0.9 (0.67‑1.20)
Neutral 90 (20) 48 (18.4) 42 (22.2)
Disagree 157 (34.9) 103 (39.5) 54 (28.6)
UOR: Unadjusted odds ratio, AOR: Adjusted odds ratio, Cl: Confidence level

donation (UOR = 3.2, 95% CI: 1.78–5.76), and kidney i.e., 230 (51.1%) respondents, suggested that they would
donation (UOR = 4.0, 9.5% CI: 2.40–6.84). However, none authorize removal of organs from the bodies of their family
of these variables could reach statistical significance on higher member if situation so arise.
level of analysis (adjusted OR [AOR]).
Higher prevalence (184, 70.5%) of willingness for OD was
More than half (239, 53.1%) of the respondents were noticed for those who wanted more information on the current
aware that organs could be removed from both living and topic (P = 0.007). However, only 119 (26.4%) respondents
dead person. Significantly (P  <  0.001) higher proportion, consented to sign a pledge card for OD and was also found to be
i.e., 82.9% (373) of the respondents, were aware that organs significantly (AOR = 12.8, 95% CI: 5.02–32.75) associated for
cannot be removed from the body without authorized permission willingness. A high of 364 (80.9%) respondents had no myth
(AOR) = 2.6, 95% CI: 1.27–5.66). Opinion was divided but or misconception that a person will be born with missing organ
45.1% believed that the rich in comparison to general population following donation. Yet, only 182 (40.4%) respondents were
are more likely to get organ transplantation in case of need. of the opinion that OD should be made mandatory after death.
Table 3 depicts the attitude and practices related to organ/tissue
donation. Nearly, 120 (26.7%) respondents had donated Discussion
their blood in the past, but this practice had no significant India witnessed its first successful corneal, kidney, and cardiac
bearing on the willingness for OD (P = 0.61). Nearly half, transplant in the year 1960, 1967, and 1994, respectively.[15]

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Table 3: Attitude and practices related to organ/tissue donation


Factors Willingness for organ donation P UOR (95% Cl) AOR (95% Cl)
Total (%) Yes (%) No (%)
Donated blood in the past
Yes 120 (26.7) 77 (29.5) 43 (22.8) 0.061 1.4 (0.92‑2.18) 1.3 (0.77‑2.30)
No 330 (73.3) 184 (70.5) 146 (77.2)
If situation so arise, would you authorize removal of
organs from your family member after death?
Yes 230 (51.1) 191 (73.2) 39 (20.6) <0.001 10.4 (6.71‑16.39) 6.6 (3.85‑11.37)
No 220 (48.9) 70 (26.8) 150 (79.4)
Do you require more information on organ donation?
Yes 292 (65) 184 (70.5) 108 (57.1) 0.007 1.7 (1.21‑2.65) 1.0 (0.60‑1.77)
No 158 (35) 77 (29.5) 81 (42.9)
Are you ready to sign a pledge card for organ donation
Yes 119 (26.4) 113 (43.3) 06 (3.2) <0.001 23.2 (9.96‑54.4) 12.8 (5.02‑32.75)*
No 331 (73.6) 148 (56.7) 183 (96.8)
Do you think there should be monetary incentive for
organ donation
Agree 215 (47.8) 142 (54.4) 73 (38.6) <0.001 1.2 (1.02‑1.55) 1.0 (0.79‑1.46)
Neutral 77 (17.1) 31 (11.9) 46 (24.4)
Disagree 158 (35.1) 88 (33.7) 70 (37.0)
People who donate organs in this life would take birth
with a missing organ
Agree 41 (9.1) 20 (7.7) 21 (11.1) 0.096 0.7 (0.55‑1.00) 7.5 (0.49‑1.13)
Neutral 45 (10) 21 (8.0) 24 (12.7)
Disagree 364 (80.9) 220 (84.3) 144 (76.2)
Do you think organ donation should be made
mandatory after death?
Yes 182 (40.4) 126 (48.3) 56 (29.6) <0.001 2.2 (1.49‑3.29) 0.8 (0.46‑1.43)
No 268 (59.8) 135 (51.7) 133 (70.4)
UOR: Unadjusted odds ratio, AOR: Adjusted odds ratio, Cl: Confidence level

Till date, many new developmental milestones have been conducted among 193 patients attending OPD of a tertiary
achieved in the country; however, OD has been consistently center at Bengaluru (Karnataka) reported 93.8% awareness,
lower than expectations. The Government of India promulgated 76.2% supported OD, 62.2% of respondents were willing to
Transplantation of Human Organ and Tissues Act in 1994, and donate organs after death, 52.3% agreed that religious people
with the view to enlarge its scope and promote cadaver OD, do not oppose OD yet, only 5.7% had heard about OD law, and
the government has brought new amendments as of year 2014 nearly 40.1% were willing to sign an OD card.[19] This as well
and 2017. In the backdrop of this journey, a cross‑sectional as many other studies confirmed that only level of education
descriptive study was conducted among 450 adult ambulatory was of statistical significant predictor for OD willingness.
visitors of a mid‑level government hospital in Delhi (India) A recent study conducted in a large private hospital[20] of
regarding KAP of organ/tissue donation. In spite of inherent Delhi (India) reported high awareness on kidney (94.1%), eye
limitation of the study setting and convenience sampling, a high donation (79%), and legislation (50.4%) along with 31.1%
level of awareness (74.9%–87.3%) but low level of positive showing willingness for OD but 56.3% were consenting to sign
attitude and practices was deduced from the present study a pledge card. While another decade old, a study conducted
along with strong association with sociodemographic variables. in Delhi showed 61.59% willingness for ODs.[21] This is
Willingness for OD  (58%) and awareness on eye suggestive of stagnation or status quo in society even after a
donation (87.3%) in our study was found to be near similar gap of more than 10 years.
with a study conducted in Mangalore, India (59.6% and On comparison with selected other countries, OD awareness
98.1%, respectively).[16] In addition, awareness on existence in Pakistan was 60%, Kuwait (68.3%), South Africa (89%),
of legislation related to OD and transplantation was also Brazil (89%), and Saudi Arabia (98%).[22‑27] A Canadian
found to be similar (28.7% vs. 29.3%). On the contrary, household telephonic survey highlighted that OD awareness
67% of respondents believed that there should not be any and willingness was universal and 54% had actually
monetary incentive for the promotion of OD. Studies registered or signed a pledge card but here also opinion
conducted in Puducherry (India) reported high willingness was divided toward the rich who are more likely to receive
for OD, i.e., 69.75% (2013) and 70.3% (2016).[17,18] A study an organ. [26] However, a lower proportion (30.0%) of

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132 Indian Journal of Transplantation  ¦  Volume 11  ¦  Issue 3  ¦  July-September 2017