Original Clinical Science

Knowledge, Attitudes, and Willingness Toward

Organ Donation Among Health Professionals
in China
Dongmei Hu, MS1,2,3 and Hai Huang, PhD1,2
Downloaded from https://journals.lww.com/transplantjournal by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3ltH2fbMApE03DORZjaFNRoAL0PaFLIXkOeMkikWUdhaBlrkMZCqvyQ== on 03/23/2020

Background. The purposes of this study were to assess the knowledge, attitudes, and willingness toward organ donation
among the health professionals in China. Methods. Questionnaires were delivered to 400 health professionals from 7 hospitals
in Dalian and 1 hospital in Chaozhou of China between October 2013 and January 2014. Results. In all, 400 health professionals
were approached, 373 valid responses were returned. Over 90% of the participants knew about organ donation, but only 17.4%
had taken part in some training courses or lectures about organ donation. Health professionals (64.9%) knew the shortage status
of organ, and doctors knew more than nurses and nonclinical staffs (P < 0.01). Health professionals (97.3%) knew brain death, and
68.9% professionals thought brain death was the reasonable criteria to judge death. Doctors showed a higher knowledge level
about brain death than nurses and nonclinical staffs (P < 0.01). Altogether, 60.1% approved deceased donation; however, only
48.5% approved living donation. Doctors' attitudes were more positive than nurses and nonclinical both in deceased donation
(P < 0.01) and in living donation (P < 0.05). In all, 49.3% were willing to donate their own organs postmortem, and doctors had
higher willingness to donation postmortem compared with nurses and nonclinical staffs (P < 0.01). The most (49.2%) commonly
cited reason for refraining from donation was: “afraid that organs would be picked up inhumanely and body would be disfigured”.
Conclusions. Health professionals showed lower favorable attitudes and willingness toward organ donation than Chinese gen-
eral public. A proportion of Chinese health professionals' knowledge about organ donation was limited.
(Transplantation 2015;99: 1379–1385)

O rgan transplantation has become the most effective

treatment for saving patients who have had organ fail-
ure. Despite these contemporary advances, there has been a
relatively slow progress in the supply of organs for transplan-
tation. Worldwide, there is a chronic imbalance between the
number of donors and the numbers of patients on a waiting
list in need for organ transplantation.1 The situation in
China is of particular concern. Over one million end-stage or-
gan failure patients need organ transplantations, whereas
only 0.01 million of them receive transplants every year in
China.2 A solution to the high demand and critical shortage
is to increase the number of organs from donors. The num-
bers of donors per million population (pmp) are higher in
Received 20 January 2015. Revision requested 10 March 2015.
Accepted 18 March 2015.
1
Graduate School, South Medical University, Guangzhou, China.
2
Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China.
3
Public Health School, Dalian Medical University, Dalian, China.
This project was supported by Science Plan Key Project of Guangdong Province
in China.
The authors declare no conflicts of interest.
All authors conceived and designed the study. H.H. reviewed the article and
approved the final version. D.H. provided data collection, data analysis and wrote
the article.
Correspondence: Hai Huang, PhD, Guangzhou General Hospital of Guangzhou
Military Command, Guangzhou, China. (whzyyhh@126.com).
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
ISSN: 0041-1337/15/9907-1379
DOI: 10.1097/TP.0000000000000798
the western countries. Some countries in Europe have rates
between 6 pmp (in Greece, 2006) and 33 pmp (in Spain,
2006),3 as compared to lower rate in Asian countries,
such as Iran (1.8 pmp, 2006),4 Japan (0.08 pmp, 2007),5
South Korea (0.97 pmp, 2007),5 especially in China, the or-
gan donation rate is only 0.03 pmp.2 Thus, increasing organ
donation rate is an important public health issue in China.
Some researchers have reported that there is a positive cor-
relation between knowledge toward organ donation and the
donation behavior.6-9 In a study on a group of rural critical
care nurses, McCoy and Bell10 concluded that knowledge
and positive attitudes were important when providing sup-
port to families and care for potential donors, which could in-
crease the supply of donors for transplants. On the other
hand, health professionals play a pivotal role in the organ
procurement process, based on their intimate relationship
with patients and their families. They are well placed to iden-
tify a potential donor and to approach the bereaved family. It
has been suggested that their knowledge, beliefs, and atti-
tudes toward organ donation have been shown to influence
public awareness and willingness to register.11,12 Insufficient
knowledge and failure to identify possible donors are consid-
ered important contributing factors responsible for the short-
age of available organs.9,13 Thus, knowing their knowledge,
attitudes, and willingness toward organ donation is essential.
Several analyses of health professional attitudes toward or-
gan donation have been performed in other countries.11,14-18
However, few researches have been undertaken on knowl-
edge, attitudes, and willingness of health professional about
organ donation in China.

Transplantation ■ July 2015 ■ Volume 99 ■ Number 7 www.transplantjournal.com 1379

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

1380 Transplantation ■ July 2015 ■ Volume 99 ■ Number 7 www.transplantjournal.com

The aim of this study was to determine the level of performed to test for differences in proportions of categorical
knowledge, attitude, and willingness toward organ donation variables between 2 or more groups. All statistical calculations
among health professionals in China. In doing this, we hoped were performed using SPSS13.0 (SPSS, Inc., Chicago, IL).
that the results would be helpful to improve attitudes and Statistical tests were 2-sided, and a level of 0.05 was consid-
willingness of health professionals toward organ donation. ered to indicate statistical significance.
At the same time, we hoped to provide useful information
for the Chinese government to develop appropriate policies
and laws. RESULTS
Demographics
MATERIALS AND METHODS
A total of 400 questionnaires were distributed and
Study Population and Questionnaire Distribution returned, 5 of which had missing information about basic
October 2013 to January 2014, anonymous self-administered background, 22 of which had not completed the question-
questionnaires were randomly distributed to health profes- naires. Those 27 questionnaires were taken as invalid and
sionals in 7 hospitals of Dalian and 1 hospital in Chaozhou, deleted, leaving 373 valid questionnaires (valid return rate
China. The participants of this study consisted of doctors, was 93.2%) for analysis: 85 participants (22.8%) were men
nurses, and nonclinical staffs, including technical staff and and 288 (77.2%) were women. Of all study participants, 134
managers, who came from various departments of the hospi- (35.9%) were doctors, 173 (46.4%) were nurses, 66 (17.7%)
tals including medicine unit, surgical unit, pediatric unit, in- were nonclinical medical staff.
tensive care unit, renal unit, emergency ward, hematology Table 1 shows the baseline characteristics of study par-
unit, cardiac care unit, and administration section. Partici- ticipants. The mean age was 32.6 ± 8.3 years, ranging from
pants were asked to fill in the questionnaires during grand 20 to 65 years. Approximately 85% of the participants did
rounds of the individual departments, and the questionnaires not have a religious belief. Nearly 60% of the participants
were collected immediately afterward. were married. With regard to educational level, 29.3%
The survey was approved by Dalian Medical University's had specialist qualifications or lower, 46.3% had a bache-
ethics committee. Each questionnaire was accompanied with lor's degree, 20.1% had a master's degree, and 3.8% had a
an information sheet describing back ground and purpose doctor's degree.
for survey. All participants were encouraged to participate
without any undue pressure. To ensure the respondents' pri-
vacy, the study was voluntary and anonymous; we did not TABLE 1.
collect the content forms. Returning a completed question- Demographic characteristics
naire indicated informed consent for study participation.
n Constituent ratio, %
Instrument
Sex
We designed a questionnaire that was divided into 2
Male 85 22.8
parts1: demographics, including sex, age, job category, ed-
Female 288 77.2
ucational level, marital status, and religion2; core ques-
Age, y
tions related to health professional's knowledge (8 items),
20-24 59 15.8
attitudes (4 items), and willingness regarding organ dona-
25-29 98 26.3
tion(4 items), which consisted of 14 single choice questions
30-39 138 37.0
and 2 multiple choice questions. The questionnaire was
40 and older 78 20.9
pilot-tested on a random sample of 30 health professionals
Educational level
regarding wording and time needed for completion. The
Doctor 14 3.8
average time to complete the questionnaire was 3 minutes.
Master 75 20.1
After the pilot testing, 2 items that were misunderstood by
Bachelor 175 46.9
most responders in the original questionnaire were modified.
Specialist qualification or lower 109 29.3
The content validity index of the questionnaire was deter-
Job category
mined by distributing the modified questionnaire to 2 experts
Doctor 134 35.9
who have experience in the area of organ donation. The test-
Nurse 173 46.4
retest reliability was tested by 50 health professionals at a
Nonclinical staff 66 17.7
2-week interval. The coefficient was 0.85, which reflecting
Marital status
a good test-retest reliability.
Married 221 59.2
Statistical Analysis Single 152 40.8
Measurement data were presented with mean values ± Religion
standard deviations ( x  s ) after testing for normal distri- None 317 85.0
Yes 56 15.0
bution. Categorical data were summarized as counts and per-
centages (%). Student t test was used to ascertain the Buddhism 33 8.8
Christianity 9 2.4
significance of differences between mean values of 2 continu-
Catholicism 2 0.5
ous variables. Mann-Whitney U test was used for 2 ordinal
Muslim 2 0.5
variables comparisons and Kruskal-Wallis H test was used
Others 10 2.7
for 3 ordinal variables comparisons. The χ2 analysis was

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© 2015 Wolters Kluwer Hu and Huang 1381

Knowledge About Organ Donation of
Health Professionals
Table 2 shows the results for each knowledge item in differ-
ent job category health professionals. Although 93.8% of the
participants knew about organ donation, only 19.6% knew
the sector where to donate organ, and 13.7% knew the proce-
dure of donation. Doctors knew more about organ donation
than nurses and nonclinical staff (χ2 = 13.648, P < 0.001).
Of all the participants, only 17.4% had taken part in some
training courses or lectures about organ donation. Over half
of (64.9%) the health professionals knew about the shortage
of organs, and doctors knew more than nurses and nonclinical
staff (75.4% vs 61.3% and 53.0%, χ2 = 11.531, P = 0.003).
With regard to the reasons for organ shortage, the 2 top rea-
sons were traditional views (75.6%) and scarce knowledge
about organ donation (59.8%).
Most (97.3%) health professionals knew about brain
death, and over half of health professionals (68.9%) thought
brain death was the reasonable criteria by which to judge
death. According to job category, doctors showed a higher
knowledge level about brain death than nurses and nonclini-
cal staff (χ2 = 18.548, P < 0.001). With respect to criteria of
death, 76.1% doctors and 70.5% nurses believed that brain
death was a reasonable criteria, comparing with 50.0% for
nonclinical staff (χ2 = 18.543, P < 0.001) (Table 2).
Attitude Toward Organ Donation of
Health Professionals
Table 3 reveals the attitude toward organ donation of
health professionals. Most of the participants (76.9%) con-
sidered that organ donation is a noble thing. About 60.1%
approved the deceased donation; however, only 48.5% ap-
proved living donation. Doctors' attitudes were more posi-
tive than those of nurses and nonclinical staff members
both in deceased donation (Z = 8.560, P = 0.014) and in liv-
ing donation (Z = 6.835, P = 0.033). More than half of the
participants (61.7%) agreed to register their willingness to

TABLE 2.
The comparison about current level of organ donation knowledge among different health professionals

Doctors (n = 134) Nurses (n = 173) Nonclinical staffs (n = 66)

n (%) n (%) n (%) Z/χ2 P
(1) Know about organ donation 13.648 0.000
Never heard 2 (1.5) 6 (3.5) 6 (9.1)
Know a little 81 (60.4) 133 (76.9) 54 (81.8)
Know more 42 (31.3) 30 (17.3) 6 (9.1)
Know very well 9 (6.7) 4 (2.3) 0 (0.0)
(2) Know the sector where to donate organ 4.551 0.103
Yes 34 (25.4) 29 (16.8) 10 (15.2)
No 100 (74.6) 144 (83.2) 56 (84.8)
(3) Know the procedure of donation 1.515 0.469
Yes 22 (16.4) 22 (12.7) 7 (10.6)
No 112 (83.6) 151 (87.3) 59 (89.4)
(4) Know the shortage status of organ 11.531 0.003
Yes 101 (75.4) 106 (61.3) 35 (53.0)
No 33 (24.6) 67 (38.7) 31 (47.0)
(5) Take part in some training courses or lectures 3.981 0.137
about organ donation
Yes 30 (22.4) 27 (15.6) 8 (12.1)
No
(6) The reason for organ shortage
Traditional view 100 (74.6) 137 (79.2) 45 (68.2)
Economic level 46 (34.3) 59 (34.1) 19 (28.8)
No effective system for organ donation and allocation 71 (53.0) 53 (30.6) 17 (25.8)
Cope with the aftermath 53 (39.6) 54 (31.2) 18 (27.3)
Mistrust to hospital 35 (26.1) 32 (18.5) 13 (19.7)
No reasonable compensation 54 (40.3) 58 (33.5) 13 (19.7)
Scarce knowledge about organ donation 82 (61.2) 110 (63.6) 31 (47.0)
Indifference and lack of humanity 35 (26.1) 33 (19.1) 16 (24.2)
(7) The knowledge about brain death 18.548 0.000
Never heard 2 (1.5) 3 (1.7) 5 (7.6)
Know a little 61 (45.5) 96 (55.5) 44 (66.7)
Know more 51 (38.1) 68 (39.3) 15 (22.7)
Know very well 20 (14.9) 6 (3.5) 2 (3.0)
(8) The reasonable criteria to judge death 18.543 0.001
Cardiopulmonary death 30 (22.4) 40 (23.1) 25 (37.9)
Brain death 102 (76.1) 122 (70.5) 33 (50.0)
Not sure 2 (1.5) 11 (6.4) 8 (12.1)

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1382 Transplantation ■ July 2015 ■ Volume 99 ■ Number 7 www.transplantjournal.com

TABLE 3.
Attitudes regarding organ donation of health professionals

Doctors (n = 134) Nurses (n = 173) Nonclinical staffs (n = 66)

n(%) n(%) n(%) z/χ2 P
(9) Consider that organ donation is a noble thing 9.296 0.054
Yes 101 (75.4) 137 (79.2) 49 (74.2)
No 10 (7.5) 5 (2.9) 0 (0.0)
Not sure 23 (17.2) 31 (17.9) 17 (25.8)
(10) Agree to register organ donation willingness applying 2.378 0.305
the ID card or driving license
Yes 89 (66.4) 100 (57.8) 41 (62.1)
No 45 (33.6) 73 (42.2) 25 (37.9)
(11) Attitude to living organ donation 6.835 0.033
Disagree at all 3 (2.2) 7 (4.0) 10 (15.2)
Disagree a little 37 (27.6) 48 (27.7) 16 (24.2)
Not sure 20 (14.9) 37 (21.4) 14 (21.2)
Agree a little 53 (39.6) 66 (38.2) 21 (31.8)
Agree at all 21 (15.7) 15 (8.7) 5 (7.6)
(12) Attitude to deceased organ donation 8.560 0.014
Disagree at all 6 (4.5) 4 (2.3) 1 (1.5)
Disagree a little 14 (10.4) 18 (10.4) 14 (21.2)
Not sure 21 (15.7) 54 (31.2) 17 (25.8)
Agree a little 60 (44.8) 75 (43.4) 25 (37.9)
Agree at all 33 (24.6) 22 (12.7) 9 (13.6)

donate their organs, during the application for an identifica-
tion (ID) card or driving license.
Health Professionals' Willingness to Donation
Table 4 shows health professionals' willingness to dona-
tion. When asked whether they were willing to donate their
own organs to family members awaiting organ transplanta-
tion, most participants (82.8%) said yes and only few of
them (6.4%) said no. About 42.1% of the participants were
willing to donate organs to their relatives or friends, 17.7%
were not willing. However, some participants (15.0%) were
willing to donate their own organs to someone unknown,
and doctors showed higher willingness than nurses and
nonclinical staff members (21.6% vs 10.4% and 13.6%,
χ2 = 10.845, P = 0.028).
Among the participants, 49.3% were willing to donate
their own organs postmortem, and only 13.7% were unwill-
ing to donate, 37.0% expressed uncertainty. Doctors had a
higher willingness to donation postmortem (64.2%) com-
pared with nurses (42.2%) and nonclinical staff (37.9%)
(χ2 = 18.806, P = 0.001). Overall, 189 (50.7%) participants
who were not willing to donate organ postmortem or uncer-
tain about donation were allowed to cite multiple reasons for
refraining from donation. The reasons for refraining from
donation are presented in Figure 1. The most commonly
cited reason for not wanting to donate organs was, “afraid
that organs would be picked up inhumanely and body would
be disfigured” (49.2%). The second most commonly cited
reason was, “believed that the regulations and laws rela-
ted to organ donation in China were far from complete”
(45.0%). 40.2% participants reported they “distrusted
the medical institutions and [were] afraid that donated or-
gans might be sold on the black market” as an influencing
factor. In addition, 32.3% said that they were unwilling to
donate their own organs based on traditional Chinese values
that people should maintain physical integrity of their bodies
after death. Figure 1 shows the reasons for refraining from
organ donation.
DISCUSSION
The potential role of health professionals in maximizing
the limited organ donor pool is essential and deserves further
study.19 Despite the critical importance of health professional
support in this arena, there is a paucity of data in the litera-
ture regarding the attitudes of Chinese health professionals
toward organ donation. This study is limited by its relatively
small sample size and lack of geographic diversity. Never-
theless, as the first survey of Chinese health professional
knowledge, attitudes, and willingness toward organ donation,
this report provides a somewhat important perspective on
organ donation.
Questions 1 to 8 were designed to determine health pro-
fessionals' basic knowledge about organ donation. The re-
sults showed that more than 93.8% of the participants
possessed a degree of knowledge about organ donation,
and 64.9% of the participants were aware of the shortage
of organs for transplantation, which was lower than the re-
sults in a survey about physicians in the United States where
approximately 86% of responders were aware about organ
shortage problem.18 In all of the participants, only 19.6%
knew the sector where to donate an organ and 13.7% knew
the procedure of donation, which indicates there is still an
immediate need to educate the health professionals with re-
gard to basic knowledge about organ donation in China. Be-
sides, most of the health professionals (82.6%) had not
taken part in any training courses or lectures about organ
donation, which is in agreement with the conclusion of a

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© 2015 Wolters Kluwer Hu and Huang 1383

TABLE 4.
Health Professionals' willingness to donation

Doctors (n = 134) Nurses (n = 173) Nonclinical staff (n = 66)

n (%) n (%) n (%) z/χ2 P
(13) Willing to donate some organs to my parents, children or spouse 1.804 0.772
Yes 112 (83.6) 142 (82.1) 55 (83.3)
No 7 (5.2) 11 (6.4) 6 (9.1)
Uncertain 15 (11.2) 20 (11.6) 5 (7.6)
(14) Willing to donate some organs to my relatives or friends 6.177 0.186
Yes 60 (44.8) 69 (39.9) 28 (42.4)
No 27 (20.1) 24 (13.9) 15 (22.7)
Uncertain 47 (35.1) 80 (46.2) 23 (34.8)
(15) Willing to donate some organs to someone unknown 10.845 0.028
Yes 29 (21.6) 18 (10.4) 9 (13.6)
No 44 (32.8) 53 (30.6) 16 (24.2)
Uncertain 61 (45.5) 102 (59.0) 41 (62.1)
(16) Willing to donate organs postmortem 18.806 0.001
Yes 86 (64.2) 73 (42.2) 25 (37.9)
No 13 (9.7) 27 (15.6) 11 (16.7)
Uncertain 35 (26.1) 73 (42.2) 30 (45.5)

research in the United States that few physicians reported
receiving formal training in donation, with most of them
rating their knowledge as limited.20 The participants consid-
ered that the 2 top reasons for organ shortage were tradi-
tional views (75.6%) and scarce knowledge about organ
donation (59.8%). These results demonstrate that the health
professionals' knowledge about organ donation in Chinese
hospitals is scarce. Research has shown that medical educa-
tion positively influences knowledge and attitude toward or-
gan donation and that better knowledge and a more positive
attitude were associated with an increased readiness to do-
nate an organ.11 Therefore, improving education efforts is
essential in improving the health professionals' knowledge
about organ donation.
Brain death is used in many countries to determine death
and is often the basis for removal of organs for transplanta-
tion. However, in China, brain death is not accepted by the
public. Donation after brain death will replace donation after
cardiac death in the future—this will be a substantial move
toward a new era for organ transplantation in China.21 Re-
searches had concluded that the understanding and accep-
tance of brain death as a valid determination of death was
a factor that significantly influences attitudes toward dona-
tion.22,23 In our study, 97.3% health professionals knew
the concept of brain death, and 68.9% thought brain death
was reasonable criteria by which to judge death. Doctors
showed a higher knowledge level about brain death than
nurses and nonclinical staff members (χ2 = 18.548, P =
0.000). Similar results were found in other research: A survey
about attitude of intensive care unit staff regarding organ do-
nation in Kuwait showed 68% anesthetists and 51% nurses
accepted brain death.24 A survey in Israel showed that 78.9%
of health care professional had a positive attitude toward
brain death.22 These results showed that brain death was
not widely accepted by health professionals, especially nurses
and nonclinical staff members. Thus, to increase the number
of donors, more efforts should be done to promote health
professionals' information and awareness of donation after
brain death, such as more education and training among all
staff members, and more seminars about organ donation.
On the other hand, over 80 countries recognize death in a pa-
tient determined to be brain dead; 14 countries have drafted
legislation to support this notion; however, in China, the con-
cept of brain death is still unclear and not widely accepted to
be a determinant in the declaration of death.25 Therefore, leg-
islation on brain death needs to be enacted to define the con-
cept of brain death and publicity of brain death needs to be
enhanced to improve the public's knowledge and acceptance
of brain death.
Questions 9 to 12 were designed to determine the health
professionals' attitudes toward organ donation. In this sur-
vey, most of the participants (76.9%) considered that or-
gan donation is a noble gesture. This result was slightly
lower than other study on general population in China that
82.2% participants regarded every donor as a “hero.”26
Interestingly, previous research9,12 has concluded that health
professionals hold a more favorable attitude than general
population, whereas in our study, health professionals
showed a lower support rate (60.1%) for deceased donation
than the general Chinese population (89.1%).27 There dem-
onstrates further need for studies to explain this difference
of opinion.
FIGURE 1. The reasons for refraining from a donation.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

1384 Transplantation ■ July 2015 ■ Volume 99 ■ Number 7
In this study, similar to other studies of health profes-
sionals,28,29 doctors showed a higher level of favorable atti-
tudes than nurses and nonclinical staff members, both in
deceased donation (Z = 8.560, P = 0.014) and in living dona-
tion (Z = 6.835, P = 0.033). Research has showed that higher
medical education was associated to positive attitude toward
organ donation and increased willingness to donate.11,19,30
This helps to explain why, in our study population, doctors
with more knowledge had higher positive attitude and will-
ingness to organ donation than nurses and nonclinical staff
members. This is important because not only do doctors have
a direct responsibility to promote organ donation but also the
rest of the staff have an important impact on the population.
In this respect, if a person who works in a hospital has an un-
favorable attitude, it is likely that this will create fear toward
organ donation among the genuine population who listens to
these people. On occasions, the hospital staff, whether or not
they are a clinical staff, show opinions against donation that
are heard by family members of a possible donor, it may neg-
atively affect their decision.23 Thus, it is necessary to make ef-
forts to improve attitude to organ donation not only in
doctors but also in all the staff in the hospital, especially in
nurses who are in close contact to patients and their relatives.
It was common practice in some countries to supply appli-
cants of driver's licenses with the necessary paperwork for
organ donation. Eighty percent of Australians register for or-
gan donations when getting their driver's licenses, and in
Britain, the rate is 45%.31 In our study, however, when the
participants were asked if they agree to register organ dona-
tion willingness at the time of applying an ID or driving li-
cense, only 61.7% gave a positive answer. Someone who
did not agree commented they thought it would be ominous.
Some others disliked the combined registration as they be-
lieve organ donation registration should follow voluntary
principles strictly. In addition, there were some participants
who thought applicants were not mature enough to make a
prudent decision when applying for an ID card or driving
license. All of these indicated that not all public in China
accepted registered organ donation willingness at the time
of applying for the ID card or driving license. Based on
Chinese culture and traditional views, therefore, the registra-
tion ways should be discussed and should not be limited in
the same way as in other countries. At the same time, a na-
tional education campaign about organ donation should be
carried out, and promotion of public awareness about dona-
tion is necessary.
Compared with 60.1% of participants who supported
deceased organ donation, only 48.5% were in favor of living
organ donation. This means that the promotion of living
organ donation faces greater resistance than deceased organ
donation. Interestingly, our results showed that most of the
people (82.8%) would donate their organs regardless of
physical harm if family members needed organs to save their
lives. However, regarding donation to relatives or friends,
only 42.1% were willing to donate their own organs to them,
and 15.0% were willing to donate their own organs to some-
one unknown. This indicated that emotional factors played a
role in decision making for living organ donation. The
bonds between parents and their children are generally
believed to be stronger in China than in Western countries.
Family values are one of the core values in Chinese culture.
Chinese people usually have a strong attachment to families.
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www.transplantjournal.com
In Confucianism, filial piety takes priority over any other
moralities. This sense of filial obligations and caring for par-
ents is rooted in Chinese culture, influencing generations of
Chinese people. Therefore, we were not surprised to note a
high percentage of participants willing to donate a living
organ to a close relative. This important finding suggests that
relatives become a potential living organ source to increase
organ donation and to save more lives. Thus, health profes-
sionals should make more efforts to encourage organ dona-
tion between relatives.
The results of this cross-sectional survey showed that more
than half of the respondents (50.7%) were unwilling to do-
nate organs postmortem. The top 3 reasons for unwillingness
to donate were disfigured corpse (49.2%), incomplete laws
(45.0%), and distrust in medical institutions (40.2%). A sim-
ilar result was found in a survey about American physicians'
attitudes toward organ donation, showing that the unfair or-
gan allocation system is one of reasons for declining to regis-
ter as organ donor.18 Therefore, a legal system regulating
organ donation should be quickly revised and reinforced to
eradicate the illegal organ trading activities both in China
and in other countries so as to eliminate fear of organ dona-
tion and change negative attitudes. In addition, 32.3% said
that their unwillingness to donate their own organs were
based on Chinese traditional values that people should main-
tain physical integrity of their bodies after death, which was
also found by several other studies as a reason for not want-
ing to donate.26,32 On the other hand, in this study, 37.0% of
the total participants answered “not sure” about their will-
ingness for organ donation postmortem, which indicated
that a part of health professionals had not been prepared
for donation, but they were not against donation. Thus, ef-
forts need to be made to motivate these potential donors to
be bona fide donors. It is necessary to develop and implement
effective educational campaigns to increase awareness, dispel
myths, and modify attitudes about donation among the
health professionals and the public.
In conclusion, Chinese health professionals showed lower
favorable attitudes and willingness toward organ donation
than the Chinese general public. Knowledge about organ
donation on the part of Chinese health professionals was
limited. Therefore, constant effective education seminars in
health professionals are needed to enhance knowledge and
promote willingness toward organ donation.
ACKNOWLEDGMENTS
The authors thank the participants for their kind coopera-
tion, and Guihua Li, Shu Jia, Haixia Liu, Yunying Zhang,
Qiuyan, Sun, Nan Huang for collecting data in this study.
REFERENCES
1. Gomez MP, Perez B, Manyalich M. International Registry in Organ Donation
and Transplantation—2013. Transplant Proc. 2014;46:1044–1048.
2. Hu XP, Liu Y, Zhang XD. The organ donation in China. Chin Med J (Engl).
2012;125:3912–3913.
3. Barber K, Falvey S, Hamilton C, et al. Potential for organ donation in the
United Kingdom: audit of intensive care records. BMJ. 2006;332:
1124–1127.
4. Goodarzi P, Aghayan HR, Larijani B, et al. Tissue and organ donation and
transplantation in Iran. Cell Tissue Bank. 2015;16:295–301.
5. Fukushima N, Konaka S, Yasuhira M, et al. Study of education program of
in-hospital procurement transplant coordinators in Japan. Transplant
Proc. 2014;46:2075–2078.
© 2015 Wolters Kluwer
6. Tokalak I, Kut A, Moray G, et al. Knowledge and attitudes of high school
students related to organ donation and transplantation: a cross-
sectional survey in Turkey. Saudi J Kidney Dis Transpl. 2006;17:491–496.
7. Sander SL, Miller BK. Public knowledge and attitudes regarding organ
and tissue donation: an analysis of the northwest Ohio community.
Patient Educ Couns. 2005;58:154–163.
8. Figueroa CA, Mesfum ET, Acton NT, et al. Medical students' knowledge
and attitudes toward organ donation: results of a Dutch survey.
Transplant Proc. 2013;45:2093–2097.
9. Boey KW. A cross-validation study of nurses' attitudes and commitment
to organ donation in Hong Kong. Int J Nurs Stud. 2002;39:95–104.
10. McCoy LK, Bell SK. Organ donation and the rural critical care nurse. Am J
Crit Care. 1994;3:473–475.
11. Schaeffner ES, Windisch W, Freidel K, et al. Knowledge and attitude
regarding organ donation among medical students and physicians.
Transplantation. 2004;77:1714–1718.
12. Radunz S, Hertel S, Schmid KW, et al. Attitude of health care professionals
to organ donation: two surveys among the staff of a German university
hospital. Transplant Proc. 2010;42:126–129.
13. Shepherd L, O'Carroll RE, Ferguson E. An international comparison of
deceased and living organ donation/transplant rates in opt-in and opt-
out systems: a panel study. BMC Med. 2014;12:131.
14. Kim JR, Elliott D, Hyde C. Korean health professionals' attitudes and
knowledge toward organ donation and transplantation. Int J Nurs Stud.
2004;41:299–307.
15. Foss S, Sanner M, Mathisen JR, et al. Doctors' attitudes to organ
donation. Tidsskr Nor Laegeforen. 2014;134:1142–1145.
16. Reddy AV, Guleria S, Khazanchi RK, et al. Attitude of patients, the public,
doctors, and nurses toward organ donation. Transplant Proc. 2003;35:18.
17. Erdogan O, Yucetin L, Tuncer M, et al. Attitudes and knowledge of Turkish
physicians about organ donation and transplantation. Transplant Proc.
2002;34:2007–2008.
18. Alkhatib AA, Maldonado AQ, Abdel Jalil A, et al. Physicians' attitude
toward organ donation and transplantation in the USA. Clin Transplant.
2014;28:149–151.
19. Symvoulakis EK, Tsimtsiou Z, Papaharitou S, et al. Kidney organ donation
knowledge and attitudes among health care professionals: findings from a
Greek general hospital. Appl Nurs Res. 2012;25:283–290.
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Hu and Huang 1385
20. Thornton JD, Curtis JR, Allen MD. Primary care physicians' attitudes and
practices regarding discussing organ donation with their patients. J Natl
Med Assoc. 2010;102:52–58.
21. Wei X, Jiang H, Li Q. Organ transplantation in China—not yet a new era.
Lancet. 2014;384:741.
22. Cohen J, Ami SB, Ashkenazi T, et al. Attitude of health care professionals
to brain death: influence on the organ donation process. Clin Transplant.
2008;22:211–215.
23. Rios A, Conesa C, Ramirez P, et al. Attitude toward deceased organ
donation and transplantation among the workers in the surgical services
in a hospital with a transplant program. Transplant Proc. 2005; 37:
3603–3608.
24. Al-Mousawi M, Abdul-Razzak M, Samhan M. Attitude of ICU staff in
Kuwait regarding organ donation and brain death. Transplant Proc.
2001;33:2634–2635.
25. Zhang L, Wang J, Kwauk S, et al. Preliminary analysis of factors
influencing organ donation rates in China. Transplant Proc. 2011;43:
1421–1424.
26. Pan X, Liu L, Xiang H, et al. Current attitudes toward organ donation
after cardiac death in northwest China. Chin Med J (Engl). 2014;127:
835–838.
27. Wang W, Tian H, Yin H, et al. Attitudes toward organ donation in China.
Chin Med J (Engl). 2012;125:56–62.
28. Alsaied O, Bener A, Al-Mosalamani Y, et al. Knowledge and attitudes of
health care professionals toward organ donation and transplantation.
Saudi J Kidney Dis Transpl. 2012;23:1304–1310.
29. Wale J, Arthur A, Faull C. An analysis of knowledge and attitudes of
hospice staff towards organ and tissue donation. BMJ Support Palliat
Care. 2014;4:98–103.
30. Conesa C, Rios A, Ramirez P, et al. Multivariate study of the psychosocial
factors affecting public attitude towards organ donation. Nefrologia.
2005;25:684–697.
31. Chinese to face organ donation choice in event of death when getting
driver's license. Available at http://news.xinhuanet.com/english2010/
china/2011-04/25/c_13845134.htm. Accessed on April 25, 2011.
32. Chung CK, Ng CW, Li JY, et al. Attitudes, knowledge, and actions with
regard to organ donation among Hong Kong medical students. Hong
Kong Med J. 2008;14:278–285.