Questionnaire (2) For Karamullah - Google Forms

09/11/2023, 17:37 Evaluating the Impact of an Aw areness/Educational Activity on Organ Transplantation and Organ Donation Among Undergradu…
Evaluating the Impact of an

Awareness/Educational Activity on Organ
Transplantation and Organ Donation
Among Undergraduate Medical Students
of Pakistan
CONSENT : Before starting please review the following
statements and mark yes if you consent for the study: "I have read and understood the
invitation letter for the
study. I understand the potential risks
and benefits of participating in this study. I understand that I am a volunteer, that I may
withdraw from the project
at any time up to the point I submit my questionnaire, and that I may choose
not to answer any question without penalty or consequences. I understand that the
electronic data I will
provide will be permanently saved."
* Indicates required question
1. Email *
2. What is your age(in years) ? *
Mark only one oval.
16-20
20-25
25-30
>30
https://docs.google.com/forms/d/1IyPbFKroJ0M5o8vAX9ygRYJD-StoHYcDNxzAsyHlCQE/edit 1/17
3. What is your gender? *
Mark only one oval.
Male
Female
4. What is your nationality *
Mark only one oval.
Pakistani
Non Pakistani
5. What is your year of study? *
Mark only one oval.
1st year
2nd year
3rd year
4th year
5th year
6. Have you ever… *
Mark only one oval per row.
yes no
Heard
about
organ
donation
through
word of
mouth
Heard
about
organ
donation
through
newspaper
Heard
about
organ
donation
through
television
Attended
organ
donation
campaign
7. Choose accordingly *
yes no
Know
about
donation
of
kidney
Know
about
donation
of blood
Know
about
donation
of liver
Know
about
donation
of
cornea
8. What does organ/tissue/blood donation mean to you? *
Mark only one oval.
Transfer of tissues or organ from a dead body to a patient
Transfer of tissues or organ from a dead body to a patient in need
Transfer of tissues/blood/organs from a living to a patient in need
All of the above
9. What organs/tissues can be donated? *
Check all that apply.
Kidney
Heart
liver
Lungs
Pancreas
Intestine
Bone
Bone Marrow
Cornea of eyes
All of the above
10. There is a donor registry in Pakistan where people register during their life to *
donate organs after death. Do you know about it?
Mark only one oval.
Yes
No
11. At what age can an individual register for organ donation? *
Mark only one oval.
At any age
18 years and above
I don’t know
12. Death could mean *
Mark only one oval.
The heart is not beating and there is no breathing
Brain death in which the heart is beating with the help of ventilator to keep
breathing
I do not know
Other
13. Brain dead persons can go back to normal *
Mark only one oval.
Myth
Fact
14. Brain dead persons are “legally” dead *
Mark only one oval.
Myth
Fact
15. Brain dead persons are “clinically” dead *
Mark only one oval.
Myth
Fact
16. Does your religion allow organ donation? *
Mark only one oval.
Yes
No
17. Do you know anyone who has donated an organ? *
Family member
Friend
Colleague
No one
other
18. Do you know that during life an individual can donate a part of his liver to his *
relative?
Mark only one oval.
Yes
No
19. Do you know that donating a part of your liver is a risk to your health? *
Mark only one oval.
Yes
No
Maybe
I don’t know
20. Do you know that you can donate one of your two kidneys during your life, to *
another person?
Mark only one oval.
Yes
No
21. Do you know the Pakistan organ donation law and policy? *
yes no
Prohibits
any
buying or
selling of
organs
Puts no
pressure
on the
deceased
donor
family or
live to
donate
All
families
of the
deceased
will be
given
social
support if
they need
it
22. What is your attitude towards organ donation? *
strongly strongly
agree neutral disagree
agree disagree
Organ
donation is
a good
thing and
should be
promoted
Registering
as organ
donor could
save
somebody’s
life
23. I am willing to register as an organ donor, if my family would have no objection to *

allowing donation of my organs at the time of my death
strongly strongly
agree disagree
If I knew
more about
what is
organ
transplant
and how it
is done
If more
information
was
available
about the
viewpoint
of my
religion
with regard
to organ
donation
If I knew
where I
could
register
24. Select the relevant option. *
strongly strongly
agree disagree
I think my
donation
whether
living or after
death is
going to
impact my
life after
death in a
good way
Organ
donation is
an act which
will be
rewarded by
God
In case of an
emergency,
doctors will
not provide
enough care
if the patient
is registered
organ donor
Organ
retrieval
process after
death may
cause body
disfigurement
Organ
donation will
increase if
social
support is
support is
support is
provided to
provided to
family of the
family of the
deceased
deceased
regardless of
regardless of
whether they
whether they
donate or not
donate or not
strongly strongly
agree disagree
You do not
find many
opportunities
to register as
organ donor
in Pakistan
Organ donor
registration
is time
consuming
process
While
registering
for organ
donation,
you may not
get answer
for all your
questions
You are not

healthy to
donate
Your age is
not fit for
donating
your organ
donation
Operation
procedure
for procuring
organs is
discouraging
26. To register as an organ donation, you will take the opinion of *
Family member
my community
religious leader
friend
other
strongly strongly
agree disagree
You are
worried that
organ donation
might leave
you weak and
disabled
I do not trust
the health care
system in
Pakistan and it
is better to go
abroad for
organ donation
and organ
transplantation
28. If someone plans to donate their organs after death *
strongly strongly
agree disagree
Emotions of
family
members
while organs
are being
taken make
you feel
concerned
A person’s kin
consent is not
needed for
organ
transplantation
29. Select accordingly *
strongly strongly
agree disagree
Do most
of the
people
who are in
need of an
organ
from a
donor
become
successful
in
receiving
one.
30. Are you willing to register as an organ/tissue donor? *
Mark only one oval.
Yes
No
31. Which organ/tissue will you prefer to donate? *
Kidney
Heart
liver
Lungs
Pancreas
Skin
bone marrow
all the above
none
32. Hvae you previously registered yourself for an organ donation? *
Mark only one oval.
Yes
No
33. Do you have religious leader who you trust? *
Mark only one oval.
Yes
No
34. Would you consider organ donation after discussion with a religious leader? *
Mark only one oval.
yes
no
35. Would you consider donating organ more seriously if you are approached by an *
organization you could trust
Mark only one oval.
strongly agree
agree
neutral
disagree
strongly disagree
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09/11/2023, 17:37 Evaluating the Impact of an Aw areness/Educational Activity on Organ Transplantation and Organ Donation Among Undergradu…

Evaluating the Impact of an

* Indicates required question

2. What is your age(in years) ? *

Mark only one oval.

3. What is your gender? *

Mark only one oval.

4. What is your nationality *

Mark only one oval.

5. What is your year of study? *

Mark only one oval.

6. Have you ever… *

Mark only one oval per row.

Mark only one oval per row.

8. What does organ/tissue/blood donation mean to you? *

Mark only one oval.

Transfer of tissues or organ from a dead body to a patient

Transfer of tissues or organ from a dead body to a patient in need

Transfer of tissues/blood/organs from a living to a patient in need

All of the above

9. What organs/tissues can be donated? *

Check all that apply.

Mark only one oval.

11. At what age can an individual register for organ donation? *

Mark only one oval.

18 years and above

12. Death could mean *

Mark only one oval.

The heart is not beating and there is no breathing

13. Brain dead persons can go back to normal *

Mark only one oval.

14. Brain dead persons are “legally” dead *

Mark only one oval.

15. Brain dead persons are “clinically” dead *

Mark only one oval.

16. Does your religion allow organ donation? *

Mark only one oval.

17. Do you know anyone who has donated an organ? *

Check all that apply.

Mark only one oval.

Mark only one oval.

Mark only one oval.

Mark only one oval per row.

22. What is your attitude towards organ donation? *

Mark only one oval per row.

23. I am willing to register as an organ donor, if my family would have no objection to *

Mark only one oval per row.

24. Select the relevant option. *

Mark only one oval per row.

25. Select the relevant option. *

Mark only one oval per row.

You are not

26. To register as an organ donation, you will take the opinion of *

Check all that apply.

27. Select the relevant option. *

Mark only one oval per row.

28. If someone plans to donate their organs after death *

Mark only one oval per row.

29. Select accordingly *

Mark only one oval per row.

30. Are you willing to register as an organ/tissue donor? *

Mark only one oval.