Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka s24
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / Mr. SAJEER ALIGOLDFINCH COLLEGE OF NURSING
NO: 150/24, KODIGEHALLI MAIN ROAD
MARUTHINAGAR
BANGALORE-560092
2 / NAME OF THE INSTITUTION / GOLDFINCH COLLEGE OF NURSING
MARUTHINAGAR
BANGALORE-560092
3 / COURSE OF STUDY AND SUBJECT / M.SC NURSING
MEDICAL SURGICAL NURSING
4 / DATE OF ADMISSION TO COURSE / 30.06.2011
5. TITLE OF THE TOPIC
“A STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE OF NURSING STUDENTS REGARDING ORGAN DONATION AFTER DEATH IN A SELECTED COLLEGE AT BANGALORE”.
6.0 BRIEF RESUME OF INTENDED WORKINTRODUCTION
“ It is said that the soul is invisible, knowing this you should not grieve for the body”
-Bhagavad Gita 2:25
“Whoever saves the life of one person who would be as if he saved the life of all mankind”
-Holy Quran 5:32
“ Freely you have received, freely give”
-Mathew 10:8
Organ donation is the donation of biological tissue or an organ of the human body from a dead or living person to a living recipient in order to save the life of the recipient. A living person can donate organ after natural death or after brain death. After natural death only few tissues only can be donated like cornea, bone, skin, blood vessels, were as after brain death almost 37 deferent body organs can be donated including critical organs2.
The laws of deferent countries allow potential donors to permit or refuse donation or give this choice to relatives. Thousands of lives are lost in India due to liver or heart failure. Since the transplantation of unpaired organs is either difficult or impossible, this is only possible on a large scale if these organs are available from cadaver donors.
The need for greater willingness to donate organs has been well-documented. Over 4,000 people die each year because a suitable donor cannot be found. Recent statistics indicate that over 71,000 people are on organ transplant waiting lists. At least half are expected to die waiting because the waiting list has been growing at three times the rate of the available supply of organs. Yet, this need could be eliminated if all people who are eligible were willing to donate. The single greatest obstacle to increasing the number of patients who receive life-saving transplants is the scarcity of available organ donations. The only way to increase organ donations is to educate the public about the importance of becoming an organ donor.
For any death where organ donation is a possibility and consent is given, there will be a medical assessment of what organs can be recovered2. There are no absolute age limits to organ donation. A handful of medical conditions will rule out organ donation, such as HIV-positive status, actively spreading cancer (except for primary brain tumors that have not spread beyond the brain stem), or certain severe, current infections. However, for most other diseases or chronicmedical conditions, organ donation remains possible.
Unfortunately, many people never indicate their wish to donate because they believe, falsely, that their age or medical condition would not allow them to donate. If you want to save and enhance lives through donation, the most important action you can take is to share your donation decision; if donation is not medically feasible, that determination will be made at the time of death.
6.1. NEED FOR THE STUDY
Thousands of lives are lost in India due to liver and heart failure. Since the transplantation of un paired organ like liver, heart, are either difficult or impossible from living persons, this is the only possible on a large scale if these organ are available from cadaver donors3.Organ donation saves thousands of lives worldwide. According to WHO, kidney transplantation are carried out but more than 91 countries. Around 66000 kidney donations, 21000 liver donations and 6000 heart donation were transplanted globally by 2005. Still thousands of patients were waiting to organ transplants.
According to the NHS, ‘Organ donation is the gift of an organ to help someone who needs a transplant. Approximately 2,700 organ transplants are carried out each year in the UK’ (NHS, 2007). In the UK, more than 7000 people are waiting for organ transplant at a time and usually people wait for kidney, heart, lung or liver transplant. The NHS maintains a donor register which is a confidential list of people who are willing to donate their organs after their death. 400 people die every year in the UK as they wait for a suitable transplant as die in circumstances in which they are not able to donate their organs. The recipient of organs may have to take immune-suppressant drugs to prevent their body from rejecting the Organ and the donor may experience prolonged pain and other complications. There are ethical issues related to live organ donation as live donors suffer from deteriorating physical health after donating organs and so organs taken from people after their death would be more ethical.17
As in many parts of the world, there is a shortage of cadaveric organs for transplantation. Worldwide, more than 20% of patients on transplant waiting lists die every year due to shortage of donor organs.
The discussions related to organ donation in an environment of grief could be challenging to any health care professional and making requests for organs during such sensitive moment and providing support to the donor family highlights the role of nurses. Specialist training to nurses should thus be given so that the organ donation process is easily facilitated and nurses can provide support to donor families. In order to have a healthy and positive approach to the donation process, it is important to have a ‘Gift of Life and Sacrifice’ viewpoint 13
A study emphasized that higher medical education is generally associated with positive knowledge and attitude towards organ donation. In fact health care professionals with higher levels of education are usually more comfortable about discussing organ donation with the donor relatives and also they themselves are likely to hold donor cards. To maximize benefits of the organ donation process, educating the health care professionals seem to be an important part of the process.9
A study highlighted that students' awareness of organ donation was not adequate and that attitude levels were lower than in other countries. If these future workers would receive adequate training, they could promote organ donation to the general public and to other hospital personnel. A study suggests, the issue of organ transplant after death could be an emotional or sentimental one as relatives would still be going through the traumatic time of losing a loved one.
A study suggests that nurses should be trained with educational programmes related to organ donation which could be given as presentations, role play situations and discussions based on organ requests and this could result in increased rates of donor consent and reduction in waiting lists for transplants or organ donations The discussions related to organ donation in an environment of grief could be challenging to any health care professional and making requests for organs during such sensitive moment and providing support to the donor family highlights the role of nurses.12
6.2. REVIEW OF LITERATURE
A review of literature is an essential aspect of scientific research. One of the major functions of review of research literature is to ascertain what is already known related to the problem of interest and this will help in developing a broad conceptual context into which a research problem will fit.
An intensive review of literature was done by the investigator to lay a broad foundation for the study and a conceptual framework was developed to proceed with the study.
The review of literature is broadly classified into three sections as follows:
Section-A: LITERATURE RELATED TO KNOWLEDGE OF ORGAN DONATION
A population based study was conducted in Brazil in 2005, to identify the prevalence of people’s willingness to donate their own organs and from their relatives, evaluating associated factors in an adult population. Amid 3159 participants, the prevalence to donate organs was 52%, amongst which 58% had expressed such willingness to a relative. Most respondents (80.1%) would authorize the donation of relative’s organs who had previously declared their willingness to do so. When the subject had not been discussed, only a third of the total number of people interviewed would authorize the donation of a relative’s organ. After adjustment to confusing factors, higher willingness was characterized among the youngest, the higher educated and those belonging to families with income over 10 minimum wages.
A study, instead of taking views from students, opinions of non students or patients were used to understand the general knowledge or misconceptions on organ transplantation and Donation among non-acutely ill outpatients visiting a community physician’s office. The study was conducted on 185 patients and the results indicated that among these 86 were willing to donate, 42 were not willing, 57 were unsure and the willingness to donate was associated with discussion with family, having known other donors, having received higher educational degrees, recognizing the problem of organ shortage and also having a family member working in primary health care4.
Section-B: LITERATURE RELATED TO ATTITUDE OF ORGAN DONATION
A study was conducted in 2008 to assess the awareness and attitudes of health care professionals towards organ donation. 691 medical students participated in the study. There were 595 undergraduates, 65 interns and 31 postgraduate students Out of 691 individuals who participated in this study, 595 were UG students, 65 were interns and 31 were PG students. The sex ratio was 1:1 and. 617 (90%) of the students were Hindus, 44 (6.4%) Christians, 18 (2.6%) Muslims and others 12 (1.7%). The students were asked about their understanding of the term "organ donation" in five different statements. 623 (90.2%) of them said that organ donation was the donation of a normal, functioning part of the human body at the time of the individual's death. 72% of the UG students and 66% of the PG students said that organ donation was donating an organ after death. 61% of the UG students, 74% of the Interns and 84% of the PG students said organ donation was donating a normal functioning part of the human body while the individual is still alive. 42% UG students, 62% Interns and 52% PG students agreed to the statement on donating a portion of the normal functioning organ. 93% participants accepted that there was a need for donating organs. The commonly stated reasons given by the participants were (i) to save a patient, (ii) to help the people in need when the donor is dying, (iii) to make a diseased person normal.3
A study was conducted to assess the attitude regarding organ donation among medical students, 56.8% were men, 91.4% were 18-24-year old and 89.4% from east region of Turkey. Of students, 65.5% were willing, 9% were not willing, 25.5% were hesitant about organ donation and 6% of willing students reported carrying a signed card. The most common reason for unwillingness to organ donation was worries about illegal behaviors (2.4%). There was a statistical relationship between willingness of students for organ donation and gender but were not any statistical relationship between willingness of students for organ donation and age, school, region and recognizing relatives whose need organ transplantation. Majority of the students listed transplantable organs truly but 63.1% were had no idea about organ donation process.
A study related to student perception was conducted on organ donation; he compared opinions of medical student on organ transplant and donation in their different stages of medical education. The study included a 10 item questionnaire which 100 students completed and their mean age was recorded
At 23.7 years. The results indicated that more than 91% of students showed a positive attitude towards organ donation and more than 87% were prepared to donate their organs after death.16
A study was conducted to examine undergraduate nursing students' attitudes towards organ donation and to determine whether or not attitudes were related to the student’s education and training. Of the 378 students contacted, 183 (48%) completed all survey questions; 140 were females (76.5%) and the mean age of students was 25. The median score of students' attitude scores towards organ donation was 151 (the attitude is positive when the score is higher than 161). No significant correlations were found to exist between organ-donation attitude and sex, age, clinical practice in hospitals with a transplant unit, nursing care to patients waiting for a transplant or dialysis patients. Only 16% of the students had previously signed a donor card consenting to their own organ donation. The study revealed that doubts about transplantable organs still exist within the student body.
A study was conducted to know the awareness, attitudes, and beliefs among the medical postgraduate students. A total of 123 post-graduates of a medical college hospital in South India participated in the study. A specially de-signed questionnaire was used in assessment. Data were statistically analyzed using SPSS Windows version 10.0. The mean age of the postgraduate students was 28.32 ± 3.5 years, 54% were males, 62% belonged to Christian religion, 69% were single, 77% were from nuclear families, 87% had urban background, and 54% were from upper socio-economic strata. About 97% said they were aware of organ donation through media, 23 understood the concept of "cadaver" as "brain-death" and 93% were able to distinguish between brain-death and persistent vegetative state. Eighty-nine percent wished to donate their organs, 77% did not believe in body disfigurement and 87% did not believe in rebirth without the donated organs, if they pledged their organs. Sixty-nine percent were willing to donate the organs of their family members. Eighty percent were willing to receive organs from family and cadaver, 40% were willing to donate a child's organs, 95% did not believe that organ donation is against their religion, 87% disagreed with the notion that doctors would not impart adequate care if they were pledged organ donors and 79% agreed that doctors would not declare death prematurely, if they had pledged their organs during life10.