Knowledge and attitude regarding organ donation among relatives of patients admitted in ICU

Context: In India rate of organ donation is low. It is attribute to lack of awareness and myths and misconceptions regarding organ donation. Knowledge and attitude of family members and relatives have a critical role in increasing percentage of organ donation. Aims: To assess the knowledge and attitude regarding organ donation among relatives of patients admitted in ICU (Intensive care unit). 1) To find out factors affecting the relatives’ decision regarding organ donation. Settings and Design: It was cross sectional study carried out among 180 relatives of patients admitted in ICU. Methods and Material: Data was collected through face to face interview based on a structured, pre-tested (piloted) questionnaire. Statistical analysis used: Data analysis was done using SPSS software version 20. Results: It was found that 81.1% participants had good knowledge and 72.8% had appropriate attitude towards organ donation. Majority, 114 (63.3%) were willing to donate organs in future. 106(58.9%) pledged to donate their organs after death. About 82% had good knowledge regarding organ donation which was reflected in the attitude and found to be statistically significant. There was significant association between education of participants with their knowledge. Conclusions: The reasons for unwillingness should be looked into more carefully and awareness campaigns should be planned to increase acceptability of organ donation.


Introduction
Organ transplantation has become an accepted medical treatment for end-stage organ failure.In India, there is a great need for human organs as there is critical shortage of the same for transplantation.The total number of brain deaths due to accidents is nearly 1.5 lakhs annually.
Other causes of brain death such as sub-arachnoids' haemorrhage and brain tumours would potentially add more numbers.There is a need of 2 lakh kidneys, 50,000 hearts and 50,000 livers for transplantation every year [1].In India rate of organ donation in India is less (0.34 per 100 000 population) compared to developed countries [2].
There is shortage for organ donation despite of education and motivation of general public about organ donation [3].Although organ transplantation has brought new horizons of hope to save patients life, it is associated with a variety of cultural, ethical, and religion-related barriers [4].
It is mainly due to lack of awareness and myths and misconceptions regarding organ donation [5].

Materials and Methods
It was a cross-sectional study conducted among relatives of patients admitted in ICU.A sample size of 180 was calculated assuming a prevalence of 50% for knowledge and attitudes of organ donation, and a sample error of 15%.
Age above 18 years and those relatives of stable patientswho were willing to take part in study were included.
Those who refused to give consent and were unable tocommunicate were excluded.Institutional Ethical Committee approval was obtained.
After taking informed consent from participants, the aim of study was stated and questionnaire was explained and the respondents were assured that their confidentiality would be maintained.Outcome: In the present study, the knowledge and attitude of patients' relatives regarding organ donation was evaluated.
11 questions are related to knowledge and a score between 0 to 11 were given based on the level of knowledge.Each true answer was givenscore 1.
Those with score of 6 and above were considered as having good knowledge and below 6 as poor knowledge.Similarly, attitude level had a score between 0-7.
Those with score of 4 and above were considered as appropriate and below 4 as inappropriate.

Statistical analysis: Statistical analysis was done
using SPSS software version 20.
After presenting descriptive analysis of data, Chisquare and Fisher tests were performed to assess the relation between demographic variables and the level of knowledge and attitude.

Results
study was among relatives of patients.There were total 180 participants.The socio-demographic details of the participants are shown in Majority 114 (63.3%) were willing to donate organs in future.Very few participants, discussed their wish to be an organ donor with member of their family.About 118(80.82%)had good knowledge regarding organ donation which was reflected in the attitude and found to be statistically significant (p<0.001).
Major reason for consenting organ donation given by the participants was that they wished to help others 149(82.77%).

Discussion
In India, the demand for for transplantation exceeds the supply.We found out that 99(83.19%)males had good knowledge, whereas only 38 females (62.30%) had good knowledge.One of the Iran studies found that 62.0% of participants had appropriate attitude to organ donation and 34.2% of them were well informed about [17].
In the present study only about (1.7%) of the participants had donor card which was similar to the study conducted by Annadurai K. [12].Though study participants have good knowledge and attitude towards organ donation it is not reflected in their practice as very few of them have donor card.

Conclusion
The study showed that considerable amount of people had good knowledge appropriate attitude about organ donation.It was also found good knowledge among the participants regarding organ donation was reflected in their attitude.
There is need to address issues regarding organ donation through mass media campaigns which is the major source of information about organ donation.The reasons for refusal should be assessed for the success of organ donation.

Recommendation:
As ICU patients are potential organ donors, information about significance of organ donation should be made available to them as they are part of decision-making team.
Knowledge and attitude of family members have a critical role in increasing percentage of organ donation.Previous studies of the factors influencing decisions to become an organ donor have also highlighted the importance of knowledge, values, attitudes and social norms towards donation[6].The study findings will indicate current status of knowledge and deficits if any, concerns or misconceptions among relatives in regards to organ donation.ICU might provide a more ideal environment for organ donation related tasks and it will be first point of contact for donor families in the initial process of organ donation.Early identification of the potential organ donation may facilitate timely referral, which can be crucial in rapidly deteriorating patients.Identifying the factors affecting relatives' decision, and making this information available to intensive care clinicians and transplant professionals, might have a greater and more immediate effect than any legislation.Healthcare professionals play a key role in identifying potential donor and if they do not identify then the process of organ donation will not progress unless family member knows about patient's wish of organ donation.Therefore, present study was conducted to evaluate knowledge and attitude regarding organ donation among relatives of ICU patients and to find out factors affecting the relatives' decision regarding organ donation Data was collected through face to face interview based on a structured, pre-tested (piloted) questionnaire.The tool was designed based on literature review [7-14].The questionnaire consisted of structured questions with two sections: Section A: This section included demographic information such as age, gender,education, occupation, monthly family income etc.Section B: Structured Questionnaire about basic Knowledge, and Attitudestoward Organ Donation among study participants.Knowledge of the respondents was assessed through questions regarding familiarity of the term "organ donation", awareness of donation from living people as well as cadavers, name of organs which can be donated, awareness about laws, national registers, consent for organ donation and the sources of information for their knowledge.Attitudes of the respondents was determined through questions consisting their opinions regarding organ donation such as the willingness to donate organs in the future and factors affecting the relatives' decision regarding organ donation.Each participant was interviewed individually in local Patil S.V. et al: Knowledge and attitude regarding organ Public Health Review -International Journal of Public Health Research 2019;6(3) Language; total time consumed by each participant was approximately 10-15 minutes.Data was collected over a period of 3 months April to June 2017.

et al: Knowledge and attitude regarding organ Public Health Review -International Journal of Public Health Research 2019;6(3) Table-3: Relation Between attitude and socio- demographic factors.
Distribution according to the attitude regarding organ donation is shown in table: 5.