https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/89 Mon, 26 Sep 2016 09:18:16 +0000 Abstract Background and objectives: In Kuwait, information regarding public knowledge and attitudes towards organ donation are scanty. This study aimed to evaluate public knowledge and attitude regarding organ donation and determine factors which predict them. Methods: This cross-sectional study was conducted among 630 participants recruited from 27 randomly selected public cooperative societies and private supermarkets in Kuwait. A self-administered questionnaire was used to collect data. Results: The prevalence rate of knowledge about organ donation was 68%, with a significantly higher rate among females than males (73% vs. 63%, respectively, p = 0.01). A composite score of knowledge was also higher among females than males (8.4 ± 5.8 vs. 6.8 ± 5.8, respectively, p = 0.001). In multivariate analysis, female gender (OR = 1.7; 95% CI =1.2, 2.4) and an educational level of bachelor’s degree or higher (OR = 2.6, 95% CI = 1.7, 3.9) were significant predictors of the knowledge. Among the barriers, more females than males mentioned about the fear of the operative procedures (p<0.001) and complications after the surgery (p = 0.011). Overall, 73% accepted the idea of organ donation during life, and 67% actually opted for donating their organs during life. However, almost everybody wanted to donate organs to their relatives. Conclusion: The study identified factors predicting knowledge and attitude regarding organ donation. The results will help in planning how to improve the rate of donors in Kuwait. IMC J Med Sci 2016; 10(1): 01-09. DOI: https://doi.org/10.3329/imcjms.v10i1.31099 Address for Correspondence: Prof. Amal K. Mitra, Professor of Public Health, Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait. E-mail: amalmitra16@yahoo.com   Introduction Many people around the world with end-stage organ failure are dying while on waiting lists for transplant surgery [1]. In 2012, 114,690 solid organs were reported to be transplanted globally, making a 1.8 % increase over the year 2011. Stillless than 10% of the global needs are met with the available donors. According to the Global Observatory on Donation and Transplantation (GODT), in 2012, the rate of organ donation in Spain was the highest worldwide, almost 35 deceased donors per one million, whereas, it was almost 26 deceased donors per one million persons in the United States, and 18 per one million in the United Kingdoms [2]. In Kuwait, the rate of organ donation is relatively low – only 6 deceased donors per one million persons, putting Kuwait well behind the US and Europe in this area. Between year 1996 and 2012 there were only 447 donations of kidneys, liver, pancreas, and heart [3]. A medical team in Al-Hamad Al-Essa Organ Transplant Center in Kuwait has performed 1,036 kidney transplant procedures from the period between November 1993 to December 2010, of which 278 were from brain death cases, 397 from relatives, and 361 from non-relative living donors. This makes the total number of kidney transplant procedures in Kuwait to be 1,596 procedures from the initiation of the program in Kuwait in February 1979 to January 2011 [3]. Still until October 2015, only 6,000 people in total in the country offering to donate their organs once they pass away through registration for organ donation card [4]. Several socio-cultural factors may influence attitudes of public towards organ donation. In a study conducted in late 2003 among Greater Detroit Arab Americans found Christian Arab Americans more likely than Muslim Arab Americans to believe organ donation after death being justifiable. Higher educational attainment and income, as well as greater acculturation into American society, were associated with greater odds of believing organ donation to be justified [5]. Regarding people’s awareness about organ donation, a national study was conducted in China which showed that nearly 94% of the people in China were aware of organ donation. However, only 19% of this sample population actually carried organ donation cards [6]. In Saudi Arabia, shortage of organ donation remains a major limiting factor for transplantation [7]. To evaluate factors affecting the knowledge and/or attitudes towards organ donation, a cross-sectional study conducted in Saudi Arabia showed that about 40% of respondents accepted the concept of organ donation after their death, hile 16% disagreed. When asked about possible reasons for organ donation refusal, 28% cited religious reasons and 23% did not want to have their bodies dissected after death [8]. Another study in Qatar revealed that about one-third of Qataris and more than onequarter of non-Qataris had no idea about the organ donation. The majority of the people in Qatar preferred donating organs to their close relatives and friends only [9]. Studies have suggested that knowledge and attitudes towards organ donation are influenced by factors such as gender, educational level, occupation, socio-demographic status, income level, culture, and religion [10]. Some of the barriers that may prevent people from donating organs include: fear of surgical and health risks, lack of knowledge, respect for cultural norms, financial loss, distrust in hospitals, and avoiding recipient indebtedness [11-12]. Studies have suggested that providing the general public by relevant information and correcting some of the misconceptions are likely to increase the number of individuals willing to donate organs [7]. In Kuwait, data regarding public knowledge and attitudes towards organ donation are scanty. Therefore, this study attempted to evaluate the knowledge and attitudes of people regarding organ donation.   Methods Study subjects The study was carried out among the general population in the city of Kuwait from December 2013 to January 2014. A list of 87 cooperative societies and private supermarkets were obtained from the Ministry of Commerce and Industry in Kuwait. Twenty-seven cooperative societies and private supermarkets were chosen by stratified random selection, using the administrative governorates as the strata. Cooperative Societies were chosen in the study for data collection since these are the main places where both expatriates and citizens from different socioeconomic backgrounds purchase their daily food supply and goods, making our sample most representative to the Kuwaiti population.   Ethical approval The study was approved by the Ethics Committees at the Health Sciences Center of Kuwait University. The approvals were then obtained from the head of all cooperative societies and the manager of each private supermarket. An informed consent was obtained from the participants before enrollment.   Data collection After reviewing published literature, a questionnaire was generated in both Arabic and English. The questionnaire consisting of 33 items was self-administered. Of them, 11 items assessed demographics, 12 items measured knowledge, and 10 items assessed attitude and willingness regarding organ donation. For each correct answer of the knowledge questions, a score of 1 was given. Regarding attitude, participants were asked if they are willing to donate, and if yes, which organs they are willing to donate and to whom (e.g. relative, friend, and/or anybody) during and/or after life. In addition, opinions about the barriers against organ donation and the best ways to promote organ donation were evaluated. The questionnaire was pre-tested among 20 persons recruited from the same population. Then modifications were made for clarity, simplicity and validity of the questionnaire. Two items were deleted for potential inconsistency in data. A convenience sample, on first-come, first-serve basis, was obtained in two shifts, morning from 9 am to 12 pm, and evening from 4 pm to 7 pm. The eligible participants were both females and males aged 18 years and above. People who could not read or write Arabic or English were excluded.   Sample size estimation Based on the published reports from Gulf region [9], the proportion of people with lack of knowledge regarding organ donation was 30%. In another study in China [6], 10% of the people had lack of knowledge about organ donation. In this study, the proportion of people with lack of knowledge about organ donation was considered to be not less than 10% (P1 = 0.10). To estimate the true proportion of the characteristics within 5% (P2= 0.15), and the power of the study being 95%, the required sample size was 562. Assuming a 10% dropout, the total sample size was 618. The sample size was estimated using the G-power program.   Statistical analysis Data analysis was done using SPSS for Windows software version 22 (SPSS Inc., Chicago, USA). Descriptive analysis was done to know the distribution of the data. For knowledge questions with known standard answers (e.g., organs to donate during life and after death) as obtained from the U.S Department of Health and Human Services (2013) [11], a scoring system was used by assigning one point for each correct answer. Mean values of knowledge scores were compared between people of either gender, nationality, marital status and education levels. Chi-square test was done for comparing categorical variables, and student t-test for continuous variables with normal distribution. Analysis of variance (ANOVA) was used to compare mean values of more than two groups. For data with non-normal distribution (e.g., knowledge scores), Mann Whitney U and Kruskal Wallis Test were used to compare mean values for two and more than two independent variables, respectively. A p-value of 0.05 was considered as statistically significant.   Results Demographics In total, 710 participants were handed out the questionnaire; 80 (11%) were dropped from this analysis due to missing data for major variables. However, those who dropped out did not differ from those who were remained in terms of demographic variables. Of the remaining 630 participants, 51.2% were females and 47.9% were males. Mean age (SD) of the participants was 33.4 (11.5) years, ranging from 18 to 76 years. Kuwaitis represented majority (66%) of the study population.   Knowledge about Organ Donation Table 1 shows that 68.3% (430/630) of the respondents knew about organ donation. Of those who knew about organ donation, 80.6% heard it from radio/television/internet as being their primary source of information, and 53.2% chose newspapers and magazines as their source of information. Only 27.7% of the respondents heard about organ donation card. A vast majority (71.1%) agreed that organ donation is possible in both during life and after death.   Table-1: Knowledge about organ donation and sources of information   Variable Male n = 302 Female n = 328 P-value All n = 630 Know about organ donation (%) 191 (63.2) 239 (72.9) 0.01a 430 (68.3) When can a person donate an organ     0.62a       During life 21/192 (10.9) 24/244 (9.8)   45/436 (10.3)     After death 39/192 (20.3) 42/244 (17.2)   81/436 (18.6)     Both 132/192 (68.8) 178/244 (73.0)   310/436 (71.1) Knowledge score             What organs a person can donate     during life (out of 8) 2.29 ± 2.08 2.79 ± 2.09 0.003b 2.55 ± 2.10     What organs a person can donate     after death (out of 8) 2.70 ± 2.84 3.40 ± 2.80 0.002b 3.07 ± 2.84     Who can donate an organ (out of 4) 1.84 ± 1.59 2.17 ± 1.56 0.007b 2.01 ± 1.58     Total score (out of 20) 6.83 ± 5.83 8.36 ± 5.82 0.001b 7.63 ± 5.87   aChi-Square Test; bMann-Whitney U Tes   Relation between Formal Education and Knowledge In terms of education, mean knowledge scores of organ donation increased linearly with higher levels of education (Figure 1). The people with a post-high school diploma showed a higher mean knowledgeable score about organ donation when compared with those with a high-school or less education, although data were not significant. Similarly, those who have had a bachelor degree or higher education showed a statistically significant higher knowledge score for organ donation compared to those who have had less than a bachelor degree education (p < 0.001). Fig.1:Knowledge scores for organ dontion by educational status of participants. Participants with bachelor’s degree or higher educational status had significantly more knowledge scores compared to the other levels of educationMultivariate Analysis to Predict Knowledge about   Organ Donation In logistic regression analysis (Table 3), female gender (OR = 1.7; 95% CI =1.2, 2.4), and an educational level of bachelor’s degree or higher (OR = 2.6, 95% CI = 1.7, 3.9) were significant predictors of those who had knowledge about organ donation. Those variables were selected based on significant associations observed in univariate analysis. The variables which were controlled for included location of residence (governorate), nationality, religion, family income, parents’ education, and occupation. Table-3:Logistic regression analysis to predict knowledge about organ donation   Variable Odds ratio 95% Confidence Intervals P value Age group       18-25 y Reference     26-45 y 1.03 0.62, 1.72 0.91 ≥ 46 y 1.98 0.97, 4.01 0.06 Gender       Male Reference       Female 1.68 1.16, 2.42 0.006 Nationality       Kuwaiti Reference     Non-Kuwaiti 1.38 0.94, 2.04 0.11 Marital status       Single Reference     Married 1.39 0.86, 2.24 0.18 Widowed or Divorced 3.58 1.09, 11.80 0.036 Education level       High school or less Reference     Post high school diploma 1.50 0.94, 2.40 0.09 Bachelor’s degree or higher 2.59 1.72, 3.89 <0.001  Attitudes about Organ Donation by Gender Table 4 shows that about 73% of the study participants opined favorably for organ donation during life. When asked if they are willing to donate his/her organs during life, 67% responded positively. A vast majority of them (98%) were willing to donate an organ for their family members, whereas 68% mentioned it for their friends, and only 37% mentioned that they would donate it for anybody. No differences were observed in the attitudes towards organ donation by gender.   Table-4:Comparison of attitudes about organ donation by gender   2026 Ibrahim Medical College. All rights reserved.