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Romanian Journal of Bioethics, Vol. 9, No. 3, July - September 2011
ORGAN DONATION AND
TRANSPLANTATION: WHAT DO THE
UPCOMING MEDICAL DOCTORS THINK
ABOUT?
Jung Harald*, Egyed - Zsigmond Emeric**, Hecser László*
Siklodi Palfi Katalin***, Csiki Gabor*, Klara Brînzaniuc**
Abstract
A majority of Europeans are willing to donate their organs after death; however there are
differences among countries in the European Union. In Romania willingness to donate is low in
the general population (31% in 2009), therefore educational strategies are necessary. Health
care professionals should be primary information providers for the public. For this reason, we
investigated the attitude of medical students towards organ donation and transplantation. From
a total of 247 interviewed students, 81.8% were positive about donating own organs, while
65.5% were in favor of donating an organ of a close person, with a significant difference
between preclinical years of study and final year (60% vs. 72%). Female students are more
inclined to discuss about the topic of transplantation and organ donation, while married students
manifest higher hesitation when deciding to donate a close person’s organ. Communication and
emotional approach are keys of educational strategies in changing people’s behavior with
regard to donation after death.
Keywords: organ donation, medical students, education, communication.
1. Introduction transplantation [2, 4, 15, 20]. The number
The primary ethical dilemmas of donated organs has remained fairly
surrounding organ transplantation arise constant over the last few years while the
from the confrontation of two values: an number of people needing organs
individual one, corporal integrity and continues to increase. Many explanations
social one, human solidarity, respectively are offered to explain the length of the
from the shortage of organs available for list – such as the number of new medical
*
UMF Tg-Mure , Institute of Legal Medicine Tg. Mure , Romania, e-mail: harald_999@yahoo.com
**
UMF Tg-Mure , Romania
***
Institute of Legal Medicine Tg. Mure , Romania
91
technological advances, the aging knowledge of people and inducing
population, the traffic safety measures positive attitudes towards organ
(airbag technology, more secure transplantation.
vehicles) that determine a lower number Some educational efforts focus on
of fatal car accidents. Nevertheless, the increasing the number of people who
consent to donate organs remains a consent to be organ donors before they
central issue in this process of looking die. Other educational efforts focus on
for more donors. Currently in Romania, educating families when they consider
once a person dies, his or her organs may giving consent for their deceased loved
be donated if the person consented to do one’s organs. In Georgia the educational
so before he/she passed away. A person’s model was designed to raise the
consent to donate his/her organs is made awareness on organ donation by
while still alive, in an advance directive encouraging physicians to participate in
(a small number of people currently in patient discussions about the ABC'S of
Romania). If the deceased person’s Organ Donation and Prevention; it has
wishes are unknown a family member been proven to be an effective protocol
must approve the organ removal – with a positive impact on organ donation
informed consent; in this case donation awareness [8].
rate highly depends on the success or In China, blood donors among
failure of the family interview and here university students have a greater
communication comes into much knowledge of transplantation and a more
attention. Many European countries positive attitude towards organ
switched to presumed consent or mixed donation[3].
systems, allowing organ retrieval if the In a study conducted in Italy medical
deceased did not “opt out” during his or students also showed a positive attitude
her lifetime. to organ donation (96% vs. 91%, fourth
We think that the conduct of medical vs first year), most of them were
students related to organ donation is prepared to donate their organs after
important for further dissemination of a death (88% vs. 87%) and 63% of the
positive attitude towards transplantation fourth year students signed a donor
among other people. card[1].
2. Objectives 3. Material and methods
The aim of our study was to evaluate We interviewed a group of 247
willingness to donate organs after death, medical students from the University of
attitudes and behavior related to organ Medicine in Tîrgu Mure , Romania, of
donation among students in the last year which 130 in the second and third year of
of study from the University of Medicine study (preclinical) and 117 in the sixth
and Pharmacy in Tîrgu Mure . We (last) year of study. All students were
compared the assessed items to those enrolled at the general medicine
obtained based on the Eurobarometer specialization within the Faculty of
questionnaire applied to the general Medicine. We used a stratified sampling
population of Romania and to the other method, the final year students being
European countries, in order to see if represented by the series of students
shortly becoming health care leraning legal medicine during a semester
professionals might be a leading (50% of all students) while for preclinical
educational force for improving students we randomly selected the groups
92
of the first series for each year of study response rate being 100%.
and their members (40.6% for each Our group was formed by 79 (32.0%)
series). We followed the items male and 168 (68.0%) female
investigated in the Special participants. Age ranged between 19 and
Eurobarometer 333 “Europeans and 34 years, average age was 22 years, with
organ donation” (2009) [16], in order to median 22 years and modal value 20
compare the collected data. years. The quartile investigation showed
Consequently, we asked for: that 50% of the students were between 20
Age of the participants – 24 years old. 49 of the total number of
Area of permanent residence students have their permanent residence
Marital status in rural areas (19.8%) and 198 in urban
Religion areas (80.2%). Marital status of the
Number of family members respondents was: in the preclinical group
(family of origin) all students were single (100%) and 6
Family discussions about organ (4.6%) declared they lived with a partner;
donation in the last year of study 15 were married
(12.8%), 16 living with a partner
Willingness to donate one of own
(13.7%), 64 single (54.7%), 19 (16.2%)
organs after death
single persons who lived in the past with
Willingness to donate the organ of
a partner, 2 other situations (affianced).
a close family member
The religion of the respondents was
Support for the use of organ
orthodox (29.6%), catholic (31,2% - no
donation cards
difference between Greek-Catholic and
The completed questionnaires were
Roman-Catholic was assessed),
entered in electronic form and statistical
Protestant (33.5%), Neo-protestant
results were produced. We represented
(4.0%); 4 students declared they were
the results in tables, and compared them
atheists (1.6%).
with those obtained for the general
To the question E01 “Have you ever
population by Eurobarometer
discussed about human organ
investigation. For statistical relevance we
transplantation or donation with your
used chi-square and binomial test at
family or friends?” we received the
significance value of p< 0.05 [13].
responses presented in table 1 (medical
students compared to Eurobarometer-
Results EB).
All the 247 students asked for opinion
poll accepted to complete the survey, the
Table no. 1 Family discussions about transplantation
Question Preclinical Sixth year Medical students Romania EU EU
E01 students students TOTAL 2009 students
YES 62.3% 56% 59.5% 22% 40% 36%
NO 37.7% 43% 40.5% 76% 59% 64%
We found significant differences discussed about organ donation or
between the responses of males and transplantation with their family, whereas
females to the question E01: 36 male the number and percentage of female
students (32% of the total males) students who did it was much higher: 111
93
(66.1%), the result is statistically and transplantation. The apparently
significant (p < 0.01). In respect to major higher percentage of affirmative answers
religions, the percentage of positive among preclinical students is also not
answers to E01 was: Orthodox – 71.2%, significant (p = 0.30).
Catholics – 57.1%, Protestants – 52.8%. To the question E03 “Would you be
The calculated p value is at the limit of willing to donate one of your organs to
the statistical significance level selected an organ donation service immediately
for rejection of null hypothesis (p = after your death?” we obtained the
0.05), therefore we cannot state a answers shown in table 2, compared with
Religion-based difference between EB.
family discussions about organ donation
Table 2 Willingness to donate own organs
Question Preclinical Sixth year Medical students Romania EU EU
E03 students students TOTAL 2009 students
YES 80.8% 83% 81.8% 31% 55% 60%
NO 3.8% 3% 3.6% 40% 27% 22%
I DON’T 15.4% 14% 14.6% 29% 18% 18%
KNOW
We notice the high percentage of sex, residence area or religion of students
positive responses of the Romanian (p > 0.05). Sixth year students and
medical students, exceeding not only the preclinical students had very close
“yes” percentage in the Romanian percentages of affirmative answers (83%
general population but also the EU vs. 80.8%, p>0.05)
average and the average of the persons of The answers to the question E04 “If
same age and comparable occupational you were asked in a hospital to donate an
status (students) in the EU. We found no organ from a deceased close family
significant differences regarding the member, would you agree?” are
answers to this question depending on represented in table 3.
Table 3 Willingness to donate an organ of a close person
Question Preclinical Sixth year Medical students Romania EU EU
E04 students students TOTAL 2009 students
YES 60% 72% 65.6% 34% 53% 53%
NO 7% 3% 5.3% 35% 25% 23%
I DON’T 33% 25% 29.1% 31% 22% 24%
KNOW
No significant differences were influences the way of thinking and thus
noticed between sexes, religions and the decision of donating an organ of a
residence area, but we found a high close person. Another characteristic is the
proportion of negative or hesitating higher affirmative response percentage
responses among married students (6 out among the final (sixth) year of study
of 15 = 40%) compared to single students compared to those of the students from
(25 out of 99 = 25.2%); statistical chi- second and third year of study (72% vs.
square test reveals a p value of 0.01. 60%), the difference is statistically
Marriage seems to be a factor that significant (p<0.05).
94
The support for the use of organ identification of persons willing to
donation cards was assessed using the donate their organs after death?” the
question E06a: “Do you support the idea answers are represented in table 4.
of using donor cards for an easier
Table 4 Support for a donor card system
Question Preclinical Sixth year Medical students Romania EU 25
E06a students students TOTAL 2006 (2006)
YES 81.5% 83% 82.2% 49% 81%
NO 3.8% 3% 3.6% 51% 19%
I DON’T 14.6% 14% 14.2% --- ---
KNOW
The question E06b was reformulated natural consequence of a culture based on
compared to the one in EB (“Do you self-denial [2, 14].
have an organ donation card”), namely it The shortage of organ donations is a
was completed with: “or did you make an major limiting factor in transplant
official written option (family physician, programs, especially in the case of
notary, transplant register) with your children and teenagers with heart
position regarding your organ donation pathology [7]. In 2006 about 1300
after death?”, because of the absence of persons were on the waiting list for
such cards in nowadays Romania. The transplantation [10]. Since a favourable
answer was negative anyway, in all 247 attitude of health professionals to organ
(100%) cases. donation can positively influence the
decision of families of potential donors,
5. Discussions the education of physicians in the first
Organ and tissue transplantation years of their careers may become crucial
started in Romania in 1980, when the in this setting [1]. Social responsibility
first renal transplant was performed; and the idea of “the gift of life” are
since 1992 organ transplantation has popularized by organizations that seek to
become a more and more available promote the idea of cadaveric organ
medical procedure; after 1998 over 800 donation. Healthcare professionals’
renal transplantations, 40 liver training was the aim of the European
transplantations and 20 heart Program - ETPOD [12].
transplantations have been performed A majority of Europeans are willing
[10]. The progress of medical science to donate their organs after their death.
was accompanied by reluctant and Citizens in Northern European countries
anxious opinions in the belletristic are more likely to envisage donating an
literature generated by the idea that organ organ. At the other end of the scale, the
transplantation could jeopardize the most reluctant citizens are almost all
identity of the receiver body itself, from the Eastern European countries,
transforming him or her into somebody Romania having the lowest willingness
else, and of the donor as well [11]. On rate, although there is a tendency of
the other hand, the Orthodox Churches increase (27%, in 2006, 31% in
released documents and supported organ 2009)[18, 19]. Our study proves that
transplantation with the motivation of Romanian medical students (limited to
spiritual benefit for the donor, as a our sample from the Medical University
95
in Tîrgu Mure ) are at the opposite side, life whether they are willing or not to
because 81.8% of them are willing to become an organ donor after death. This
donate their own organ; this percentage is resulted in nearly 4.7 million
much higher compared to EU average registrations, of which 55% consented.
(55%), but also to the average of This result is generally considered to be
European (not only medical) students too low for a successful increase in donor
(60%). The fact that female students organ recruitment [17].
turned out to discuss more frequently
about transplantation to their family 6. Conclusions
could mean a higher inclination towards It is important to raise the public’s
communication and this skill might be general willingness to donate and
useful in future educational approaches. upcoming doctors might play a key
However, no differences between males educational role as first strategy to
and females were observed regarding the increase organ donation after death. The
attitude towards organ donation itself. ethical debate of informed vs. presumed
The positive attitude and behavior in consent is still open and education should
connection to transplantation seems to be help decision-making in informed
more a result of the medical education consent process.
(considered as a whole block); it has The medical students attending our
been demonstrated that donation University show a positive attitude
coursework prior to or during medical towards organ donation and
school was significantly associated with transplantation, willing both to donate
an increased knowledge of donation and their own organs and of a close person.
knowing where to find answers to Lower openness when it comes to a close
patients’ questions regarding donation[6]. person together with higher
A difference above 15% (in minus) of indecisiveness of married students
positive answers when it comes about suggests a strong emotional factor in
donating an organ of a close person, decision making about organ donation.
together with the higher percentage of The higher percentage of final year
undecided married students, indicate a students who accept organ donation from
strong emotional factor in making close relatives is an indicator of the
decisions (giving consent) about organ education role in developing positive
retrieval. The donation process is attitudes on this theme.
experienced by the entire family, Female students seem more
regardless of who signs the consent form. communicative when discussing about
At times, it is precisely the discussion the topic of transplantation, and they
about what is conflicting that will enable should form the target group when
the family decision [16]. developing an educational strategy.
Medical students support the idea of a
donor card system, however none of Acknowledgement: This paper is
them has made an official option by now partly supported by the Sectorial
neither for “opt in” nor for “opt out”. In Operational Programme Human
western European countries 12% Resources Development (SOP HRD),
(average) of the respondents to the EB financed from the European Social Fund
declared to have a donor card [19]. In the and by the Romanian Government under
Netherlands approximately 35% of the the contract number POSDRU 60782.
adult population have indicated during
96
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