Objective: To evaluate the impact of interventional “educational module” on knowledge and attitude regarding organ donation amongst resident doctors and nurses in the Institute of National Importance. Study Design: Interventional and prospective. Methods: We devised an interactive educational module covering various aspects of organ donation through a series of audiovisual lectures and information booklets. Resident doctors and nurses posted in those areas of the 1948-bedded Postgraduate Institute of Medical Education and Research (PGIMER), where head injury patients were treated and were subject to intervention using this module. The pre and postinterventional scores of their knowledge and attitude regarding organ donation were compared to find out impact of the intervention. Results: A total of 242 nurses and 87 resident doctors participated in this research. Higher knowledge score was observed preintervention amongst doctors as compared to nurses. Significant improvement was seen in total knowledge scores of both groups postintervention. Doctors had better scores for the “concept of organ donation,” while nurses were more familiar with “procedures and protocols.” Both had low knowledge about “clinical criteria for brain death” and “legal issues” preintervention which improved significantly postintervention. The positive impact of intervention was also observed on attitude in both categories. A significant impact of intervention was observed on overall propensity of doctors and nurses to promote organ donation, for pledging their own organs and for counseling of the patient/attendants on this cause. Conclusion: Scientifically designed educational modules have a promising role in improving awareness and attitude of health care professionals regarding organ donation and their propensity to be prospective donors, effective counselors, and advocates of organ donation. Keywords Transplantation, deceased organ donation, brain death, donor conversion rate, organ pledge, interventional study Introduction Organ transplantation, an exemplary achievement of modern Department of Hospital Administration, Postgraduate Institute of Medical health care, has marked a new era of medicine. Dr Francis L Education and Research (PGIMER), Chandigarh, India Delmonico said, “The work of organ donation is hard, but Department of Neurosurgery, PGIMER, Chandigarh, India measures the best of us in humanity….” This trending Transplant Coordinator, PGIMER, Chandigarh, India treatment modality across the globe for end-stage organ failure offers the most cost-effective alternative and ensures Corresponding author: tremendous improvement in the quality of life and its span Pranay Mahajan, Department of Hospital Administration, PGIMER, also. Organs and tissues from one donor can save lives of up Block-D, Ground Floor, Nehru Hospital, Chandigarh 160012, India. 2,3 E-mails: firstname.lastname@example.org; email@example.com to eight patients and help up to 50 others. Doctors have Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution- NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-Commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https:// us.sagepub.com/en-us/nam/open-access-at-sage). Mahajan et al. 243 successfully transplanted kidneys, heart, liver, intestines, in countries like India who practice the “Opt In” system for pancreas, lungs, thymus, ovaries, uterus, hand, face, penis, organ donation. Hence, this study was conceived to assess windpipe, cornea, skin, ligaments, tendons, bones, cartilages, their awareness level and attitude and then evaluate the heart valves, blood vessels, nerves, islet of langerhans cells, impact of educational intervention on awareness and 4–15 bone marrow, etc. However, a disparity between need and perception regarding organ donation amongst these resident availability of organs persists worldwide. Organs for this doctors and nurses. We intended to provide scientific evidence purpose need to be made available through donations by in favor of/against such interventional initiatives targeted living beings and cannot be synthesized artificially in toward health care professionals for improving their potential laboratories. For this reason, there is an acute shortage of of organ tapping from deceased donors. 16–20 organs for transplantation globally. Countries like Spain and USA have strategically achieved Methods cadaveric organ donation rates as high as 48.9 and 36.88 per 21,22 million population (pmp), respectively, in the year 2019. This was an interventional study conducted over a period of India, on the contrary, even after being second most populous six months in PGIMER, which is one of the largest tertiary country of the world with about every sixth person on this health care and research institutes of the northern part of earth being an Indian, is struggling hard to tap its potential of country and handles a large number of head injury patients in cadaveric organ donations with a donation rate of meager its 100-bedded Advanced Trauma Center (ATC) and parts of 0.65 pmp in 2019. It stood at 64th rank amongst 70 countries 900-bedded Nehru Hospital. Patients with head injury are whose cadaveric organ donation statistics were reported to most prone to brain death and constitute major proportion of International Registry in Organ Donation and Transplantation 21 potential organ donors. Hence, all areas receiving head injury (IRODaT). To quantify the need, an estimated 1,80,000 patients in these centers were included in the study. Staff kidneys, 30,000 livers, 50,000 hearts, and 1,00,000 cornea nurses and resident doctors posted in the study areas are required for transplantation annually in India. However, constituted study population. All resident doctors (from only around 6000 kidneys, 1200 livers, 15 hearts and 40,000 departments dealing with such patients namely neurosurgery, corneas are actually transplanted. Compared to the number general surgery, orthopedics, anesthesia, and internal of brain deaths, number of donations is abysmally low in the medicine) and all nursing staff posted in the study area were country. Post Graduate Institute of Medical Education and invited, as all of them were expected to come in contact with Research (PGIMER) is a tertiary health care and research such patients invariably while being posted in these areas. institute with leading organ donation program amongst public-sector hospitals of the country. Based on “Imminent Approval from the Institutional Ethics Committee and 24,25 brain death-Glasgow Coma Score (IBD-GCS)” criteria, informed consent of each participant were obtained. 120 patients were reported as potential organ donors by Two study tools were used: (a) a semi-structured self- treating clinicians in the institute in the year 2019. However, administered “questionnaire,” prepared by referring similar 27–31 consent for organ donation was provided by 41 families, out studies, as “assessment tool” to assess the level of of which actual donation could be achieved only in 31 cases, knowledge and attitude regarding organ donation amongst thus a donor conversion rate of 25.8% only (hospital data). study population pre and postintervention and (b) an Treating doctors and nurses are those health care “educational module” as the “interventional tool” consisting of professionals who are in closest contact with patient and an information booklet and educational lectures. The relatives and are considered to influence their thoughts about questionnaire consisted of 53 questions of different kinds, organ donation the most, and thus are in an advantageous namely dichotomous (24 items), multiple choice (six items), position to motivate relatives of patient for organ donation. Likert scale based (11 items), and unstructured questions (one Their own awareness, skills, and attitude about organ donation item), collecting demographic details, awareness/knowledge make all the difference in this motivation. Earlier studies in (34 items), and attitude (18 items) related data of the the institute showed overall high level of awareness regarding participants. Questions were designed to judge knowledge organ donation amongst these health care professionals. under four parameters, namely (a) concepts of organ donation, However, information regarding certain practical aspects (b) procedures and protocols being followed at PGIMER, (c) such as brain death, legislation, and protocols was lacking, clinical criteria for brain death, and (d) legal issues. Attitude which led to confusion and loss of interest to perform. They was assessed on four parameters, namely (a) willingness for have expressed the need for more information to be provided organ donation, (b) negative beliefs regarding organ donation, regarding the same. Although their attitude was favorable, the (c) positive beliefs regarding organ donation, and (d) propensity reason of avoiding hassles impoverished their intent to get for promoting organ donation. Two separate printed information 26,27 involved in this process. An improvement in their booklets as well as educational lectures supplemented with awareness level and attitude is supposed to bring about a PowerPoint presentation were designed for resident doctors positive change in their motivating capacity and willingness, and nurses containing relevant content suiting the two groups. thereby increasing donor conversion rate, especially needed Educational module covered five domains namely introduction 244 Annals of Neurosciences 27(3-4) to organ donation, its legal aspects, concept of brain death, manner to demonstrate the impact of intervention on organ donation process in PGIMER, and roles and knowledge and attitudes of these doctors and nurses. responsibilities of transplant coordinators. An in-house training program of 1 h 45 min duration was Results devised. Each participant was given a preintervention questionnaire (to be filled in 30 min), followed by an A total of 242 nurses and 87 resident doctors participated in educational lecture (45 min) and an interactive session of 30 the study. Their demographic details have been depicted in min. Information booklets were distributed in the last, and Table 1. Gender representation was converse between the two organ pledging forms were also offered. All were given a sections, 76.4% nurses being females, while 82.8% doctors week’s time to go through the information booklet after which being males. Amongst nurses, about two-third (62.8%) were they were subjected to the postintervention questionnaire. posted in surgical interventional areas and one-third (37.2%) Data from pre and postintervention questionnaires was in medical areas, while doctors were almost equally compiled and analyzed using Microsoft Excel and SPSS 20 distributed (51.7% and 48.3%, respectively). Majority of software, respectively. Normality of the data was checked nurses 96.7% were from the nonadministrative cadres (grades using Shipora–Wilk test. Mean values ± standard deviations I and II) who were responsible for the direct management of were used to present measurement data, while categorical patients. There was equal representation of junior and senior data being summarized as counts and percentage. Wilcoxon resident doctors amongst participants. More than two-third signed-ranks test and Mann–Whitney U test were used as the (67.4%) nurses were at least graduate and one-third (36.8%) test of significance. Chi-square test was used to analyze residents had completed their postgraduation. Two-third qualitative data. All the tests were two sided, and the level of nurses (62.8%) had more than three years’ experience of α = 0.05 was taken as significant. Results were compiled in a Table 1. Demographic Distribution of Participating Nurses and Resident Doctors Nurses Doctors Demographic Variable Category N* Frequency (%) N Frequency (%) Male 57 (23.6) 72 (82.8) Sex 242 87 Female 185 (76.4) 15 (17.2) Medical departments 90 (37.2) 45 (51.7) Departments grouped 240 87 Surgical departments 150 (62.0) 42 (48.3) Administrative cadre (DNS Junior Resi- 7 (02.9) 43 (49.4) + ANS) dent Designation 241 87 Grade I 32 (13.2) Senior Resi- 44 (50.6) dent Grade II 202 (83.5) Pursuing Diploma 79 (32.6) 55 (63.2) MD/MS Qualification 242 87 Graduate 148 (61.2) Pursuing DM/ 32 (36.8) MCh Postgraduate 15 (06.2) < 1 year 48 (19.8) 22 (25.3) 1–2 year 13 (5.4) 38 (43.7) 2–3 year 29 (12) 18 (20.7) Experience 242 87 3–6 year 44 (18.2) 7 (8.0) 6–10 year 53 (21.9) 2 (2.3) > 10 years 55 (22.7) 0 < 3 years 90 (37.2) 78 (89.7) Experience grouped 242 87 > 3 years 152 (62.8) 9 (10.3) Hindu 127 (52.5) 75 (86.2) Muslim 3 (1.2) 3 (3.4) Religion Sikh 242 72 (29.8) 87 6 (6.9) Christian 38 (15.7) 1 (1.1) Others 2 (0.8) 2 (2.3) Note: *A few respondents did not answer few questions. Hence frequencies in some categories do not add up to 242. Mahajan et al. 245 working at PGIMER. Contrary to this, 89.7% doctors had less doctors who have had counseled patients or their relatives for organ donation was observed (Q. 12 and13). than three years’ work experience at PGIMER. Hindu religion majority was observed amongst both the participating groups. The analysis of “knowledge” levels of nurses and resident Discussion doctors regarding organ donation has been depicted in Table 2. A statistically significant (P < .001) increase in knowledge Of the total nurses called for contribution in this study, scores under all four categories for both nurses and resident 83.74% participated. Comparatively, a very low proportion doctors was seen postintervention. of the resident doctors (30%) posted in the study areas The analysis of the “attitude” of nurses and doctors consented to participate. In a survey conducted in the same regarding organ donation is shown in Table 3. Regarding institute by Ahlawat et al. to assess the knowledge and “willingness for organ donation” (Q. 35–39), a statistically attitude of health care workers toward deceased organ significant increase was observed in both nurses (Z = –8.686, donation, a very high response rate was observed amongst P < .001) and doctors (Z = –3.125, P = .002) owing to the all categories of participants (99%). However, Flanigan et interventions. There was more than two-fold increase in the al. have also observed in their literature review that in number of nurses having pledged their organs postintervention, general, the response rate of physicians is low in surveys. from 22.9% to 48.3% (P < .001). Only three doctors pledged Higher response rate by nurses in this study may also be their organs postintervention, and the increase in pledge rate, attributed to the fact that nurses in the institute are directly i.e., 28.7% to 32.2%, was statistically insignificant (P = .84). under the administrative control of the investigator’s The analysis of impact on the “beliefs” (negative and department and were in routine communication with the positive) of participants regarding organ donation has been investigator for other educational activities, whereas most of provided in Table 3. Postintervention, a significant reduction the participating doctors were not previously in direct in the prevalent myths and negative beliefs regarding organ association with the investigator. Also, the proportion of donation was observed amongst the nurses (Q. 1–4 and 6). doctors posted in the study areas was comparatively very Similar findings were observed amongst the doctors for the less as compared to the nurses, so most of them could not myths which were having higher scores preintervention (Q. 1 afford to participate because of their hectic schedule. and 2). A statistically significant improvement was also The level of knowledge amongst participating health care observed in the positive beliefs having low-score professionals was higher as compared to that of general preintervention amongst both the sections (Q. 7 and 8). Both population (nonmedical) established in the studies by Mithra 33 34 nurses and doctors showed a significant improvement (P < et al. in Karnataka and Mishra et al. in New Delhi states. .001) in the propensity to promote organ donation (Q. 9 to 11) India has been badly suffering from ignorance on this latest postintervention. Also, after being subjected to the teaching modality of transplantation medicine and has a miniscule module, a significant increase in the number of nurses and organ donation rate of 0.65 pmp. The most important factor Table 2. Knowledge Scores of Nurses and Resident Doctors in Different Categories Concerning Organ Donation Nurses Resident Doctors Mean Score ± Standard Mean Score ± Stan- Deviation dard Deviation Maxi- mum S. No Score Preinter- Postinter- Preinter- Postinter- Category Possible vention vention Z P vention vention Z P Concept of 10.16 ± 1 11 5.65 ± 1.54 8.55 ± 1.66 –12.701 < .001 6.94 ± 1.73 –7.967 < .001 organ donation 1.12 Procedures and protocols 2 for organ 6 4.88 ± 0.92 5.75 ± 0.59 –10.495 < .001 4.81 ± 1.40 5.80 ± 0.44 –6.368 < .001 donation in PGIMER Clinical criteria 3 3 0.38 ± 0.54 1.49 ± 0.91 –11.404 < .001 1.21 ± 0.98 2.35 ± 0.83 –6.841 < .001 for brain death 4 Legal issues 9 4.09 ± 1.49 7.55 ± 1.31 –13.341 < .001 5.87 ± 8.75 8.75 ± 0.53 –7.634 < .001 Total knowl- 5 29 18.7 ± 3.46 23.3 ± 3.25 –11.935 < .001 18.8 ± 4.15 27.0 ± 1.89 –8.110 < .001 edge Table 3. Question Wise Change in Attitude of Nurses and Resident Doctors Pre and Postintervention Negative Beliefs Regarding Organ Donation (Q. No. 1–6) Nurses Resident Doctors Preinterven- Postinterven- Preinterven- Postinterven- tion tion tion tion Q. Likert Likert No. Question Score Frequency (%) Frequency (%) Z Score Frequency (%) Frequency (%) Z P 1 22 (9.1) 4 (1.7) 1 4 (4.6) 0 (0) If my organs are requested after 2 68 (28.1) 41 (17.2) 2 17 (19.5) 5 (5.7) my death, it would place an ad- 1 3 61 (25.2) 65 (27.2) –6.865 < .001 3 18 (20.7) 12 (13.8) –5.259 < .001 ditional burden on my family at 4 58 (24.0) 78 (32.6) 4 24 (27.6) 40 (46.0) the time of grief. 5 26 (10.7) 51 (21.3) 5 21 (24.1) 30 (34.5) 1 13 (5.5) 4 (1.7) 1 5 (5.7) 1 (1.1) 2 69 (29.4) 39 (16.2) 2 18 (20.7) 3 (3.4) Members of my family would 2 object to donate my organs 3 89 (37.9) 80 (33.2) –6.702 < .001 3 21 (24.1) 20 (23.0) –5.077 < .001 after I die. 4 53 (22.6) 91 (37.8) 4 21 (24.1) 38 (43.7) 5 11 (4.7) 27 (11.2) 5 19 (21.8) 25 (28.7) 1 5 (2.2) 2 (0.8) 1 0 (0) 0 (0) Donating my organ would place 2 18 (7.8) 6 (2.5) 2 0 (0) 0 (0) a financial burden on my family 3 3 40 (17.3) 22 (9.1) –5.406 < .001 3 9 (10.4) 10 (11.5) –0.966 .33 because of the cost of proce- 4 107 (46.3) 113 (46.9) 4 39 (44.8) 44 (50.6) dure. 5 61 (26.4) 98 (40.7) 5 36 (41.4) 33 (37.9) 1 14 (6.5) 6 (2.5) 1 3 (3.4) 0 (0) If I express my willingness to donate organ after my death, 2 47 (21.8) 28 (11.6) 2 5 (5.7) 0 (0) the doctors or nurses might do 4 3 31 (14.4) 26 (10.7) –5.420 < .001 3 12 (13.8) 15 (17.2) –1.955 .05 something to me before I am 4 64 (29.6) 70 (28.9) 4 23 (26.4) 35 (40.2) dead, so that they may get my organs. 5 60 (27.8) 108 (44.6) 5 44 (50.6) 37 (42.5) 1 3 (1.3) 2 (0.8) 1 1 (1.1) 0 (0) 2 6 (2.5) 8 (3.3) 2 3 (3.4) 0 (0) My religion does not allow 5 organ donation, and my next life 3 17 (7.2) 11 (4.6) –1.943 .05 3 4 (4.5) 7 (8.0) –0.341 .73 may be affected. 4 96 (40.5) 85 (35.4) 4 22 (25.3) 36 (41.4) 5 115 (48.5) 134 (55.8) 5 57 (65.5) 44 (50.6) 1 5 (2.3) 3 (1.2) 1 1 (1.1) 1 (1.1) 2 16 (7.2) 7 (2.9) 2 1 (1.1) 2 (2.3) Donating my organ would dis- 6 figure/mutilate my body because 3 29 (13.1) 21 (8.7) –4.069 < .001 3 11 (12.7) 8 (9.2) –0.746 .46 of extraction of the organ. 4 97 (43.9) 103 (42.6) 4 32 (36.8) 36 (41.4) 5 74 (33.5) 106 (43.8) 5 42 (48.3) 40 (46.0) (Table 3 Continued) (Table 3 Continued) Positive Beliefs Regarding Organ Donation: Q. No. 7 and 8 Preinterven- Postinterven- Preinterven- Postinterven- tion tion tion tion Q. Likert Likert No. Question Score Frequency (%) Frequency (%) Z P Score Frequency (%) Frequency (%) Z P 1 40 (17.1) 56 (23.1) 1 23 (26.4) 40 (46.0) I would feel comfortable if the 2 119 (50.9) 138 (57.0) 2 36 (41.4) 36 (41.4) organs of any family member 7 3 53 (22.6) 39 (16.1) –4.759 < .001 3 16 (18.4) 10 (11.5) –2.363 .02 of mine are asked for donation, 4 17 (7.3) 3 (1.2) 4 4 (4.6) 1 (1.1) after his/her death. 5 5 (2.1) 5 (2.1) 5 2 (2.3) 0 (0) 1 36 (16.2) 66 (27.3) 1 28 (32.2) 42 (48.3) 2 149 (67.1) 154 (63.6) 2 36 (41.4) 31 (35.6) If necessary, I would accept an 8 organ transplant in order to 3 28 (12.6) 18 (7.4) –5.048 < .001 3 19 (21.8) 13 (14.9) –0.835 .40 save my life. 4 6 (2.7) 0 4 2 (2.3) 0 (0) 5 2 (0.9) 0 5 2 (2.3) 1 (1.1) Propensity for Promoting Organ Donation: Q. No. 9–13 Preinterven- Postinterven- Preinterven- Postinterven- tion tion tion tion Q. Likert Likert No. Question Score Frequency (%) Frequency (%) Z P Score Frequency (%) Frequency (%) Z P 1 27 (12.2) 46 (19.3) 1 16 (18.4) 33 (37.9) The staff I work with feels it 2 140 (63.3) 162 (68.1) 2 47 (54.0) 36 (41.4) important to request organ 9 3 43 (19.5) 26 (10.9) –4.624 < .001 3 19 (21.9) 17 (19.5) –2.085 .04 donation from the families of 4 8 (3.6) 2 (0.8) 4 4 (4.6) 1 (1.1) potential donors. 5 3 (1.4) 2 (0.8) 5 1 (1.1) 0 (0) 1 11 (4.9) 4 (1.7) 1 4 (4.6) 2 (2.3) If I ask the family of any brain- 2 111 (49.3) 82 (34.6) 2 37 (42.5) 12 (13.8) dead patient for organ donation, 10 3 58 (25.8) 84 (35.4) –5.223 < .001 3 24 (27.8) 15 (17.2) –6.469 < .001 the grieving family may be 4 40 (17.8) 53 (22.4) 4 18 (20.7) 34 (39.1) burdened and feel offended. 5 5 (2.2) 14 (5.9) 5 4 (4.6) 24 (27.6) 1 22 (9.7) 45 (18.9) 1 16 (18.4) 31 (35.6) I am confident about my ability 2 128 (56.6) 155 (65.1) 2 44 (50.6) 37 (42.5) to request an organ donation 11 3 63 (27.9) 33 (13.9) –5.774 < .001 3 16 (18.4) 15 (17.2) –1.792 .07 from the family of a potential 4 12 (5.3) 4 (1.7) 4 11 (12.6) 3 (3.4) donor. 5 1 (0.4) 1 (0.4) 5 0 (0) 1 (1.1) (Table 3 Continued) (Table 3 Continued) Nurses Resident Doctors Preinterven- Postinterven- Preinterven- Postinterven- tion tion tion tion Q. 2 2 No. Question N Frequency (%) Frequency (%) χ P N Frequency (%) Frequency (%) χ P Have you ever coun- seled the relative/ 12 attendants of any 242 144 (61.8) 162 (68.1) 87.50 < .001 87 50 (57.5) 55 (63.2) 68.40 < .001 patient for organ donation? Do you think organ donation in PGIMER 13 is sufficient to meet 242 164 (71.3) 209 (86.7) 31.08 < .001 87 69 (79.3) 85 (97.7) 7.85 < .001 the demand for or- gans in the institute? Mahajan et al. 249 46 47 attributable to this lack of awareness is least efforts being put similar to the findings of Verma. Cohen et al. concluded in in for information, education, and communication (IEC) on their study that proper understanding and familiarity with the this topic. However, after the establishment of the national concept of brain death makes health care professionals more framework consisting of a network of well-coordinated comfortable with the situations involving organ donation and National, Regional, and State Organ and Tissue Transplant facilitates the organ procurement process. Organizations (NOTTO, ROTTOs, and SOTTOs, Both groups had poor knowledge regarding “clinical respectively), the country has witnessed a two-fold increase criteria for brain death” prior to the intervention and the in its cadaveric organ donation rates over the last five years scores were least in this knowledge category corresponding 21,22 35 from 0.36 in 2014 to 0.65 in 2019. This is clearly with the findings of Bener et al. Knowledge about laws attributable to the increased level of IEC and transplantation governing organ and tissue donation was also observed to be activities under the aegis of these organizations and the low in this study as compared to that of Mishra et al. promising role of media. Compared to the knowledge level of Intervention improved the scores significantly in both these health care professionals observed in the studies by Mithra et categories, and therefore, continuous education proves to be 33 34 al. and Mishra et al., their preintervention knowledge level highly promising. was found to be even higher in this study. This may be because A more favorable attitude toward organ donation was of the fact that at the time this study was conducted, PGIMER observed amongst nurses and doctors as compared to general Chandigarh had already achieved the status of being a public- public, similar to the observations of Reddy et al. Much sector institute with the highest incidence of organ donation higher willingness has been observed in this study as in the country. Moreover, the ROTTO for eight northern compared to the study conducted by Ahlawat et al. in the states is also located in this institute. same institute, in a similar setting and on similar population Similar to the findings of this study, Bener et al., Alsaied in 2009. This may be attributed to increased activities and 36 37 38 et al., Akgun et al., and Jeon et al. also observed higher awareness regarding organ donation in the institute over the baseline knowledge scores of doctors as compared to nurses span of time. The positive effect of intervention on attitude as on this topic. A great improvement in total knowledge was observed in this study has also been established by Ramadurg 28 40 41 42 observed after intervention amongst both doctors and nurses et al., Farahani et al., McGlade et al., Zahra et al., (28.3% and 16.1% increase, respectively). The positive Kiberd, and others. Strongly positive attitudes were also impact of educational interventions on this topic has also observed regarding the advocacy for organ donation by been established amongst the medical and nursing students different religions, similar to the observation of Bapat et al. 39 40 41 by Kaiser et al., Farahani et al., McGlade et al., Zahra et Prior to intervention, only one-fifth of the population feared 42 43 44 28 al., Kiberd, Rykhoff et al., and Ramadurg et al. There is mutilation or disfigurement of body because of organ sufficient evidence that strategies to increase the participation donation, which improved further to less than one-sixth of health care professionals and students on voluntary as well postintervention, the observations being in contrast to that of as curricular basis in activities related to awareness regarding Hu et al. organ donation would prove to be highly promising in A very low proportion of nurses and doctors (22.9% and increasing organ donation. 28.7%, respectively) had pledged their organs before When compared, the knowledge about the “concept of intervention. About one-fourth (58) of the nurses pledged organ donation” was higher in doctors than nurses in both their organs immediately after the interactive session. Only phases and also improved significantly for both groups 57.5% doctors and 61.8% nurses working in PGIMER had postintervention. The findings are consistent with Hu et al. ever counseled a patient or their attendant for organ donation. in their study on 400 health care professionals. The impact of In this study, a significant impact of intervention was observed intervention on awareness about “procedures and protocols in on the overall propensity of doctors and nurses to promote PGIMER” was statistically significant for both groups. A organ donation, for pledging their own organs, and for lower proportion of doctors as compared to nurses knew the counseling the patient/attendants on this cause. procedure to be followed for declaring brain death in the One limitation of this study was that it was conducted in institute, probably because nurses in this setup are supposed one locale of the institution receiving only head trauma to organize and complete the procedures related to brain patients. Thus, findings may not be generalized to the whole death declaration and, hence, are more familiar with the population of doctors and nurses in the institute and might not procedures. Only 41.4% doctors and 14.9% nurses knew be representative of similar population in other hospitals. initially which all organs can be transplanted. Significant Similar studies are required in future to strengthen impact was observed postintervention (85.1% and 82.6%, generalization of the results. Second, the data have been respectively). Interestingly, fewer doctors than nurses could collected purposefully for certain specific variables pertaining correctly respond that organ donation was possible at “any to organ donation and many others may not have been included age”; however, they took a significant lead from nurses unintentionally. As such, the results may not be a wholesome postintervention. More than two-third participants confused reflection of the clinico-administrative perspectives of this “brain death” with other medical terms such as coma, topic. Further, no follow up for the retention of the gained persistent vegetative state, etc. wherein life still persists, knowledge and better attitudes was done. 250 Annals of Neurosciences 27(3-4) Acknowledgment Conclusion The motivation, guidance, and encouragement received from Both nurses and doctors were aware of organ donation, and Professor A. K. Gupta, Head, Department of Hospital Administration their attitudes were also favorable, but information regarding and Medical Superintendent, PGIMER, Chandigarh, is sincerely some basic and practical aspects of organ donation was acknowledged and so is the constant support of heads of all relatively lacking. This not only prevented them from being participating departments. The quintessential support of Nursing Superintendent and team ROTTO PGIMER, Chandigarh, in prospective donors, but also acted against them being accomplishing the study is deeply acknowledged. effective counselors and advocates of organ donation. Besides ensuring a promising role of educational interventions in Declaration of Conflicting Interests improving awareness and attitude of health care professionals regarding organ donation, the moot point worth pondering The author declared no potential conflicts of interest with respect to which emerged out of this study was whether the IEC the research, authorship, and/or publication of this article. measures being taken by the government and other organizations are sufficient and aptly framed especially Ethical Statement observing the lower scores in various categories This study was approved by the Institutional Ethics Committee of preintervention amongst the study population, particularly PGIMER Chandigarh with the Reference Number NK/2088/ considering the fact that it comprised of the section of society MHA/5457-58. The written expected to be most informed on this topic. Also, coupling of informed consent was obtained from the participants in the study. the promotional activities for organ pledging with scientifically designed educational sessions can greatly Funding enhance the organ pledge rates. The authors received no financial support for the research, authorship, and/or publication of this article. Questionnaire Questionnaire Name Age Sex : Male Female Email Contact No. Department Designation Doctor Junior Resident Senior Resident Nurse DNS ANS Grade I Grade II Qualification Doctor : Pursuing MD / MS Pursuing MCh / DM Nursing : Diploma Graduate Post Graduate Experience in PGIMER < 1 year 1-2 years 2-3 years 3-6 years 6-10 years >10 years Religion Hindu Muslim Sikh Christianity Others Pg 1 of 5 Mahajan et al. 251 1. Can non-functioning (damaged) organs of one person be replaced by the healthy organ from another person? YES NO 2. Does organ transplantation help a patient lead a better life: YES NO 3. Organ Transplantation is a type of medical treatment: YES NO 4. Which of the following organs do you know that can be transplanted ?( multiple options may be marked ) Brain Kidney Lungs Heart Stomach Eyes 5. When can the organs be harvested / taken from an organ donor ? Only after death At any time, even when alive Depends on the Organ 6. Which of the following organs can one donate even before death ?( multiple options may be marked ) Brain Kidney Lungs Heart Skin & Bone Eyes 7. What can be the age of an organ donor ? Adult but < 60yr of age Any Adult Any Age 8. Can a person with a beating heart be dead ? YES NO 9. Do you know the concept of brain death ? YES NO 10. “Brain death is irreversible” TRUE FALSE 11. Which of the following means same as “Brain Death” ? Coma Persistent Vegetative State Locked in Syndrome None 12. Is brain death certification required for DCD (Donation after Cardiac Death) ? YES NO 13. What is the source of your knowledge regarding organ donation ? ( multiple options may be marked ) Mass Media Course Curriculum Organ Transplantation Coordinator 14. Was the concept of Organ Donation ever taught in your graduation course curriculum (in MBBS / Nursing Dip or Degree syllabus)? YES NO 15. Were you ever asked a question regarding organ donation in your examinations during these courses? YES NO ii 252 Annals of Neurosciences 27(3-4) 16. Is Organ Transplantation done in PGIMER ? YES NO 17. Does PGIMER has Transplantation Coordinators ? YES NO 18. Do you know whom to contact if you feel your patient is a potential donor ? Director PGIMER Medical Superintendent HOD Transplant Surgery Transplant Coordinator Officer Incharge of Emergency/ATC 19. Are you aware of the procedure for declaring brain death in PGIMER ? YES NO 20. Do you know the clinical criteria for declaring a patient as brain dead ? YES NO 21. In which of the following cases the patient can NOT be declared brain dead ? ( multiple options may be marked ) Serum Sodium=170mEq/L Blunt Abdominal Trauma Myocardial Infarction Sepsis Random Blood Sugar = 110 mg/dl All of the above 22. In which of the following conditions, brain death cannot be declared ? Patient of hanging Ruptured Spleen Hypothermia 23. Which of the following Reflexes must NOT be present while declaring a patient brain dead?( multiple options may be marked ) Corneal Reflex Plantar Relflex Pupillary Reflex All of the above 24. When can brain dead declaration be done in PGMER ? During office hours in week days 9 to 5 pm on all days Any Day & Any Time 25. Which of the following organs are transplanted in PGIMER ? ( multiple options may be marked ) Brain Kidney Liver Heart Pancreas Eyes 26. What is THOA ? A clinical criteria for declaring brain death Organ retrieval body in PGIMER Law governing Organ Transplantation “The Human Organs Assosiation” 27. Which of the following systems for organ donation is followed in India ? Opt In Opt Out Both of these depending on the situation 28. Can the organs be pledged during life time (i.e. when alive) ? YES NO 29. Which of the following is not considered a “next of kin” for giving consent as per law ? Parents Siblings Spouse Grand Parents Nephew iii Mahajan et al. 253 30. If a person has pledged his own organs, is the consent of anyone else required for donation ? YES NO 31. Can the donor be paid in cash or kind for the organ he donated ? YES NO 32. Is a license mandatory for any hospital to carry out organ transplantation ? YES NO 33. Brain Death committee consists of the following members EXCEPT : Hospital Administrator Treating Physician Neurologist HOD Transplant Surgery 34. What maximum fine can be imposed for breach of law regarding Organ Donation in India ? Rs. 10,000 Rs. 20,000 Rs. 10 lakh Rs. 20 Lakh Rs. 1 Crore 35. Would you like to donate your organs after your death ? YES NO 36. Given that kidney donation is possible when alive, would you donate your kidney if needed by a family member or a friend? YES NO 37. Have you pledged your organs ? YES NO 38. Do you have a donor card ? YES NO 39. Have you ever donated blood in a camp for an unknown person ? YES NO From 40 to 53, Tick √ the “most appropriate” option as per your view 40. If my organs are requested after my death, it would place an additional burden on my family at the time of grief : Strongly Agree Agree No Opinion Disagree Strongly Disagree 41. Members of my family would object to donate my organs after I die : Strongly Agree Agree No Opinion Disagree Strongly Disagree 42. Donating my organ would place a financial burden on my family due to cost of procedure : Strongly Agree Agree No Opinion Disagree Strongly Disagree 43. If I express my willingness to donate organ after my death, the doctors or nurses might do something to me before I am dead, so that they may get my organs : Strongly Agree Agree No Opinion Disagree Strongly Disagree iv 254 Annals of Neurosciences 27(3-4) 44. My religion does not allow organ donation, and my next life may be affected: Strongly Agree Agree No Opinion Disagree Strongly Disagree 45. Donating my organ would disfigure / mutilate my body due to extraction of the organ : Strongly Agree Agree No Opinion Disagree Strongly Disagree 46. I would feel comfortable if the organs of any family member of mine are asked for donation, after his / her death : Strongly Agree Agree No Opinion Disagree Strongly Disagree 47. The staff I work with feels it important to request organ donation from the families of potential donors : Strongly Agree Agree No Opinion Disagree Strongly Disagree 48. If I ask the family of any brain dead patient for organ donation, the grieving family may be burdened and feel offended : Strongly Agree Agree No Opinion Disagree Strongly Disagree 49. I am confident about my ability to request an organ donation from the family of a potential donor : Strongly Agree Agree No Opinion Disagree Strongly Disagree 50. If necessary, I would accept an organ transplant in order to save my life : Strongly Agree Agree No Opinion Disagree Strongly Disagree 51. Have you ever counseled the relative / attendants of any patient for organ donation ? YES NO 52. Do you think organ donation in PGIMER is sufficientto meet the demand for organs in the institute ? YES NO 53. If your answer is “No” in above question, then what do you think should be done to promote organ donation in the institute ? _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________ Mahajan et al. 255 20. Santiago-Delpin EA. The organ shortage: a public health cri- ORCID iD sis. What are Latin American governments doing about it? N. Pandey https://orcid.org/0000-0001-6119-5946 Transplant Proc 1997; 29: 3203–3204. 21. 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Annals of Neurosciences – SAGE
Published: Jul 1, 2020