Factors influencing attitude toward organ and tissue donation among patients in primary clinic, Sabah, Malaysia

Kai Joo Lim, and Timothy Tsin Jien Cheng, and Mohammad Saffree Jeffree, and Firdaus Hayati, and Phee Kheng Cheah, and Kuok Ong Nee, and Mohd Yusof Ibrahim, and Shamsul Bahari Shamsudin, and Fredie Robinson, and Khamisah Awang Lukman, and Aza Sherin Mohd Yusuff, and Dr Swe, and Naing Oo Tha, (2020) Factors influencing attitude toward organ and tissue donation among patients in primary clinic, Sabah, Malaysia. In: Transplantation Proceedings.

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Abstract

Introduction Worldwide, the gap between organ supply and demand has widened over the years. Malaysia has one of the lowest deceased organ donation rates. Success rate of organ or tissue procurement depends on not only the approach rate by health care providers but also the awareness among the public, whereby it can be a platform for family initiation of organ donation. The purpose of this study is to assess the knowledge of and determine the factors influencing attitude toward organ and tissue donation among patients in a primary clinic. Methods A cross-sectional analytical study was carried out. Self-administered questionnaires were given to 400 patients who registered at an outpatient clinic in April 2018. Convenience sampling was applied. Results Monthly income, education level, occupation, and knowledge level are significantly associated with attitude of the respondents toward organ and tissue donation. Occupation influenced attitude toward organ donation. Knowledge of organ donation and brain death both significantly affected attitude toward organ donation. Conclusion The greater the knowledge of organ donation and brain death, the more positive impression or attitude toward organ donation. Education level and income are the main predictors that influence attitude toward organ donation. Hence, it is important for public health units to promote and deliver public education on organ donation, change public misconceptions, and work parallel with hospitals to increase organ donation rates in Sabah. Previous articleNext article Worldwide, the gap between organ supply and demand has widened over the years. Malaysia has one of the lowest deceased organ donation rates (0.7 donations per million population) compared with countries such as Spain, which had the highest with a donation rate of 36 per million population in 2014. Other Asian countries are not far off from Malaysia, such as Myanmar (0.02) and Thailand (1.26) [1]. The World Health Organization defines transplantation as the transfer of human cells, tissues, or organs from a donor to a recipient with the aim of restoring functions in the body [2]. In Sabah, the Sabah Regional Transplant Procurement Management Unit has made effort for all government hospitals in Sabah to have a Tissue Organ Procurement team for identification and referral of eligible cases. Sabah is a Malaysian state with a high number of potential cadaveric or deceased donors for referral, but the consent for organ donation is still low. Transplantation is the only hope and definitive treatment for patients with organ failure. Donors can be either living or deceased. Unlike a deceased donor or cadaveric donor, a living donor can only donate part of the liver, 1 kidney, and bone marrow. A cadaveric donor can donate more organs and tissues without giving risk to the donor. Thus, a cadaveric donor is a preferable type of donor; however, cadaveric donation is very low in Malaysia. In 2015, Malaysia had its highest number of cadaveric donors, but Sabah only contributed 1 donor. The whole Malaysia had 35 cadaveric donors in 2017. Among them only 1 donor was from Sabah state. The demand and supply cannot meet up due to the lack of organs. Since 1998, the Malaysia Ministry of Health has initiated a number of activities to promote the development of organ donation and transplantation. Many countries have faced a similar problem of organ shortage for transplantation in patients with end-stage organ failure. Organ transplantation is the only hope for patients with end-stage organ failure to improve their quality of life. If a cadaveric organ donation program is not supported by the community, this may end up in organ trafficking. If the family of the deceased has a lack of knowledge of organ donation and the procurement process, this will lead to refusal in donating the organs and tissues. The deceased’s family’s consent is the last step in organ harvesting. Hence, it is important for public health units to promote and deliver public education on organ donation, change public misconceptions, and work together with hospitals to increase organ donation rates in Sabah. The purpose of this study is to determine the factors influencing attitude toward organ and tissue donation among patients, and to assess the knowledge of organ donation and brain death among patients. Methods A cross-sectional analytical study was conducted at primary health clinic Kota Kinabalu, from October 2017 to July 2018 with a total of 10 months’ duration. It is located in Sabah state in Malaysia and is under the lead of 1 family medicine specialist with 15 medical officers. Monthly patients in outpatient clinic range from 4000 to 6000. The study population targeted is registered patients more than 18 years old who visited an outpatient clinic during the study period. Data collection was done during working hours until the preferable sample size was obtained. Nonprobability convenience sampling was used. Respondents who were selected followed the Queue Management Server (QMS) numbering system from number 1 to the end of the day. Those respondents who agreed to participate were given a self-administered questionnaire. The entire questionnaire was placed at the registration counter and distributed together with the QMS number before seeing the doctor. A sample size of 383 patients was taken by calculating the pilot study samples using the Sample Size Calculator for Prevalence Studies (SSCPS version 1.0.03). All the registered patients who agreed to participate and were above 18 years old were included in the study. Patients who were not registered or had no document or refused or were less than 18 years old were excluded from the study. Respondents could choose to withdraw at any time. The items in the questionnaire for the knowledge part were mainly modified from the study by Ozturk Emiral et al [3]. This was to ensure the items were appropriate and able to be answered by respondents. The Malay version of the questionnaire was pilot tested by the patients from the Emergency and Trauma Department 1 month before data collection. Thirty respondents were obtained by using patients grouped in the green zone at the Emergency and Trauma Department for reliability test. These 30 samples were not included in the study. Cronbach’s alpha was used to determine the internal consistency of the scale on 12 knowledge and exposure questions in Part B and 11 questions on attitude toward organ and tissue donation in Part C of the questionnaires. A total of 23 items were tested for reliability. Cronbach’s alpha for the overall scale was 0.870. There are a total of 36 questions in the questionnaires, which can be divided into the following 3 parts: Part A: Sociodemographic characteristics; Part B: Exposure and knowledge in organ donation and brain death; and Part C: Acceptance or attitudes toward organ donation. After the questionnaire was pilot tested and obtained acceptable reliability testing, the questionnaires were distributed to the study population. The questionnaire was validated before the main study was done. Descriptive analysis was done by using frequencies, and the χ2 test was used to determine association between sociodemographic characteristics and attitude toward organ donation, and to study the association between knowledge levels of the respondents toward attitude for organ donation. Statistical analysis was performed using SPSS version 22 (IBM, Armonk, NY, United States) throughout the study. Results A total of 400 self-administered questionnaires were distributed, of which 383 (95.75%) were successfully completed. Most of the respondents had secondary educations, which consisted of 337 respondents (88%) compared with primary education of 46 (12%). A total of 313 (81.7%) were aged less than 40 years, and 70 (18.3%) of the total respondents were aged over 40 years. The mean age for the sample was 32.69 ± 9.239. Most of the respondents, 193 (50.4%), had monthly income of at least RM2000. A total of 151 (39.4%) of the respondents were government servants. Most were married 251 (65.5%). Respondents consisted of 155 (40.5%) men and 228 (59.5%) women. Knowledge of Organ Donation A total of 339 (88.8%) respondents answered the first question correctly, which asked about the organ donation definition. For the second question, which is the age limit for organ donation, only 178 (46.5%) respondents answered correctly that there was no age limit for organ donation. Most of the respondents, 292 (76.2%), answered correctly for causes of organ transplant. Respondents correctly answered for organ transplant causes with the statement, “High blood pressure and diabetes are common causes for people to require a kidney transplant.” A total of 307 (80.2%) respondents answered correctly what organs can be donated in Malaysia (kidneys, liver, heart, and lung), whereas 211 (55.1%) respondents answered correctly what tissues can be donated in Malaysia (bone, skin, heart valves, and cornea) (Table 1). Based on organ donation knowledge questions, responses were further categorized into good and poor knowledge of organ donation. One correct answer for 1 question was considered 1 mark, thus the maximum mark for this section was 5 marks and the lowest was 0 marks, with none of the questions answered correctly. We considered respondents with ood knowledge of organ donation to be those who answered correctly for 4 questions and above (4 and 5 marks), whereas those poor knowledge answered correctly for 3 questions and below. A total of 213 (55.6%) had good knowledge of organ donation, whereas the other 170 (44.4%) respondents had poor knowledge of organ donation (Table 2).

Item Type: Conference or Workshop Item (UNSPECIFIED)
Uncontrolled Keywords: Organ supply , organ donation , health care , clinic
Subjects: R Medicine > RA Public aspects of medicine
Divisions: FACULTY > Faculty of Medicine and Health Sciences
Depositing User: Noraini
Date Deposited: 10 Jul 2020 06:54
Last Modified: 10 Jul 2020 06:54
URI: http://eprints.ums.edu.my/id/eprint/25601

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