EXPERIMENTAL AND CLINICAL TRANSPLANTATION

Objectives: This study investigated the level of organ donation awareness among students at vocational schools of different sectors in order to measure of awareness of organ donation among young population of our society.
Materials and Methods: Voluntary participants consisted of 404 students who were in their second term at vocational schools affiliated to our university. Participants were from a health services vocational school (n = 167; 41.3%), a social sciences vocational school (n = 77; 19.1%), or from 2 technical sciences vocational schools (n = 160; 39.6%). We collected data during face-to-face interviews. We used the following forms: sociodemographic characteristics of the participants, organ-tissue donation and transplant information, and the Organ-Tissue Donation and Transplant Information Scale.
Results: Mean age was 20.9 years (range, 17-58 y). Female-to-male ratio was 1:1.21. Among participants, 2.2% stated that they had donated their organs, 27.7% had considered organ donation, 30.2% were unwilling to donate, and 41.8% were indecisive. Among participants, 53.5% stated their desire to have detailed information. Rate of students who already had information on how to donate organs was 35.1%. Mean Organ-Tissue Donation and Transplant Information Scale scores were 9.78 ± 4.38 (range, 0-16) for health services vocational school participants, 9.24 ± 4.72 (range, 0-16) for social sciences vocational school participants, and 8.24 ± 3.96 (range, 0-16) for technical vocational school participants.
Conclusions: Our results suggested that many participants (especially for participants at schools other than health) did not have proper information about organ donation. Information campaigns to explain the social, legal, and technical infrastructure of organ donation for young people will simultaneously increase their awareness and the tendency for increased awareness among the whole society about organ donation.

Key words : Knowledge, Organ transplantation, Students

Scientific advances in the field of health have prolonged life, treated diseases, and improved quality of life of people. One of these advances is organ transplant. Organ transplant is the replacement of the organ that does not function in the body with a healthy organ taken from a medically compatible living or deceased donor.^1-3 Organs for transplant include heart, lung, liver, kidney, skin, cornea, bone marrow, pancreas, blood, and small intestine. Similar to the situation in Turkey, the number of people waiting for organ transplant has been increasing globally. An important stage is having an adequate supply of organs to be transplanted from living or deceased donors in ethically and medically correct conditions.^4,5

In 2017, Spain ranked first among countries with the highest number of organ donations, followed by Portugal, Belgium, Croatia, and the United States. In Turkey, 60% to 65% of transplants are from living donors; however, in Europe, 80% of transplants are from deceased donors. As of 2021, 292 206 people are registered on the organ and tissue transplant waiting list in Turkey, and 78.7% of this list consists of patients waiting for kidney transplant.^1,6

Many factors, including education level, economic reasons, sociocultural and religious factors, and lack of adequate information, are among reasons for the low rate of deceased donors in Turkey. A study conducted in Africa showed that about 3 million patients diagnosed with end-stage renal failure die every year; in addition, despite 130 to 150 corneas collected annually in Ethiopia, approximately 300 000 people are waiting for cornea transplants.^7-9 It is obvious that there is a need for more studies and trainings to raise awareness of the society and to eliminate insufficient information and negative attitudes on organ and tissue transplant.^4,10

Studies on the subject of raising awareness of organ and tissue transplant have emphasized the need to increase the level of education and awareness of students.^1,5,8 Raising awareness among the young population can contribute to education initiatives and provide long-term awareness in society. Students in vocational schools are enrolled in various fields and will be in contact with various segments of the society after graduation. Therefore, determining the knowledge and attitudes of vocational school students about organ donation and increasing their awareness before graduation could result in positive effects on attitudes and thoughts about organ transplant of the whole society. In this context, we aimed to determine knowledge and views on organ transplant and organ donation in vocational students to determine barriers to organ transplant and donation in society.

Materials and Methods

We performed a descriptive and cross-sectional study to determine the knowledge and thoughts on organ donation among students studying in vocational schools affiliated to Baskent University (a health services vocational school, a social sciences vocational school, and 2 technical sciences vocational schools). We collected data from face-to-face interviews conducted between November 5 and December 10, 2022.

Eligibility criteria and patient selection

Our study population consisted of students studying at vocational schools affiliated to Başkent University. Because the study aimed to reach the entire population, the sample size was not calculated. Our study sample included 404 vocational school students. Other inclusion criteria were (1) being enrolled in one of the vocational schools affiliated to Başkent University, (2) over 18 years of age, and (3) voluntarily agreed to participate in the study.

Data collection tools were developed by the researchers after a literature review.^10-14 We collected data during the aforementioned time period when the participants were available by using a face-to-face interview technique. We had 3 data collection tools: (1) an information form on sociodemographic characteristics, (2) an organ donation and transplantation information content form, and (3) the Organ-Tissue Donation and Transplantation Knowledge Scale.

Information form on sociodemographic characteristics

This form included 8 questions on participant's age, sex, chronic diseases, education level of mother and father, place where they lived the longest, and the vocational college where they were enrolled.

Organ donation and transplantation information content form

This form included 10 questions on participants'organ donation status of themselves and their relatives, why they want to donate organs and why they do not want to donate organs, and organ donation and transplant information content.

Organ-Tissue Donation and Transplantation Knowledge Scale

The Organ-Tissue Donation and Transplantation Knowledge Scale was developed by Öztürk Emiral and colleagues in 2017. This scale can be used to measure participant's level of knowledge about organ-tissue donation and transplant. The scale consists of 17 items and has a Likert-type scoring system, with scale items on a 3-point Likert scale based on true, false, and I don't know. Eight of the scale items (items 2, 6, 8, 9, 10, 13, 15, 17) have a reverse coding feature. In addition, the scale items consist of 2 subdimensions. The correct answer to each item in the scale is calculated as 1 point. The higher the score obtained from the scale, the higher the level of knowledge on the subject. The highest score that can be obtained from the scale is 17. The first subdimension includes items related to donor characteristics, and the second subdimension includes items related to legal, ethical, and medical processes related to organ tissue donation and transplant. Reliability of the scale per Cronbach α value for the first subscale has been determined as 0.73, reliability per the Cronbach α value for the second subscale has been determined as 0.86, and reliability per the Cronbach α value for all items has been determined as 0.88.¹⁴

Ethical statements

All procedures adhered to the ethical standards of the responsible committee on human experimentation (institutional and national) and were conducted in accordance with the Helsinki Declaration of 1964 and its subsequent versions. Ethical approval (No. E-62310886-605.99-175755) was obtained from the Ethics Commission of Başkent University. We obtained written permission via e-mail from the researchers who developed the Organ-Tissue Donation and Transplantation Knowledge Scale to use the scale in our study. In addition, verbal and written permissions were obtained from participants after we explained the purpose and content of the study. The participants were informed that they could leave the study at any time and that the results of the study would be published for scientific purposes without any participant identification information.

Statistical analyses

We presented descriptive statistics as frequency (with percentage), mean ±SD, or median (with interquartile range), where appropriate. We used the SPSS Program for Windows (version 26.0) for statistical analyses. The Shapiro-Wilk test, histograms, and Q-Q plots were used for evaluation of normality of distribution. We used the t test and analysis of variance to analyze the data. P < .05 was significant.

Among the study participants, 54.7% were female and 62.4% were between the ages of 17 and 20 years. Most students (85.1%) lived in the province for a long time, 41.3% were enrolled in the Vocational School of Health Services, 89.6% did not have a chronic disease, and 63.6% did not have a chronic disease in their family. In addition, 43.3% of mothers and 48% of fathers of participants had high school education level (Table 1).

Views of participants on organ donation and transplant showed that 2.2% stated that they themselves donated their organs, 7.9% stated that their relatives donated their organs, 1.2% stated that their relatives were waiting for organ transplant, 4.7% stated that there was someone in their family who had an organ transplant, and 27.7% stated that they were considering donating their organs (Table 2). Although 21.8% of study participants wanted to be organ donors because they wanted to save someone's life, 15.1% wanted to do a good deed, and 13.1% knew the importance of the issue, findings showed that 15.1% did not want to be organ donors because their body integrity would be disrupted and 12.1% did not want their own lives to be at risk.

Information of participants on organ donation and transplant showed that 35.1% had information about organ donation, 86.6% would donate their organs if someone in their family needed an organ transplant, 72% would like to receive organs from other people if they or someone in their family needed organ transplant, and 72.3% found organ donation to be a reliable and beneficial practice (Table 3). In addition, participants stated that rich and poor patients were not given equal opportunities in organ transplant (44.3%), that they would donate their organs to someone of another religion (60.1%), that the society is not fully aware about organ donation (61.1%), and that they would like to be informed about organ donation (53.5%).

Table 4 shows the distribution of responses to the Organ-Tissue Donation and Transplantation Knowledge Scale among participants. The average score of participants was 9.07 ±4.33. The reliability of the scale that we found per the Cronbach α value was 0.74 for the first subscale and 0.80 for the second subscale.

When mean score of the Organ-Tissue Donation and Transplantation Knowledge Scale and variables were compared, the mean scale score for women (9.97 ±4.19) was higher than the mean scale score for men (7.98 ±4.26) (Table 5). Mean scale scores of participants who donated organs (14 ±2.95) and participants whose relatives donated organs (11.65 ±2.88) were significantly higher than scores of participants who did not donate. Mean scale scores of participants studying at the Vocational School of Health Services (9.78 ±4.38) were higher than participants studying at the Vocational School of Social Services (9.24 ±4.72) and the Vocational School of Technical Sciences (8.24 ±3.96). In addition, the mean scale score of participants who considered donating organs (10.08 ±3.98) was higher than the score of participants who did not want to donate organs (7.39 ±4.56).

Although substantial developments in organ and tissue transplant have occurred, the gap between patients waiting for transplant and receipt of transplant has not decreased. This situation is an important problem both in our country and worldwide. Recent work has emphasized the importance of conducting studies on organ and tissue donation.14 To solve this problem, it is necessary to communicate with more people from all segments of society. Communication with young people, especially with students who are aiming to work in the field of health, will contribute to these attempts. In this process, informing students correctly and sufficiently about organ transplant will create public awareness and will be effective in increasing organ donation in the long term.

Our study showed that the mean scores of the Organ-Tissue Donation and Transplantation Knowledge Scale of female students were significantly higher than scores of male students. Our results confirmed a previous study conducted by Alex and colleagues that reported that female medical students had higher attitude scores toward organ donation and transplantation than male students.15 In another study, female students gave more correct answers to organ donation information questions than male students.16 This finding indicates that young women have higher positive attitudes than young men, probably because of the higher emotional values.

According to the data in our study, mean scores of the Organ-Tissue Donation and Transplantation Knowledge Scale of participants who themselves donated, participants who had a relative who donated organs, and participants who were considering organ donation were significantly higher than participants who did not fit these categories. Knowledge on organ donation and transplantation among students because of family is reflected in their behaviors and high scores in the Organ-Tissue Donation and Transplantation Knowledge Scale. In addition, support of family members is important in motivating and maintaining the willingness to donate organs for a potential donor. In a study from Kokcu, similar to our findings, scores of those who donated organs and those who were considering donation were higher.¹⁷

In a previous study, Özdemir reported that 86.4% of health program students and 79.2% of social and technical program students had knowledge about organ transplant.¹⁸ Among our study participants, the Organ-Tissue Donation and Transplantation Knowledge Scale scores of students studying at the Vocational School of Health Services were significantly higher than scores of students studying at the Vocational School of Social Sciences and the Vocational School of Technical Sciences. This finding may be due to the educational curriculum of the students studying at the Vocational School of Health Services and their attention directed toward the field of study at their school. According to our results, students in fields other than health services need a more comprehensive approach on informative programs on organ donation. Studies on organ donation in the literature are generally conducted on a certain segment or a specific population. In this context, in studies involving the general public, individual awareness of organ donation and attitude is less, suggesting a need for more information. In the study from Arısoy and Önal, in which the attitudes and awareness of the society toward organ donation were examined, organ donation attitude scores were also low.¹⁹

A limitation of our study was that data were obtained from schools of limited sectors at a single institution. Therefore, the results cannot be generalized. Another limitation is that the questionnaires only measured knowledge.

University students did not have sufficient knowledge on organ and tissue donation and transplantation. Thus, university students in our country of Turkey need further information and correct guidance about the great need for organ donation. Because about half of the students stated that they wanted to receive information about organ donation and transplant within the scope of our study, information campaigns should be organized in a positive way to change the thoughts of young people who do not want to donate organs and are undecided. Having these activities throughout the university and increasing the relevant campaigns will be effective in changing the thoughts of young people and increasing their awareness. In line with the results of our study, plans have been made to organize activities on organ donation and transplant at our university.

Volume: 22 Issue: 10 October 2024 - Supplement - 5

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