Are health professionals responsible for the shortage of organs from deceased donors in Malaysia?

Knowledge, Attitudes and Intention to Donate Organs among the Public, Health Sciences Students and Health Personnel: A Scoping Review with a Systematic Review of Malaysian Studies

Background

Various barriers lead to a shortage of organs for transplantation in Malaysia. One drive to improve the organ donation rate operates through future healthcare practitioners and practitioner advocacy. This scoping review was carried out to establish and summarise findings about organ donation-related articles among the public, health sciences students and health personnel. A further aim was to synthesise the latest data on knowledge and attitudes towards organ donation in the Malaysian population.

Methods

PubMed, Scopus, Google Scholar and the Malaysian Medical Repository (MyMedR) were used for a search conducted up to May 2022. Relevant search terms included 'Organ donation' and 'Malaysia'. Journal articles related to knowledge, attitudes and intention were grouped under the general public and health science. Students and health personnel were included. Eligible studies were reviewed by two independent reviewers. Any disagreements were resolved by consensus with a third reviewer.

Results

The 31 included articles revealed an increased level of awareness among the public regarding organ donation. The analysis identified that nonrecognition of brainstem death (38.5%), no knowledge of how to contact the Organ Transplant Coordinator (82.3%) and never approaching the families of a potential donor (63.9%) led to a lack of confidence among healthcare practitioners to promote organ donation.

Conclusion

The shortage of organ donors is the result of the failure to identify the expected donor, obtain consent and procure the organs due to the passivity of Malaysian health professionals in promoting the organ donation process.

Determining the Knowledge and Attitudes of Theological Students in Turkey about Brain Death and Organ Donation

This descriptive study was performed to determine the knowledge and attitudes of 492 Faculty of Theology students in Turkey regarding organ donation and the determinants of organ donation intention according to the theory of planned behavior. The study used the Attitudes Toward Organ Donation Scale and the Organ-Tissue Donation and Transplantation Knowledge Scale. According to the results of the regression analysis, the factors affecting organ donation intention were attitude (OR 1.19, 95%CI 1.11-1.27), subjective norms (OR 1.10, 95%CI 1.01-1.20), and perceived behavioral control (OR 1.30, 95%CI 1.18-1.44). In this study, behavioral intention was significantly associated with attitude, subjective norms, and perceived behavioral control.

Opinions of healthcare students on organ and tissue donation for transplantation

OBJECTIVES

to analyze the opinions of healthcare students on organ and tissue donation for transplantation.

METHODS

qualitative document analysis study, using the records of a database and analyzing data from two perspectives: 1) Lexical analysis, with the IRAMUTEQ software, and 2) Thematic content analysis.

RESULTS

from the analysis, 3 main categories were generated: 1) Organ and tissue donation as an act of love for others and an opportunity of a new beginning; 2) Clarification and awareness on organ and tissue donation; and 3) Importance of communicating the family and promoting organ and tissue donation.

FINAL CONSIDERATIONS

despite being in favor of donation, students also recognize the presence of social taboos; the discussion in the family nucleus, promoting the theme and raising awareness in society are considered important. Additionally, the education of students is one of the possibilities of intervention for the issue.

Assessment of knowledge and attitudes regarding organ donation among doctors and students of a tertiary care hospital

Organ donation is a lifesaving treatment option for patients with end-organ damage. However, many patients are unable to avail this option due to the low availability of viable organs for transplantation. The availability of donor organs can be improved by increasing awareness and resolving organ donation misconceptions among the general population. It can be assumed that healthcare workers are most aware of the value of organ donation. They are also in a position to influence the willingness of the general population to donate organs after death or sign up for an organ donor card. The knowledge and attitudes of current and future healthcare professionals regarding this subject have neither been evaluated nor considered a topic of priority in the existing Indian medical education program.

OBJECTIVES

To evaluate the knowledge, attitudes, and beliefs of licensed medical doctors and undergraduate Bachelor of Medicine and Bachelor of Surgery (MBBS) students and analyze differences between the two groups with respect to the above.

METHODOLOGY

A total of 650 doctors and MBBS students from a Tertiary care hospital were included in the study and subjected to a questionnaire with 11 questions. Responses to the questionnaire were analyzed to evaluate knowledge and attitudes regarding organ donation. Statistical analysis was carried out using IBM SPSS Statistics for Windows, version 24.

RESULTS AND CONCLUSIONS

About 29.9% of doctors and 49.8% of students knew about the law governing organ donation. The concept of brain death was entirely understood by only 31.7% of doctors and 14.7% of students. Only 16% of doctors and 3.2% of students had filled an organ donor card. About 40.9% of doctors and 51% of students favored the opt-out system, as followed by western nations. Fear of illegal selling or purchase of organs was predominant in 61.9% of doctors and 52.2% of students. The current study reveals that the medical fraternity's knowledge and personal responsibility need improvements. However, the system also needs to be improved to win their trust.

Attitude, Willingness, and Associated Factors in Organ Donation Among Health Professionals in Gondar, Northwest Ethiopia

BACKGROUND

Organ transplantation is considered one of the greatest advances of modern science, and it has given many patients a renewed lease on life. The demand for organs far exceeds the supply. Health professionals are fundamental in the process of organ procurement.

OBJECTIVE

To assess the attitude, willingness, and associated factors in organ donation among health professionals of Gondar, Ethiopia.

METHODS

Our cross-sectional study was conducted among 382 randomly selected health professionals in Gondar using a self-administered questionnaire. Multivariable logistic regression analysis was applied to analyze the data.

RESULTS

Among health professionals, 79.1% had favorable attitude toward organ donation and 74.6% were willing to donate their organs. After adjusting for covariates, the odds of having a favorable attitude about organ donation were 3.2 and 11.9 times higher in the professions of laboratory technologists and medical doctors, respectively. By keeping all other variables constant, attitude was found to be positively associated with awareness (adjusted odds ratio [aOR] 12.74, 95% confidence interval [CI] 3.71-43.8) and being a member of the Red Cross Association (aOR 5.24, 95% CI 1.46-18.96). Willingness was positively associated with awareness (aOR 6.25, 95% CI 2.0-19.53), a member of the Red Cross Association (aOR 5.09, 95% CI 1.5-17.22), a laboratory technologist (aOR 3.57, 95% CI 1.37-9.29), and a medical doctor (aOR 6.52, 95 % CI 1.93-22.01).

CONCLUSIONS

The main findings indicated that the majority of health professionals in Gondar had a favorable attitude toward organ donation and were willing to donate their organs in times of need.

What is "shared" in shared decision-making? Philosophical perspectives, epistemic justice, and implications for health professions education

BACKGROUND

Drawing from the philosophical work of Hans-Georg Gadamer and the perspectives of theorists Mikhail Bakhtin and Kenneth Burke, the aim of this paper is to critically reflect on the meaning of the word "shared."

METHOD

The authors draw on the concept of epistemic justice, which they argue permeates the clinical encounter, to discuss how various forms of, and claims to, knowledge may influence the attainement of shared decision-making in health care contexts. The specific objectives are twofold: first, the authors draw key concepts from key Gadamerian, Burkean, and Bakhtinian philosophical perspectives to consider shared decision-making in relation to two types of epistemic injustice: testimonial and hermeneutic epistemic injustice. Second, building on philosopher Paulo Freire's critical pedagogy, the authors emphasize that major changes in educational structures and systems are required to promote the critical reflexivity required to address issues of epistemic justice, in the broader pursuit of authentic shared decision-making.

RESULTS

They propose three main areas of focus for helath professions education: (a) changes in content (moving from a focus on biomedical knowledge to more content on social sciences) and methods of teaching (more dialogue and the creation of moments of dissonance); (b) a re-examination of teachers' role in promoting epistemic justice; and (c) inclusion of patients as partners.

CONCLUSIONS

Without major transformation in what, how, and with whom we teach, future clinicians may be unprepared to enact shared decision-making in a manner that does justice to the various ways of knowing.

Knowledge and attitudes of healthcare professionals and the impact on willingness to donate organs: a tertiary hospital survey

INTRODUCTION

Healthcare professionals (HCPs) working in critical care areas play an important role in the organ donation (OD) process. We studied HCPs' own willingness to be organ donors and its association with sociodemographic factors as well as their knowledge and attitudes about OD and transplantation.

METHODS

A cross-sectional survey of HCPs working in four critical care units in a major transplant centre in Malaysia was undertaken using a validated structured questionnaire. Responses were analysed using multivariable analysis with willingness to donate as the dependent variable.

RESULTS

Of the 412 respondents (response rate 98.1%), the majority were nurses (60.4%), Malay (71.1%) and female (77.2%). Overall, 68.0% were willing to donate. The independent predictors of willingness to donate were profession (p < 0.001) and the Hindu religion (p = 0.001). Ethnicity (p = 0.003), religious belief (p < 0.001), knowledge (p = 0.016), belief in brain death (p = 0.018) and confidence in transplantation (p < 0.001) also independently correlated with willingness to donate, while attitudes to OD did not. Of those willing to donate, only 37.3% were carrying a donor card and only 63.1% had informed their family of their intention to donate.

CONCLUSION

Although willingness to donate was higher in critical care HCPs than HCPs in general, significant knowledge gaps as well as certain beliefs and perceptions that could pose a barrier to OD were identified in this group. Measures to improve OD rates in Malaysia should include targeted educational programmes for HCPs working in critical care areas.

Knowledge Does Not Correlate with Behavior toward Deceased Organ Donation: A Cross-Sectional Study in Japan

Background

Although knowledge is an important factor that influences decisions regarding deceased organ donation, the associations of knowledge with attitude and behavior regarding organ donation remain uncertain in countries with low organ donation rates like Japan.

Material/Methods

We conducted a cross-sectional survey of hospital medical and non-medical staff in 15 Japanese medical facilities. The questionnaire included items on knowledge, attitude, and behavior toward deceased organ donation and transplantation. Participants were divided into 3 groups according to the tertile of knowledge score. Modified Poisson regression models were used for associations of knowledge score with organ donor registration and willingness to become an organ donor after death.

Results

Of the 1967 staff, 1275 returned the questionnaires (response rate, 64.8%). There were 1190 study subjects with complete data for analysis. For the lowest (n=512), middle (n=428), and highest (n=250) tertile knowledge groups, the proportions of participants who registered and expressed willingness to donate organs were 20.1%, 23.4%, and 28.4% and 31.1%, 38.3%, and 44.0%, respectively. The adjusted proportion ratios for organ donor registration were 0.90 (95% CI, 0.73–1.10) for the middle and 1.00 (0.80–1.26) for the highest tertile of knowledge, compared with the lowest tertile. However, participants with the highest tertile of knowledge score expressed higher willingness for organ donation than the lowest tertile (adjusted proportion ratio, 1.37; 95% CI, 1.13–1.66).

Conclusions

For hospital staff in Japanese medical facilities, high knowledge about organ donation and transplantation was not associated with donor registration, but was associated with willingness to become an organ donor.

Factors Associated with Health Care Professionals' Attitude Toward the Presumed Consent System

OBJECTIVES

This paper explores health care professionals' potential attitude toward organ donation if the presumed consent system were to be implemented in Malaysia, as well as factors associated with this attitude.

MATERIALS AND METHODS

We used self-administered questionnaires to investigate the attitude of 382 health care professionals from the University of Malaya Medical Center between January and February 2014. The responses were analyzed using logistic regression.

RESULTS

Of the 382 respondents, 175 (45.8%) stated that they would officially object to organ donation if the presumed consent system were to be implemented, whereas the remaining 207 (54.2%) stated that they would not object. The logistic regression showed that health care professionals from the Malay ethnic group were more likely to object than those from Chinese (adjusted odds ratio of 0.342; P = .001) and Indian and other (adjusted odds ratio of 0.341; P = .003) ethnic groups. Health care professionals earning 3000 Malaysian Ringgit or below were more likely to object than those earning above 3000 Malaysian Ringgit (adjusted odds ratio of 1.919; P = .006). Moreover, respondents who were initially unwilling to donate organs, regardless of the donation system, were more likely to object under the presumed consent system than those who were initially willing to donate (adjusted odds ratio of 2.765; P < .001).

CONCLUSIONS

Health care professionals in Malaysia have a relatively negative attitude toward the presumed consent system, which does not encourage the implementation of this system in the country at present. To pave the way for a successful implementation of the presumed consent system, efforts should be initiated to enhance the attitude of health care professionals toward this system. In particular, these efforts should at most target the health care professionals who are Malay, earn a low income, and have a negative default attitude toward deceased donation.

Organ donation and transplantation: Awareness and roles of healthcare professionals-A systematic literature review

AIMS AND OBJECTIVES

To examine the role of healthcare professionals in the organ donation and transplantation process.

BACKGROUND

Globally, there remains a perennial disequilibrium between organ donation and organ transplantation. Several factors account for this disequilibrium; however, as healthcare professionals are not only strategically positioned as the primary intermediaries between organ donors and transplant recipients, but also professionally situated as the implementers of organ donation and transplantation processes, they are often blamed for the global organ shortage.

DESIGN

Mixed-method systematic review using the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols 2015 checklist.

METHODS

Databases were searched including CINAHL, MEDLINE, Web of Science and EMBASE using the search terms "organ donation," "healthcare professionals," "awareness" and "roles" to retrieve relevant publications.

RESULTS

Thirteen publications met the inclusion criteria. The global organ shortage is neither contingent upon unavailability of suitable organs nor exclusively dependent upon healthcare professionals. Instead, the existence of disequilibrium between organ donation and transplantation is necessitated by a web of factors. These include the following: healthcare professionals' attitudes towards, and experience of, the organ donation and transplantation process, underpinned by professional education, specialist clinical area and duration of professional practice; conflicts of interests; ethical dilemmas; altruistic values towards organ donation; and varied organ donation legislations in different legal jurisdictions.

CONCLUSION

This review maintains that if this web of factors is to be adequately addressed by healthcare systems in different global and legal jurisdictions, there should be sufficient organs voluntarily donated to meet all transplantation needs.

RELEVANCE TO CLINICAL PRACTICE

There is a suggestion that healthcare professionals partly account for the global shortage in organ donation, but there is a need to examine how healthcare professionals' roles, knowledge, awareness, skills and competencies might impact upon the organ donation and transplantation process.

The Dark Side of Medical Tourism?

There are 4 principles that should govern the response of the healthcare system in its treatment of individual medical problems. These may be summarized as: 1. medical care should be accessible to all; 2. the principle of patient autonomy should govern decision-making; 3. medical treatment should be recognized as being part of cultural behavior; and, 4. the medical profession should support the benefit of the patient. However, the combination of these with the rising cost of healthcare and the impact of globalization, has led to a dark side for medical tourism. In this situation, both patients and physicians are faced with ethical, human security and sustainability issues. This chapter examines 3 major issues in medical tourism: end of life choice, trafficking in human bodies and body parts, and organ transplants. In the healthcare systems of many countries, these issues can also involve criminal activities.

For and against Organ Donation and Transplantation: Intricate Facilitators and Barriers in Organ Donation Perceived by German Nurses and Doctors

Background. Significant facilitators and barriers to organ donation and transplantation remain in the general public and even in health professionals. Negative attitudes of HPs have been identified as the most significant barrier to actual ODT. The purpose of this paper was hence to investigate to what extent HPs (physicians and nurses) experience such facilitators and barriers in ODT and to what extent they are intercorrelated. We thus combined single causes to circumscribed factors of respective barriers and facilitators and analyzed them for differences regarding profession, gender, spiritual/religious self-categorization, and self-estimated knowledge of ODT and their mutual interaction. Methods. By the use of questionnaires we investigated intricate facilitators and barriers to organ donation experienced by HPs (n = 175; 73% nurses, 27% physicians) in around ten wards at the University Hospital of Munich. Results. Our study confirms a general high agreement with the importance of ODT. Nevertheless, we identified both facilitators and barriers in the following fields: (1) knowledge of ODT and willingness to donate own organs, (2) ethical delicacies in ODT, (3) stressors to handle ODT in the hospital, and (4) individual beliefs and self-estimated religion/spirituality. Conclusion. Attention to the intricacy of stressors and barriers in HPs continues to be a high priority focus for the availability of donor organs.

Factors Associated With Medical and Nursing Students' Willingness to Donate Organs

Malaysia suffers from a chronic shortage of human organs for transplantation. Medical and nursing students (MaNS) are future health professionals and thus their attitude toward organ donation is vital for driving national donation rates. This study investigates MaNS' willingness to donate organs upon death and the factors influencing their willingness. A cross-sectional design was used with a sample of 500 students (264 medical and 236 nursing) at the University of Malaya. A self-administrated questionnaire was used. The responses were analyzed by using descriptive statistics and multiple logistic regression. Of all respondents, 278 (55.6%) were willing to donate organs upon death, while the remaining 222 (44.4%) were unwilling to donate. Only 44 (8.8%) had donor cards. The multiple logistic regression revealed that the minorities ethnic group was more willing to donate organs than Malay respondents (adjusted odds ratio [aOR] = 1.98, P = 0.010). In addition, medical students were more willing to donate than nursing students (aOR = 2.53, P = 0.000). Respondents who have a family member with a donor card were more willing to donate than respondents who do not (aOR = 3.48, P = 0.006). MaNS who believed that their religion permits deceased donation were more willing to donate than their counterparts (aOR = 4.96, P = 0.000). Household income and sex were not significant predictors of MaNS' willingness to donate organs upon death. MaNS have moderate willingness, but low commitment toward deceased organ donation. Strategies for improving MaNS' attitude should better educate them on organ donation, targeting the most the Malay and nursing students, and should consider the influence of family attitude and religious permissibility on MaNS' willingness.

The Cost and Utility of Renal Transplantation in Malaysia

Kidney transplantation is the optimal therapy for the majority of patients with end-stage renal disease. However, the cost and health outcomes of transplantation have not been assessed in a middle-income nation with a low volume of transplantation, such as Malaysia.

AIM AND METHODS

This study used microcosting methods to determine the cost and health outcomes of living and deceased donor kidney transplantation in adult and pediatric recipients. The perspective used was from the Ministry of Health Malaysia. Cost-effectiveness measures were cost per life year (LY) and cost per quality-adjusted LYs. The time horizon was the lifetime of the transplant recipient from transplant to death.

RESULTS

Records of 206 KT recipients (118 adults and 88 children) were obtained for microcosting. In adults, discounted cost per LY was US $8609(Malaysian Ringgit [RM]29 482) and US $13 209(RM45 234) for living-donor kidney transplant (LKT) and deceased donor kidney transplant (DKT), respectively, whereas in children, it was US $10 485(RM35 905) and US $14 985(RM51 317), respectively. Cost per quality-adjusted LY in adults was US $8826 (RM30 224) for LKT and US $13 592(RM46 546) for DKT. Total lifetime discounted costs of adult transplants were US $119 702 (RM409 921) for LKT, US $147 152 (RM503 922) for DKT. Total costs for pediatric transplants were US $154 841(RM530 252) and US $159 313(RM545 566) for the 2 categories respectively.

CONCLUSIONS

Both LKT and DKT are economically favorable for Malaysian adult and pediatric patients with ESRD and result in improvement in quality of life.

Views of health care personnel on organ donation and transplantation: A literature review

The purpose of this study was to review the empirical studies on health personnel's views towards organ donation and transplantation. A scoping review was carried out in English, Portuguese and Spanish. The search was conducted in eight databases, and two search engines. Four groups of descriptors were used. The period covered was 1985 to 2013. Frequency and content analysis was performed. Two hundred forty-eight articles were selected, out of 316 identified. The literature is temporally and geographically clustered. Quantitative studies predominate. The studies prioritized the perspective of medical and nursing personnel over other actors, such as directors and organ donation coordinators. Health personnel's attitudes toward deceased organ donation was the most examined topic. In conclusion, a growing quantitative literature analyzes the perspective of physicians and nurses with regard to deceased organ donation and transplantation.

Attitude of healthcare professionals: a major limiting factor in organ donation from brain-dead donors

Public attitude toward deceased donor organ recovery in Poland is quite positive, with only 15% opposing to donation of their own organs, yet actual donation rate is only 16/pmp. Moreover, donation rate varies greatly (from 5 to 28 pmp) in different regions of the country. To identify the barriers of organ donation, we surveyed 587 physicians involved in brain death diagnosis from regions with low (LDR) and high donation rates (HDR). Physicians from LDR were twice more reluctant to start diagnostic procedure when clinical signs of brain death were present (14% versus 5.5% physicians from HDR who would not diagnose death, resp.). Twenty-five percent of LDR physicians (as opposed to 12% of physicians from HDR) would either continue with intensive therapy or confirm brain death and limit to the so-called minimal therapy. Only 32% of LDR physicians would proceed with brain death diagnosis regardless of organ donation, compared to 67% in HDR. When donation was not an option, mechanical ventilation would be continued more often in LDR regions (43% versus 26.7%; P < 0.01). In conclusion, low donation activity seems to be mostly due to medical staff attitude.