|Year : 2018 | Volume
| Issue : 2 | Page : 59-63
Organ donation awareness and attitude among Riyadh City Residents, Saudi Arabia
Aws Almufleh1, Rasha Althebaity2, Ali S Alamri3, Nada A Al-Rashed4, Eman H Alshehri5, Lina Albalawi6, Reem Alameer7, Eman Hajr8, Ismail A Raslan9, Faisal A Alsaif10
1 Cardiac Sciences Department, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
2 Department of Surgery, College of Medicine, Majmaah University, Al Majmaah, Saudi Arabia
3 Department of Surgery, King Saud Medical City, Riyadh, Saudi Arabia
4 General Surgery Registrar in Security Forces Hospital, Riyadh, Saudi Arabia
5 Department of Obstetrics and Gynecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
6 Demonstrator, Internal Medicine Department, Almajmaah University, Al Majmaah, Saudi Arabia
7 Infectious Diseases Section, Internal Medicine Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
8 Saudi Board in Otorhinolaryngology Head and Neck Surgery, Otology/Neurotology Fellow, Al Imam Mohammed Bin Saud University, Riyadh, Saudi Arabia
9 Department of Internal Medicine, College of Medicine, Riyadh, Saudi Arabia
10 Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
|Date of Web Publication||6-Jun-2018|
Faisal A Alsaif
HPB and Transplant Surgery, College of Medicine, King Saud University, Riyadh
Source of Support: None, Conflict of Interest: None
Introduction: Organ donation is widely contentious among the Saudi population though remains largely understudied. In the aim to understand the public perception of organ donation, willingness to donate, and the reasons for donation refusal, we carried out this study. Methodology: A cross-sectional questionnaire-based study was conducted on a stratified-by-region random sample of 2596 Saudi residents in Riyadh area between 15 and 70 years of age in March 2010. The main outcomes were rates of organ donation awareness, willingness to donate, and awareness of Islamic opinion permitting organ donation. Secondary exploratory analysis was performed to determine reasons for organ donation refusal. Results: Seventy-six percentage of the sample had some background knowledge of organ donation; however, 41% were unwilling to donate their organs, with only 30.1% of our sample having had a prior knowledge about Islamic opinion about organ donation. Overall, of those who had background knowledge of organ donation, 79.5% thought that organ donation was important or very important. Respondents who are women, older, more educated, and in higher income group were more likely to be aware of organ donation (P < 0.05) and those younger than 35 years old were more likely to be unaware of the Islamic opinion (P < 0.001). The most cited reasons for donation refusal included the desire to be buried with complete parts (43.8%) (i.e., not disfigured), having an incomplete idea about brain death (24%), and because they thought that it was forbidden in Islam (15.1%). Conclusion: The level of organ donation awareness was comparatively high, but knowledge of the Islamic views of organ donation lacked among high portion of our sample, which partially explains the high organ donation refusal rate. There remains a large need to promote public awareness about the importance of organ donation and to clear the confusion of the Islamic view.
Keywords: Donation awareness, organ donation, organ transplantation
|How to cite this article:|
Almufleh A, Althebaity R, Alamri AS, Al-Rashed NA, Alshehri EH, Albalawi L, Alameer R, Hajr E, Raslan IA, Alsaif FA. Organ donation awareness and attitude among Riyadh City Residents, Saudi Arabia. J Nat Sci Med 2018;1:59-63
|How to cite this URL:|
Almufleh A, Althebaity R, Alamri AS, Al-Rashed NA, Alshehri EH, Albalawi L, Alameer R, Hajr E, Raslan IA, Alsaif FA. Organ donation awareness and attitude among Riyadh City Residents, Saudi Arabia. J Nat Sci Med [serial online] 2018 [cited 2019 Jan 19];1:59-63. Available from: http://www.jnsmonline.org/text.asp?2018/1/2/59/233820
| Introduction|| |
Organ transplantation is currently recognized to be the treatment of choice for multiple end-stage organ diseases. The need for organ transplantations is rapidly increasing in Saudi Arabia. For instance, the number of end-stage renal disease patients in Saudi Arabia approached 12,116 in 2011 and is predicted to double in the next decade., The expected posttransplantation 5-year survival rates are 85% for kidney transplant, 70% for liver transplant, and 65% for heart transplant, which are much higher when compared to the conventional supportive therapy. According to the Saudi Center for Organ Transplantation latest statistics, 309 of patients undergoing brain death in Saudi Arabia were eligible for organ donation, but unfortunately only 23% of those patients' families agreed to donate their organs. An even lesser rate was reported in a study reviewing 162 brain-dead patients' families' response when approached for organ donation in King Abdulaziz Medical City, where only 17% agreed for donation. The reason for family refusal differs widely, but a common denominator was found to be the lack of understanding of the concept of brain death  and misconception of the Islamic view on organ donation.
A study carried out in Riyadh and Jeddah cities in Saudi Arabia in 1995 revealed that 68% of respondents were willing to donate their relatives' organs in case they endured brain death and 38% agreed to donate their own organs., Not unexpectedly, a recently published systematic review has shown religious opinion to be a very important factor to affect organ donation in the Middle East., The above studies were mostly from single-center and covered small nonrepresentative samples, which highlights the need for larger study to establish a better understanding of rates of organ donation awareness, willingness to donate, and awareness of Islamic opinion.
| Methodology|| |
The study was approved by King Saud University Ethics Review Board; it was an observational cross-sectional study that targeted a stratified-by-region random sample taken from the population of Riyadh city and surrounding villages, i.e., Riyadh area. Riyadh city was geographically sectioned into four quarters, i.e., south, west, east, and north. Within each quarter, based on local residents' advice about the most populated malls, schools and colleges were targeted. Outside the city, concentric villages were chosen to complement the urban Riyadh city with its rural surroundings. The study was conducted in a 2-week period in March 2010 in association with educational campaign aimed to increase the awareness of Saudi society about organ donation. The activities of campaign took place in several sites, for example, schools, universities, colleges, and main malls. Age range was between 15 and 70 years. The target population approached was 3000 male and female participants, 2596 out of which completed our questionnaire. The remaining 404 participants were excluded as they either did not return their questionnaires or had incompletely filled them. We utilized list-wise deletion to handle questionnaires with missing data.
A standardized questionnaire was used to ascertain the awareness, knowledge, and attitude toward organ donation and transplantation as well as few background and demographic questions. The questionnaire was based on several previous validated questionnaires used in previous studies.,, It was then tested on a pilot of 65 individuals who were chosen randomly from King Saud University Center. The format and content were found to be clear and straightforward, suggesting no further edition on the questionnaires. They were distributed by trained personnel who had a clear idea about research questions, choices, and possible answers. It was ascertained that questionnaires were filled by participants before attending the activity of educational program and without influence on their opinions by the members of campaign.
Data were entered and analyzed using the SPSS Inc. Released 2008. SPSS Statistics for Windows, Version 17.0. (Chicago, US: SPSS Inc). Chi-square tests of independence were performed to test the association between the various study variables. Based on the Chi-square test results, odds ratios (ORs) were calculated and reported along with the 95% confidence interval. P < 0.05 was considered statistically significant.
| Results|| |
The study targeted 3000 recipients, 2596 of whom returned the questionnaires filled, making the response rate of 86.5%.
As shown in [Table 1], while the majority of our population were from Riyadh area, were students, and were 15–20 years of age, our sample spectrum included substantial numbers from all categories across the Saudi demographics, students, workers, and unemployed people of both genders, and all socioeconomic and occupational levels were included.
When asked about whether they heard about organ donation or not before, 76.3% said yes, while only 23.7% never heard about organ donation prior to the campaign. Awareness level was found to be higher among older participants, with a statistically significant difference (P = 0.01). [Table 2] shows the participants' answer to most of the study questions.
The degree of perceived importance of organ donation was important or very important in 79.8%, but neutral in 16.9% and unimportant in 3.5%.
In response to the question regarding willingness to agree to organ donation of a relative if they had brain death, 56% agreed, 16% did not, while 27.4% remained undecided. The reason behind the willingness to donate organs was humanity and giving reasons in 47%, religious rewards in 37%, and because they witnessed someone in need to organs 13.7%. On the other hand, among those who refused donation, 27.7% reported the fear to be buried “incomplete,” 17.7% thought the donor's body will be disfigured, 19.7% reported the disagreement of family in this issue, 19.4% refused because they lacked the basic understanding of brainstem death, and finally 15% refused donation because they thought it was forbidden in Islam.
About 70% of our study participants were unaware of the presence of a religious opinion permitting organ donation, while only 30% had prior knowledge about it. Rate of lack of awareness of Islamic opinion was higher in younger participants (<20 years of age), P < 0.001, OR =1.603).
| Discussion|| |
Our study is, by far, the largest in Saudi Arabia investigating organ donation awareness in the general population. The level of organ donation awareness in our study (74%) was higher than the previous national study which estimated awareness to be 44% among urban and 31% among rural populations. A possible explanation to the higher level of awareness in our study is the increasing number of organ donation awareness campaigns which is proposed to be a key factor in improving awareness. Our study, however, in contrast to previous national studies, reported no statistically significant difference [Table 3] between Riyadh and its surrounding rural villages, which probably reflects the fast spread of knowledge to Riyadh's neighboring villages and the higher rate of villages' urbanization.
|Table 3: Factors affecting level of organ donation awareness across our population and the statistical significance of their interaction|
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Reported willingness to donate brain-dead relatives' organs was 56% in our study, about 12% lower than the previous 1996 national-based study, a discrepancy that can be explained by the limited awareness of religious opinion in our sample (30% only) compared to 42% in the 1996 study. Reasons for refusal that included body disfigurement, religious opinion unawareness, and family disagreement were consistent with the two previous studies.,
Organ donation awareness was found to be significantly more in women, higher educated individuals, those with higher socioeconomic status, and in married people [Table 3]. This goes in synchronization with many previous studies ,, that identified those to be strong predictors for higher levels of organ donation awareness.
All studies of organ donation awareness in Saudi Arabia, including ours, have consistently yielded lower awareness (30%–74%) levels than most of its counterparts around the world [Table 4].,,, However, compared to previous studies in Saudi Arabia, the increased rate of organ donation awareness in our study reflects a promising trend and a higher chance of having next-of-kin agreement to organ donation in case of a relative's brain death. As the morbidity of end-organ dysfunction continues to plague the country, improvement of organ donation awareness in our study, albeit marginal, represents a step in the right direction. However, the knowledge of Islamic opinion was only 30% which calls for more awareness campaigns that include Islamic education about the permissibility of organ donation.
|Table 4: Comparison between levels of awareness and willingness for organ donation across five large countries|
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Finally, although our study has a considerably large sample size and included both urban and rural areas, it is important to note some limitations. First, our study design was observational with its inherent limitations. Second, the study only included the central region of Saudi Arabia; therefore, caution should be exercised before generalizing its findings to the rest of the country. Furthermore, 13.5% of the participants approached did not return completed questionnaires and therefore were excluded; whether this impacts the true rate of organ donation awareness is unknown.
| Conclusion|| |
Disseminating the idea of the organ donation, explaining the concept of brain death, and utilizing mass media in that purpose are a cornerstone in improving the culture of organ donation in the long term. Larger, more comprehensive study covering all Saudi Arabian regions is needed to help us understand the full dimension of this issue in the country.
The research team would like to acknowledge the contributions by Ahmed M. Alaqeel, Omar M. BenHusain, Rawabi H. Alhathlool, Adel A Alahaidib, Bilal Marwa, Mohammed Alotaibe, Saad A Bin Ayeed, Faiza Alotaibi, Afnan Almass, Amjad Aldrees, Dana Aldehmashy, Sarah Hawidi, Asma Alaqeel, Auroabah S. AlMufleh, and Raed Faraj. We are grateful to Dr. Salwa Tayel for her help in coding system of the data and for her useful comments on an earlier version of the manuscript. We would also like to remark the amazing effort shown by “Save a Life” organ donation awareness campaign that followed our data collection and has probably had a major impact in improving organ donation and brain death concept awareness in our community.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Aldawood A, Al Qahtani S, Dabbagh O, Al-Sayyari AA. Organ donation after brain-death: experience over five-years in a tertiary hospital. Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia. 2007;18:60-4.
Shaheen FA, Souqiyyeh MZ. Current status of renal transplantation in the Kingdom of Saudi Arabia. Transplant Proc 2004;36:125-7.
Transplantation SCfO. Renal Replacement Therapy Organ Donation and Transplantation in the Kingdom of Saudi Arabia National Data 2011 SCOT annual Report. 2011;1:55-7.
Shaheen FA, Souqiyyeh MZ, Al-Attar B, Jaralla A, Al Swailem AR. Survey of opinion of secondary school students on organ donation. Saudi J Kidney Dis Transpl. 1996;7:131-4.
Shaheen FA, Souqiyyeh MZ. Improving transplantation programs and patient care. Transplant Proc 2005;37:2909-10.
Al Shehri S, Shaheen FA, Al-Khader AA. Organ donations from deceased persons in the Saudi Arabian population. Exp Clin Transplant 2005;3:301-5.
Newton JD. How does the general public view posthumous organ donation? A meta-synthesis of the qualitative literature. BMC Public Health 2011;11:791.
Alghanim SA. Knowledge and attitudes toward organ donation: a community-based study comparing rural and urban populations. Saudi J Kidney Dis Transpl 2010;21:23-30.
] [Full text]
Bapat U, Kedlaya PG. Organ donation, awareness, attitudes and beliefs among post graduate medical students. Saudi J Kidney Dis Transpl 2010;21:174-80.
] [Full text]
Rady MY, McGregor JL, Verheijde JL. Mass media campaigns and organ donation: managing conflicting messages and interests. Med Health Care Philos 2012;15:229-41.
Bilgel H, Sadikoglu G, Goktas O, Bilgel N. A survey of the public attitudes towards organ donation in a Turkish community and of the changes that have taken place in the last 12 years. Transpl Int 2004;17:126-30.
Manninen DL, Evans RW. Public attitudes and behavior regarding organ donation. JAMA 1985;253:3111-5.
Ashraf O, Ali S, Ali SA, Ali H, Alam M, Ali A, et al
. Attitude toward organ donation: a survey in Pakistan. Artif Organs. 2005;29:899-905.
Chen JX, Zhang TM, Lim FL, Wu HC, Lei TF, Yeong PK, et al
. Current knowledge and attitudes about organ donation and transplantation among Chinese university students. Transplant Proc 2006;38:2761-5.
Wang W, Tian H, Yin H, Liu H, Zhang XD. Attitudes toward organ donation in China. Chin Med J (Engl) 2012;125:56-62.
Minniefield WJ, Muti P. Organ donation survey results of a Buffalo, New York, African-American community. J Natl Med Assoc 2002;94:979-86.
Symvoulakis EK, Komninos ID, Antonakis N, Morgan M, Alegakis A, Tsafantakis E, et al
. Attitudes to kidney donation among primary care patients in rural Crete, Greece. BMC Public Health 2009;9:54.
[Table 1], [Table 2], [Table 3], [Table 4]