J Indian Acad Forensic Med.

2019 Jul-Sep; 41(3): 171-175

doi: 10.5958/0974-0848.2019.00050.2

ORIGINAL ARTICLE

Knowledge, awareness and attitude towards organ donation among undergraduate

medical students of Haryana
Hitesh Chawla1, Ashish Tyagi1, Ranjana Malhotra2, Shiv Shankar1, Naresh Sharma3
1 Department of Forensic Medicine, SHKM Government Medical College, Nalhar, Nuh, Haryana, India
2 Civil Hospital, Gurugram, Haryana, India
3 Department of Physiology, SHKM Government Medical College, Nalhar, Nuh, Haryana, India

Abstract
The knowledge and attitude of society toward organ donation is far from satisfactory even among the educated sections. Since medical
students are the future doctors of the country, their optimistic attitude and elevated knowledge can build a constructive environment
and encourage organ donation. A descriptive, cross-sectional study was carried out on undergraduate medical students of a
Government Medical College of Southern Haryana. A questionnaire was adopted to know the knowledge, awareness and attitude of
medical students toward organ donation. The data obtained from answer sheet was evaluated and incorporated on Microsoft Excel
sheet, and descriptive analysis in terms of mean, standard deviation and percentage was carried out. A total of 249 medical students
comprising of with 185 males and 64 females took part in the study. A steady increase in awareness of organ donation was seen from
81.08% to 86.07% from 1st MBBS to 3rd MBBS years of education. Television was found to be the most effective source of awareness
(70.27%) of organ donation for 1st MBBS students while medical college was the maximum source (78.48%) of awareness for 3rd
MBBS medical students. 70.88% 3rd year medical students expressed their willingness to be an organ donor, and the majority of them
are willing to donate for their family members as compared to a friend or unknown person. More emphasis on the topic of organ
donation in the medical curriculum should be given. This will help to fill the gaps and lack of knowledge regarding organ donation and
issues related therewith.

Keywords
Organ donation; Transplantation; Medical; Students; Brain dead

Introduction The act was further strengthened and amended with new rules
Organ donation is the practice of surgically removing an organ and regulations in 2008, 2011 and 2014.5-8 Organ donation is yet
or tissue from one person (donor) and placing it into another to gain impetus in India even after the decades of
person (recipient) who is in need of that.1 It is the gift of an implementation of legislation. The knowledge and attitude of a
individual to aid somebody who requires an organ for his society toward organ donation is far from satisfactory even
morbid condition. Transplantation has significantly improved among the educated sections.9 Since medical students are the
the outlook of patients suffering from end stage of organ failure. future doctors of the country, their optimistic attitude and
It has been one of the greatest landmarks in the history of elevated knowledge can build a constructive environment and
modern science.2 Priceless human lives can be saved if ethically encourage organ donation. Hence, this study was carried out to
suitable quality organs are retrieved from a donor and determine the current level of knowledge of medical students
transplanted to the desirable person in a prescribed time frame.3 and their attitude toward organ donation and to identify the areas
The first kidney transplant was done in India in the 1970's, since of want of the knowledge and to further suggest counteractive
then it has been a leading destination for organ transplantation.4 measures to amplify the knowledge in those areas.
Lack of any legislation in that era lead to the rampant sale of
human organs. It was then; The Transplantation of Human Materials and Methods
Organs Act (THOA) was enacted in 1994 with the objectives to A descriptive, cross-sectional study was carried out on
provide the regulation of removal, storage and transplantation undergraduate medical students of a Government Medical
of human organs for therapeutic purpose and for the prevention
College of Southern Haryana. First, second and third year
of commercial dealings in human organs and for matters
MBBS students were included in this study. Only those students
connected therewith or incidental thereto. This act, for the first
who gave informed consent were incorporated. The
time recognized brain death for facilitating retrieval of organs.
methodology was explained to them in detail. A questionnaire
adapted to the study requirements from the published research10
was designed to know the knowledge and attitude of medical
Corresponding Author
Dr. Hitesh Chawla (Associate Professor) students toward organ donation. The questionnaires were
E-mail: [email protected] pretested on a sample of ten undergraduate students and
Mobile: +91-9996530900 finalized after being thoroughly tested for clarity of the
Article History questions as well as time period required for response. These
Received: 19th April, 2019; Revision received on: 4th June, 2019 questionnaires were not incorporated in the final evaluation.
Accepted: 25th June, 2019
The questionnaire comprises of structured questions with

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 J Indian Acad Forensic Med. 2019 Jul-Sep; 41(3)

regard to demographic data, the level of knowledge and 1st MBBS students while medical college was maximum source
awareness toward organ donation and attitude of the subjects in (78.48%) of awareness for 3rd MBBS medical students.
regard to organ donation. Questionnaires were administered to Table 3 represents the level of knowledge of students about the
the participating medical students in paper format. Students different organs that can be donated, the related
were asked to indicate their responses as a tick mark in contraindications to organ donation and the ability of one donor
appropriate columns and were instructed to give their own to donate to multiple recipients. Knowledge about the organs
answers and discussion with peers was not permitted. A time that can be donated is seen maximum for eyes (95.58%) in all
period of 15 minutes for completion of the questionnaire was the medical students. Only 58.22% of 3rd MBBS students had
given to each student. The data obtained from the answer sheets knowledge about the present laws related to organ donation and
was evaluated and incorporated on Microsoft Excel sheet and transplantation.
descriptive analysis in terms of mean, standard deviation and
Table 3: Knowledge about different organs donated and contraindications to
percentage was carried out. organ donation

1st MBBS 2nd MBBS 3rd MBBS

Knowledge about
Results (N=74) (N=96) (N=79)
Organ that can be donated
A total of 249 medical students comprising of 185 males and 64 a) Eye 71 (95.94%) 91 (94.79%) 76 (96.20%)
females took part in the study (Table 1). b) Lung 07 (9.45%) 22 (22.91%) 29 (36.70%)
c) Liver 52 (70.27%) 67 (69.79%) 75 (94.93%)
Table 1: Demographic data of the study participants d) Intestine 05 (6.75%) 06 (6.25%) 03 (3.79%)
e) Heart 55 (74.32%) 72 (75%) 73 (92.4%)
1st MBBS 2nd MBBS 3rd MBBS f) Stomach 03 (4.05%) 06 (6.25%) 06 (7.59%)
Total 74 96 79 g) Kidneys 70 (94.59%) 89 (92.70%) 76 (96.2%)
Males 50 76 59 h) Spleen 08 (10.81%) 18 (18.75%) 22 (27.84%)
I) Skin 17 (22.97%) 29 (30.20%) 44 (55.69%)
Females 24 20 20 j) Pancreas 08 (10.81%) 11 (11.45%) 15 (18.98%)
Age Range (in years) 18 - 22 18-23 20-23 k) Bone Marrow 51 (68.91%) 61 (63.54%) 59 (74.68%)
Mean Age (in years) ± SD 19.47 ± 1 20.44 ± 1.09 21.32 ± 0.98 l) Bones 06 (8.1%) 09 (9.37%) 23 (29.11%)
Organ donation can't be done
if the donor:
The awareness of the subjects regarding organ donation, a) Is HIV, Hepatitis B or C + 60 (81.08%) 69 (71.87%) 67 (84.81%)
possible donors and source of awareness along with knowledge b) If donor has active cancer 40 (54.05%) 62 (64.58%) 49 (62.02%)
of brain death was obtained (Table 2) . That one donor can donate
to multiple recipients?
Table 2: Knowledge and awareness of organ donation and different a) Yes 35 (47.29%) 58 (60.41%) 65 (82.27%)
categories of donors with specific knowledge of brain death b) No 19 (25.67%) 14 (14.58%) 05 (6.32%)
c) Can't Say 20 (27.02%) 24 (25%) 09 (11.39%)
1st MBBS 2nd MBBS 3rd MBBS
Item Studied
(N=74) (N=96) (N=79) A majority of students believes that there is a need for the laws to
Awareness of organ donation 60 (81.08%) 82 (85.41%) 68 (86.07%) govern the process of organ donation (Table 4).
Awareness of possible donors
a) Living healthy person 32 (43.24%) 28 (29.16%) 43 (54.43%) Table 4: Knowledge of legalities related to organ donation
b) Brain dead 18 (24.32%) 37 (38.54%) 22 (27.84%) 1st MBBS 2nd MBBS 3rd MBBS
c) Already dead 13 (17.56%) 14 (14.58%) 20 (25.31%) Item Studied
(N=74) (N=96) (N=79)
d) Don't know 13 (17.56%) 21 (21.87%) 14 (17.72%)
e) No answer 02 (2.7%) 08 (8.33%) 04 (5.06%) Is there need for laws to
govern the process of organ
Source of awareness donation?
a) Newspaper 51 (68.91%) 51 (53.12%) 39 (49.36%) a) Yes 69 (93.24%) 78 (81.25%) 71 (89.87%)
b) Television 52 (70.27%) 46 (47.91%) 37 (46.83%) b) No 02 (2.70%) 03 (3.12%) 04 (5.06%)
c) Internet 50 (67.56%) 58 (60.41%) 48 (60.75%) c) Can't Say 03 (4.05%) 15 (15.62%) 04 (5.06%)
d) Social Media 43 (58.1%) 58 (60.41%) 45 (56.96%)
e) Family Members 34 (45.94%) 26 (27.08%) 22 (27.84%) Are there laws regarding
f) Medical College 51 (68.91%) 55 (57.29%) 62 (78.48%) organ donation activity
presently?
Knowledge of brain death a) Yes 53 (71.62%) 52 (54.16%) 46 (58.22%)
a) Irreversible loss of brain 54 (72.97%) 75 (78.12%) 69 (87.34%) b) No 06 (8.1%) 06 (6.25%) 07 (8.86%)
functioning 11 (14.86%) 08 (8.33%) 17 (21.51%) c) Can't Say 15 (20.27%) 38 (39.58%) 26 (32.91%)
b) Patient on ventilator 07 (9.45%) 06 (6.25%) 06 (7.59%)
c) Patient can recover from it 00 00 00 Whether the family of
d) Body feels warm 02 (2.7%) 09 (9.37%) 04 (5.06%) deceased person can pledge
his organs even if the person
had not signed a donor card
A slight but steady increase in awareness of organ donation was during his lifetime?
seen from 81.08% to 86.07% from 1st MBBS to 3rd MBBS a) Yes 24 (32.43%) 37 (38.54%) 33 (41.77%)
b) No 15 (20.27%) 18 (18.75%) 16 (20.25%)
years of education. Television was found to be the most c) Can't Say 35 (47.29%) 41 (42.7%) 30 (37.97%)
effective source of awareness (70.27%) of organ donation for

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70.88% 3rd year medical students expressed their willingness to which is adjoining to the national capital, also figuring at the
be an organ donor and majority of them are willing to donate for bottom of the Niti Aayog's recent list of 101 most backward
their family members as compared to friend or unknown person. districts in the country14 reported nil organ donation as per
A majority still doesn’t believe in the system behind organ NOTTO stats.13
donation and transplantation (Table 5). Total of 249 undergraduate medical students participated in this
Table 5: Attitude towards organ donation, willingness to donate organs and to study. While those in the 1st year of MBBS had just started their
promote organ donation and reasons for unwillingness to be an organ donor medical education, those in the 2nd year of MBBS were
1st MBBS 2nd MBBS 3rd MBBS undergraduate students with some knowledge of pharmacology,
Item Studied
(N=74) (N=96) (N=79) microbiology, pathology and forensic medicine. The 3rd year
Would you like to be part of students were the final year medical students who had started
Organ donation group and
motivate others for organ attending clinics and hospital regularly as per the Medical
donation? Council of India curriculum.
a) Yes 53 (71.62%) 74 (77.08%) 59 (74.68%)
b) No 05 (6.75%) 08 (8.33%) 04 (5.06%) Regarding knowledge and awareness of organ donation and
c) Can't Say 16 (21.62%) 14 (14.58%) 16 (20.25%) different categories of donors with specific knowledge of brain
Do you feel that organ death, the third year MBBS students were found to be slightly
donation is an individual
more aware of organ donation (86.07%) than 1st MBBS students
social commitment?
a) Yes 47 (63.51%) 61 (63.54%) 61 (77.21%) (81.08%). Increased awareness of 3rd MBBS students can be
b) No 09 (12.16%) 12 (12.5%) 11 (13.92%) attributed to their knowledge gained during the course of study
c) Can't Say 18 (24.32%) 23 (23.95%) 07 (8.86%)
in a medical college. However, cent percent knowledge was still
Would you like to be an
organ donor? not seen as observed by Bharambe et al.10 Our study shows low
a) Yes 53 (71.62%) 63 (65.62%) 56 (70.88%) awareness among the students that a brain dead person could be
b) No 02 (2.7%) 14 (14.58%) 02 (2.53%)
c) Can't Say 19 (25.67%) 19 (19.79%) 21 (26.58%)
a possible donor (1st MBBS- 24.32%, 3rd MBBS- 27.84%) while
Whom would you like to 43.5% students were aware of brain death in study conducted by
donate to? Shah et al.15 Medical college found to be leading source of
a) Family 56 (75.67%) 73 (76.04%) 43 (54.43%)
b) Friend
awareness of organ donation with steady increase seen from 1st
15 (20.27%) 26 (27.08%) 19 (24.05%)
c) Unknown 16 (21.62%) 30 (31.25%) 38 (48.1%) MBBS (68.91%) to 3rd MBBS (78.48%). The teaching of organ
d) No answer 10 (13.51%) 12 (12.5%) 10 (12.65%) donation and transplantation in IInd year MBBS curriculum can
Reasons for not opting for be the reason behind the same. Somewhat similar findings
organ donation
a) Do not believe in organ 06 (8.1%) 06 (6.25%) 04 (5.06%) observed by Bharambe et al.10 Newspaper, internet and social
donation media arealso observed as a valuable source of awareness in
b) Due to disfigurement 24 (32.43%) 17 (17.7%) 08 (10.12%)
involved majority of all prof MBBS students, which was also observed by
c) Do not believe whether 22 (29.72%) 34 (35.41%) 29 (36.7%) Sam et al1, Shah et al.15 and Cetin et al.16 Sindhu et al. concluded
system fair/unfair
d) No approach to center for 06 (8.1%) 18 (18.75%) 16 (20.25%) in their study television (37.9%) was the predominant source of
organ donation
e) No answer 17 (22.97%) 21 (21.87%) 23 (29.11%) knowledge of medical students followed by the internet
(21.3%), newspaper (16.6%), and only 10.1% of the students
reported that they got the information from their medical
Discussion schools which are inconsistent with our findings.17
About 9.5 million deaths ensuing in India annually out of which For knowledge about the different organs donated and
nearly one-lakh deaths occur due to organ failure.11 There is an contraindications to organ donation, almost 95% of the students
extensive gap between the demand and availability of organs were aware of eye and kidney as the organs that can be donated.
required for transplantation. Only 0.34 individuals per millions Similar results were observed by Sam et al1 and Shah et al.15
of population donated in India while 36 persons per millions of Extensive advertisement in both print and digital media for eye
population donated organs in Spain, 35 donated in Croatia, donation and negative publicity of kidney scandals in media as
27.02 donated in the United States in 2014.12 National Organ and well as in movies could be the reason for the same. Awareness
Tissue Transplant Organization (NOTTO), India reported about different organs such as liver, heart, and bone marrow was
26132 living transplants while 1300 cadaveric donation since comparatively low but progressive increase in knowledge about
1995. In the last 8 years (2011-2018) total 3929 organ donations other possible organs that can be donated was observed from 1st
occurred in Haryana out of which 3873 was living while 46 were MBBS to 3rd MBBS. Bharambe et al. made similar observations in
cadaveric donations.13 Nuh (earlier Mewat) district of Haryana, their study.10

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In the current study, 84.81% 3rd year MBBS students agreed that higher than their 1st and 2nd year counterparts. Bharambe et al.
organ donation couldn't be done if a donor is HIV, Hepatitis B or C observed that 80.4% to 84.7% of the respondents were willing
positive while 62.02% stated that active cancer patient couldn't to participate in any organ donation promotional activity.10
donate their organs. 96.5% of nursing students agreed that The majority of the students were willing to donate the organs to
hepatitis and cancer are a contraindication for organ donation.18 It their family members while 48.1% of 3rd MBBS students agreed to
is a common myth in general public that one cannot donate an donate organs to unknown. 40.99% students were shown their
organ if he has been suffering from (or have had) hepatitis B or C. preference for organ donation to their family members in the study
conducted by Adithyan et al.9 In the present study, 36.7% 3rd
Steady increase in knowledge that single donor can donate to
MBBS students and 35.41% 2nd MBBS students do not believe in
multiple recipients seen from 1st MBBS (47.29%) to 3rd MBBS
the system that’s why they are not opting for organ donation. In a
(82.27%) medical students which can be attributed to the
study conducted by Sam et al., 29.4% of students did not believe in
knowledge gained in medical college. the ability of the system to support the donated organ until they
Regarding the legalities related to organ donation, the majority reach a suitable donor.1 Bharambe et al. concluded that 21.7% of
of students of 1st MBBS (93.24%), 2nd MBBS (81.25%) and 3rd the final year medical students were opting against organ donation
MBBS (89.87%) felt that there is a need for laws to govern the as they did not believe in the ability of the medical infrastructure to
process of organ donation while 67.7% students felt the same in take care of the donated organs until they reach a suitable donor.10
the study conducted by Sam et al.1 Only 58.22% of 3rd MBBS It was observed in a pilot study that single classroom exposure
students have the knowledge, that there are laws prevalent to had the potential to increase knowledge levels of organ and
organ donation presently, while 71.62% of 1st MBBS students tissue donation among secondary school students.20 In a study
are aware of the prevailing laws related to organ donation. on high school students in Turkey, it was concluded that
However, The Transplantation of Human Organs Act (THOA) educational program significantly boosted the students’
was enacted in 1994 in India. Adithyan et al9 observed that knowledge and awareness related to organ donation and
transplantation.21
96.9% medical students were aware about legality of organ
donation in India while 56.6% students were aware about the
same in study conducted by Sam et al.1 36% students were aware Conclusions
regarding local and international legislation with regard to The present study concludes that knowledge of organ donation
organ donation in study conducted by Kaur et al.18 Only 41.77% and related issues are still inadequate in medical students
of 3rd MBBS students have the knowledge that the family of especially regarding concepts of ‘brain-death’ and other aspects
deceased person can pledge his organs even if the person had not such as legal requirements related to organ donation. More
signed a donor card during his life time while majority of emphasis to the topic of organ donation in the medical
students of all professionals (1st MBBS-47.29%, 2nd MBBS- curriculum should be given. This will help to fill the gaps and
lack of knowledge regarding organ donation and issues related
42.7% and 3rd MBBS- 37.97%) didn't have the knowledge about
therewith. Other educational tools such as advertisements,
the same. Our results were somewhat similar to what was
exhibitions and campaigns at the grass root level, especially in
observed by Sam et al.1 and Bharambe et al.10 It often happens
rural areas can improve the awareness and attitude about organ
that the family members have to take the decision of organ donation among the general population also. Since media,
donation on behalf of the deceased person. Awareness of this social as well as electronic, is well established and accepted by
issue and the legalities involved is necessary for all health care masses; an initiative of broadcasting through these agencies
professionals to promote organ donation following “brain- should be made about the need for organ donation and
death” of patients.10 legislative laws involved.
For the attitude towards organ donation, willingness to donate
organs and to promote organ donation and reasons for Conflict of interest: None to declare
unwillingness to be an organ donor, more than 70% of students Source of Funding: None to declare
in each group agreed to be a part of organ donation group and
motivate others for organ donation while 20.25% 3rd MBBS
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