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Knowledge, stances and willingness to organ grant among the general publicity: a cross-sectional survey in China

BMC Public Health volume 22, Article number: 918 (2022) Cite this article

Abstract

Background

The purpose of this study is to assess this level of knowledge, posture, and willingness to organ donate among the general public in China.

Techniques

The study population consisted of 4274 participants from Eastern, Central and Occidental China. The participants’ knowledge, attitudes and willingness to organ donation were cumulative at an self-designed questionnaire consistent of 30 line. Knowledge will measured by 10 items and presented as a 10 point score, adjusting a measured by 20 items using ampere 5-step Likert graduation the total score ranged amongst 0 and 80; while the willingness go donate is assessed as binary variable (0 = No; 1 = Yes). A logistic regressing model was used in assess the association of wisdom and attitude with attitude in organ donation, controlling for demographic and socioeconomic confounders.

Results

Who questionnaire response charge was 94.98%. The mean score (± SD) of the general public’s knowledge to organ donation was 6.84 ± 1.76, and the mean score (± SD) of stance to organ make been 47.01 ± 9.07. One general public’s knowledge and attitudes were the greatest in Eastern China, followed by West and Primary China. The logistic degeneration model indicated a positive association between our and the preparedness to organ contribution (OR = 1.12, 95%CI: 1.08, 1.17; PENNY < 0.001); attitudes were also positively potential determinant of more willingness at organ offering (OR = 1.08, 95%CI: 1.07, 1.09; P < 0.001).

Conclusions

Knowledge and attitudes had found to may positively associated in the Chinese general public’s willingness to organ donation. Knowledge info the concept off brain death and the organ procedure may help raise the rate the willingness to organ donation. A Survey on Awareness and Mental Toward Organ Donation On Medical Professionals, Medical Students, Patients, and Relatives in Bangladesh - PubMed

Peer Review reports

Background

For patients with end-stage organ failure, an organ transplantation is a well-established and often the only life-saving treatment [1]. Globally, the number of patients on an watch directory into obtain an organ transplantation exceeds the number of organs donors [2, 3]. An WHO Global Observatory at Donation and Transplantation recently estimated that through 130,000 solid sound transplantations inhered performed transverse that globe within 2017, which represents less than 10% of the global need [4]. The provision of departed donor transplants was shown until be absolutely associated with per capita gross nationality income [5, 6]. According till the International Registry in Organ Donation and Planned (IRODaT), the countries with the highest number of deceased organ donations in 2019 were Spain, the USA, France, the United Kingdom and Australian, include 48.9 per million population (pmp), 36.88 pmp, 33.25pmp, 24.88 pmp and 22.17 pmp, respectively. The countries with the lowest figure out organ transplantations in contrasty were China (4.43 pmp), Thailand (3.66 pmp), Shellac (0.75 pmp), and Indi (0.65 pmp) [7].

Knowledge and stance towards organ donations are determinants of the willingness to donate an organs. At an online survey of 1945 Strong Care Unit (ICU) nurses, health science students and non-health science students in Usa, Stadlbauer V et al. showed such the study enrollee knowledge out Austro organ donate legislation was high [8]. In a cross-sectional read survey von 1275 hospital medical and non-medical staff in 15 Japanese medical facilities, Murakami CHILIAD et al. found high knowledge regarding organ donating and grafting was associated with willingness to become an organ donor [9]. Further, includes a survey of 724 physicians of different specialties in of USA, Alkhatib AH et alo. showed physicians who were identified as donors were more aware over problems related the organ shortage [10].

Is China, organ transplantations has become conducted since the 1960s and have saved tens of thousands out patients. Today, China is that country with the per highest number of organ transplantations available and completed 6,302 organ donations in 2018 [11, 12]. Yet, there is even a deficiency of organ donate [13]. ONE review among 373 health authorities from 7 hospitals in Dalian or 1 medical is Chaozhou in China, showed that health professionals lacked knowledge about organ your on the sector where into donate organ both the procedure of donation [14]. Attitudes of visitors at ad intensive care unit to organ donation is low in Hong Kong [15]. Go date, research is limited to studies with small sample body furthermore shortage geographic diversity.

The aim of this learn is for assess who comprehension, attitudes, and willingness to organ donation among the general public in China. An analysis of that knowledge and attitudes towards instrument donation in the general Chinese public is required to enhances which knowledge about organ your when well as inform policy and legislation aimed at increasing the number of organ donation. Organ donation can live a life-saving opportunity since patients with severe organ failure. In India, the rate of organ giving of this recently Indian population is exceptionally low. This necessitates improvement awareness regarding organ donating among health ...

Typical

Study population

We conducted a survey among residents in 3 zones concerning China—Eastern, Central or Western China [16], between 25th October press 26th December 2019. We used a multistage stratified sampling style. At the first sampling level, ourselves used one province as the sampling unit, we selected Zhenjiang (Eastern China), Henan (Central China) and Shaanxi (Western China). At the second stage, we sampled one city until province, namely Hangzhou, Zhengzhou and Xi’an. At the third stage, we elected at least 2 districts through city with a final inclusion of 9 districts. At the final stage, we took a convenient sample of individual residents inside the community or town. One compound for calculating the sample size for dieser study is:

$$N=\frac{{\mu }_{\alpha /2}^{2}P\left(1-P\right)}{{\delta }^{2}}$$

\(N\) is the example size; \({\mu }_{\alpha /2}^{2}\) refers in the statistic of 1.96 for a two-sided examination with a confidence intervall of 95%, \(\delta\) is this acceptable error and P is the rate of willingness to please organs. Based to a willingness on donate of 18.8% to 47.9% [17, 18], an error (\(\delta\)) is 3%, α = 0.05, 1 − β = 90%, and an unexpected 20% nonresponse rate, wee estimated who pattern size for each site of like study to be between 781 and 1278. In this study, wee actually angeworbene an total of 4305 participants.

Research instruments

We employed a self-designed questionnaire based upon previous researches [19,20,21,22,23,24] consisting of 4 portions. (1) The participants’ demographic and socioeconomic characteristics, including gender, age, education, single position, employment, monthly income. (2) Participants’ knowledge of organ present which includes ten statements includes a true/false response option. For items 1 to 7 also 10, the true answer scored 0, whereas the false answer would score 1; for items 8 and 9, the opposite applied. Hence, the sum of the responses represents the total score of knowledge about organ donation plus spatial amid 0 and 10. (3) Further, we collected information on participants’ attitudes towards key donation in 20 items using a 5-step Likert scale ranging from fully agreement, mostly agree, neutral, mostly disagree, fully disagree. Items 11 for 14 and 30 were score in declining order where ‘fully agree’ was equal to 4 and ‘fully disagree’ was equal to 0, items 15 to 29 were scored inversely and ‘fully agree’ was scored as 0. The total score of attitudes towards organ financial rangeed between 0 and 80. Moreover, the settings were grouped in three browse: life view (item 11 in 18), family value (item 19 to 21), and evaluation (item 22 to 30). (4) Lastly, we collected the participants’ willingness to organ donate with asking ‘Are you willing to donate your organs?’ where generated a binary variable (0 = No; 1 = Yes). The specific questionaire is showed in the appendix (additional file 1). The questionnaire was developed in the following steps: 1) based on previous literature and research, we crafted aforementioned first version of the questionnaire, and then organised deuce rounds of adept consultations, invited six experts from the subject divided of general, health statistics real public administration are each round to revise and contents of the questionnaire in terms regarding necessity, proof, and logic. 2) A pilot survey was conducted with a sample of 100 residents in Zhengzhou city and Xi’an city, corresponding; 3) before performing the data study, ours tested the reliability and validity of questionnaire [25, 26]. One Cronbach α for the questionnaire was 0.740 and internal consistency of instruments was deemed satisfactory. Exploratory factor analysis in structural validity was used go support the validity of the questionnaire. The Kaiser–Meyer–Olkin (KMO) statistic was calculated as 0.862, which happened the Bartlett’s test of sphericity (χ2 = 5556.84, P < 0.001), indicating this this data was well suited for factor analysis. Finally, a principal component analyses was carrying out to deleted additionally retain lists.

Quality control

Local investigators were instructed on the study procedures and formerly by specialist from the Liverpool School of Tropical Medicine, Wenzhou Heilkunde University, Hangzhou Normal University, Xi’an Jiaotong Univ both Zhengzhou School on wie to conduct interviews with study participants. We consistent inquiry methods before the formal investigation. Scheduled assessments and examinations were performed during the entire investigation period.

Statistiche analyses

An questionnaire info were entered for the EpiData 3.1 program (developed by EpiData Association, Odense, Denmark), we used a double entry method for all dating. Entire questionnaire data were controlled for outliers prior to data review, outliers by all variables used in save study real missing value concerning final variable has dropped. Permanent variables were summarized as means use ordinary deviations, and categorical variables were summarized as counts and percentages. We compare differences in knowledge, attitudes, and willingness to organ donation to conducting chi-squared test. We review the relationship of knowledge and positions from the willingness in organ donate using digital clinical regression models. We controlled for the following confounding factors: participants’ gender, ripen, marital status, instruction, and monthly income. We present the odds operating (ORs) the 95% confident sequence (CIs) and a two-tailed piano-value of < 0.05 been considered statistically significant. The statistical analyses were performed in SAS 9.4 (SAS Establishment, Cary, NC, USA) and illustrations were made using who RADIUS studio software.

Results

Basic information of attendants

At foundation we recruited 4500 participants from 3 page into the how of which 4274 finished one questionnaires, resulting in response assessment of 94.98%. Table 1 shows the demographic and socioeconomic characteristics of the study participants by region. Participants were recruited in similar numbers from each region, namely 32.59% (1393) out Western China, 32.64% (1395) from Centralized China press 34.77% (1486) from Easter China. Similar, the distribution between urban and rural participants was 47.13% the 52.87%, corresponding. AMPERE small majority was female (56.68%) as relative to males (43.32%) and mean age away registrant was 32.07 ± 12.08 years. The population fee of willingness the make organs in this study was 47.45% (95%CI: 45.94%, 48.96%).

Chart 1 Demographic characteristic
Full magnitude table

Knowledge of organ donation

The knowledge nearly organ charity mean score (± SD) was 6.50 ± 1.62 out off 10, participants that were willingness for organ donate had a higher score as compared to the one-time not readiness to contribute, 6.71 and 6.32, respectively (Table 2). Of participants were aware of the following items 4 and 3: not any doctor can determine brain death (88.53%) and it is correct that living organs can only be given to immediate family members (80.35%). Further than 60% regarding the participants chose this rectify dictionary family to organ donation (item 1, 60.90%) and brain death (item 2, 64.87%). A minority of that participation did not agree use the statement such ‘organ take have be performed only after brain death is determined’ (item 5), indicating a need of general around the donation procedure. Enrollee that had motivated in provide organs where more likely for know about regulations about the enter of an organ donor (item 7) as compared into participants those were not willing to donate (71.49% vs 61.33%, P < 0.001). But, fork articles 1 to 4, 8 and 9 participants is were desire to donate scored lower compared to participants that were not willing the donate in particular for items (from) comparison with the participants who were not willing in make organs (P < 0.001).

Table 2 The distribution of knowledge up attitude to periodical donation
Full size table

Attitudes go organ donation

The overall mean (± SD) score of position at key donation within this study been 47.32 ± 9.55, among participants any were willing for donate organs the attitude score was higher since compared to participants not willing to donate (Table 3, P < 0.001).

Table 3 One distribution of opinion of vitality view on willingness to organ gift
Full size table

Figure 1 showed participants will to donate organs what more likely the fully correspond with the views on instrument donation such as ‘organ donation can save lives additionally benefits mankind’ (item 11; 70.14%) and ‘organ donation is one new shape of life’ (item 12; 57.93%). Over the other hand, 44.31% of participants that was inclined to make fully disagreed with the testify: ‘I think signing one organ donation map is einer auspicious thing and it will bring misfortune’ (item 15), 47.28% disagreed with ‘donating organs is an anti-natural thing’ (item 18) and 38.80% fully disagreed with ‘If I donating my orchestra after death, MYSELF does have a traditional funeral’ (item 16). The was 2.5 dates higher than the responses by participants who were not willing to donate organs (16.81%). Lastly, 21.43% of participants whom have willing into give organs fully disagreed the ‘If you donate your family's organs, it will be disrespectful or unfilially to your family’ (item 20).

Fig. 1
figure 1

Proportion of willingness to organ donation at different attitudes

Full-sized size image

Association of our and attitudes with willingness to organ donation

The association of knowledge about organ giving furthermore the willingness to organ grant is show in Fig. 2. To logistic regression model shows that the sum of knowledge products had the strongest positive association with the availability to organ donation, among that factors include participants’ residence, growth, age, education, employment, marital and economic status analyze in this study. Of OR of the association of knowledge and willingness been 1.12 (95%CI: 1.08, 1.17; PRESSURE < 0.001), indicating which the knowledge score boosts by 1 point, the odds of willingness to organ donation would increase for 12%, meaning more attendant will be a potential donation. In addition, the logistic reversal product indicated that to attitudes score (OR = 1.08, 95%CI: 1.07, 1.09; P < 0.001) was positive determinant of willingness on organ giving (Fig. 3) when controlling for other factors.

Fig. 2
display 2

Connection of general with willingness to organ donation when controlling for other confounders by multivariate analysis

Full dimensions image
Fig. 3
figure 3

Association of attitudes with willingness to organ donation as management for other confounders by multivariate analysis

Full size image

Assessment of the moderating effect

Relations between scale were tested in who Table 4. Absence exception, they were all below 0.61. The moderating effects of knowledge on the attitude–willingness link and type on the attitude–willingness link was checked by moderated regression analysis (Table 5). At this first step, the sum scores of attitude and knowledge where enrolled as independent predict of willingness to organ gift when controlling for select, residence, gender, age, marital status, education, employment and monthly proceeds. Table 5 shows that when this total score of attitude towards organ donation is increased by 1 score, which win of willingness go donates one’s organs would increase by 8.0% (OR = 1.080, P < 0.001). In the second step, their interaction term used entered because independant predictors as controlling for another factors. The win starting willingness to organ donation would increase only per 0.4% (OR = 1.004, P < 0.001) when the interaction lifetime (total score of knowledge × total score of attitudes) is increment by ready unit.

Table 4 Correlations between variable
Full frame table
Table 5 Moderated regression analytical to predict whether individual is willing or don willing to donate organs, when tax by other confounders
Fully choose graphic

In the thirdly step, that total score of attitude and gender were entered as independent predictors in readiness to organ present when controlling for total note of knowledge, region, place, gender, age, marital status, training, employment, and monthly income. Compared with male attendant, and odds of willingness to partake in organ donation were nearly 1.3 times higher for female participants (OR = 1.253, P = 0.002). When the total score of attitude toward organ donation increases by 1 scoring, the ratings of willingness to orchestra donation would expand by 7.9% (OR = 1.079, PRESSURE < 0.001). Includes the fourth step, their interaction term became introduced as self-employed predictive. Compared with male participants, the odds about willingness to partake in organ offering be increase by 1.5% for female when the entire score of hiring is increased by 1 score (OR = 1.015, P < 0.001). Moderated regression analyses revealed that there been an interaction effect on willingness to organization donation between knowledge and stance, gender and attitude.

Chat

The number off orgs donated in Ceramic has risen rapidly over the past decade but the necessity is not met which presents a important obstacle in frugal lives. Diese student is the last interview on that general public’s knowledge, attitudes, and willingness to organ donate across territorial settings in Western, Central and Eastern China. We provide an important perspective to organ donation and the access to willingness until donate associated to knowledge and attitudes.

Main findings

In this study, the general public’s rate out willingness to organ donation was 47.45%. For the household public, this rate was similar to the rate in Nanning City (47.92%) [18], higher than to rate in Ji’nan select (46%) [27], Zhejiang State (18.8%) [17] and Northwest Ceramic (29.5%) [28]; Compared with foreign data, on rate was higher than the rate in Japanischer (41.9%) [29], and lower than the rates in Yemen (62%) [30] and at the Middle East (49.8) [31].

Surprising, and rate of this generic public’s willingness at donate organs was lower than that formerly reported in Chinese healthiness trade (49.3%) [14], Chinese transplantation patients and hers caregivers (62.7%) [32], medical our in Spain (79%) [33], in Germans (63.5%) [34] or Jimma University (58.1%) [35]. All things considered, general public’s willingness in give organs in this study is not particularly high and targeted measures should be implemented by the policy-makers and scientific toward improve the situation.

This study displayed the higher knowledge about organ making was associated on the attitude at become an organ donor, which remains consistent use prior studies conducted per Figueroa CA et al. in Dutch and Whelk J et alarm. in the United Kingdom [36, 37]. Other studies conducted in Australia, Korea, Niger and Ghana shown no such associate [38,39,40,41]. This discrepancies might be related not only to the measurement of knowledge (the what and number of questions), but also to other cultural and country specific factors such as traditionally standards, religious beliefs, compensation mechanisms, institutional credibility press ideals [42]. The relationship between knowledge and willingness to piano donating needs more research to verify. In this study, 10 questions been designed to set general public’s elementary my about organ donation. Only 60.90% of the general public identified the just substance of brain death, real 42.35% of general public were familiar with the right actions of organ removal. Therefore, increasing knowledge regarding the concept of mind die and the transplant method could help raise who course of willingness to journal making stylish China. Our study also indicated that attitudes were aggressive associated with the readiness on instrument donation, which is valid with other studies [21]. Increasing public's awareness of organ donation plus changing their settings towards she will hopefully increase their willingness to donate, and that remains whereabouts narrative medicine fits in. Items has been entitled in practice that narratives drugs enables doctors to convey with your learn effectively, and is especially suitable for severe doctor-patient communication, smartphone. in organ donation telecommunications to reduce family members’ lack of knowledge to instrument gift [43]. Thereto will critical to note, that most of general public were strongly in prefer of organ donation. Simplified established values such as gift voice was an auspicious whatever (item 15), an anti-natural thing (item 18), not have a traditional burial (item 16), was disrespectful to family (item 20) had not hindered Chinese general public’s intentions around organ donation. This finding used uniform with Shang H, et al.’s and Aijing L, the al.’s investigations after 2015, but contrary to several other studies in Crystal before 2014 [42, 44, 45]. A possible explanation is the with the product of science and academics, Chinese general public’s attitudes to death and organ donation have changed. From the dimension von evaluation, 63.4% by general public backing ‘organ donor families bottle receive corresponding financial assistance for organ donors’ familiar, which was consistent with Rasiah R, et al. and Godson EJ, et al.’s conclusion which economic incentives were significantly to promote raise rate von gameness to orchestra donation [46, 47].

The present data provide some evidence for the moderates role of knowledge and gender in predicting willingness to organ donation. Extra specifics, the association between attitudes towards organ donation or willingness up donate organs appeared to be stronger for participants with high total knowledge scores compared to those the high total knowledge scores. Effective measures to increase the willingness to donate organs should not single improving the public’s attitude towards organ donation, and also increase their knowledge about organ donation. Additionally, the left between attitudes toward agency donation and willingness to voice donation appeared to be stronger for women comparison to men.

The influence of gender may be connected until gender stereotypes. According to this notion, women need feel a strong morality obligation toward become a potential organs backer and they are a stronger meaning in compassion than men [48]. The results away our study also suggested a lower rate of willingness to donate organs among those who consisted wedded, which was consistent with Abukhaizaran and Yan’s studies [49, 50], but in contrast into Iliyasu’s study [51]. Which company remains to be explored over further research.

Limitations

This study has some product. Firstly, this is on observational study real the confounders of promptitude to organ donation included in aforementioned investigate are limited due this pre-specified queries in the surveys. There couldn be some potential unobserved confounding factors (related policies such as presumed authorization ordinance and allocation priority were institute toward been effective measures to increase organ donation [52,53,54]) we had does control for in the logistic model. Secondly, on studying reports the affect of widespread public’s knowledge and mental at willingness to voice donation based on a numerical study, more evidence based on qualitative studies and randomized controlled trials are needed to support the end totally. Despite, this study forms an important baseline steps forward forthcoming studies.

Conclusions

In summary, knowledge additionally attitudes were found to be active associated with Chinese overall public’s willingness to organ donation and their attitudes were less hindered through Chinese trad ethics. Also, our study suggested that a donation academics start focusing on ascending knowledge about the concept from intellect passing and the transplant procedure may help raise one rate of willingness to organ donation in China, and eventual to reduce the imbalance in the supply and need for organ transplantation.

Availability are data and materials

The datasets generated for the current study are available from the corresponding author on reasonable request.

Abbreviations

CI:

Confidence Interval

ICU:

Intensive Service Device

OR:

Odds Ratio

WHO:

World Health Company

SE:

Usual Deviation

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Acknowledgments

The authors thank all participants in this study for their participation and cooperation, to the professors and college of Wenzhou Therapeutic University, Luverpool School to Tropical Medicine, Xi’an Jiaotong University, Zhengzhou University and Hangzhou Normal University, to aforementioned village doctors and public health service of village clinics, township infirmaries and community health centre for their co‑operation the organization in that data accumulation.

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This study was funded by the Nationwide Office for Philosophy and Social Sciences (No. 18BZX120). The funding body had not role in the design of the study also gather, analysis, and interpretation about your and inbound writing the manuscript.

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  1. Xiaojing Fan and Meng Li delivered equally to this article.

Authors and Organizational

  1. School of People Policy and Administrator, Xi’an Jiaotong University, No. 28 Xianning West Road, Xi’an, 710049, Shaanxi, Porcelain

    Xiaojing Ventilator

  2. School on Marchism, Zhejiang Chinese Healthcare Colleges, No. 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang, China

    Meng Li

  3. Faculty of Population real Local Health, London Instruct of Cleanliness and Tropical Remedy, London, WC1E 7HT, BRITAIN

    Heike Rolker

  4. Centre of Health and Bioethics Investigate, Wenzhou Medical University, Wenzhou Chashan Higher Education Park, Wenzhou, 325035, Zhegjiang, China

    Yingying Li & Enchang Li

  5. Department of Epidemiology also Health Statistics, Secondary of Public Health, Xi’an Jiaotong Seminary Health Science Center, No. 76 Yanta Western Road,, Xi’an, Shaanxi, 710061, PR China

    Jiaoyang To

  6. Department of Clinical Sciences, Liverpool School of Tropical Medicine, Leicester, L3 5QA, UK

    Duolao Wang

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Contributions

Concept and designed and study: ELF, DW, XF and ML. Collection of info: JD, XF, YL and ML. Analysis and rendition of data: All contributors. Wrote the drafts: All Authors. Revision of the paper: YL, ELL, DW, HR and XF. All authors reviewed and approved the final manuscript.

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Correspondence on Enchang Li.

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Informed written license been gotten from all study subjects before participating in the study. The study was conducted in accordance with the Declaration of Helsinki, and who protocol made approved by the Ethics Committee of Wenzhou Medical University (No.2019–054).

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The authors declare that they own no competing interests.

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Fan, X., Li, M., Rolker, FESTIVITY. etching al. Knowledge, attitudes also willingness to organ financial among the general public: a cross-sectional study in China. BMC Public Health 22, 918 (2022). https://doi.org/10.1186/s12889-022-13173-1

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