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AL-Mustansiriyah University College of Medicine

Family &Community Medicine Dept.
Fourth Stage
Group 2
2017 - 2018
Contents Page No.

Abstract 3

Introduction 5

Methods 12

Results 16

Discussion 24

Conclusion 28

References 30

2
‫‪Abstract‬‬
‫مرسى عزالدين‬
‫عائشة باسل‬

‫‪3‬‬
Abstract
Introduction
Once an organ loses its function or gets damaged can nothing be done to cure it and often leads
to death. ORGAN DONATION is the gift of giving an organ to someone who has lost one, to
overcome the detrimental consequence of this loss. ORGAN DONATION is the only treatment
for late stages of organ failure, such as advanced heart and kidney diseases. Two types of
ORGAN DONATION are known: one when an organ is taken from a live donor, and another
when an organ has been donated after death. Death involves either cessation of heart beats or
brain death, brain death is the irreversible end of all brain activities.
The aim of the study was to assess knowledge and attitude of medical students of
MUCOM toward organ donation and associated factors.

Methods
A cross sectional study conducted among undergraduate medical students of Al-Mustansiriyah
university. The study sample comprised of first to sixth year medical students. The original
questionnaire consisted of, 13 items measuring knowledge and 11 items measuring attitude,
the order of items was randomized data conducted by direct interview with the student.
Results
Stratifying 300 participants students of MUCOM in the survey of ORGAN DONATION, the
majority of them 296(98%) was aware about ORGAN DONATION, 4(2%) never heard about
It. 153 participants (51%) had poor knowledge while 147(49%) had good knowledge. The
majority of them 244(81%) don't know about the law regulating organ transplantation. The
sixth stage students had 34(68%) of good knowledge and 16(32%) poor knowledge .while the
third stage students were the least of knowledge about ORGAN DONATION about 11(22%)
with good knowledge and 39(78%) with poor knowledge and the rest stages in between.
Conclusion
Knowledge development about study problem is start to improve at 4 year and above reaching
the maximum level at 6 year. The source of this information are media and curriculum.
Concerning attitudes development it seems that it pass parallel to knowledge development. No
obvious gender identify concerning knowledge and attitude

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‫‪Introduction‬‬
‫محمد أحمد رشيد‬
‫عمر رضوان‬

‫‪5‬‬
Introduction
A major challenge health care has been facing is the occurrence and consequences of severe
tissue damage and organ failure, whether pathological or traumatic. Not only once an organ
loses its functionality or gets damaged can nothing be done to cure it, but also the patient, along
with his/her family may be faced with severe problems. Bottom-line, without replacing a failed
organ, i.e. transplantation, patients go through much suffering, which often leads to death. With
that in mind, organ donation (OD) is the gift of giving an organ to someone who has lost one,
to overcome the detrimental consequence of this loss. Two types of OD are known: one when
an organ is taken from a live donor; and another when an organ has been donated after death.
Death in turn involves either cessation of heart beat and or brain death. Brain death is the
irreversible end of all brain activities, including involuntary functions necessary to sustain life
due to total necrosis of the cerebral neurons following loss of brain oxygenation [1].
International Perspective of Organ and Tissue Transplantation
The organ transplantation (OT) idea has a history of stormy dispute everywhere it has been
raised. The debate continued globally for a long time, until OT now is undoubtedly considered
one of the most significant achievements in the history of medicine. In many cases, it is the
only treatment for the late stages of organ failure, such as chronic heart and advanced kidney
diseases. Many countries today engage in OT surgeries, but successful programs in these
countries do not necessarily offer an organized method for the procurement of organs from
donors of various cultural, religious and economic backgrounds [2].
Rather a high level of societal awareness, particularly among doctors, lawmakers, potential
donors, and organ recipients is the key to the success of OT. Although it is a basic tenet that
donation must be the foundation for all organ and tissue transplants, the rarity of organs has
given rise to a growing commercial market for organs on the local, regional and international
levels. As a result, abuse and exploitation take place, especially of the poor for the benefit of
the rich, and also for the benefit of local or cross-border intermediaries, in what unfortunately
progressed into “transplant tourism” and “organ trafficking” [3].
Estimates show that transplant tourism accounts for 10% of all OT practices worldwide [4].
Ever since the transplant of organs from living or deceased donors to patients suffering from
organ failure first began, international medical organizations and agencies have been careful
to issue resolutions prescribing guidelines for the regulation of professional standards and
ethics in this field. Now that these regulations were provided by governmental agencies as the
policy maker party, but not by the medical organizations, vitalizing the role of these regulations
in preventing unlawful OT entails involving concerned medical organizations to take part as a
key in this process. The World Health Organization (WHO) has condemned organ trafficking
on many occasions. [5]

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Urging member states to exercise effective supervision on OT and seek out living as well as
deceased organ donors. A legal consent for the extraction of organs from corpses should be
acquired. Also donation from the living is only allowed as long as the professionals provide
necessary care and quality follow-up to the donors. No any coercion may be practiced on the
donors who should only be motivated by a real desire to donate their organs. Moreover, the
donation must be made without promise of payment or any other material reward [6].
The number of organs required to satisfy the needs of transplantation far exceeds the number
of donor organs available. In the case of renal transplantation in the UK there are
approximately 7000 patients waiting for transplantation, but only around 3500 transplants
performed annually, which has led to a median waiting time for transplantation of three years.
Although the idea of organ transplantation is an old one, successful transplantation did not
occur until the Twentieth Century. When different blood types and their respective
compatibility or incompatibility, as well as a method of preserving blood, were discovered,
blood transfusions became an accepted medical procedure. They were widely used during the
First World War. Dr. Emmerich Ullmann experimented on dogs with kidney transplants in the
early 1900's. He found that the transplanted organ functioned longer, the closer the donor and
recipient were genetically related. Human skin grafts were attempted in the late 1920's.
It was found that they could be performed without the problem of rejection between identical
twins. In the early 1940's Dr. Peter Medawar and his team experimented with rabbits. They
began to understand the immune system which exists in higher animals and human beings.
Antigens, on the surface of cells, enable higher organisms to recognize a foreign body. They
stimulate the production of antibodies which are important in fighting infection. This, however,
also causes the phenomenon of rejection in organ transplantations. [7]
The more similar the tissues' antigens, of donor and recipient, the less likely they are to
recognize each other as alien bodies. Tissue typing and matching is based on this. Rejection
remains one of the main causes of failure in organ transplantation because it is difficult to find
completely matching tissues. New drugs (e.g. cyclosporine) greatly ease the rejection problem.
Recipients, except in the case of a transplant between identical twins, need to take such drugs
for the rest of their lives. In the case of a successful kidney transplant, however, the costs
related to the transplant and the required drugs are cheaper than the alternative of renal dialysis.
The quality of life of the recipient is also better. [8]
Today the transplantation of many organs between well-matched human beings is quite
successful, with the majority of recipients living five or more years. Kidney, cornea, bone
marrow and skin transplants today, for example, are considered routine for certain conditions.
Heart and lung or heart-lung transplants, liver and pancreas (or pancreatic islets) transplants
are also becoming more common. According to Dr. Robert White, even a human head
transplant (perhaps better referred to as a body transplant) may be possible. The recipient in
this case though would resemble a quadriplegic because it would be impossible to connect the
100 to 200 million severed nerve endings. [9]

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Experiments continue to be done to try to improve the technology and possibilities regarding
transplantation. For example, research is being done regarding human cell cultures, transplants
from human fetuses, including brain tissue, and from animals to human beings. The latter
includes attempts to genetically design animals with organs that are less likely to be rejected
by human beings. Some animal products (e.g. insulin and pig heart valves) are already used
regularly. Research also continues to be done to improve artificial organs and other artificial
aids to human functioning.
Since many people can benefit greatly in terms of length and quality of life from organ and
tissue transplants, the demand usually exceeds the supply. The costs related to some organ
transplants are very high as well. Therefore, many questions are raised today regarding how
best to procure more organs, how to fairly distribute limited resources, and whether all
transplants should be covered by public funds. [10]
The ethical and legal issues related to organ and tissue procurement and transplantation are
often discussed in light of such principles as autonomy, benevolence, non-maleficence, free
and informed consent, respecting the dignity, integrity and equality of human beings, fairness,
and the common good. The Judeo-Christian perspective affirms the great dignity of each
human person created in the image of God. The various aspects, parts and functions of a human
person participate in this dignity. We are also social beings who have a responsibility as co-
creators and stewards of God's creation. "In the donation and transplantation of human organs,
respect is to be given to the rights of the donor, the recipient and the common good of society.
[11]

Ethical Issues Regarding the Donor

a) From the Deceased
In general it is seen as praiseworthy to will one's body or parts of one's body for the benefit of
others after one's death. [12]
According to Islam, the majority of Islamic religious leaders accept organ donation during life
(provided it does not harm the donor) and after death in order to save life. Most religious
leaders do not accept brain death as a criterion and consider cessation of all signs of life
including heart beat as a precondition for declaring death. [12]
In 1956 Pope Pius XII summed up the Catholic view on this:
A person may will to dispose of his [or her] body and to destine it to ends that are useful,
morally irreproachable and even noble, among them the desire to aid the sick and suffering.
One may make a decision of this nature with respect to his own body with full realization of
the reverence which is due it....this decision should not be condemned but positively
justified.[13]

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More recently (1985) the Pontifical Academy of Sciences stated:
Taking into consideration the important advances made in surgical techniques and in the means
to increase tolerance to transplants, this group holds that transplants deserve the support of the
medical profession, of the law, and of people in general. The donation of organs should, in all
circumstances, respect the last will of the donor, or the consent of the family present.
Such a donation can greatly benefit others and cannot harm the donor who is dead. Not to offer
such a donation can be a sign of indifference to the welfare of others. To donate, however, is
not considered obligatory. Transplantation is against some people's consciences for religious
or other reasons. Consideration for the sensibilities of the survivors may also make some
people hesitate to sign over their bodies. [13]
In any case proper respect should always be shown human cadavers. Although they are by no
means on par with a living human body/person, they once bore the presence of a living person.
The probably dying potential donor should be provided the usual care that should be given to
any critically ill or dying person. Because of a potential conflict of interest, it is widely agreed
that the transplant team should be different from the team providing care for the potential
donor, who is not to be "deprived of life or of the essential integrity of their bodily functions....
No organs may be removed until the donor's death has been authenticated by a competent
authority other than the recipient's physician or the transplant team. Various parts of the human
body can often be kept in good condition for transplant purposes after the death, irreversible
cessation of all brain functions, of the donor. [14]
b) From Living Persons (Adults, Mentally Disabled, Minors)
Transplants between living persons raise the question whether it can ever be ethical to mutilate
one living person to benefit another. Concerning this many distinguish between parts of the
body that can regenerate (e.g. blood and bone marrow) and parts that do not regenerate.
Regarding the latter some are paired (e.g. kidneys, corneas and lungs), whereas others are not
(e.g. heart). [15]
As said previously in Islam, the majority of Islamic religious leaders accept organ donation
during life (provided it does not harm the donor) and after death in order to save life. Most
religious leaders do not accept brain death as a criterion and consider cessation of all signs of
life including heart beat as a precondition for declaring death. [15]
Before transplants of organs such as kidneys were performed, many Catholic theologians
considered this unethical between living persons. They thought it violated the Principle of
Totality which allowed the sacrifice of one part or function of the body to preserve the
person's own health or life (i.e. a part could be sacrificed for the sake of the whole body), but
did not allow one person to be related to another as a means to an end. When such transplants
began in the early 1950's ethicists gave the problem closer study. [16]

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Basic to medical ethics is the Principle of Free and Informed Consent. To be properly informed
the potential living donor should be given the best available knowledge regarding risks to
him/herself, the likelihood of success/failure of the transplant and of any alternatives. In some
cases there is much pressure to donate (e.g. from family members if one is a good match). The
courts have rightly refused to compel such donations. Motivated by charity, which includes a
properly ordered love for others and oneself, one could decide not to offer an organ [17]
A competent adult can give free and informed consent to be or not to be a living donor, but an
incompetent person cannot. Can a guardian ethically consent for a legally incompetent person,
such as a severely mentally disabled adult or a minor, to be a living donor? Concerning this
issue some distinguish, for example, between a young child and a mature minor's ability to
comprehend the implications of donating. [18]
Regarding medical decisions an incompetent person's guardian is to act for their benefit or
best interests, and, as far as possible, their wishes, if known and reasonable. Some think
children and the mentally disabled should never be living donors. They are simply being used
with a violation of their bodily integrity, risks to their health and life, and no benefit to
themselves. An argument against their being a living donor of an organ such as a kidney, is
that an alternative such as renal dialysis is often available until a suitable deceased donor can
be found. Others argue that in some cases the psychological benefit to the donor (e.g. a child's
sibling lives) could outweigh the risks (e.g. of donating bone marrow). [18]
When a living person donates an organ as a result of a personal decision, then the organ's
transplant is to be carried out with due attention, and post-operative medical care of the donors
as well as the recipients must be provided. Further, consideration must be given so that no
problems develop in the relationship between the donor and the recipients (dependence,
excessive gratitude, guilt feeling) [19]
Buying and Selling Human Organs and Tissues
Some argue in favor of allowing human organs and tissues to be bought and sold to increase
the supply and to respect people's autonomy. Others argue against such saying that to treat the
human body and its parts as commodities violates human dignity. Human tissues and organs
are in fact being sold in some places. For example, a French pharmaceutical firm buys
placentas from 110 Canadian hospitals to manufacture vaccines and other blood products, and
some living poor people in countries such as India sell one of their kidneys for $700 or so. In
Bombay, for example, there have also been some cases of kidnapping where victims regain
consciousness to find that one of their kidneys was removed while they were drugged. [20]

10
Concerning this whole issue some distinguish between human waste products such as
placentas, body parts that regenerate such as blood, and non-regenerative human organs such
as kidneys. Many distinguish profit making from covering the donor's expenses. Paying for
organs can constitute unjust moral pressure on the donor. It could invalidate any free consent
or a contract. Some also fear that the buying and selling of organs and tissues, if it became
widespread, would undermine the altruism (giving motivated by love) and social bonding now
associated with transplants. It could also lead to organs going to the highest bidder. Equity
would be violated with ability to pay rather than medical need determining the distribution of
organs. Some others, however, argue that this could be controlled by regulating sales, and that
totally forbidding the buying and selling of human tissues and organs would drive the market
underground. Because of the controversy and ethical problems surrounding the buying and
selling of human body parts, some say that other alternatives should be pursued to increase the
supply. [21]
According to Islam it is forbidden to sell any part of the human's body because he doesn't own
it, it's Allah who owns it. [22]
Concerning the Christian vision which sees human life and the body as "a gift of the Creator,
which persons cannot dispose of as they please", the German Bishops' Conference and the
Council of the German Evangelical Church say, "This does not exclude compensation for the
expenses incurred by the donation of tissue and organs, but it does forbid deriving profit from
it. The Catholic Health Association of Canada holds that the buying and selling of human
organs, tissues and blood "contradicts the principle of charity which is part of the necessary
justification for such transplantations. [23]

The Aim of the Study:

To assess the knowledge and attitude towards organ donation and associated factors among
medical students from 6 different stages in AL-Mustansiriyah University College of Medicine
using a simple questionnaire.

11
‫‪Methodology‬‬
‫فخر يعرب‬
‫محمد انمار‬

‫‪12‬‬
Methodology

Study Design:
A Cross sectional study, of a convenient type.
Setting:
Place: At Al-Mustansiriyah University, college of Medicine.
Time: The data collection time was carried from the 15th of February to the 1st of March,
2018.
Target Population:
A sample of 300 medical students from the first to the sixth year was selected randomly. With
50 students from each stage. The response rate was 95%

Data Collection:
A self-administered questionnaire was distributed among students on campus between
lectures. Information about the questionnaire were given and the purpose of the study was
explained to each student. They were also asked not to discuss the questions among
themselves. The questionnaires were collected immediately afterward. Only completed
questionnaires were utilized for the study.
Questionnaire:
The original questionnaire consisted of 29 items: 4 items assessing demographics, 13 items
measuring knowledge regarding organ donation and 12 items measuring attitude. The order
was randomized and the questionnaire was translated to Arabic for convenience. [See
appendix]
Ethical Consideration:
The survey was approved by the supervisor and permission was obtained from the department
head to conduct the study. Anonymity and confidentiality of respondents were obtained and
participation was voluntary. Consent was taken from each student that the data will only be
used for research purposes.
Statistical Analysis:
Data was entered using MS Excel spreadsheet. The Knowledge score ranged from (1-18) the
participants were stratified into poor knowledge (score: 1-9) and good knowledge (score: 10-
18). The Attitude score ranged from (1-11) the participants were stratified into poor knowledge
(score: 1-5) and good knowledge (score: 6-11) Percentages of the total knowledge and attitude
were presented in tables, pie and bar charts.
13
Questionnaire

1. Name 10.What organs can be donated?

*heart
2. Sex *kidney
*male? *liver
*female? *lung
*others
3. Academic year *I don’t know
*First year?
*Second year? 11.Do have any knowledge about laws
*Third year? and rules related to organ donation?
*Fourth year? *yes
*Fifth year? *no
*Sixth year?
12.Who should give an approval for the
4. Residence donation of anonym's dead people?
*Baghdad *judge
*others *police
*doctor
5. Did you ever heard about organ donation? *no body
*yeas *I don’t know
*no
13. Does organ donation
6. What is your source of information? Involves any risk for the donor?
*social media *yes
*media like (TV, newspapers, radio) *no
*collage study *I don’t know
*relatives or friends
14.Do believe in the idea of donating
7. What is organ donation? organs after death?
*transfer organ from live person to another *yes
live person *no
*transfer organ from live person to a dead *I don’t know
person
*all of the above 15.Do you believe in the idea of donating
*I don’t know organs while you are still alive?
*yes
8. Do you know how organ donation works? *no
*yes *I don’t know
*no
16.Donate your organs while you are?
9. Where organ donation works? *live
*teaching hospital *after death
*general hospital *all of above
*privet hospital *I don’t want to donate 14
*I don’t know
17. Have you ever donated an 24.If yes, what is brain death?
Organ? *same as coma
*yes *the irreversible end of brain function
*no *cannot donate the organ of a brain dead
person
18.For who you may donate? *it’s the full death
*family member
*friend 25. Do you agree that people
*any body With brain death can donate
*no body organs?
*yes
19.Do you think that organ donation *no
is allowed in your religion?
*yes 26.Do you support encouraging people
*no about organ donation?
*I don’t know *yes
*no
20.Do you agree to donate for someone
of different religion from you? 27.Do you support selling organs?
*yes *yes
*no *no
*not sure
28.Are you going to use internet to
21. Would you sign a document know more about organ donation?
that says you would donate *yes
your cadaver to medical *no
schools for educational
purpose? 29.If you refuse to donate, what is the
*yes reason?
*no *religious reason
*afraid from the operation
22.Is there anyone from your relatives *afraid from organ selling
who has received an organ? *family refuse
*yes *others
*no
*I don’t know

23.Do you have sufficient knowledge

about brain death?
*yes
*no

15
 ‫‪Results‬‬
‫محمد احمد رشيد‬
‫لينا غيث‬
‫مريم كمال‬
‫مصطفى مثنى‬
‫هالة رامز‬
‫طه رضا‬
‫عائشة باسل‬

‫‪16‬‬
Results:
Stratifying 300 participants students of MUCOM in the survey of OD, the
majority of the participants 296 (98%) was aware about organ donation,
4 (2 %) never heard about OD.

Awareness
2%

98%

Aware Not aware

Figure 1: Awareness of the participants. (Pie chart)

153 participants (51%) had poor knowledge while 147 (49 %) had good
knowledge about OD.

Knowledge

51% 49%

good poor
17
Figure 2: Total knowledge of the participants. (Pie chart)
 The following table shows the distribution of participants according to
their general information.
Stages Gender Place of Residence
Male Female Baghdad Others
1st stage 20 (40%) 30 (60%) 40 (80%) 10 (20%)
2nd stage 19 (38%) 31 (62%) 40 (80%) 10 (20%)
3rd stage 10 (20%) 40 (80%) 43 (86%) 7 (14%)
4th stage 26 (52%) 24 (48%) 45 (90%) 5 (10%)
5th stage 35 (70%) 15 (30%) 47 (94%) 3 (6%)
6th stage 25 (50%) 25 (50%) 49 (98%) 1 (2%)
Total 135 (45%) 165 (55%) 264 (88%) 36 (22%)

Table 1: Distribution of participants according to their general information.

The majority of the participants 244 (81 %) don't know about the law
regulating organ transplantation, 56 (19%) know about it.

knowledge About Rules and Law

19%

81%

Know Don't know

Figure 3: The participants' knowledge about rules and laws regulating OD (Pie chart)

18
 The next table shows the Knowledge and Attitude of the participants.
Stage Good Knowledge Poor knowledge Positive Attitude Negative Attitude

1st stage 46% 54% 68% 32%

2nd stage 34% 66% 66% 34%

3rd stage 22% 78% 62% 38%

4th stage 64% 36% 78% 22%

5th stage 64% 36% 68% 32%

6th stage 68% 32% 88% 12%

Total 49% 51% 71% 29%

Table 2: Knowledge and Attitude of the participants.

The 6th stage students had the highest number of knowledge 34 (68%) of
good knowledge and 16 (32%) poor knowledge.
While the 3rd stage students were the least of knowledge about OD about
11 (22%) with good knowledge and 39 (78%) with poor knowledge, and
the rest stages are in between as shown in figure "4".
78%
80%

68%
70% 66%
64% 64%

60% 54%
51%
49%
50% 46%

Good Knowledge
40% 36% 36%
34% Poor knowledge
32%
30%
22%
20%

10%

0%
1st stage 2nd stage 3rd stage 4th stage 5th stage 6th stage All stages
19
Figure 4: Knowledge of the participants according to each stage. (Bar chart)
Concerning the participants' attitude toward OD, the overall attitude of all
stages was 213 (71%) positive attitude, and 87 (29%) negative attitude.
The 6th stage students had the highest attitude with 34 (68%) positive
attitude while 16 (32%) negative attitude.
The least attitude was with 3rd stage students 11 (22%) positive attitude
while the majority 39 (88%) negative attitude. As shown in figure "5".
88%
90%
78%
80% 71%
68% 66% 68%
70% 62%
60%
50% Positive Attitude
38%
40% 32% 34% 32% Negative Attitude
29%
30% 22%
20% 12%
10%
0%
1st stage 2nd stage 3rd stage 4th stage 5th stage 6th stage All stages
Figure 5: Attitude of the participants according to each stage. (Bar chart)

Concerning knowledge resources, 102 (34%) knew about OD from the

media, 88 (29%) from academic study and 82 (27%) from social media.

Source of Information

35%
30%
25%
20%
34%
15% 29% 27%
10%
10%
5%
0%
Media Academic study Social media Friends and
Family 20
Figure 6: Source of Information. (Bar chart)
Regarding to the relationship between the gender of the participants, and
their knowledge toward OD. Male was 80 (27%) good knowledge, while
55 (18%) poor knowledge. Female was 69 (23%) good knowledge, while
95 (32%) poor knowledge. As shown in figure "7".

Knowledge

27%
32%
Male good knowledge
Male poor knowledge
18% female good knowledge
23%
female poor knowledge

Figure 7: Knowledge of the participants according to the gender. (Pie chart)

Concerning the relationship between gender and attitude of the
participants, male had an attitude of 97 (32%) positive, while the rest 38
(12%) negative attitude. Female had an attitude of 117 (39%) and 48
(17%) negative attitude. As shown in figure "8".
Attitude

17%
32%

39% 12%

male + male - female + female - 21

Figure 8: Attitude of the participants according to the gender. (Pie chart)
Regarding to the organs that can be donated, 114 (38%) of participants
chosen the heart can be donated, 267 (89%) for kidney, 111 (37%) for
liver, 42 (14%) for lung and 33 (11%) for other organs to be donated.

Organs Can Be Donated

100%
90%
80%
70%
60%
50%
89%
40%
30%
20% 38% 37%
10% 14% 11%
0%
Heart Kidney Liver Lung other

Figure 9: Organs can be donated in the opinion of the participants. (Bar chart)

Concerning the participants' attitude toward the time they donate their
organs, 24 (8%) chosen to donate during their lives, 124 (41%) after
death, 54 (18%) both during live and after death and 97 (32%) don't want
to donate.

Time of Donation

8%

32%

41%

18%

During life After death Both Don't want

22
Figure 10: Time of donation. (Pie chart)
Regarding to the participants that have donated an organ, only 3 (1%)
donated an organ, 297 (99%) did not. As shown in figure"11".

Donated An Organ
1%

99%

Donated Did not

Figure 11: Donation of organs by the participants. (Pie chart)

Regarding to the knowledge about brain death, 174 (58%) do know about
it, 125 (42%) do not, as shown in figure"12".

knowledge about brain death

42%

58%

know Do Not
Figure 12: Knowledge of the participants toward brain death. (Pie chart)

23
‫‪Discussion‬‬
‫هالة رامز‬
‫عبدهللا جمال‬
‫فاتن جمال‬
‫مصطفى مثنى‬
‫لينا غيث‬
‫نادين حلمي‬
‫هادي علي‬

‫‪24‬‬
Discussion
Organ transplantation is an important issue in the recent medical care in the world. Some
organs damaged by trauma or disease that will lead to death; for this reason the modern
management of these organs require transplantation to save the human life.
Organ transplantation require to look for the ethical aspect for both the donor & recipient.
Medical students should be aware about organ donation and the ethical aspects from. The
results of the present study showed that 98% were aware about organ donation. This could be
contributed to that they may had read about it in their school life or the propagation of OD on
media and social media shown in Figure 1.
Regarding the knowledge of the students about organ donation, 49 % have good knowledge,
Figure 2. This result is much higher than that of Egypt study that showed that 36% of medical
students interviewed in at Faculty of Medicine, Mansoura University, have good knowledge,
this high difference may be attributed to the fact that medical students in AL-Mustansiriyah
University have better studying systems and programs which affect their knowledge. [24]
Our study in MUCOM showed that only 19% of medical students know about the law and
rules which may be attributed to the fact that they don’t have reference or guidelines return to
it, although it exists in the first item of Article 61 and Third item of Article 73 of the Iraqi
Constitution (2016). Figure 3.
Some rules In Iraqi Kurdistan, which has its own borders, parliament and laws, it is illegal to
sell one's organs. However it is perfectly legal to donate an organ, like a kidney, voluntarily.
The donors must fulfil certain prerequisites – things like being in sound mental and physical
health and over the age of 18 years. When donating the kidney, the donor is supposed to come
to the hospital with a member of the beneficiary's family. If there is any suspicion that the
kidney is being sold, then the hospital is supposed to discontinue the process. [25], [26]
The results revealed that 55% of all participants are female. This is due to female percentage
is higher than male percentage in each stage. And 88% of the participants are from Baghdad,
and this is normal according to the college site which is in Baghdad. Table 1.
The sixth grade students had the highest frequency (86%) of good knowledge; in other hand
the third stage had the lowest frequency (22%) of good knowledge, Figure 4. These finding
was similar to study conducted at AL-Mansoura University in Egypt that revealed that good
knowledge of sixth grade was(68%) and that of first grade was(38%).[24]
These findings may contribute to differences in the level of education that explains the high
percent of good knowledge of 6th stage students. And may be due to inappropriate filling of
questionnaire by students of 3rd stage due to their stress situation that led to some bias.
In assessing medical students attitude toward organ donation, the overall positives attitude was
very high about (71%), Figure 5. Which is quite higher than a study that was reported in
Western India that reveal that overall positives attitude was (53.5%) [27]
25
Many important factors play a critical role in influence to be donor or not, these factors include:
1) Religious factor 2) Culture influence
3) Relation ties 4) Body integrity and many other factors.
Regarding to our survey, the sixth grade also had the highest positives attitude (88%) and the
third grade had the lowest positives attitude (62%) which are also higher than those of Egypt
that reveal that positives attitude of sixth grade (51%) and of first grade (38%).[24]
There is a strong association between education level and attitude that may explain diversity
in attitude between two stages. Socioeconomic factor, student belief, family influence, all
contribute to these differences.
Another interesting finding in the survey was the source of information about organ donation.
The majority of the students had their knowledge about organ donation from media (34%) and
only (10%) knew about organ donation from friends and family, Figure 6.
These results are coinciding with those of India that reveal that majority of them knew about
organ donation from media (83%) and only (18%) knew about organ donation from friends
and relatives. [28], but it completely differs from those Pakistan in which most of them knew
about organ donation from social media (34.1%) and only (22.5%) knew from media. [29]
These differences in the source of information about organ donation may be due to preference
of each individuals, as some individuals use social media more than TV and vice versa ,or it
may be due the level of developing of each country.
Regarding gender distribution toward knowledge of organ donation , we found that the
knowledge of male gender was ( 26%) higher than the knowledge of female gender that
was ( 23 %), Figure 7. This is may be the male has good communication with social media
and spend more time on social media.
On the contrary Hosam Mohammed, reported in his study that the knowledge of female gender
is (21.4%) higher than the knowledge of male gender (14.4%) [30]
Our study show that the female gender has positive attitude (39%) higher than the attitude of
male gender that was (32%), Figure 8. This may be due the female gender in the sample of
our study is more than the male, and also may be due to females are more warmhearted and
sympathize with organ donation more than males.
our study resembles to the study done in 2011-2012 that included attitude of Turkish medical
and law students toward organ donation that found the female gender has positive attitude
(48.7%) higher than the attitude of male gender that was (41.1%) [31]

26
There are currently 121,678 people waiting for lifesaving organ transplants in the U.S. Of
these, 100,791 await kidney transplants .
In 2014, 17,107 kidney transplants took place in the US. Of these, 11,570 came from deceased
donors and 5,537 came from living donors. (1, n.d( .
While there is, 1,400 people in the United States are on the national transplant waiting list for
a donor lung. [32]
Our study in MUCOM about organ donation showed the commonest organs that can be
donated to another person (kidney, liver, lungs, heart and others) have a variable percentages.
We found Organ specific willingness for donation was highest for kidney 89% followed by
heart 38% , liver 37% and lung 14% However, there has been only limited acceptance of
donation of other organs. Figure 9.
We didn't use to have any organization in Iraq about organ donation until 2014, this
organization was held in Sulaymania providence to aware and encourages people to donate
and since that time hundreds of people assigned to donate their organs after death [33].
Since there isn't good awareness and no formal course exists on Organ donation and
transplantation, students suffer from misconceptions that remain unaddressed throughout their
medical school years.
A Brazilian study shows medical students willingness increased as their number of years in
medical school increased [34], while a Pakistani study shows that the number for willingness
to donate remained stagnant. [35]
Possible reasons for hesitancy in medical students might be procurement procedure as was
illustrated by a study in United States or fear of organs used for commercial use [36].
In our study nearly 35% of students refused to donate due to religious causes as well as parent's
refusal or fear from surgery and selling organs, Figure 11. The study showed that people
whose parents held ‘positive’ attitudes were more supportive of organ donation.[37] Thus,
organ donation not influenced by information only, but very strongly also by social and
familial factors.
Brain death is a complete loss of brain function including involuntary activity necessary to
sustain life.
The results showed that (58%) of the participants know about brain death and (42%) don’t
know, Figure 12. This is a high value compared with other results of medical students , and
this is may be due to the curriculum of our college or in the high schools or may be the
knowledge from the media or social media or even personal education.
In Brazil the knowledge about brain death was low and this was due to limited contact of the
students with this subject prior to graduation, and there was only one class about brain death
in the clinical neurology division. [38]

27
‫‪Conclusion‬‬
‫هدير سرمد‬
‫لينا محمد‬
‫نورالهدى احمد‬
‫عمر صادق‬

‫‪28‬‬
Conclusion
 Half of the students have good knowledge.
 Knowledge about study problem started at 4th stage and above reaching its maximum
at 6th stage, while the 3rd stage had the least knowledge.
 The source of these information’s are the media and curriculum.
 Males have more knowledge and attitude than females.
 Regarding the organ that can be donated, majority of the participants had chosen the
kidney.
 The majority of the students chosen to donate their organs after their life.
 Approximately all the students participated in this study didn’t donate their organs.
 More than half of participants don’t know about brain death.
Recommendations
 Medical curriculum must highlight and focus on the importance of organ donation, the
value of organ donation and the concept of brain death, especially in the
 Other educational tools include lectures, campaigns and advertisements will raise the
awareness and improve attitude toward organ donation among medical students and
modifying teaching methods toward further attitude development.

29
 References
‫مريم كمال‬

References
1. Caplan A. Daniel H. Coelho (Editor). The Ethics of Organ Transplants: The
Current Debate. Prometheus Books; 1999.

30
2. International Standards Established by Organizations for Organ and Tissue
Transplantation.
3. Delmonico FL. The declaration of Istanbul on organ trafficking and transplant
tourism. Indian J Nephrol.
4. World Health Organization (WHO). Media Center. “WHO Proposes Global
Agenda on Transplantation” 30 March; 2007.
5. Fortieth World Health Assembly Geneva,4-15 MAY; 1987. WHA40.13.
Developmentof Guiding Principles for Human OrganTransplants.
6. Fifty-Seventh World Health Assembly Wha57.18 Agenda Item 12.14 22 May;
2004.Human Organ and Tissue Transplantation.
7. Batten, Helen Levine (1990). "The Social Construction of Altruism in Organ
Donation," Ch. 8 in Organ Donation and Transplantation: Psychological and
Behavioral Factors, ed. by James Shanteau and Richard Jackson Harris.
Washington, DC: American Psychological Association.
8. Johnston, Cameron (1993). "Transplanting Animal Organs Into Humans Could
Soon Become a Reality in Canada," The Medical Post, 5 Jan. 1993
9. (Varga, Andrew C. (1984). The Main Issues in Bioethics, Revised Edition.
Ramsey: Paulist Press, Chs. 11 and 12.)4
10. Human Organ Procurement and Exchange Program (1993). Organ & Tissue
Donation (pamphlet). Edmonton: University of Alberta Hospitals.
11. Catholic Health Association of Canada (1991). Health Care Ethics Guide.
Ottawa. 7
12. Moazam, Farhat (September 2006). Bioethics and Organ Transplantation in a
Muslim Society: A Study in Culture, Ethnography, and Religion. Indiana
University Press. pp. 32ff. ISBN 978-0-253-34782-4
13. MacNeil, Archbishop Joseph N. (1986), excerpt in "Your Religion and Organ
Donation" (pamphlet). Edmonton: Lions Eye Bank. 8

14. Jonsen, Albert R. (1989). "Ethical Issues in Organ Transplantation," Ch. 9 in

Medical Ethics, ed. by Robert M. Veatch. Boston: Jones and Bartlett Publishers,
229-52.9
31
15. Moazam, Farhat (September 2006). Bioethics and Organ Transplantation in a
Muslim Society: A Study in Culture, Ethnography, and Religion. Indiana
University Press. pp. 32ff. ISBN 978-0-253-34782-4
16. Duncan, Glenn E. (1992). "Grim Harvest," The Catholic World Report, Aug.
10
17. Ashley, Benedict M., OP; and Kevin D. O'Rourke, OP (1986). Ethics of
Health Care. St. Louis: Catholic Health Association of the United States.11
18. Law Reform Commission of Canada (1992). Procurement and Transfer of
Human Tissues and Organs, Working Paper 66. Ottawa: Canada Communication
Group - Publishing. 12
19. Garrett, Thomas M.; Harold W. Baillie; and Rosellen M. Garrett (1993).
Health Care Ethics: Principles and Problems. Englewood Cliffs: Prentice Hall,
Ch. 9. 13
20. Wallace, Charles P. (1992). "Trafficking on Kidney Street: The Rich get
Healthier from Trade in Human Organs," Science and Medicine, 13 Sept. 1992.
14
21. Garrett, Thomas M.; Harold W. Baillie; and Rosellen M. Garrett (1993).
Health Care Ethics: Principles and Problems. Englewood Cliffs: Prentice Hall,
Ch. 9. 13
22. Law Reform Commission of Canada (1992). Procurement and Transfer of
Human Tissues and Organs, Working Paper 66. Ottawa: Canada Communication
Group - Publishing. 12
23. German Bishops' Conference and the Council of the German Evangelical
Church (1988). "Christians and the Ethics of Organ Transplants," Catholic
International
24.Hamed H, Awad ME, Youssef KN, Fouda B, Nakeeb AE, et al. (2016)
Knowledge and Attitudes about Organ Donation among Medical Students in
Egypt: A Questionnaire. J Transplant Technol Res 6: 155. Doi: 10.4172/2161-
0991.1000155
25. Kawa Sheikh-Abdulla / Kidneys For Sale in Kurdish Camps/ the rules and
law of OD in kurdistan of iraq : Jul 2, 2015 niqash.org › articles › society
26. manipal university official website .
32
Maleka manipal medical college history.
27.Manish R. Balwani, Manoj R. Gumber, Pankaj R. Shah, Vivek B. Kute,
Himanshu V. Patel, Divyesh P. Engineer, show alPages 582-588 | Received 03
Oct 2014, Accepted 12 Dec 2014, Published online: 06 Feb 2015Attitude and
awareness towards organ donation in western India
28. KL Balajee, N Ramachandran, and L SubithaAnn Med Health Sci Res. 2016
Sep-Oct; Awareness and Attitudes toward Organ Donation in Rural Puducherry,
India
29. Taimur SaleemEmail author, Sidra Ishaque, Nida Habib, Syedda Saadia
Hussain, Areeba Jawed, Aamir Ali Khan, Muhammad Imran Ahmad, Mian Omer
Iftikhar, Hamza Pervez Mugha
30. Hosam Mohammed; Mohamed Elhosseny Awad, et al (2016) Knowledge and
attitude about organ donation among medical students, Egypt: AQuestionnaire .J
Transplant Technol Res 6:155 doi.
31. Attitude of Turkish medical and law students towards organ donation, Erciyes
University, kayseri, Turkey, in 2011_2012
32. Centers for Disease Control and Prevention, National Center for Health
Statistics. Underlying Cause of Death 1999-2013 on CDC WONDER Online
Database, released 2015. Data are from the Multiple Cause of Death Files, 1999-
2013, as compiled from data provided by the 57 vital statistics jurisdictions
through the Vital Statistics Cooperative Program. http://wonder.cdc.gov/ucd-
icd10.html. Accessed June 30, 2015.
33. https://www.iraqhurr.org/a/26725578.html
34. Dutra MMD, Bonfim TAS, Pereira IS, Figueiredo IC, Dutra AMD, Lopes AA
(2004) Knowledge about transplantation and attitudes toward organ donation: a
survey among medical students in northeast Brazil. Transplant Proc 36: 818-820

35. Nisreen Feroz Ali2*, Amal Qureshi2, Basmah Naser Jilani2 and Nosheen
Zehra1
Knowledge and ethical perception regarding organ donation among medical
students

33
36. Hobeika MJ, Simon R, Malik R, Pachter HL, Frangos S, Bholat O, Teperman
S, Teperman L: U.S. surgeon and medical student attitudes toward organ
donation. J Trauma 2009, 67(2):372–375.
37. Sirois BC, Sears SF Jr, Marhefka S. Do new drivers equal new donors? An
examination of factors influencing organ donation attitudes and behaviors in
adolescents. J Behav Med 2005; 28:201-12.
38. Garcia CD, Goldani JC, Neumann J, Chem R, Chem E, Camargo JJ, et al.
Importância do programa educacional de doação e transplante em escolas
médicas. J Bras Transpl. 2009; 12(1):1049-51.

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