#2311 Comparative analysis of knowledge and attitude regarding deceased donation in health care workers and the general population
Authors: Bari Amit , Islam Sumona , Nobi Farnaz , Akther Niyoti , Yousuf Eshaba , Begum Nura Afza Salma , Kashem Tasnuva , Sultana Shanjida , Nomany Shoeb , Arefin Mohammad Shakib Uz Zaman , Rashid Harun Ur 
Published: May 2024

Abstract

Background and Aims
Kidney transplantation is widely regarded as the best treatment option for end stage kidney disease. Despite being introduced over 40 years ago, the rate of kidney transplantation in Bangladesh is still very low at an average yearly rate of below 200 transplants over the last 5 years. Lack of donors and financial constraints have emerged as the biggest obstacles. Until recently, live related transplantation was the only option. There have been only 2 deceased transplantations last year, both from the same donor. In order to understand these low rates, we aim to understand the prevailing knowledge and attitude towards transplantation in the community and among the health care workers (HCWs) and how much they differ.

Method
This cross-sectional study has been ongoing since May 2022. It is a self-administered survey using a paper-based questionnaire, developed by the Asian Society of Transplant, asking about the respondent's knowledge and attitude regarding deceased organ donation in Bangladesh. The survey was administered in both HCWs and non-HCWs using a pre-tested questionnaire. The HCWs were recruited from 9 hospitals across Bangladesh and the non-HCWs were recruited from Universities, attendants accompanying patients in hospital waiting areas and a few offices. Convenient sampling technique was used. Data was analyzed by statistical analysis software (SAS) studio.

Results
Data was collected from 1351 respondents, 874 (65.6%) were HCWs and 458 (34.4%) were non-HCWs. Among the HCWs, 131 (15%) were doctors, 745 (85.2%) were nurses and 130 (14.9%) were final year medical students. Among the non-HCWs, business (10.3%), acting (8.9%) and teaching (4.4%) were the predominant professions. The mean age of the respondents was 36.4 (±14.1) years, 65.5% were female. The HCWs were significantly younger and had more females, mostly owing to the large sample of nurses.
Twenty percent of the non-HCWs never heard about deceased donation compared to 3.4% HCWs (p &lt; 0.0001). 79.5% of the HCWs said they knew very little or not at all about deceased donation. The self-assessment was about similar in the non-HCWs. Only 11.6% HCWs said they received education about organ donation, compared to 20.5% of the non-HCWs (p = 0.0004). Regarding deceased donation, 36% HCWs had a positive attitude, 58.7% were neutral and 5.3% were negative. Among the non-HCWs, 30.5% were positive, 35.5% were neutral and 34% were negative (p &lt; 0.0001).
Regarding willingness, 11.1% HCWs were very willing to donate themselves, 61.3% were contemplating and 27.6% were unwilling. Among the non-HCWs, 11.2% were willing to donate, 48.8% were contemplating and 40% were unwilling. When asked to list all reasons for not willing to donate, lack of information was most common (64.8% HCWs, 49.6% non-HCWs), followed by fear of donation (12.5% HCWs, 25.9% non-HCWs) and religious beliefs (6.8% HCWs, 15.6% non-HCWs) (p &lt; 0.0001).
When asked about the most reliable sources of information in order to promote deceased donation, the opinion varied widely. The most popular ones were online contents (63.9% HCWs, 12.4% non-HCWs), outdoor events (36.2% HCWs, 21.2% non-HCWs) and TV advertises (30% HCWs, 6.1% non-HCWs) (p &lt; 0.0001).

Conclusion
The overall knowledge regarding deceased donation was poor. Most people had a neutral attitude towards donation and were contemplating donation themselves. The HCWs were more willing to donate. Lack of information was the leading reason behind unwillingness. Online promotions were considered the best modality for future promotion.