Public awareness of organ donation.
ABSTRACT A telephone survey of public attitudes toward organ donation and transplantation was conducted in a community in southwestern Ontario. The subjects were selected at random; the response rate was 57%. Of the 50 respondents 62% stated that they had signed the organ donor card accompanying their driver's licence. These respondents were more likely than those who did not sign it to have discussed organ donation with their families. At least 80% of the respondents said they would agree to donate their organs and those of their next-of-kin, and 80% said that the organ donor card should be considered a legal document. Organ transplantation was regarded by all but one respondent as an acceptable medical procedure. Also discussed were concerns about organ donation and possible strategies to improve the availability of organs for transplantation.
[show abstract] [hide abstract]
ABSTRACT: Questionnaires were administered to 108 university psychology students to investigate attitudes and behaviour related to organ donation. Three groups (committed, uncommitted and opposed) were identified. A multivariate analysis of variance showed that, compared with uncommitted donors, committed donors felt better informed about organ donation, had discussed donation more often with family members and knew more people who had signed donor cards. The subjects in the opposed group and those in the uncommitted group cited different reasons for not signing a donor card. Empathy, religious beliefs and attitudes about death did not affect willingness to donate. Analyses of the interaction between willingness to donate one's own organs and willingness to donate those of a family member revealed a monotonic increase in willingness to donate the organs of a family member as the type of recipient became more personally relevant. Our findings indicate that when health care professionals request donor organs the potential recipients must be presented to the potential donors in a personally relevant manner. Educational programs must be developed to train medical personnel in how to effectively ask for organs without coercing the potential donor or invading the privacy of the potential recipient.Canadian Medical Association Journal 08/1989; 141(1):27-32. · 8.22 Impact Factor
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ABSTRACT: As the great majority of the population in Saudi Arabia is Muslim, the Islamic views about organ donation and transplantation have been the focus of interest to the transplant community in this and other Muslim countries. The first resolution of the Islamic council in Saudi Arabia (Senior Ulama Commission) about organ donation and transplantation was issued in 1982. It permitted tissue and organ transplantation from both living and cadaveric donors. This resolution marked a new era in organ transplantation in Saudi Arabia, leading to the formation of the Saudi Center of organ transplantation (SCOT), which organizes the process of organ donation and transplantation in Saudi Arabia. There were major strategies to reach the goals of the organ procurement centers adopted by SCOT: improving the awareness of the medical community to the importance of organ donation and transplantation, improving the awareness of the public at large to the importance of organ donation and transplantation, and developing an efficient coordinated system with both the donating hospitals and the transplant centers. Various organs had been transplanted in Saudi Arabia through the end of 2002: 3759 kidney transplants (1267 cadaver, 2492 living); 279 liver transplants(225 cadaver, 54 living); 92 heart transplants; 421 cornea transplants; 8 lungs; and 5 combined kidneys and pancreas. In addition, there have been many tissue donations of bone marrow, heart valves (264 hearts), skin, and bone. Despite the success of the Saudi program, there have been public and medical obstacles that have obviated the full benefit of cadaver donors. We suggest increasing the awareness of the medical community and the public at large to the importance of organ donation and transplantation.Transplantation Proceedings 10/2004; 36(7):1878-80. · 1.00 Impact Factor
I Clinical and CommunityStudies
Public awareness of organ donation
Susan Evers, PhD
Vernon T. Farewell, PhD
Philip F. Halloran, MD, PhD
A telephone survey of public attitudes toward
organ donation and transplantation was con-
ducted in a community in southwestern Ontario.
The subjects were selected at random; the re-
sponse rate was 57%. Of the 50 respondents 62%
stated that they had signed the organ donor card
accompanying their drivers licence. These re-
spondents were more likely than those who did
not sign it to have discussed organ donation
with their families. At least 80% of the respon-
dents said they would agree to donate their
organs and those of their next-of-kin, and 80%
said that the organ donor card should be consid-
ered a legal document. Organ transplantation
was regarded by all but one respondent as an
acceptable medical procedure. Also discussed
were concerns about organ donation and possi-
ble strategies to improve the availability of
organs for transplantation.
Enquete telephonique dans une ville du sud-
ouest de l'Ontario sur les opinions de la popula-
tion quant au don et a la greffe d'organes. Parmi
les sujets choisis au hasard 57% repondent. Des
50 repondants 62% disent avoir signe la carte de
consentement qui accompagne le permis de con-
duire. Ceux qui ont signe, plus souvent que ceux
qui n'ont pas signe, avaient parle du don d'orga-
nes avec leur famille. Plus de 80% des repon-
From the Department ofHealth Studies, University of Waterloo,
Waterloo, Ont., and the Division ofNephrology and Immunolo-
gy, University ofAlberta Hospital, Edmonton
Reprint requests to: Dr. Susan Evers, Department of Health
Studies, University of Waterloo, Waterloo, Ont. N2L 3G1
dants consentiraient a donner leurs organes et
ceux de leur plus proche parent. Pour 80% des
repondants la carte de consentement devrait
avoir force de loi. Tous, a l'exception d'un seul,
la greffe d'organes
bonne chose du point de vue medical. On
discute aussi de certaines inquietudes au sujet
du don d'organes et des moyens d'augmenter la
disponibilite des organes pour fins de greffe.
he public's negative attitude toward organ
donation is consistently cited as the major
factor in the current shortage of organs for
50% of possible donor situations actually resulted
in donations such a shortage would not exist.4
In general, public opinion surveys have found
that while most people have a positive attitude
toward organ donation and transplantation this
seldom results in concrete action.23 A 1983 survey
by the Kidney Foundation of Canada found that
while 90% of the respondents agreed with the
concept of organ donation, only 20% had signed a
donor card.4 A 1984 study in Ontario had similar
findings: 89.1% of the respondents had heard of
organ donor cards, but only 25.5% stated that they
had signed one.' A comparison of the results from
Gallup polls in 19831 and 1987 (Toronto Star, Mar.
16, 1987: page A2) showed an increase, from 21%
to 25%, in the proportion of people who had
signed an organ donor card. The results of a survey
on public attitudes, commissioned by the Ontario
Ministry of Health's task force on kidney donation,
indicated a resistance to expressing support for
organ donation and transplantation by signing
organ donor cards.5 In that survey 60 individuals
It has been estimated that if
CMAJ, VOL. 138, FEBRUARY 1,1988
people who had signed an organ donor card,
people who had not signed a card and parents of
children who had their driver's licence - under-
went a 2-hour interview. To our knowledge, no
population-based studies have been done in Cana-
We conducted a small survey to ascertain
public attitudes toward organ donation and the
bases for these attitudes and thus to identify
predictors of attitude and behaviour.
We developed a questionnaire based on the
literature to date and conducted a telephone sur-
vey in a city of 80 000 people in southern Ontario.
While most of the questions had multiple-choice
answers, several were open-ended so as to identify
issues that were not suggested by the literature.
The subjects were selected from listed tele-
phone numbers by the use of a table of random
numbers. Only one person, aged 18 years or older,
per household was selected because of the expect-
ed correlation in responses among people in the
same household. If there was no answer when the
call was placed, the interviewer was instructed to
try the number two more times over the next 2
weeks before removing
contacted were asked if, for purposes of research
on kidney transplantation, they would be willing
to answer questions on medical procedures.
it from the list. Those
Of the 88 people contacted by telephone 50
(57%) were willing to be questioned. Their demo-
graphic characteristics are shown in Table I. There
were no significant differences between the re-
spondents who stated that they had signed the
organ donor card accompanying their driver's li-
cence and those who had not. However, more of
the respondents who had signed the organ donor
card (20 of 31) than of those who had not signed it
(4 of 14) had discussed organ donation with their
families (p = 0.027).
Organ transplantation was viewed as accepted
medical treatment by all but one of the respon-
dents (Table II). At least 80% of the respondents
said they would agree to organ donation for
themselves and their next-of-kin. Also, 80% felt
that the organ donor card should be a legal
document whose provisions should not be usurped
by the next-of-kin.
Newspapers or magazines and television were
cited by 90% of the respondents as being the
primary sources of information about organ trans-
plantation. The driver's licence itself was cited by
32%. The two most frequently cited determinants
of whether the respondents would agree to organ
donation were altruism (cited by 40%) and the
knowledge that a friend or relative needed an
organ (cited by 32%).
There were several specific concerns about
organ donation and transplantation, the two most
common being that financial status might deter-
mine who would receive an organ transplant (cited
by 16%) and that the donated organ might be of
inferior quality or from a carrier of human im-
munodeficiency virus (cited by 10%). We did not
find a differential reaction to the type of organ
donation; that is, the respondents were as support-
Table I-- Demographic characteristics of respondents
and number who had signed an organ donor card
Level of edUcation
Less than high school
High school, some
college or university
C%ollege or university
No. who had
N o. of
respondents organ donor cardt
*Four of the respondents did not state their sex, age or level
+Numbers in parenthesis indicate number of people answer-
ing the question about organ donor cards if different fromn
the total number of respondents.
organ donation and transplantation
--- Respondents' answers to questions on
No. (and %) of
Organ transplantation is an acceptable form
of medicai treatment
Want next-of-kin to give consent for
donation of organs
Willing to give consent for donation of
organs from next-of-kin
Has discussed organ donation with family
A signed donor card should be a legal
document whose provisions should not
be usurped by next-of-kin
Familiar with the term brain death
Acceptable that a person should be
maintained on a life support system for
A central registry should be established as
organrs become available
CMAJ, VOL. 138, FEBRUARY 1, 1988
ive of kidney transplantation as they were of heart
or other organ transplantation. The respondents
who stated that it was acceptable to maintain a
person on a life support system for purposes of
organ donation (38 of 50) were also queried on
what would be an acceptable length of time.
Surprisingly, most (27 of 38) said that 48 hours or
more was acceptable. Finally, 12 of the 14 respon-
dents who said that they had not signed the organ
donor card said that they were willing to do so.
We have demonstrated the feasibility of a
random population-based survey of public atti-
tudes toward organ donation. The results give
some insight into factors affecting behaviour. Since
62% of the respondents had signed a donor card,
and since the response rate was 57%, we estimated
that at least 35% of the population has signed a
donor card. Our findings on the factors that
however, to the people who responded to the
Further research into the issues and concerns
about organ donation and transplantation is essen-
tial for the development of public education strate-
gies. The disparity between the numbers of re-
spondents who were willing to donate organs and
of those who had already signed a donor card
suggests that the solution to the current shortage of
organs for transplantation is not solely an increase
in public acceptance of the procedure. The goal
may be to ensure that people who are willing to
sign an organ donor card do so and make their
intentions known to their families. Approximately
one-third of the respondents cited the driver's
licence as a source of information on organ dona-
tion. Thus, the donor card should receive more
attention in public education campaigns. Because
there is support for making the organ-donor card a
legal document, a central registry of names of
people who have given consent might also be
1. Robinette MA, Marshall WJS, Arbus GS et al: The donation
process. Transplant Proc 1985; 17 (suppl 3): 45-65
2. Manninen DK, Evans RW: Public attitudes and behavior
regarding organ donation. JAMA 1985; 253: 3111-3115
3. Richardson KE: Attitudes toward organ donation and trans-
plantation at an urban university. Dialysis Transplant 1982;
4. Gilmore A: Procuring donor organs: firm but friendly en-
couragement required. Can Med Assocj 1986; 134: 932-937
5. Corlett S: Public attitudes towards human organ donation.
TransplantProc 1985; 17 (suppl 3): 103-110
Actions: Hydralazine hydrochloride exerts its hypotensive action byreducing vascular resistance through
directrelaxation ofvascular smooth muscle.
Indicatons: APRESOLINE Oral: Essential hypertension.
APRESOLINE isused inconjunction with adiuretic and/orother antihypertensivedrugs butmaybe usedas
theinitial agent inthosepatients inwhom, inthejudgment of thephysician, treatmentshould bestarted with
APRESOLINE Parenteral: Severe hypertension when the drug cannot be given orally orwhen there is an
urgent need to lower blood pressure (e.g. toxemia of pregnancy or acute glomerulonephritis). It should be
usedwithcaution in patientswithcerebral vascularaccidents.
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disease, andacute dissectinganeurysm oftheaorta.
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patientdevelopsarthralgia,fever,chest pain, continued malaiseorotherunexplained signsorsymptoms.If
theresultsofthesetestsareabnormal, treatmentshould bediscontinued.
Usage in Pregnancy
Animal studies indicate that high doses of hydralazine are teratogenic. Although there is no positive evi-
denceofadverseeffectsonthehuman fetus, hydralazineshouldbeusedduring pregnancy onlyithebenefit
clearlyjustifies the potential risk tothefetus.
Precautions: Caution is advised in patients with suspected coronary-artery disease, as it may precipitate
anginapectorisorcongestive heartfailure, and ithasbeen implicated inthe production ofmyocardial infarc-
tion. The "hyperdynamic" circulation caused by APRESOLINE may accentuate specific cardiovascular
inadequacies, e.g. mayincrease pulmonary arterypressure in patientswith mitral valvulardisease.
Mayreduce thepressorresponses toepinephrine. Postural hypotension may result.
Use with caution in patients with cerebral vascular accidents and in patients with advanced renal damage.
Peripheralneuritis has been observed and published evidence suggests an antipyridoxine effect and the
addition ofpyridoxine totheregimen i symptoms develop.
Blooddyscrasiasconsistingofreduction inhemoglobinandred cellcount, leukopenia, agranulocytosis and
purpurahavebeen reported. Insuchcasesthedrugshouldbewithdrawn. Periodicbloodcountsareadvised
during therapy. MAO inhibitors should beused with caution inpatients receiving hydralazine. Slow acetyla-
torsshouldprobably receivenomorethan200mgofAPRESOLINE perday.Whena higherdose iscontem-
plated, and, wheneverpossible, itmaybeadvisable todetermine the patient's acetylation phenotype.
AdverseRsatons: Within thefirstdayortwo: headache, palpitations, tachycardia, anorexia, nausea, vom-
iting, diarrhea,andanginapectoris. Theyareusually reversiblewhendosage isreducedorcanbeprevented
orminimized byadministering reserpine orabeta-blocker togetherwith hydralazine;
Less Frequent: nasal congestion; flushing; lacrimation; conjunctivitis; peripheral neuritis; evidenced by
paresthesias, numbness, and tingling; edema; dizziness; tremors; muscle cramps; psychotic reactions
characterized bydepression, disorientation, or anxiety; hypersensitivity (including rash, urticaria, pruritus,
fever, chills, arthralgia, eosinophilia, and, rarely hepatitis); constipation; difficulty in miturition; dyspnea;
paralytic ileus; lymphadenopathy; splenomegaly; blood dyscrasias, consisting of reduction in hemogloin
and red cell count, leukopenia, agranuocytosis, thrombocytopenia with or without purpura; hypotension;
LateAdverse Reactions: Long-term administration at relatively high doses mayproduce an acute rheuma-
toid state. When fully developed a syndrome resembling disseminated lupus erythematosus occurs. The
frequencyoftheseuntowardeffectsincreaseswithdosageanddurationofexposure tothedrugand ishigher
inslowthan in fast acetylators. Antinuclear antibody and positive L.E.-cell testsoccur.
SymptomsandTreanentofOverdosage: Symptoms: hypotension, tachycardia, headache, generalized
skinflushing, myocardial ischemiaandcardiacarrhythmia candevelop. Profoundshockcanoccurinsevere
Treatment: Noknownspecificantidote. Evacuategastriccontent, takingadequateprecautionsagainstaspi-
ration and for protection of the airway; it general conditions permit, activated charcoal slurry is instilled.
These procedures may have to be omitted or carried out after cardiovascular status has been stabilized,
sincetheymight precipitate cardiac arrhythmiasor increase thedepth ofshock.
Support of the cardiovascular system is of primary importance. Shock should be treated with volume
expanderswithout resorting touse ofvasopressors, ifpossible.
Ifavasopressor isrequired, atypethatisleastlikelytoprecipitate oraggravate cardiac arrhythmia should be
used, andthe E.C.G. should bemonitored while theyarebeingadministered.
Digitalization maybe necessary. Renalfunction mustbemonitoredandsupportedasrequired.
Noexperience hasbeen reported withextracorporeal orperitoneal dialysis.
DosgeandAdministration: Adjustdosageaccording to individual blood pressure response.
Orally: Initial: 10mg4timesdailyforthefirst2to4days,25mg4times dailyforthe remainderofthefirstweek,
Maintenance: adjustdosage tolowest effective levels. Following titration, somepatientsmaybemaintained
on atwice dailyschedule.
Usual maximum dailydose is200mg, upto300mgdaily maybe requiredin some patients. In such cases a
lowerdosage ofAPRESOLINEcombined withathiazide, reserpineorboth, orwith abeta-adrenergic-block-
ing agent may be considered. When combining therapy, individual titration is essential to ensure that the
lowestpossible therapeuticdoseofeachdrug isadministered.
Parenterally: patientsshouldbehospitalized. Usualdose is20-40mg1.M. orbyslow I.V. injectionorl.V. drip,
repeatedas necessary. Patientswith marked renaldamagemayrequirealowerdosage.
For I.V. drip, theampoule(s)shouldbeadded to59 sorbitol solution, physiological salineorRinger solution;
glucose solution is notsuitable forthis purpose. Blood pressure levels should be monitored. It maybeginto
fall within afewminutes after injection, with an average maximal decrease occurringin 10 to80 minutes. In
caseswithapreviously existing increased intracranial pressure, loweringthe bloodpressure mayincrease
Most patientscanbetransferred tooralAPRESOLINE within 24 to48 hours.
AvaIabIlIty: Tablets of 10 mg: yellow, uncoated, biconvex, scored, and imprinted"FA" on one side and
Bottlesof 100and 500.
Tabletsof25mg: blue, coated, printed "GF" ononesideand "CIBA" onthe other.
Bottlesof 100and 500.
Tabletsof50mg: pink, coated, printed"HG" on onesideand "CIBA" on theother.
Bottles of 100and 500.
Ampoules: 1 ml, each containing 20 mg hydralazine hydrochloride, 103.6mg propylene glycol, 0.65 mgof
Complete PrescribingInformation availableonrequest.
Missssauga. Ontaro L5N ?W5EvS
CMAJ, VOL. 138, FEBRUARY 1, 1988