The results of the present study showed that the knowledge of physicians and nurses about DCD was moderate to high. The personnel were well aware of the costs of organ donation and transplantation, family presence at the time of discontinuation of supportive treatments, the impact of the time elapsed since death on the outcome of organ transplantation, including their survival, all of which suggests an ability to identify and screen eligible individuals for organ donation. However, they had less knowledge of the number of organs that can be removed/transplanted as they considered only identifying primarily the kidneys and liver.
A study by D’Alessandre et al. (2008) showed that the level of knowledge of DCD by health care professionals was low . Likewise, Rodrigue et al. (2018) reported that a small number of the personnel answered the questions related to the knowledge about DCD, indicating their low awareness . A study by Burker et al. (2015) also showed that paramedics had less awareness of DCD, feeling they were inadequately skilled in the DCD process . However, Beaulieu et al. showed that healthcare personnel such as nurses and physicians were well aware of organ donation . In contrast to these prior studies the results of the present study suggest that ED staff possess a high level of knowledge. However, this knowledge appears to pertain to the general aspects of organ donation rather than the special aspects of DCD.
The results of the present study showed that physicians and nurses had a relatively positive attitude towards DCD, as assessed by the finding that the highest attitude score was attributed to the statement that DCD was a positive outcome of death. Meanwhile, less familiarity with criteria of DCD and the complexity of DCD process compared to organ donation after brain death had the lowest attitude score. The study by Martínez et al. showed that healthcare personnel in hospitals had a positive attitude toward organ donation, which is consistent with our findings . Rodrigue et al.’s study also showed that intensive care unit (ICU) personnel had a positive attitude toward DCD . Burker et al. findings also showed that paramedics had a positive attitude toward organ donation . Marck et al. (2016) conducted a study on the attitude of emergency personnel toward cadaveric organ donation, and reported that the majority of them had a positive attitude toward organ donation. In the present study emergency medicine specialists obtained a higher total attitude score as compared with emergency medicine residents and nurses, which is consistent with the findings of Schaeffner et al. [24, 25] Based on the present results, it seems that the only barrier to the implementation of the DCD program is the lack of protocols. The success of the Iran DCD program is depended on the resolution of the apparent legal, ethical and professional obstacles to this model of donation. The underlying principle of the program is that donation can on many occasions be legitimately viewed as part of the care a person might wish to receive at the end of their life.
There was no statistically significant association between physicians’ and nurses’ attitude and any of the socio-demographic characteristics (Sex, age, history of general and emergency services, religion, educational background, and employment status). Amani et al. study on attitude toward organ donation and willingness to donate reported no significant association between age and sex .
The majority of participants agreed with organ donation but few of them had an organ donation card. Physicians who had one however had a more positive attitude towards DCD. Also, marital status was found to have a statistically significant relationship with agreement with organ donation. There are few studies in support of this latter finding although Jeon et al. (2012) reported that marriage and education level significantly affected this result. Those who were married as well as those possessing a higher education had a higher knowledge score concerning organ donation. In addition, social characteristics such as sex, age, marriage, education, and occupation also affected the attitude towards brain-death organ donation . In contrast, Rodrigue et al. (2008) reported that there was no difference in the decision to donate an organ based on parent Sex, race, employment status, or marital status . For nurses, there was a statistically significant association between agreement with organ donation and ethnicity and sex. With regards to these findings it must be considered that the majority of the participants in the present study were Turkish and Shia- Muslim and as such this finding may not be generalizable to other ethnicities in Iran.
With regards to the residents’ positive attitudes about organ donation Fontana et al. showed that the majority of the medical students agreed with organ donation although few of them registered as organ donors. One quarter of them reported family disagreement with this concept. Furthermore, although the majority knew of the term donation after brain death only a few were aware of the criteria used to define it . In Arjmand et al.’s study on the attitude of those who had an organ donation card toward organ donation and transplant, no statistically significant relationship was found between their attitude and sex . Bogh (2005) reported on ICU personnel’s attitude towards organ donation in northern Denmark, half of them were willing to donate organs, though they had a positive attitude toward organ donation, which is inconsistent with the results of our study .
The present study has several limitations. The main limitation of the study is that only the knowledge and attitude of nurses and physicians has been evaluated. However, in order to design such services, the views of health and medical managers, as well as the opinions of patients and their families, should be considered. Other limitation include the fact that all participants work in the same country (and the same city) and have a very similar cultural and religious background.
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