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Original Article

Knowledge, Attitude, and Practices Regarding Organ Donation

among Adult Visitors in a Public Hospital in Delhi, India
Sandeep Sachdeva*, Anika Sulania, Nidhi Dwivedi
Department of Community Medicine, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India

Abstract
Objective: To assess knowledge, attitude, and practices regarding organ/tissue donation. Materials and Methods: A cross‑sectional descriptive
study was conducted among ambulatory, consenting adult (>18 years) visitors of a mid‑level government hospital using a predesigned,
pretested, semistructured interview schedule. Data were analyzed by calculating proportion, Chi‑square test, and odds ratio (OR). Results: Of
450 respondents, 271 (60.2%) were aged more than 31 years, 264 (58.7%) were male, 345 (76.7%) were married, 374 (83.1%) were Hindu,
304 (67.6%) had studied up to 10th class, 278 (61.8%) were working, 217 (48.2%) had 0–2 previous visit to this hospital, and 142 (31.6%)
reported history of hospitalization. Majority (337, 74.9%) of the respondents had heard the term organ donation (OD). On probing further, nearly
87.3% and 82.4% of respondents had ever heard of eye and kidney donation, respectively. Encouragingly, more than half of respondents, i.e.,
261 (58.0%), showed willingness for OD. Statistically (P < 0.001) higher odds for OD willingness was found among participants who were
aware of the term OD (unadjusted OR [UOR] = 2.8, 95% confidence interval [CI]: 1.82–4.39), eye donation (UOR = 3.2, 95% CI: 1.78–5.76),
and kidney donation (UOR = 4.0, 9.5% CI: 2.40–6.84). Similarly, higher willingness was found among single/separated participant and with
higher level of education (P < 0.05). About one‑fourth (120, 26.7%) of respondents had donated blood in the past, but this practice had no
statistical bearing on the willingness for OD (P = 0.61). Nearly half of the respondents, i.e., 239 (53.1%), were aware that organs could be
removed from both living and dead person; 373 (82.9%) of respondents were aware that organs cannot be removed from the body without
authorized permission (UOR = 2.7, 95% CI: 1.57–4.88 and adjusted OR [AOR] = 2.6, 95% CI: 1.27–5.66). However, only 119 (26.4%)
respondents consented to sign a pledge card for OD. Higher odds (AOR = 12.8, 95% CI: 5.02–32.75) for OD willingness was found among
those who consented to sign a pledge card. A high of 364 (80.9%) respondents had no misconception that a person will be born with missing
organ following donation of organ/tissue in this life. Conclusion: A high awareness but low level of positive attitude and practices was noticed
among sampled metropolitan respondents toward organ/tissue donation.

Keywords: Awareness, cornea, developing country, kidney, legislation, organ, perception, program, tissue, training, transplantation

Introduction No country in the world till date collects sufficient organs to

Organ transplantation is a successful medical intervention
available for end‑stage organ failure. For the last couple of
decades, it has assumed public health significance due to
shortage of high‑quality human organs. In conjunction with
other needs, it is one of the drivers of medical, reproductive,
and transplant tourism across the globe.[1,2] Currently, organ
donors are broadly classified into two types: donor after
brain death and donor after cardiac death with removal
of organs/tissue possible during both living and deceased
state. Organ and tissue transplantation is expensive medical
intervention, primarily driven by private sectors in the country,
and young deaths due to road traffic accident or cardiovascular
event provide a best option for high‑quality organ yield.
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meet the needs of its citizens. It is estimated that currently organ
transplantation covers <10% of the global needs. Spain, Austria,
Croatia, USA, Norway, Portugal, Belgium, and France stand out
as countries with high rates of deceased organ donors.[3‑5] Spain
has consistently recorded highest deceased organ donation (OD)
rate of 33–35 donors per million population and many countries
across the world have been following Spanish model for OD.[6,7]
Contrary to general perception, the long‑term cost of renal
Corresponding Author: Dr. Sandeep Sachdeva,
Department of Community Medicine, North Delhi Municipal Corporation
Medical College and Hindu Rao Hospital, New Delhi ‑ 110 007, India.
E‑mail: sachdevadr@yahoo.in
This is an open access article distributed under the terms of the Creative Commons
Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak,
and build upon the work non-commercially, as long as the author is credited and the new
creations are licensed under the identical terms.
For reprints contact: reprints@medknow.com

DOI: How to cite this article: Sachdeva S, Sulania A, Dwivedi N. Knowledge,

10.4103/ijot.ijot_35_17 attitude, and practices regarding organ donation among adult visitors in a
public hospital in Delhi, India. Indian J Transplant 2017;11:127-32.

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Sachdeva, et al.: Organ donation and transplantation

transplantation is lower compared to hemodialysis or peritoneal proportion, Chi‑square test, odds ratio (OR) to assess the
dialysis. Even the quality of life and survival are reportedly association with covariates and considered significant at
better among renal transplant recipients.[8,9] P < 0.05.
India needs at least 260,000 organs every year, i.e., 180,000
kidneys, 30,000 livers, and 50,000 hearts whereas only Results
6000 kidneys, 1200 livers, and 15 hearts are transplanted Of 450 respondents, 271 (60.2%) were aged more than
annually (National Organ Transplant Program). Unfortunately, 31 years, 264 (58.7%) were males, 345 (76.7%) were married,
India with a 1.2 billion population is lagging in OD with a 374 (83.1%) were Hindu, 304 (67.6%) had studied up to
national deceased donation rate of <1 per million population.[10] 10th class, 278 (61.8%) were working, 217 (48.2%) had 0–2
Country has well‑developed corneal donation and transplant previous visit to this hospital, and 142 (31.6%) reported “ever”
program; however, even eye donation after death has been history of hospitalization. Sociodemographic profile of study
relatively slow to take off.[11‑14] In the backdrop of annual respondents is shown in Table 1.
requirement of 100,000 corneas, around 50,000 were collected
during the past few years and yet 40% could be transplanted Encouragingly, more than half of respondents, i.e., 261 (58.0%),
due to quality issues (personal communication). showed willingness for their organ/tissue donation.
Higher willingness was found in participants who were
The government has initiated specific sustained actions for the single/separated (P < 0.05) and those having higher level of
promotion of organ and tissue donation, but it has not been able education (P  <  0.05). There was no statistically significant
to come to a stage of full realization. The myriad reason for this difference noticed with regard to age, gender, religion, working
state of affair could be due to individual, community, and health status, and previous visits to this institution or hospitalization
system issues. With this background, a study was conducted to toward willingness for OD.
assess the knowledge, attitude, and practice (KAP) regarding
organ/tissue donation and transplantation among adult visitors Majority (337 of 450 respondents, i.e., 74.9%) had heard the
of a government hospital in Delhi, India. term OD (ang daan). Details are shown in Table 2. However,
on probing further, nearly 87.3% and 82.4% of respondents
had ever heard of eye and kidney donation, respectively.
Materials and Methods Statistically (P  <  0.001) higher odds for OD willingness
A cross‑sectional descriptive study was conducted among was found among respondents who were aware of the term
ambulatory, coherent, consenting adults (>18 years) visiting OD (unadjusted OR [UOR] =2.8, 95% CI: 1.82–4.39), eye
a mid‑level municipal teaching hospital of Delhi using a
predesigned, pretested, semistructured interview schedule
during the period of February–March 2016 after obtaining Table 1: Sociodemographic profile of study respondents
clearance from the institutional ethics committee. A sample Variables Total (n=450), n (%)
size of 400 was calculated assuming the prevalence of OD Age (years)
awareness at 50%, relative error of 10%, and 95% confidence 18‑30 179 (39.8)
interval (CI). However, we were able to mobilize and interview ≥31 271 (60.2)
450 respondents visiting the outpatient department (OPD). Sex
Male 264 (58.7)
Study respondents either a patient or accompanying attendant
Female 186 (41.3)
were contacted based on convenience by the researchers
Marital status
after obtaining informed verbal consent in hospital premises, Married 345 (76.7)
galleries, patient waiting area, garden, cafeteria, and snack Single/separated 105 (23.3)
corner in a comfortable, nonjudgmental, and confidential Religion
manner. On completion of successful interaction, participants Hindu 374 (83.1)
were thanked for their cooperation and all related doubts Others 76 (16.9)
cleared followed by prompt additional help, if any, was Level of education
extended. Studied till 10th class 304 (67.6)
>10th class 146 (32.4)
The study instruments consisted of two sections: Part‑I
Occupation status
which is sociodemographic background and Part II which
Working 278 (61.8)
captured specific items related to knowledge, perception,
Students/house wife/nonworking 172 (38.2)
attitude, practices, and willingness of organ/tissue donation.
Previous visits to this hospital
The responses of some of the questions were categorized into 0‑2 217 (48.2)
Likert‑based scale of agree, neutral, and disagree. ≥3 233 (51.8)
There were no missing values and data were entered into a History of at least 24 h hospitalization
Microsoft Excel sheet and analyzed using SPSS software Yes 142 (31.6)
version 16 (IBM Inc, Armonk, New York, USA) by calculating No 308 (68.4)

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Sachdeva, et al.: Organ donation and transplantation

Table 2: Knowledge and perception of organ/tissue donation

Factors Willingness for organ donation P UOR (95% Cl) AOR (95% Cl)
Total (%) Yes (%) No (%)
Ever heard about organ donation?
Yes 337 (74.9) 217 (83.1) 120 (63.5) <0.001 2.8 (1.82‑4.39) 1.3 (0.67‑2.70)
No 113 (25.1) 44 (16.9) 69 (36.5)
Ever heard about eye donation?
Yes 393 (87.3) 242 (92.7) 151 (79.9) <0.001 3.2 (1.78‑5.76) 1.0 (0.39‑2.98)
No 57 (12.7) 19 (7.3) 38 (20.1)
Ever heard about kidney donation?
Yes 371 (82.4) 237 (90.8) 134 (70.9) <0.001 4.0 (2.40‑6.84) 2.0 (0.83‑4.80)
No 79 (17.6) 24 (9.2) 55 (29.1)
Organ donation means removal of organs from
Both living and dead person 239 (53.1) 162 (62.1) 77 (40.7) <0.001 1.7 (1.35‑2.16) 0.8 (0.58‑1.21)
Dead person only 108 (24) 55 (21.1) 53 (28)
Don’t know 103 (22.9) 44 (16.9) 59 (31.2)
Can organs be removed without permission of patient or
family member?
Yes 77 (17.1) 59 (22.6) 18 (9.5) <0.001 2.7 (1.57‑4.88) 2.6* (1.27‑5.66)
No 373 (82.9) 202 (77.4) 171 (90.5)
Awareness regarding legislation on organ donation and
transplantation?
Yes 129 (28.7) 89 (34.1) 40 (21.2) 0.002 1.9 (1.25‑2.97) 1.2 (0.67‑2.21)
No 321 (71.3) 172 (65.9) 149 (78.8)
In general do people in society donate organs
Yes 195 (43.3) 129 (49.4) 66 (34.9) 0.001 1.9 (1.29‑2.81) 1.2 (0.74‑2.09)
No 255 (56.7) 132 (50.6) 123 (65.1)
Do you know that some people die because of
nonavailability of organs?
Yes 356 (79.1) 215 (82.4) 141 (74.6) 0.030 1.5 (1.00‑2.51) 0.9 (0.50‑1.83)
No 94 (20.9) 46 (17.6) 48 (25.4)
Does your religion allow organ donation?
Yes 328 (72.9) 214 (82.0) 114 (60.3) <0.001 2.7 (1.83‑3.97) 1.1 (0.69‑1.92)
No 122 (27.1) 47 (18.0) 75 (39.7)
Only rich and VIPs are provided organs for transplantation
Agree 203 (45.1) 110 (42.1) 93 (49.2) 0.057 0.7 (0.64‑0.98) 0.9 (0.67‑1.20)
Neutral 90 (20) 48 (18.4) 42 (22.2)
Disagree 157 (34.9) 103 (39.5) 54 (28.6)
UOR: Unadjusted odds ratio, AOR: Adjusted odds ratio, Cl: Confidence level

donation (UOR = 3.2, 95% CI: 1.78–5.76), and kidney
donation (UOR = 4.0, 9.5% CI: 2.40–6.84). However, none
of these variables could reach statistical significance on higher
level of analysis (adjusted OR [AOR]).
More than half (239, 53.1%) of the respondents were
aware that organs could be removed from both living and
dead person. Significantly (P  <  0.001) higher proportion,
i.e., 82.9% (373) of the respondents, were aware that organs
cannot be removed from the body without authorized permission
(AOR) = 2.6, 95% CI: 1.27–5.66). Opinion was divided but
45.1% believed that the rich in comparison to general population
are more likely to get organ transplantation in case of need.
Table 3 depicts the attitude and practices related to organ/tissue
donation. Nearly, 120 (26.7%) respondents had donated
their blood in the past, but this practice had no significant
bearing on the willingness for OD (P = 0.61). Nearly half,
i.e., 230 (51.1%) respondents, suggested that they would
authorize removal of organs from the bodies of their family
member if situation so arise.
Higher prevalence (184, 70.5%) of willingness for OD was
noticed for those who wanted more information on the current
topic (P = 0.007). However, only 119 (26.4%) respondents
consented to sign a pledge card for OD and was also found to be
significantly (AOR = 12.8, 95% CI: 5.02–32.75) associated for
willingness. A high of 364 (80.9%) respondents had no myth
or misconception that a person will be born with missing organ
following donation. Yet, only 182 (40.4%) respondents were
of the opinion that OD should be made mandatory after death.
Discussion
India witnessed its first successful corneal, kidney, and cardiac
transplant in the year 1960, 1967, and 1994, respectively.[15]

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Sachdeva, et al.: Organ donation and transplantation

Table 3: Attitude and practices related to organ/tissue donation

Factors Willingness for organ donation P UOR (95% Cl) AOR (95% Cl)
Total (%) Yes (%) No (%)
Donated blood in the past
Yes 120 (26.7) 77 (29.5) 43 (22.8) 0.061 1.4 (0.92‑2.18) 1.3 (0.77‑2.30)
No 330 (73.3) 184 (70.5) 146 (77.2)
If situation so arise, would you authorize removal of
organs from your family member after death?
Yes 230 (51.1) 191 (73.2) 39 (20.6) <0.001 10.4 (6.71‑16.39) 6.6 (3.85‑11.37)
No 220 (48.9) 70 (26.8) 150 (79.4)
Do you require more information on organ donation?
Yes 292 (65) 184 (70.5) 108 (57.1) 0.007 1.7 (1.21‑2.65) 1.0 (0.60‑1.77)
No 158 (35) 77 (29.5) 81 (42.9)
Are you ready to sign a pledge card for organ donation
Yes 119 (26.4) 113 (43.3) 06 (3.2) <0.001 23.2 (9.96‑54.4) 12.8 (5.02‑32.75)*
No 331 (73.6) 148 (56.7) 183 (96.8)
Do you think there should be monetary incentive for
organ donation
Agree 215 (47.8) 142 (54.4) 73 (38.6) <0.001 1.2 (1.02‑1.55) 1.0 (0.79‑1.46)
Neutral 77 (17.1) 31 (11.9) 46 (24.4)
Disagree 158 (35.1) 88 (33.7) 70 (37.0)
People who donate organs in this life would take birth
with a missing organ
Agree 41 (9.1) 20 (7.7) 21 (11.1) 0.096 0.7 (0.55‑1.00) 7.5 (0.49‑1.13)
Neutral 45 (10) 21 (8.0) 24 (12.7)
Disagree 364 (80.9) 220 (84.3) 144 (76.2)
Do you think organ donation should be made
mandatory after death?
Yes 182 (40.4) 126 (48.3) 56 (29.6) <0.001 2.2 (1.49‑3.29) 0.8 (0.46‑1.43)
No 268 (59.8) 135 (51.7) 133 (70.4)
UOR: Unadjusted odds ratio, AOR: Adjusted odds ratio, Cl: Confidence level

Till date, many new developmental milestones have been
achieved in the country; however, OD has been consistently
lower than expectations. The Government of India promulgated
Transplantation of Human Organ and Tissues Act in 1994, and
with the view to enlarge its scope and promote cadaver OD,
the government has brought new amendments as of year 2014
and 2017. In the backdrop of this journey, a cross‑sectional
descriptive study was conducted among 450 adult ambulatory
visitors of a mid‑level government hospital in Delhi (India)
regarding KAP of organ/tissue donation. In spite of inherent
limitation of the study setting and convenience sampling, a high
level of awareness (74.9%–87.3%) but low level of positive
attitude and practices was deduced from the present study
along with strong association with sociodemographic variables.
Willingness for OD  (58%) and awareness on eye
donation (87.3%) in our study was found to be near similar
with a study conducted in Mangalore, India (59.6% and
98.1%, respectively).[16] In addition, awareness on existence
of legislation related to OD and transplantation was also
found to be similar (28.7% vs. 29.3%). On the contrary,
67% of respondents believed that there should not be any
monetary incentive for the promotion of OD. Studies
conducted in Puducherry (India) reported high willingness
for OD, i.e., 69.75% (2013) and 70.3% (2016).[17,18] A study
conducted among 193 patients attending OPD of a tertiary
center at Bengaluru (Karnataka) reported 93.8% awareness,
76.2% supported OD, 62.2% of respondents were willing to
donate organs after death, 52.3% agreed that religious people
do not oppose OD yet, only 5.7% had heard about OD law, and
nearly 40.1% were willing to sign an OD card.[19] This as well
as many other studies confirmed that only level of education
was of statistical significant predictor for OD willingness.
A recent study conducted in a large private hospital[20] of
Delhi (India) reported high awareness on kidney (94.1%), eye
donation (79%), and legislation (50.4%) along with 31.1%
showing willingness for OD but 56.3% were consenting to sign
a pledge card. While another decade old, a study conducted
in Delhi showed 61.59% willingness for ODs.[21] This is
suggestive of stagnation or status quo in society even after a
gap of more than 10 years.
On comparison with selected other countries, OD awareness
in Pakistan was 60%, Kuwait (68.3%), South Africa (89%),
Brazil (89%), and Saudi Arabia (98%).[22‑27] A Canadian
household telephonic survey highlighted that OD awareness
and willingness was universal and 54% had actually
registered or signed a pledge card but here also opinion
was divided toward the rich who are more likely to receive
an organ. [26] However, a lower proportion (30.0%) of

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Sachdeva, et al.: Organ donation and transplantation
willingness was also reported from another developing
country like Nigeria.[28]
OD is a highly sensitive personal choice and arises only under
pivotal circumstances of medical need, poverty/financial
exploitation, or spiritual charity. All over the world,
governments put forward variety of policy approaches or
strategies to improve OD, i.e., informed consent (opt‑in) or
presumed consent (opt‑out).[15] In countries with informed
consent or “opt‑in” legislation, such as the UK, Germany, and
Sweden, an individual or his/her family must give explicit
permission for organ removal. Presumed consent countries
such as Spain, Portugal, and Austria assume universal consent
without explicit registration otherwise.[29] In India, we follow
opt‑in system where donor/legal guardian gives consent at
the time of OD.
Presumed consent policy means that individuals who have not
opted out of OD will automatically donate their organs upon
time of death depending on suitability of clinical condition.
A research finding indicates that individuals are more likely to
donate their organs than to consent for donation of a relative’s
organs. Both decisions are affected by regulation (presumed
consent), awareness of regulation, and social interactions.
Furthermore, education (more educated) and age (younger),
expressing some sort of political affiliation, determine
willingness to donate one’s own organs and consent to the
donation of those of a relative.[28] Various studies have indicated
that policy of presumed consent increases OD worldwide.[30,31]
The government at central/state level, nongovernmental
organizations, and media have been undertaking
awareness‑generation activities and highlighting successful
cases of OD and transplant since the last couple of years
that has probably increased general awareness in the society.
However, on the contrary, this heightened awareness is not
translating into increased organ/tissue donation either because
of bureaucratic procedures, lack of system preparedness,
and poor specific communication by health staff to harness
organs/tissue at critical phase of life.
Conclusion
This study not only reiterates high awareness of organ/tissue
donation among sampled respondents visiting a mid‑level
government hospital in the metropolitan city but also reflects
low level of positive attitude and practices.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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132 Indian Journal of Transplantation  ¦  Volume 11  ¦  Issue 3  ¦  July-September 2017