Body Politic:
Examining the views and reasoning of medical
students towards organ donation.
Shervin Poladi - Supervisor -
Georgia Testa
1. Background
2. Aims
3. Study design and rationale
4. Methods
5. Results
6. Conclusions & Implications
1. Background
• 1902: Alexis Carrel
pioneered the joining
of blood vessels
• 1954: First successful
kidney transplant in
Boston, USA
• 2015: Langone
Medical Center, the
worlds most extensive
full face transplant
1.2 Background
• 1.1 million new individuals have
registered as donors in last year
1.2 Background
• 1.1 million new individuals have
registered as donors since Literature
Review
• Appositely named “Donation Gap”
• Opt-in system currently (1 December
2015, Wales became the first UK
country to introduce a soft opt-out
system)
1.3 Background
• Self-design project
• Sought approval from School of Medicine Research Ethics
Committee
• Ethical landscape is very contentious
• Research suggests that healthcare workers’ “knowledge,
attitudes, and behaviors are essential factors for creating and
promoting an environment that has a positive influence on organ
donation rates” (Evanisko et al., 1998).
2. Aims
1. To investigate the level of factual knowledge (and/or deficit) of medical students with regard to organ donation.
2. To examine the various ethical positions held by medical students and their reasoning.
3. Study Design & Rationale
Literature Review
• Critical appraisal of field
• Decided on observational qualitative study
Preliminary informal interviews
• Conducted with a small cohort of medical students (n=7) & NHSBT specialist nurses (n=3) ≤ 30 minutes
• Strength: can elicit new questions, novel concepts & practice. Recommendations for formal.
Formal semi-structured interview
• Larger cohort (n=41) ≤ 50 minutes
• Bank of 29 open & closed questions
• Questions on factual knowledge & ethical views
• 1st year Vs 5th year
4. Method
• Recruitment
• REC approved email sent to 1st and 5th year mailing list
• Invited to participate in project
Information sheet
• Respondents sent FAQ of project
• Details such as interview is anonymous and aims of project
• Those still interested, arrangement made for interviews at University
Consent form
• Form presented at interview
• Data Governance explained
• Explained that participants can withdraw at any point
4.2 Method
Interview & Transcribing
• Questions asked in neutral manner• REC approved each stage of the process and the
material used.• Transcribed electronically and kept on firewall
protected university sever and FileVault encrptedcomputer
• Copies doubled checked for errors or discrepancies
5. Results
5.2 Results
Kidneys Liver Heart Lungs Pancreas Small Bowel Cornea Tissue
1st year 21 15 21 9 1 0 13 5
5th year 20 19 20 11 0 1 15 8
0
2
4
6
8
10
12
14
16
18
20
22
Nu
mb
er
of
me
nti
on
s
Figure 1 | Do you know which organs you can donate? 1st Year Vs 5th Year
5.3 Results
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
Opt-out
Opt-in
Contact for organ donation?
Types of death
1st 5th
Figure 2 | 1st Year Vs 5th - Knowledge and Opinion
5.4 Results
5.5 Results
5.6 Results
6. Conclusion
• “Can you tell me what you know about organ donation?” Without fail “scarcity” and “shortage” were mentioned
• 40 of the 41 participants stated that they would like more teaching on the subject
• Clear deficits in some factual knowledge – e.g. which organs can be donated and HIV donors
• Require such little extra reinforcement but that could have such a large positive impact on the interaction between doctor and patient, as well as on a system as a whole.
• Medical students engaged very well in the ethical discussions, particularly when they were now able to lend a name or title to a theory the already believed in
6.2 Conclusion
• Novel or original proposals to help with organ donation:
Driving License to have a symbol denoting if they are a donor GP to ask about their donation status, as they do with smoking or drinking status. Individuals could be reminded or prompted during the national census
• Implications of project could assists medical educators for the future Further studies with larger cohorts Development of Questionnaire
• These are the views of “tomorrows doctors”, the same doctors that will be influencing patients and their families with regard to organ donation
• Leeds MBChB curriculum changed starting 2017, with extra symposium added in 3rd Year.
References
• Blair R D, Kaserman D L. (1991). The economics and ethics of alternative cadaveric procurement policies. Yale J Regul. Summer;8(2):403-52.• Bardell T, Hunter DJ, Kent WD, (2003). Do medical students have the knowledge needed to maximize organ donation rates? Can J Surg 46:453.• Blumstein JF, Sloan FA (1986). Organ transplantation policy: issues and prospects. Durham, London: Duke University Press.• Boyce, B. (2013) Opt-out Organ Donation: Virtue Ethics, Utilitarianism and the problem of consent. Australian Catholic University,
http://www.academia.edu/6153153/Opt-out_Organ_Donation_Virtue_Ethics_Utilitarianism_and_the_problem_of_consent Thesis School of Philosophy and Theology. (Accessed: October 2014)
• Bramstedt, Katrina A. (2006. Is it ethical to prioritize patients for organ allocation according to their values about organ donation? Progress in Transplantation.16(2)170-170
• Estlund, David M. (2009). Democratic Authority: A Philosophical Framework. Princeton University Press• Ettner BJ, Youngstein KP, Ames JE (1998). Professional attitudes toward organ donation and transplantation: results of a 1986 –1987 survey of
transplant professionals. Dial Transplant 17:72.• Evanisko MJ, Beasley CL, Brigham LE, (1998). Readiness of critical care physicians and nurses to handle requests for organ donation. Am J Crit Care 7:4.• Falvo DR, Woehlke P, Tippy P (1987). Family practice residents’ attitudes toward organ donation. J Fam Pract 25:163.• Laslett, Peter. (1988) Locke: Two Treatises of Government and the Revolution of 1688. Cambridge Texts in the History of Political Thought. Cambridge
University Press. • NHS, (2010). "The NHS in England - About the NHS - NHS core principles".
http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspx. (Accessed: October 2014) • NHSBT (2013). NHS Blood and Transplant – Activity Report 2013
http://www.organdonation.nhs.uk/statistics/transplant_activity_report/current_activity_reports/ukt/nhs_organ_donor_register.pdf (Accessed: October 2014)
• NHSBT (2014). NHS Blood and Transplant – Lives Saved. Statistics March 2014. http://www.organdonation.nhs.uk/statistics/index.asp. (Accessed: October 2014)
Thank You
Any Questions?