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      Devising focused strategies to improve organ donor registrations: A cross-sectional study among professional drivers in coastal South India

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          Abstract

          Background

          In India, annually, 500,000 people die due to non-availability of organs. Given the large proportion of brain death amongst road accident victims, any improvement in organ donation practices amongst this cohort could potentially address this deficit. In this study, we identify the potential areas for intervention to improve organ donation amongst professional drivers, a population more likely to suffer from road accidents.

          Methods

          300 participants were surveyed using a structured, orally-administered questionnaire to assess knowledge, attitudes and practices regarding organ donation. Multivariate analysis was performed to identify key variables affecting intent to practice.

          Results

          Nearly half our participants had unsatisfactory knowledge and attitude scores. Knowledge and attitude was positively correlated, r s (298) = .247, p < .001, with better scores associated with a higher likelihood of intent to practice organ donation [AOR: 2.23 (1.26–3.94), p = .006; AOR: 12.164 (6.85–21.59), p < .001 respectively]. Lack of family support and fear of donated organs going into medical research were the key barriers for the same [AOR: 0.43 (0.19–0.97), p = .04; AOR: 0.27 (0.09–0.85), p = .02 respectively].

          Conclusion

          Targeted health-education, behaviour change communication, and legal interventions, in conjunction, are key to improving organ donor registrations.

          Related collections

          Most cited references 29

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          Legal and ethical aspects of organ donation and transplantation

           Sunil Shroff (2009)
          The legislation called the Transplantation of Human Organ Act (THO) was passed in India in 1994 to streamline organ donation and transplantation activities. Broadly, the act accepted brain death as a form of death and made the sale of organs a punishable offence. With the acceptance of brain death, it became possible to not only undertake kidney transplantations but also start other solid organ transplants like liver, heart, lungs, and pancreas. Despite the THO legislation, organ commerce and kidney scandals are regularly reported in the Indian media. In most instances, the implementation of the law has been flawed and more often than once its provisions have been abused. Parallel to the living related and unrelated donation program, the deceased donation program has slowly evolved in a few states. In approximately one-third of all liver transplants, the organs have come from the deceased donor program as have all the hearts and pancreas transplants. In these states, a few hospitals along with committed NGOs have kept the momentum of the deceased donor program. The MOHAN Foundation (NGO based in Tamil Nadu and Andhra Pradesh) has facilitated 400 of the 1,300 deceased organ transplants performed in the country over the last 14 years. To overcome organ shortage, developed countries are re-looking at the ethics of unrelated programs and there seems to be a move towards making this an acceptable legal alternative. The supply of deceased donors in these countries has peaked and there has been no further increase over the last few years. India is currently having a deceased donation rate of 0.05 to 0.08 per million population. We need to find a solution on how we can utilize the potentially large pool of trauma-related brain deaths for organ donation. This year in the state of Tamil Nadu, the Government has passed seven special orders. These orders are expected to streamline the activity of deceased donors and help increase their numbers. Recently, on July 30, 2008, the Government brought in a few new amendments as a Gazette with the purpose of putting a stop to organ commerce. The ethics of commerce in organ donation and transplant tourism has been widely criticized by international bodies. The legal and ethical principles that we follow universally with organ donation and transplantation are also important for the future as these may be used to resolve our conflicts related to emerging sciences such as cloning, tissue engineering, and stem cells.
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            Organ donation, transplantation and religion.

            Religious concerns may be an important reason why patients decline listing for a renal transplant. These issues may be equally, or even more, important when live donation is discussed. There is good reason to believe that religious concerns play a significant role much more often than clinicians and transplant teams believe. The issue is certainly further compounded by the fact that a few, if any, patients come forward with their religious concerns, not least because issue of transplantation is new to them anyway and because they meet with transplant teams whom they do not know. Health professionals, on the other hand, may wish to avoid this sensitive issue altogether or may lack knowledge on religious issues pertaining to transplantation. Some may be entirely unaware. We encountered a case in clinic that revealed our remarkable lack of knowledge in this regard. Here, we aim to provide an overview on how the different religions view transplantation and organ donation, with an emphasis on practical points for health care professionals who are involved in transplant listing, organ donation and retrieval, and transplantation itself. Knowledge of these facts may provide a background to deal with these issues professionally and appropriately and to increase transplant numbers.
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              Analysis of fatal road traffic accidents in a coastal township of South India.

              Road traffic accidents (RTAs) are important causes of mortality and morbidity due to the increasing number of vehicles, changes in lifestyle and the risk behaviours among general population. With the aim of exploring various epidemiological characteristics of RTAs, this retrospective analysis of medico-legal autopsies was conducted between January 2005 and December 2009 in the Department of Forensic Medicine, Kasturba Medical College, Manipal in Karnataka, South India. The information was collected from post-mortem registers and inquest documents received from the investigating police officers. The collected information was analysed using SPSS version 11.0. Out of the 879 autopsies conducted during the study period, 39% were due to RTAs. Among the victims, 89.8% were males and 10.2% were females. The mean age of victims was 38.7 years, which was slightly higher in females compared to males. Most of the male victims belonged to the age group 20-29 years. The head injuries were responsible for nearly 3/4th of deaths followed by abdominal injuries (6.7%). The mean duration of survival following road traffic accident was 6-7 days. Occupants of motorized two wheelers (43%) and pedestrians (33%) were the most common victims of RTAs followed by occupants of light motor vehicles (LMVs). The most common offending agents in road traffic accidents were heavy motor vehicles (35.2%) followed by light motor vehicles (31.7%). In view of the above finding, it is apt to conclude that RTAs are important public health hazards and should be addressed through strengthening of emergency healthcare, stricter enforcement of traffic laws and health education. Copyright © 2012 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: MethodologyRole: SupervisionRole: Writing – original draft
                Role: Data curationRole: Formal analysisRole: InvestigationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Funding acquisitionRole: Project administrationRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: MethodologyRole: Visualization
                Role: Data curationRole: Formal analysisRole: MethodologyRole: Supervision
                Role: ConceptualizationRole: Formal analysisRole: Project administrationRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: SoftwareRole: ValidationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                21 December 2018
                2018
                : 13
                : 12
                Affiliations
                [1 ] Undergraduate Students, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
                [2 ] Department of Anatomy, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
                [3 ] Department of Statistics, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
                University of Toronto, Rotman School, CANADA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Article
                PONE-D-18-22591
                10.1371/journal.pone.0209686
                6303053
                30576381
                © 2018 Jagadeesh et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 3, Tables: 2, Pages: 16
                Product
                Funding
                This work was supported by the Kasturba Medical College Short-term-studentship (KMC—STS) 2017 grant. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Social Sciences
                Anthropology
                Cultural Anthropology
                Religion
                Social Sciences
                Sociology
                Religion
                Medicine and Health Sciences
                Health Care
                Health Education and Awareness
                People and Places
                Geographical Locations
                Asia
                India
                Medicine and Health Sciences
                Health Care
                Patients
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Transplantation
                Organ Transplantation
                Renal Transplantation
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Urinary System Procedures
                Renal Transplantation
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Digestive System Procedures
                Liver Transplantation
                Living-Related Liver Transplantation
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Transplantation
                Organ Transplantation
                Liver Transplantation
                Living-Related Liver Transplantation
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Transplantation
                Organ Transplantation
                Lung Transplantation
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Respiratory System Procedures
                Lung Transplantation
                People and Places
                Population Groupings
                Educational Status
                Custom metadata
                All the data regarding the study have been deposited with the journal and is provided with supporting file. There are no restrictions on public sharing of data by the journal.

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