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

Email

• 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?