CHAPTER- 1

INTRODUCTION
“what you leave behind is not what is engraved in stone monuments
, but what is worth woven into the lives of others.”
“- pericles ”

Organ donation is the gift on an individual to help someone who suffers from damage and gross
malfunction of their organ .organ transplantation has greatly improved the looks of patient
suffering from end stage organ failure.

“ When we donate life, we give someone more then resorted health and wellbeing .we given
them hope for a better tomorrow.” The gift of the donated organ and tissue provide recipients
with the opportunity to regain health and productive period of life . The donor’s family also
views their beloved one’s gift of donated organ and tissue as a source of comfort ,during the
time of intensive sorrow.

Organ transplantation is a routine life saving procedure , due the demand for organs out strips
the supply when organs such as heart ,kidney and liver fail and no drugs are available , a
transplant can be the only option .organ transplant were first attempted a hundred years ago ,but
the early failed because of rejection .The body sees the new tissue as foreign and immune system
destroys it.

Some organs such as kidneys, lungs ,can be provided by living donor , most people can survive
with one kidney, at time affected part of the other kidney may also can come back to health
with the transplant. Organ donation is the process of surgically removing an organ or tissue from
one person and placing it into another person . Types of organ donation are living donation ,
deceased donation , vascularized composite allograft VCA. Type of transplantation are
autograft, allograft , sograft , xenograft.

In 1994, the government of india passed the transplantation of human .Organs act legalized the
concept of brain death and for the facilited organ procurement from heart beating , brain dead
donors, however this concept has not caught on well in india for want of public education and
awareness this is turn in perpetuating the commercial sale of human organs due to the widening
gap between the demand and supply. Thousands of lives are last in india annually from heart and
liver failure since transplantation of unpaired like hearts , liver, and pancrease is either difficult
or impossible from living donors this in only possible on a large scale if these organs are
available from cadaver donors.
Medical science is expanding its horizons by leaps and bounds and edging towards hence
successes by unveiling gods god miraculous mystery-human being and primarily human body. In
any of the organs of the human body fails to function, medical science can extend its functioning
for some time , but when an end stage failure is reached , just like a machine whose parts are
changed the failed organ needs to be replaced . There are millions of needy patients all over the
world who suffers from various end stage organ failures and whose liver can be saved only by
the timely replacement of the failed organ.

Human to human (allogencie) transplantation of cell tissue and organs has become the best
treatment and often the only for a wide range of fatal disease. Transplantation has been
increasing over the previous decades. However the human organ of the therapeutic material
entails the potential for safety and ethical violation .One of the miraculous discoveries of
medical science has brought a ray of hope in the lines of those needy patients by transplanting
these functioning organs from the bodies of brain these functioning organs from the bodies of
brain dead patient to these patient . This is cadaver organ transplantation.

Whenever there is an injury to the brain stem or intracranial hemorrhage the patient goes into
coma . The brain is the almost important organ of the body and on irreversible damage to the
some leads to the death of the living being but other internal organ remain functional. Though
the advances in medical science have made transplantation of lose their lives because the donor
are not available in adequate numbers. More than 150,000 people are damaged with end stage
kidney disease every in India . However , not more than a few thousand transplants are
performed every year and the patients are forced to survive on dialysis.

There is a district lack of awareness among the general public in India about how immensely
beneficial donating organs can prove to be for the recipients and their familiar . Most of the
people needing transplantation belong to the young and middle age groups . Hence donating
vital organ to a person belonging to these age groups can save a whole family from being ruined.
There is also superstition and among people that by donating organs, they will be born
deformed and disfigured in their next birth.

Hence urgent action is required on several fronts if the acute shortage of human organs in india
has to be met. Awareness should be increased about the benefits of organ donations through the
means of mass communication and superstitions among people should be fought by the way of
religious in junctions.

BACKGROUND OF THE STUDY –

Organ transplantation on saves thousands of lives worldwide . According to WHO, kidney
transplantation are carried out in 91 countries . Around 66,000 kidney donations 21,000 liver
donations and 6000 herat donations were transplanted globally in 2005[1] . Organ for donation
are procured from both living donors as well as cadavers. In south-east Asia and Pakistan .
However , almost all organ donation come from living donors [2]

According to the estimates of a prominent kidney transplants center of Pakistan . Sindh Institute
of urology and transplantation (SIUT), approximately 15,000 patients in Pakistan suffer from
kidney failure every year . The only treatment option available for these patients are either
dialysis or kidney transplantation [4] . As of 2007 there are 12 transplantation centers in
Pakistan with five being in the public sector and seven in the private sector. Approximately 400
renal transplants are done every year despite the increasing number of patient with end stage
renal disease, The donors being living It is dismal fact that there is no liver transplantation center
in the country [5] despite the estimated prevalence of Hepatitis B and Hepatitis C in our
population ; being 3-4% % 6% respectively.

The law is important to protect the impoverished section of the society from exploitations. A
survey of kidney vendors done is Punjab, Pakistan , showed that 34% were living below the
poverty line . Most of these kidney vendors were illiterate, 69% were bonded laborers.

Overall, globally the prevalence of knowledge for organ donation ranges from 60% to 85%
using different knowledge variables [16]. The trend has been reported to very with the
development status of the country. Motivation to donate has been shown to have an association
with knowledge and awareness of organ donation.

Therefore the aim of our study was to fill the gaps regarding public awareness of organ donation
in Pakistan . Also we wished to determine factors that motivate or dissuade Pakistani individuals
from organ donation .This information would be helpful for tailoring more precisely targeted
programs and compaigns in the future.

NEED FOR THE STUDY –

Organ transplantation is unique among surgical procedures in that the procedure cannot take
place without the donation of an organ or a partial organ from another person.

In Who , since 1988, than 390,000 organ have been transplanted , with approximately 30 percent
of the transplanted organs coming from deceased donors. In 2005 , 7,593 deceased donors
provided 23,249 transplanted organs in the united states, and there were 6,896 living donors
(OPTN, 2006)

In India, around 6000 people die every day waiting for organ transplant every 17 minutes
someone die waiting for transplant. . Every 13 minutes someone is added to waiting list .India
however slips to the 40th rank in study of 69 countries in terms of number of transplants per
million population with only three in a million getting the kidney in case of a renal failure
according to a new report of the kidney international . The journal of international society of
nephrology3,200 transplants took place in India .
 In MP, In the last 10 years in Ujjain , only 80 people have filled up to consent form for body
donation of which the R.D Gard i medical college has received 7 bodies . Each day an average
of 75 people receive organ transplants. However, an average of 20 people died each waiting for
transplants that can take place because of the shortage of donated organs . In November 2010,
the national waiting list was 45% white , 29% Black , 18%Hisponic and 6% Asian . In 2007
there were almost 2.5 million deaths in US due to shortage of organs. 105,567 people is in
waiting list 28,463 transplants took place , diseased and living donors are 14,630.

Hence ,we are conducting this research because we have seen that there is less knowledge among
GNM 2nd year regarding organ donation and to give education on organ donation to GNM 2nd
year student to enhance their knowledge.

PROBLEM STATEMENT:-
“ A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING
PROGRAMME ON KNOWELEGE REGARDING ORGAN DONATION AMONG
GNM 2ND YEAR STUDENT IN SELECTED NURSING COLLEGE OF JABALPUR
CITY’’

OBJECTIVES:-
1 .Assess the pre-test knowledge regarding organ donation among GNM 2nd year student in
selected college of Jabalpur city.

2. Assess the post-test knowledge regarding organ donation among GNM 2nd year student in
selected of Jabalpur city.

3. Compare pre-test and post-test knowledge score regarding organ donation among GNM 2nd
year student in selected of Jabalpur city.

4. Associate pre-test knowledge score with selected demographic variable

OPERATIONAL DEFINITION:-
1.ASSESS : It refers to estimate the quality of attitude and knowledge of GNM 2nd year
student in selected nursing college of Jabalpur.

2.KNOWLEDGE : It refers to the ideas expressed by GNM 2nd year student related to
organ donation in selected nursing college of Jabalpur.

3.ATTITUDE : It refers to feeling expressed by the GNM 2nd year student related to
organ donation in selected nursing college of Jabalpur.
4.EFFECTIVENESS : It refers to desired changes brought about the plan teaching
programme on the knowledge and attitude of GNM 2nd year student related to organ donation
in selected nursing college of Jabalpur.

5.PLANNED TEACHING PROGRAMME : It refers system of planned

instructions desired to impart information in order to gain knowledge regarding organ donation
of GNM 2nd year student related to organ donation in selected nursing college of Jabalpur.

6.ORGAN DONATION : It refers to removal of specific organ of the human body

from a person who has recently died or from living donor , for the purpose of transplanting
them in to other person.

ASSUMPTION :-
THE STUDY ASSUMES THAT :
The GNM 2nd year student will have some knowledge regarding organ donation.

The teaching programme will enhance the knowledge and attitude of a GNM 2nd year student
regarding organ donation.

DELIMITATION :-
THE STUDY IS LIMITED TO :
The GNM 2nd student in the age group 17-21 year.

In selected nursing college of Jabalpur.

HYPOTHESIS :
HO – There will be significant difference between pre-test and post-test score of GNM 2nd
year student regarding organ donation in selected nursing college of Jabalpur.

H1 – There will be no significant difference betweenpre-test and post-test knowledge score of

nd
GNM 2 year student regarding organ donation in selected nursing college of Jabalpur.

CONCEPTUAL FRAMEWORK :
According to polit hungler(1994), conceptual framework is cohesive and
supportive linkage of selected inter related concepts . It serves as a guide to research and a
spring board for the generation of research hypothesis .Not every study is based on a theory or
conceptual model but every study has its in a framework and study is based on system model
(1985) a guide for development utilization and evaluation.

In present study input refer to the demographic variable such as age ,sex.

Process refers to the assessment knowledge and to provide planned teaching programme on
organ donation among GNM 2nd student in selected nursing college of Jabalpur.

Output refers to the adequate knowledge of GNM 2nd year student regarding organ donation
that may lead to increase in the knowledge of GNM 2nd year student regarding organ donation.
2. REVIEW OF LITERATURE
Review of literature is systemic identification selection, critical analysis and reporting
existing on the topic of material for study

The review of literature of the present is organized under the following heading .

2.1 Studies related to effectiveness of planned teaching programme regarding oggan donation.

2.2 Studies related to organ donation in general.

2.3 Studies related to knowledge and attitude regarding organ donation.

2.1 Studies related to effectiveness of planned teaching programme

regarding organ donation –
2.1.1 A descriptive study conducted at the department of medical ethics and history of
department of medical ethics and history of medicine university of Gottingen on public
attitudes toward organ donation and its commercialization on 120 urban people. The study found
that current political and legal discourse , neglects the central role of reciprocity for long people
and patients. Lake of awareness and misconceptions is the main cause for shortage of organ .

Arunjose (2006)

2.1.2 The cross sectional studies was conducted on knowledge, attitude and practices about organ
donation among college studies in Chennai. Tamil Nadu 75% respondents were in favour of
organ donation but only 2% were registered for organ donation.

Annadurai k , mani k et al, (2012)

2.1.3 The cross sectional study was conducted on community attitude toward kidney donation in
Mumbai India. This study resulted that participants had an average level of awareness regarding
kidney donation and a neutral attitude.

Almeida N et al , (2013)

2.1.4 The pre-experimental design was conducted for this study to assess the effect of structured
teaching programme regarding organ donation 60 sample were selected by purposive sampling
technique. The pilot study selected was conducted on 6 subject of Rajiv Gandhi college of
Nursing Jammu. The findings showed that the pre-test knowledge ie,31 (51.76%) had
inadequate knowledge and 9(15%) had moderately adequate knowledge. And the attitude in pre-
test 25(41.7%) Had neutral and 35(58.3%)had negative attitude .The post-test attitude revealed
that all subjects ie,60(100%) had positive attitude paired ‘+’ test was applied to assess the effect
of teaching programme on attitude of subject . The obtained ‘+’ value was found to be highly
significant at the level of P<0.05.

Shantha seelan G and Esha sharma(2016)

2.2 Studies related to organ donation in general –

2.2.1 The cross sectional studies was conducted on university of delhi analysis the opinion and
understanding of adult patients about organ donation and transplantation among 347 samples
voluntarily completed a questions with 17 queries concerning organ donation. The study
concluded that lack of interest and moderately positive attitude of patients towards organ
donation and lack attitude is because of the prelevence of misconception .

Arun Jose(2006)

2.2.2 The cross sectional study was conducted on 850 health care workers self administered
questionnaires were used to obtain information from participants in which 716 (90%) returned
their completed questionnaires .The mean +_ SD age of participants had heard of organ donation
82.5% and 39.4% would be willing to donate and counsel potential organ donation cards .Only
19.4% belived that organ transplantation is often organ effective and 63.4% belived they were
permitted by their religion to donate permission by religion (OR 3.5;95%CI 2.3 to 5.3) good
knowledge (OR 2.9:95%CI1.4 to 5.7) readiness to sign donation (OR 2.6:95%CI 1.7 to 3.8)
discus organ donation(OR 2.7:95% CI 8 to 63.8)and knowing somebody who had donated (OR
2.9) independently influenced willingness to donate organ .There is disparity in knowledge of
organ donation and willingness to donate among health care workers.

R. Oluyombo et al(2012)

2.2.3 The cross sectional studies was conducted on 193 randomly selected relatives of patients
attending the outpatient department at a tertiary care center, we used a structured questionnaire to
collect data through face-to-face interview we found that 52.8% of the participants has adequate
knowledge and 67% had a positive attitude towards organ donation .while 181 (93.8%)
Participants were aware of organ donation and 147 (76.2%) supported organ donation .Only
120(62.2%) were willing to donate organ after death further there were significant asssociations
between age ,gender ,education ,economic status and background of the participants with their
intention to donate organ or study advocate for public education programme to increase
awareness among the general population about the legislation related to organ donation.

Poreddi vijaylakshmi et al(2014)

2.2.4 The cross sectional stud was conducted on among undergraduate nursing student at a
college of nursing , Bengoluru , south India. A total of 278 students were eligible to participate
in the stud. However , seven questionnaires were discarded because of incomplete responses and
few were absent during data collection ( n=4). Hence final sample comprised 267 undergraduate
nursing students with high response rate (94%) . the sample the present study consisted of 267
individuals of whom 99.3%(n=265) were women. The mean age of the participants was [mean
± standard deviation (SD)] 19.20 ±1.23 year. Majority of the participants were Christian
(n=207,77.5%) . All of them head about organ donation and were in favor of organ donation.
However , only 51.3% (n=137) of them were awere of brain death . A vast majority of the
participants were unaware of organ donation low (n=251,941). A great majority also knowledge
that newspapers (61%) and television (58%) were then main source of information about organ
donation .

Vijay alakshmi poreddi et al(2014)

2.2.5 The randomized controlled trial conducted at saku central hospital nursing school located
in nagano prefecture, japan. The number of registered nursing student in the school is 253. Data
of 203 (99.0%) student were analyzed At study end seven of 102 student (6.9%) of the
programme group and one of 101 student (1.01%) of the booklet group consented to donate
organ (proportion ratio 6.93[95%CI 0.87-55.32]) There were significant between group
differences in willingness to consent for donation (54.9% VS 39.6% ;proportion ratio 1.39[95%
CI 1.03- .87]) family discussion (31.4% VS 15.9% ;1.98 [1.16-3.38]) and donor designation of
family member( 11.8% VS 2.0;5.94[1.36-25.88]). No group difference were found in
willingness for organ donation by student and family members.

Minaru murakami et al (2016)

2.3 Studies related to knowledge and regarding organ donation.

2.3.1 The cross section study was conducted on among 1136 medical student and physicians to
evaluate the knowledge about and attitude toward organ donation and transplantation at a large
academic medical center in Germany. The authars used a 28 item questionnaire that include item
on knowledge, attitude and demographic. Only 8% of the respondents felt sufficiently relative of
potential organ donors. Knowledge about and attitude toward organ donation were highly
associated with increasing level of medical education. In multivariate analysis knowledge ( 1. 17
, 95 % confidence interval [CI] , 1.08-1.25] attitude [ OR , 1.03,95% CI ,1.02-1.04] and level of
education. Were significantly associated with likelihood of holding on organ donor card,
whereas age, gender and personal experience with renal replacement therapy were not.

Windisch w. et al (2004)

2.3.2 The cross section study was conducted on among 440 students age 18 year and above in
Hindustan. Ars and science college Chennai, Tamilnadu. The student were interviewed with a
pretested questionnaire. The study was conducted between January 2012 to September 2012.
Through all the participants were aware of the term organ donation, knowledge about different
aspects was low 86.1 % were not legislation. 75% of respondents were in favor of organ
donation but only about 2 % were registered for organ donation. The study implies the need for
intensified and sustained education campaign to raise the knowledge on organ donation and its

Amadurai k. et al (2012)

2.3.3Thecross sectional study was conducted on among 298 undergraduate dental student of the
paninecya . Institute of dental sciences and hospital , Hyderabad India A 27 item self
administered questionnaire , which assessed the levels of knowledge [Q1-13] , Positive attitude
[Q14-Q24] and practice habits [Q25-Q27] regarding organ donation with dichotomous scale. As
campaired to males , females reported better mean ± SD scores in knowledge [8.22±1.51] and
practice [0.91±0.8] higher mean ± SD attitude score [8.55±1.56] were reported among males
[p<0.00]. While second year dental student has higher scores for their knowledge [8.55±1.56]
and practice [1.02±0.44] campaire to other year of training. There are an average level of
knowledge and low levels of positive attitude and practice habits among studied dental students
towards organ donation and transplantation.

K.chakradhar.et al (2013)

2.3.4 The cross sectional study was conducted on among 150 nurses recruited in randomly. After
taking infarmed consent questionnaires were filled. The data collection tool was a multipart
questionnaire including demographic information. 18 question about attitude and practice and 15
question about knowledge toward organ donation. Most of participants (76%) were 25-44 year
old. About 81.3%of them female [n=112].The attitude average score between males and female
was 85.25±35.61 and 70.37±46.53 respectively. The practice average score in females was
34.43±47.71 and between males was 29.63±46.53. The knowledge average score were
50.60±16.19 and 56.54±17.48 for two group [p<0.05]. the knowledge average scares between
different age groups was significant [P<0.05]

Mohadese bobaie; et al (2013 )

2.3.5 The cross sectional study was conducted on relatives of trauma patients referred to the
emergency department of sina hospital , Tabriz, Iran ,through 2013 to 2014.The questionnaire
included parts of demographic data and socio-economic situations as well as status of
knowledge and regarding organ donation .A score between 0-7 was belonged to each person
based on his/her level of knowledge .Attitude level has a score between 0-12 chisquare .fisher
and mann-whitney U test were performed to assess the relation between demographic variables
and the level of knowledge and attitudes. P<0.05 was considered as a significant level.79persons
[57.1%males] with the mean age of 31.3 ±11.3 year were evaluated. 57 [ 73.1%] of subjects
agreed with organ transplant. The present study showed that 73.1% of participants agreed with
organ donation.
 Mahboob pouraghaei; et al (20014)