GLUTAMINE:

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physicians were significantly more likely to know someone who had received a transplant (Alsaied et al., 2012).

Another study on prevalence of organ donation, conducted among 297 hospice staff revealed that 8.1% of the respondents had donated an organ, 13.1% had a relative who donated an organ, and 6.7% stated that their relatives had received a transplant organ (Enginyurt et al., 2013). In Nigeria, the practice of organ donation is not also common. Only kidney (Fadare and Salako, 2010), cornea (Faderin, 2011) and more recently bone marrow transplants (Madike, 2011) have been done. Many studies have reported various factors as responsible for low donation rates. Some of these factors are uncertainty about the safety of donation, (Boulware, Ratner, Sosa, Tu, Nagula et al., 2002), perceptions and ethical values of health professionals (Spital, 1996), lack of appropriate skill in approaching family members (Bia, Romos, Danovitch, Gastron, Harmon et al., 1995) and the presence of medical conditions in some potential donors (Canaud and Mion, 1995; Barsoum, 1994).

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The results of two studies - one in 2000 and the other in 2009 - conducted by Sorensen and Lone on willingness to donate organs after death among ICU staffs in Northern Denmark revealed that there was a significant change in willingness to donate from 49% in 2000 to 69% in 2009 (p < 0.01). It was also evident that there were considerable variations between the professions. The highest willingness was found in the doctors‟ group: in 2000, 70% were willing to donate their own organs while in 2009, 81% would do so. In the nurses group the figure rose from 45% to 67%, whereas in the group of social and health care assistants the increase was insignificant from 47% to 48% (Sorensen and Lone 2013).

In 2009, a study was conducted among medical and nursing staff of the West London renal and transplant centre, to assess their views on the current practice of live donor kidney transplant. Most respondents were willing to donate a kidney to a blood relative (92.6%), a non-blood relative or friend (81.5%), and 12.0% were willing to donate to a stranger.

Considering themselves as potential recipients, most were willing to accept a kidney from a blood relative (91.7%) or non-blood relative or friend (85.2%), while 44.5% would accept a kidney from a stranger (Mazaris, Warrens and Papalois, 2009). Akgun et al. (2003) conducted a study among health care professionals in Turkey and the findings of the study revealed that 44.2% of the respondents were willing to donate their organs and the rate of willingness to donate was significantly higher among doctors than nurses.

Another study was conducted in Turkey to document health personnel‟s willingness to donate their organs. Only 36.7% of the 297 personnel studied were willing to donate their organs while 20.5% were unwilling, and 41.8% were indecisive of the issue. Majority (79.8%) of those willing to donate stated the need to save a live or improving someone‟s health status as reason for their disposition while 36.1% of those unwilling to donate stated that they did not want their body to be mutilated. However, majority (77.4%) of them were willing to receive an organ transplant if the need arises. The findings of the study further revealed a lack of correlation between age, sex, level of education and being a donor or intent of organ donation (Enginyurt et al., 2013).

A study conducted in the United Kingdom aimed at identifying factors associated with the wish of hospice doctors, nurses and healthcare assistants to donate their organs after death

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revealed that of the 76 staff studied, 43 (56.6%) were willing to donate their organs. The doctors and nurses were significantly more willing to donate (p=0.011) and also more likely to have discussed organ donation with their families (p<0.001) compared to healthcare assistants (Wale, Arthur and Faull, 2013).

Results from another study conducted among categories of health care professionals also found that support for organ donation was high among all the categories of health care professionals studied and that majority of the doctors (78.6%), nurses (68.5%) and EMS technicians (67.2%) were willing to donate a kidney to a family member in need. Only 26.6%, 21.3% and 17.2% of the doctors, EMS technicians and nurses respectively were open to the idea of donating a kidney to a stranger. The study further revealed that majority of the doctors (74.7%) and EMS technicians (62.3%) and half (50.7%) of the nurses were willing to receive an organ transplant if the need arises. The doctors were also significantly more willing to receive an organ transplant if needed. Only a few of the EMS technicians (27.9%), nurses (24.1%) and doctors (16.2%) had discussed their decision to donate or otherwise with their family members (Alsaied et al., 2012).

A Bangladesh study conducted among categories of health professionals, nursing and medical students revealed that 33.8% of the respondents were willing to donate their organs after death. Further analysis of the result of this study by categories of respondents showed that half (50.7%) of the respondents who were graduate doctors expressed willingness to donate their organs after death followed by 40.6% of the postgraduate doctors, 30.2% of the medical students, 30% of the Bsc nursing students and 26.8% of the diploma nurses (Ahmad et al., 2010).

The results of the study conducted by Siddiqui et al. (2012) revealed that 53.9% of health professionals were supportive of living organ donation while 34.0% opposed it. Similarly, support for deceased donation was 51.4% while 36.6% of the respondents opposed. A little above one-third (35.8%) of the respondents were willing to donate their organs after death while the rest were unwilling or undecided. In contrast, more than half (56.4%) of the respondents were ready to receive an organ if necessary. The study further revealed that only

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36.6% expressed willingness to discuss the issue of deceased-donor transplants with their family members and more physicians compared to nurses were significantly more willing to engage in this discussion.

Most noteworthy among the reasons given by health care professionals for unwillingness to donate was religious concerns (86.8%): 56.8% were concerned that religious rulings was against it, 66.3% considered organ procurement as blasphemous mutilation of the body and 55.1% were concerned about transplanting organs to a person of another religion (Siddiqui et al., 2012). Other reasons adduced for refusal were mistrust of doctors (77.4%), body with missing parts (40.3%) and body disfigurement (30.0%). Misconception, fear, and adverse socio-cultural beliefs have been identified as some of the factors responsible for the unwillingness to donate a kidney in developing countries with transplantation programs (Siminoff et al., 1995; Ka Siske, Ma, Louis and Swan, 1995).

In Nigeria, results from a study carried out to document attitudes toward kidney donation among health workers, patients‟ relatives and rural dwellers in Ile-Ife revealed that 62.0% of the health workers, 52.1% of the patients' relatives and 27.1% of the rural dwellers expressed willingness to donate. While there was no significant difference regarding the willingness of health workers and patients' relatives to donate a kidney, each of these groups was significantly more willing to donate than the rural dwellers. The same study reported altruism as the primary motivation for those willing to donate a kidney and fear of adverse health consequences as the most important reason for refusal to donate (Aghanwa et al., 2003).

Babalola, Samaila, Ezepue, Waziri-Erameh and Abiona (1995) carried out a multi-centre study on knowledge and attitude of Nigerians towards cornea donation and tried to establish the willingness of Nigerians to donate their cornea after death. In the study, 37% of the respondents were willing to donate their cornea after death but the authors also noted that a substantial proportion in all probability may be unwilling when it comes to actual donation.

Approximately 12 years later, partly informed by the results of the study by Babalola et al.

and the need to indirectly verify its findings, Waziri-Erameh et al. (2007) conducted a similar study among ophthalmologists and found that 41% of respondents were willing to donate their cornea while only 21% signed the donor forms. This Nigerian study also revealed that more

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respondents were willing to donate a close relative‟s cornea and give permission for close relatives to receive donor cornea from executed prisoners when compared to the respondents.

The study also suggested that the belief in reincarnation or life after death as the reason many respondents were not willing to donate.

In a study of 502 physicians, nurses and medical students in Jos University Teaching Hospital, Nigeria, Agaba et al. found that 75.6% of respondents were willing to be living kidney donors (Agaba, Ocheke, Agaba, Idoko, Ugoya et al., 2008). The study revealed that respondents who were unwilling to donate their kidneys cited reasons such as religious beliefs, ethical considerations, and perceived risk associated with donation. A similar study among doctors and nurses in Ile-Ife, Nigeria revealed that 59.3% of the respondents were willing to donate their organs. Age and attitude were positively correlated with willingness to donate organs and being a medical doctor was the strongest predictor of willingness to donate an organ (Esezobor, Disu and Oseni, 2012).

Previous study by Terasaki, Cecka, Gjertson and Takemoto (1995) has showed that these misconceptions militating against organ donation can be corrected thereby increasing people‟s willingness to donate organs. This has provided impetus for researches and made many countries to develop strategies to help in increasing the number of donors such as passing legislation and the use of organ donor card of a deceased person to be legally binding based on previous wishes (El-Shoubaki, Bener and Al-Mosalamani, 2006).

Studies on the relationship between socio-demographic variables, knowledge, attitude and willingness to donate organs have showed contradicting results and this has been stated as an indication that there is no clear to pinpoint the factors that play significant roles in the process of organ donation decision-making (Shaheen and Souqiyyeh, 2000; El-Shoubaki and Bener, 2005; El-Shoubaki, 2006). However, if barriers to the willingness for organ donation can be identified, these barriers can then be targeted for change (Morgan and Miller, 2001).