1.0 INTRODUCTION
1.1 Background of the study
Organ transplants have been increasingly important in modern medicine and may be a life saving option for some people who experience organ failures. Kidney failure, heart disease, and liver problems are some conditions that might be effectively treated through organ donations. Organ transplant can only be done if there is an organ donor either from a recently died person or a living donor. Kidney, skin and liver are examples of organs that could be donated by a living person whereas heart and cornea are usually transplanted to the needed patients from a dead donor or donors.
The problems face by surgeons today is the demand for transplants has far surpassed the supply of donated organs. Because there are not enough organ donors, patients would have to wait months and even years for their chance of recovery. Some died because they did not receive the transplant in time.
Even though organ donation is considered a noble act, not many people are willing to pledge organ. There could be some reasons toward these phenomena. First, majority of people are still skeptical to organ donation pledge due to fear and perceptions that their body would be mutilated (Razak Abdullah, 2008) in order to remove the organs from the body. To some people who believe that a dead body should be respected and treated with tender, especially the Muslims, organ donation is something to be avoided because they believe such acts could hurt the dead. They also believe that organs from Muslim must only be donated to another Muslim (Razak Abdullah, 2008) and these misconceptions are among the factors which caused the relatively small number of Muslims pledged their organs for donation as compared to other races. Second, while one may be willing to donate organ, especially to a family member, he may have concerns. Would having an organ removed ruin his good health and ability to work? What would life be like with only one kidney? These are among some reasons that turn people away from pledging organ donations.
1.2 Statement of the Problem
Organ transplant is one way of saving lives. However, without organ donors, transplantations cannot take place and this remains the main obstacle to the success of a transplantation program not only in Malaysia but also in the world (Chua, 2004). Despite many campaigns on organ donation, there are still people who are not aware the importance of it and are not willing to pledge their organs. The Ministry of Health is very concerned about this matter and thus a committee has been set up to investigate the matter.
The objectives of the study are:
1.3.1 to investigate the trend in pledging and donating organs among Malaysians over the years.
1.3.2 to find out the types of organs pledged.
1.3.3 to identify the reasons for people not pledging their organs.
1.4 Scope of Study
The study covers data on organ donations from year 2005 to 2008 only. Respondents selected to participate in the study were people who seek outpatient treatment from Hospital Kuala Lumpur (HKL) as well as visitors to HKL wards.
1.5 Significance of Study
Getting people to pledge organs is the biggest challenge faced by the medical institutions not only in Malaysia but also in the world. Ignorance and lack of information are said to be some of the factors that deter people from pledging organs. The results of this study will give more insights on this matter and thus help the Ministry to take necessary measures to overcome the problem.
2.0 METHODOLOGY
Records from The National Transplant Resource Centre, Hospital Kuala Lumpur on organ donations were used to elicit the data on organ pledges and donation. Records from 2005 to 2008 were analysed according to race and types of organs pledge. In addition, a survey was conducted to find out reasons why people were reluctant to pledge organ. For this purpose, 2500 respondents either out patients or hospital visitors were selected randomly for the interview. Ten enumerators were appointed and trained to interview the respondents. The interviews were carried out between 21 May 2009 and 10 June 2009 at outpatient clinics and wards of HKL. Each interview took approximately 10 minutes.
The following are results obtained from the study:
3.1 The trend in pledging and donating organs among Malaysians over the years. Table 1 shows organ pledges and donors according to race from 2005 to 2008. Data were obtained from National Transplant Resource Centre, Hospital Kuala Lumpur.
It can be seen from the data that there was a fluctuation trend in organ pledging across races in four years time. The table shows that there was an increase in the number of pledges from 7494 in 2005 to 10085 in 2006. However, the number declined to 8889 in 2007 before it increased again to 10605 in 2008. In general, there is an encouraging trend in organ donation in which more people pledge organ in 2008 compared to four years ago. Despite the fluctuation across the years the number grew from 7494 in 2005 to 10605 in 2008.
Among races, it was found that the Chinese constitutes the highest number of pledges and donors in which 18143 pledges their organs and 47 donated their organs or tissues. This is followed by the Indians with 9957 pledges and 25 donors. The Malays ranked third with 8131 pledges and 7 donors respectively. Other races made up the least number of pledges and donors with 842 pledges and 7 donors.
One of the reasons for the fluctuation in the numbers of organ pledges and donors could be due to the level of publicity given to organ donations. It was reported that the number of pledges usually went up after there was a huge media coverage on the need and importance of organ donations (Vijaindren, 2008) such as in the Tee Hui Yi’s case, the heart transplant recipient. However, the pledges went down again after the media focus ended.
As for why there were a lower number of pledges among the Malays, it could probably due to their misconception that organ donation is not encouraged in Islam. Others have a misconception that donating their organ could result it be transplanted into a non-Muslim body, which is not permissible in Islam. As stated by Razak Abdullah (2008), this ignorance deters the Malays from becoming organ donors.
3.2 Types of Organs Pledged
Table 2 shows the types of organs pledged from 2005 to 2008. From the total number of pledges, 28232 pledged all organs and tissues. For single organ
pledges, kidneys get the highest number of pledges (839), followed by corneas (479), heart (475), skin (164), liver (156), bones (66) and lungs (47).
Kidney received the highest number of single organ pledges could be due to people awareness that they could actually live with only one kidney. Since it is widely known that many people are suffering kidney problems, getting people especially close relatives and family members on kidney pledge is relatively easier than other types of organs and tissues.
3.3 Reasons for not Pledging Organs
Figure 1 shows reasons for not pledging organs among Malaysians. Objection from family members tops the reasons why people do not pledge organs. This finding is in line with statement by Chitra Ramasamy of Selayang Hospital Tissue and Organ Procurement team, that it is the biggest challenge to convince the family to donate organs and tissues even though the deceased individual is a pledged donor (Vijaindren, 2008).
The pie chart shows that 36 percent of the respondents gave family objection as the reason for not pledging organs while fear ranked second, with 23 percent of the respondents claimed they were afraid to donate organs. The third highest reason for not pledging is ethical and religious constraint (17 percent), followed by unaware of the importance of organ donation (10 percent), do not know where to sign up for organ donation (7%) and not physically fit to donate organs (5%). The other two percent did not give specific reason for not pledging organs.
It is interesting to note that despite fatwas issued by Malaysian government and other Islamic countries, including Saudi Arabia - which is considered an orthodox people afraid to pledge organs.
Muslim country - to support organ donations (Chua, 2004), many are still skeptical to do so. The fact that all religions condone organ donation, as long as it is done for humanistic reason, still fail to convince some people to donate their organs. Fear that doctors do not work as hard to save organ donors as well as the aftermath of organ donation may be the reason why
4.0 CONCLUSIONS
The following conclusions can be made based on the findings:
1. Lack of information and understanding on organ donation are the main reason why people do not pledge organ donation. Even though majority of people are aware of the importance of organ donation, many did not do so due to
ignorance such as fear, family objection and religious issue. Other reasons are either unaware or do not know how and where to sign up for organ pledge. 2. Chinese are the highest organ donors compared to the Malays who are the
lowest donors among the three major races. The Malays reluctance to pledge organs could be due to religious misconceptions of organ transplantation.
3. Media coverage and publicity given to organ donation pleads could have a significant effect on the number of people pledging organ donation.
5.0 RECOMMENDATIONS
The following are some of the measures could be taken by the relevant parties to ensure a more positive response toward organ pledging and donation.
1. Wide media coverage and publicity is a key to encourage people to come forward to organs pledges. The government, through its relevant agencies, should spread and reinforce the message on the need for organ pledges and work together with the media to publicise and create awareness on the reasons and importance of organ transplantation. This should be done continuously through campaigns, documentaries or public announcement by various media.
2. Helping people understand exactly how the process of organ donation works is the first step toward alleviating fears of organ donation. Misconceptions that doctors don’t work as hard to save organ donors should be clarified. Organ donors should be given priority in healthcare should the need arise. This could encourage people to come forward to organ pledge.
3. Ignorance among Muslims on organ donation should be clarified. This could be done through public sermons during Friday prayer as well as through religious talks and programs. Organ donation should be portrayed a noble act of charity – a gift to give life - that one can do especially after death to help other people.
