Asian Journal of Transfusion Science
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ORIGINAL ARTICLE Table of Contents   
Year : 2021  |  Volume : 15  |  Issue : 1  |  Page : 37-45
A comparative study of knowledge, attitude, and practices about organ donation among blood donors and nonblood donors

1 Department of Transfusion Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
2 Department of Transfusion Medicine, SGPGI, Lucknow, Uttar Pradesh, India
3 Department of Physiology, Mahatma Gandhi Medical College, Sri Balaji Vidyapeeth (Deemed to be University), Puducherry, India
4 Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
5 Department of Transfusion Medicine, Blood Bank, Apollo Hospitals, Vellore, Tamil Nadu, India

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Date of Submission25-Jan-2021
Date of Acceptance21-Mar-2021
Date of Web Publication12-Jun-2021


Introduction: Shortage of organs by donation is a national problem which needs a multipronged approach for its strengthening. Educating the people and increasing the awareness of the need for donation would be of the foremost priority. Identifying the target population who are more likely to respond would be very important to reap the maximum results. There is speculation that blood donors would be more amenable and likely to accept the idea and thought of organ donation. This study is being designed to study the same.
Methodology: This was a cross-sectional comparative questionnaire-based study among two groups: blood donors and nonblood donors. Donors were defined as aged above 18 years and have made at least one whole blood/apheresis donation. Nondonors were the ones who were aged above 18 years and have not donated whole blood/apheresis blood products in the past. All the responses were entered in the Microsoft Excel sheets, and statistical analysis was carried out using Statistical Package for Social Sciences.
Results: A total of 829 participated in the study. Among the 829 participants, 416 were donors, and 413 were nondonors. There was no difference in knowledge regarding organ donation among the groups except for perceived risks of organ donation among nondonors. Concerning attitudes, they were more favorable among blood donors, and it was statistically significant at a P < 0.05.
Conclusion: There was no difference with respect to knowledge between donors and nondonors. However, donors had a more favorable attitude toward organ donation. Factors like concerns about misuse of donated organs, lack of clarity on their religion's policy toward organ donation, and potential for harm for the organ donor seem to account for the unfavorable attitude of nondonors toward organ donation.

Keywords: Blood donors, nondonors, organ donation

How to cite this article:
Basavarajegowda A, Arjunan C, Nalini Y C, Parameshwaran S, Kannan S. A comparative study of knowledge, attitude, and practices about organ donation among blood donors and nonblood donors. Asian J Transfus Sci 2021;15:37-45

How to cite this URL:
Basavarajegowda A, Arjunan C, Nalini Y C, Parameshwaran S, Kannan S. A comparative study of knowledge, attitude, and practices about organ donation among blood donors and nonblood donors. Asian J Transfus Sci [serial online] 2021 [cited 2022 Dec 4];15:37-45. Available from:

   Introduction Top

The organ donation rate is low in India, and there is a gross mismatch between the number of people developing organ failure requiring transplantation and the organ donor pool.[1] A multipronged strategy is necessary to improve organ donation in India. Even though many individuals have heard about organ donation, only 1/3rd of adults were found to have adequate knowledge of organ donation in Puducherry.[2] Therefore, efforts at improving awareness about organ donation among the public may contribute to improved donation rates. Identifying a suitable target population to focus the awareness activities will be useful.

People who donate blood or have donated blood in the past (”donors”) are more likely to engage in other prosocial behaviors such as engaging in other voluntary activities, donating cash or kind, participating in citizen initiatives, and taking care of needy people compared to individuals who have never donated blood (nondonors).[3] It is expected that the donors may accept the idea of organ donation more easily because they are already involved in acts of altruism.[4] There is little literature comparing the knowledge and attitudes of donors and nondonors. This study was designed to study the differences between the knowledge and attitudes about organ donation among blood donors compared to nonblood donors.

   Methodology Top

Study design and study setting

This was a cross-sectional comparative study among two groups: blood donors and nonblood donors. Donors were defined as people who were aged above 18 years and have made at least one whole blood/apheresis donation. Nondonors were the ones who were aged above 18 years and have not donated whole blood/apheresis blood products in the past.[5] Knowledge refers to facts or information known to the donors, theoretical or practical understanding regarding organ donation. Attitude refers to the views or opinions of the subjects regarding the act of organ donation. Practices refer to the act of donating or pledging organs by the subjects. Since the questionnaire was in English, only participants who could read, write, and comprehend English were chosen for the study. Donors (>18 years of age) were selected from those who had made at least one previous blood donation from the blood center at our institution and outdoor blood donation camps. Nonblood donors were selected from age- and sex-matched controls attending blood camp as volunteers and others who have never donated and have accompanied the donors at various sites.

Sample size and sampling method

The sample size was estimated using the statistical formula for comparing two proportions. The minimum expected percentage difference between the two groups about knowledge and favorable attitude was kept at 10% with an overall prevalence of 50%–60%. The sample size was estimated to be a minimum of 385 in each group, with a sample error of 5% at a 95% confidence interval. The study was powered at 80%. Purposive sampling was used to achieve the required sample size.


The standardized questionnaire used by Taimur et al. from Pakistan in their study was utilized for this study after validating its content to our setting and checking for reliability.[6] The questionnaire had a total of 27 items enquiring about their knowledge (K1-12) and what they feel about organ donation (A1-9). There were 6 questions (P) which enquired if they have already donated an organ or have committed to do so in the future and so. The questions were designed to allow the selection of the most appropriate response among the options provided, with the option to write remarks if any.

Method of data collection

Both the groups answered the questionnaire in written format on their own or with assistance from the interviewer if required, after obtaining their written consent for participation in the study. The participants' sociodemographic details were also collected, including Education status, occupation, religion, monthly income, family structure, and mode of transport regularly used by the individual for day-to-day commutes used.

Statistical analysis

All the responses were entered in the Microsoft Excel sheets, and statistical analysis was carried out using Statistical Package for Social Sciences version 20, IBM Corp, Chicago, IL, USA. Descriptive statistics about the sociodemographic status and responses were summarized as frequency and proportions. The difference among groups was tested using the Chi-square test for independent variables, and P < 0.05 was considered significant.

Ethical considerations

The study was reviewed by the Institutional Ethics committee and approved on January 30, 2017 (IEC approval number JIP/IEC/2016/1000). All the data were collected in an anonymized manner.

   Results Top

Out of 4802 people approached in 94 blood donation camps, a total of 829 participated in the study. Twenty-six entries were incomplete and hence excluded from the analysis. Among the 829 participants, 416 were donors, and 413 were nondonors. The sociodemographic characters of the participants are summarized in [Table 1].
Table 1: Frequencies of sociodemographic characters of the participants

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Of the participants, 4.2% had not heard of the term “organ donation.” A quarter of them (25.7%) of the participants were not aware of organ donation was allowed in their religion. Similarly, 26% of the participants were not aware of who should consent for organ donation if the donor was mentally disabled. Of the participants, 63.5% who regularly used a personal vehicle for day-to-day commutes thought that there was some risk involved in organ donation. About 27.6% of the participants were aware that there is some legislation regarding organ donation. Sixty-seven percent of the participants felt a need to have effective laws to govern organ donation. Most participants (87.5%) felt that organ donation needs to be actively promoted among the population.

Nine questions were in the format of yes, no, and do not know as responses. The responses with differentiation between donors and nondonors for these questions are summarized in [Table 2]. The awareness about the various organs that could be donated between the groups is compared and shown in [Figure 1].
Table 2: Donation characteristics of the blood donor group

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Figure 1: Reactions reported to blood donation by donors

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Responses to questions assessing the knowledge among the participants about who should give the consent for organ donation in various circumstances are summarized in [Table 3]. The other responses to various knowledge and attitudes items among the two groups of participants are summarized in [Table 4] and [Table 5]. [Figure 2] shows the responses of participants on, which all organs can be donated. [Table 6] summarizes the preference of their donation about the characters of the recipients among the groups.
Table 3: Responses for knowledge and attitude and practices questions among the participants

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Table 4: Responses for knowledge assessing questions among participants about consent for organ donation

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Table 5: Responses for knowledge and attitude questions among the participants

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Table 6: Responses for questions regarding preferences to organ donation among the participants (A9)

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Figure 2: Responses of participants on awareness about the organs that can be donated (K12)

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Six of the donors had committed to donating their organs in which 4 of them had committed to donating eyes, and the other two had committed to donating kidneys after death. One of them had already donated a kidney to his brother. Among the nondonors, one of them had committed to donating all the organs after death.

Of the Christians, 32% preferred to donate their organs to people of their religion only. This preference to donate to the same religion was 25% in Hindus whereas it was least in Muslims (13%).

   Discussion Top

Our study showed that there was not much difference in the knowledge about blood donation between donors and nondonors. However, their knowledge concerning who should give organ donation consent was more accurate than the nondonors. Regarding attitude, the donors were much more favorable compared to nondonors. Donors attributed organ donation to be a responsibility, whereas the nondonors thought it as less so. Comparatively, a more significant number of donors expressed willingness to donate if the need arises. They were also more liberal regarding whom the recipient should be and the risks associated with donation than nondonors. A greater number of blood donors also had signed the blood donor cards. A significant number of nondonors thought that organ donation will harm the donor.

A study from Hong Kong has shown that blood donors have better knowledge about organ donation and are more willing to donate their organs and sign an organ donation card compared to the general public.[7] Our study did not show significant differences, possibly because both groups were derived from the same population with similar exposure to resources and matching demographical profiles.

More commonly, donors learned about organ donation from the doctor and other health-care providers, whereas nondonors learned mostly from multiple sources, including magazines and newspapers. This may be because donors tend to come across doctors while donation and health checkups are more likely to discuss health-related issues more often with them. They are also more likely to visit health-care facilities or hospitals and seek health-related information. People who are donors are also people who tend to be surrounded by others who have their way of thinking and attitudes toward the donation.

Medical mistrust or concerns of misappropriation of organs can have implications on the decision to donate or likelihood to register as an organ donor and affect their ability to motivate others. There was no significant difference among groups regarding these thoughts, but the majority (80%) of the participants had some reservations. A study by Peters et al. in America said that nondonors had a more remarkable lack of trust in the organ utilization. The most essential thing in the decision to donate was noted to be the assurance of the respectful treatment of organs in the case of nonblood donors. This may also reflect the mindset of these people who have not been blood donors in the first place.[3]

Studies from Randhawa and Moloney in Asian and Australian populations have shown that religion does not seem to be a significant barrier to organ donation. None of the religion objects to organ donation in principle. However, it is possible that given the sensitiveness of the issue, health professionals may avoid discussing them or even may be unaware of the religious issues about transplantation.[8] Islam, Judaism, and Christians influenced by Greco-Jewish notions are known to be in a fix about the clerical interpretation of the requirement of the body of deceased to “remain unmodified pending bodily resurrection.” This is supposedly countered by higher duty toward saving a life by organ donation.[4] Religious belief was a far common factor among nondonors concerning the deterrent for organ donation. They also more commonly felt that it would harm the donor. Strong religious beliefs are known to be predictive of lower willingness to donate.[9]

Far a greater number of blood donors felt that the parents/guardian could make substitute decisions for mentally disabled persons regarding organ donation compared to nondonors. In India though neither Mental Health Act, 1987 nor the Organ Transplant Act, 1994 throws clarity on this.[10],[11] Donors probably felt it more so because of an emotional thought to accentuate donation. For the obvious reason that they were not aware of the process of donation, a greater number of nondonors did not know that for living donors, the consent is given by the donor themselves.

Significantly a greater number of donors denied any risks being associated with organ donation compared to nondonors. Donors who already have donated would know the proceedings of the procedure for the same. Once they have successfully donated, they are aware of the possible risks with it or deny it as very minor. The same mindset would make them believe the same about organ donation. However, nondonors have known to conceive the concept of donation to lead to some form of injury and would be extrapolating the same regarding organ donation. Studies have shown that self-perceived adverse effects of donation have been admitted as a significant deterrent to blood donation. The perception is quite common that around 15% feared surgeries in living donors whereas 38% of the respondents said they did not want to donate from the deceased body to avoid mutilation of the integrity of the body.

Pain and bleeding were the more common risks of organ donation among blood donors. Nondonors mostly presumed it to others like infection, weakness, and anxiety. Donors with previous blood donation experience would be obviously aware of the pain and sometimes bleeding associated with blood donation. Nondonors have been presumed to have few myths about blood donation that they would cause infection, weakness, or anxious about the process of donation. The same seems to have been reflected in organ donation.

It was noted that more than half of nondonors did not know their blood group, whereas most of the blood donors (95%) remembered their blood group. This is expected because most of the donors get to know their blood group before donation. Many blood centers also issue a card or a certificate for those who have donated and usually have the blood group mentioned on it. Also, people who are willing to donate usually make sure of their group to offer the donation when the need arises for a particular group. Awareness of blood groups has widely varied in different populations and geographical locations. Studies on undergraduate medical students about being aware of their blood groups in the first year have shown to be as low as 44% in Nigeria, 74% in Bangalore, India, and 87% in Poland,[12],[13],[14] whereas it is reported that nearly half of the American adult population do not know about their blood group by Emily Petsko in a magazine article in January 2019.[15] Blood group plays an important role in organ donation/transplant, just knowing your type makes a huge difference.

Surprisingly, a greater number of nondonors felt that organ donation should be actively promoted and that there should be effective laws to govern the process of organ donation. This could be explained by the fact that the nondonors were comparatively from a better educational background in our study group. This is probably a response associated with their higher social capabilities, literacy regarding health, and information-seeking competencies.

A larger proportion of donors felt that organ donation should be made as a responsibility. In contrast, it was attributed as a compassionate thing among nondonors. 43.5% of donors admitted that they definitely would want to donate an organ if the opportunity arises compared to 35.8% among nondonors. Altruism, social trust, and perceived confidence in their capacity to donate are known to drive the decision to donate more so with blood donors than nondonors. These personal characteristics are also known to determine their prosocial identity and giving behavior.[16]

The recipient's health status was the most critical factor determining the consideration for organ donation among blood donors, whereas, in nondonors, it was about the assurance of respectful treatment of the donated organ. Donors were more particular that their organs be given to nonsmokers, mentally sound, physically fit, and younger age recipients. Donors are usually known to be more conscious of their health and follow a better and healthier lifestyle. Maybe, also the reason why they preferred the recipients of their donors also to be healthier and probably a worthier use of their organs. Younger-aged recipients and nonsmokers have a better prognosis posttransplant compared to elders and smokers.[17]

The strength of the study is that it was done on a reasonably large sample size. The questionnaire was detailed and comprehensive. Certain limitations as well would be inevitable with this study. Being an interview-based study, some participants would have filled it up without taking help from the interviewer due to hesitancy despite not having clarity on what is expected. Also, when few people took the help of the interviewer, they would have been a bit biased in answering it either because of the interviewer or peer pressure when there were other people around.

   Conclusion Top

We would like to highlight subtle but important differences in the knowledge and especially in attitudes among donors compared to nondonors toward organ donation. They seem to be more amenable and receptive to a request comparatively, and hence the efforts toward sensitization and recruitment for organ donation toward them would be probably more fruitful. The blood donors may be reached through prevailing blood organizations or their registries, resulting in effective recruitment as organ donors. Future research may be planned to investigate which of the behaviors and factors regarding attitude and knowledge translates into practice.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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Correspondence Address:
Dr. Sreejith Parameshwaran
Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajts.ajts_9_21

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  [Figure 1], [Figure 2]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]

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