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Original Research (Original Article) 


Kholoud Hamdan Alruwaili et al, 2019;3(11):889–893.

International Journal of Medicine in Developing Countries

Awareness, knowledge, and attitudes regarding eye donation and corneal transplantation among medical and paramedical students

Kholoud Hamdan Alruwaili1, Thamer Abdullah Alanazy1*, Khaled Abdelsalam Zaki2, Kholoud khulaif Alruwaili1, Tayf Muhammad Alhamad1, Meshari Owaid Alanazi1

Correspondence to: Thamer Abdullah Alanazy

*Medical Student, Jouf University, Skaka, Saudi Arabia.

Email: Thamir_1111 [at] hotmail.com

Full list of author information is available at the end of the article.

Received: 29 August 2019 | Accepted: 01 September 2019


ABSTRACT

Background:

Eyes are sensitive, and highly specialized sense organs which are exposed to several disorders, many of which lead to impaired vision. The aim of this study was to assess the level of awareness and determine the level of willingness to donate eyes among the medical and paramedical students in Saudi Arabia.


Methodology:

A cross-sectional study was conducted on 350 paramedical and medical students from all six levels of study. The sampling method was convenience sampling. Data collection was done through online questionnaires which included demographic data, knowledge of eye donation, and willingness to donate.


Results:

The analysis on awareness of eye transplant among paramedical and medical students revealed that students who were aware of eye transplant were 35%, p = 0.065, 95% Confidence interval (CI) (25.5%, 35.45). The proportion of those who were aware that Saudi Arabia has an eye bank was less than 7%, p = 0.000, 95% CI (4%, 3.3%). Willingness to donate eye(s) and awareness of eye donation were independent χ(1) = 0.213, p = 0.644.


Conclusion:

The study findings indicate that organ donation and particularly eye donation is still low in Saudi Arabia. There is an acute need to increase awareness among the public.


Keywords:

Eyes, donation, ophthalmology, Saudi Arabia.


Introduction

Human body has five senses’ organs, in which eyes are considered as the most important sensory organs because eyes render vision and the ability to see. Eyes are sensitive, and highly specialized sense organs which are exposed to several disorders, many of which lead to impaired vision. Cornea is the clear protective layer which covers the anterior part of the eye; also, it is a focusing part of the eye. The vision is dramatically diminished or lost if it becomes cloudy. This loss of the vision is meant to as “corneal blindness.” The most important causes of corneal blindness in the developing countries include corneal ulceration following xerophthalmia due to the deficiency of vitamin A, ophthalmia neonatorum, the use of destructive traditional medicines, onchocerciasis, trachoma, leprosy, and ocular trauma [1]. World Health Organization (WHO), revealed that approximately 39 million people suffer from blindness; another 285 million people suffer from low vision. Statistics further showed that out of the reported 45 million cases of total blindness, corneal blindness comprises 6–8 million [24]. The statistics above show the importance of corneal transplantation as it is a major option of treatment for restoring vision in those who have corneal blindness, but its surgery is not as common as cataract surgery. However, since Eduard Zirm performed the first corneal transplantation on 7 December 1905, it has become the most widely practiced and successful clinical transplantation [57].

The most important things in the corneal transplantation surgery are: matching blood group is not mandatory between the donor and the recipient, age, systemic diseases, such as diabetes, hypertension, heart disease, and kidney disease, are not barriers for eye donations, hence, anybody can donate eyes. However, corneas are the least donated organs, based on the statistics from the Saudi Center for Organ Transplantation [8]. Therefore, a key challenge in Saudi Arabia is a large number of people waiting for corneal transplant and a small number of corneas donated, despite many specialized eye hospitals in major cities of the country, where transplantation can be performed [9]. There are many factors that contribute to the low level of awareness and willingness to donate eyes, including education, employment, and cultural practices, such as beliefs and others [10].

One of the major factors is a low level of public awareness about eye donation. A study by Hameed et al. [11], in Medina, confirmed that the awareness of eye donation was 35.8%. Less than one fourth of the participants were willing to donate their eyes. Majority of the participants (97.5%) didn't know about any eye bank in Kingdom of Saudi Arabia. Approximately, one third (29.7%) of the participants knew that the cornea can be removed separately from the donor and (13.9%) knew that the entire eye can be removed. The majority of the participants (82.6%) didn't know that the donor's eye can be removed before the transplant. The lack of awareness and the fear of unknown were the most important reasons for the unwillingness of eye donation [11]. Additionally, in 2018, another research was done by Bugis et al. [12], who found that only 2.9% had good knowledge about eye donation. Concerning religion, 96.3% knew that eye donation is not against the religious beliefs. Only 7% were aware that Saudi Arabia maintains eye banks. About 61.5% agreed to donate their eyes and 23.3% agreed to donate eyes of their relatives after their deaths. All of these studies showed quite low level of knowledge and awareness on eye donation amongst the studied participants and these results addresses the need to increase level of awareness among medical and paramedical students on eye donation after death so that they can spread awareness among their families, friends, and general public community. Nowadays, artificial cornea has gained significant attention among the scientists and medical researchers.

Medical and paramedical students are the future health care workers and inherent to serve their communities. They can also motivate people for the donation during their postings in community medicine [13]. The aim of this study was to assess the level of awareness and determine the level of willingness to donate eyes among the medical and paramedical students in Saudi Arabia.


Subjects and Methods

A descriptive cross-sectional study was carried out between September 2018 and April 2019 to detect the knowledge and awareness level toward eye donation and corneal transplantation among medical and paramedical students (included males and females) from different universities. The study included all medical and paramedical students, selected by random convenient technique. The sample size was determined as 350.

Self-administered questionnaires in electronic form were sent to potential respondents through social media. The questionnaire included: Socio-demographic data (age, gender, medical specialty, and name of university), characteristics of the eye donation, knowledge of eye donation, and corneal transplantation.

A pilot study was conducted among 20 students to adjust the questionnaire. These students were not included in the original survey. Reliability of Questionnaire was detected by using Cronbach’s alpha (0.879).

The data were analyzed via SPSS ver23 software. Mean, median, mode, range and standard deviation of individual, and total score of knowledge factors were calculated. Cross tables were done between demographics (age groups, gender medical specialty, and name of university) and other variables. Z-scores, mean ± standard deviation and Chi-square test was used. The statistical significance was set at 0.05.


Results

The sample consisted of 350 students, where 52% were enrolled in paramedical programs and 48% were enrolled in medical program.

Only 19% of the sample consisted of male participants while the remaining 81% of the sample were females. The average age of the male participants was 23.24,(SD = 3.03), while that of the female participants was 21.56 years (SD = 2.08) as shown in Table 1.

The majority of the sample participants were in their third year of college (22.3%), while the least were in first-year (11%). The number of students in the level of education is shown in Figure 1.

Most students in the sample were not aware of eye donation (70%). The remaining proportion of the students was aware of eye donation in Saudi Arabia (Figure 2).

68.3% of sample respondents reported that the consent for eye donation should be given by the donor before death.

Table 1. Summary statistics of the sample age by gender.

Gender Mean SD Median N
Male 23.24 3.03 23.00 68
Female 21.56 2.08 21 282

Figure 1. Level of education of the participants (year of study by frequency percentages).

Figure 2. Awareness frequency distribution.

Figure 3. Consent for donation (consent by frequency percentages).

A sizeable percentage (25.7%) did not know who should give the consent for eye donation, while a small number of 6% of the sample respondents thought that relatives should have some say in eye donation (Figure 3).

A small percentage of individuals who were aware of eye donation also reflected in the small percentage of respondents who were willing to donate their eyes. However, the latter percentage is 3% higher than the percentage of those who are aware of eye donation (Figure 4).

Test for single population proportion was carried out to test hypotheses that helped assess students’ awareness of eye transplants. The general hypotheses are summarized in Table 2.

Figure 4. Willingness to donate.

Table 2. Inference on population proportions.

Variable Hypothesized proportion 95% confidence interval p-value
Awareness 35% (25.5%, 35.4%) 0.065
Willingness 25% (28.2%, 38.3%) 0.001
eye bank awareness 7% (0.4%, 3.3%) 0.000

Table 3. Chi-square results for student type and awareness.

Variable pair Chi-square p-value
Student type and knowledge of part of eye removed χ(6) = 11 0.078
Student type and awareness of donation χ(1) = 4.213 0.04
Student type and importance of Blood group χ(2) = 4.479 0.107

Awareness of eye transplants was not significantly different from 30%. Willingness to donate was significantly different from hypothesized proportion of 25%, p < 0.05, while the awareness that Saudi Arabia has an eye bank was significantly different from hypothesized proportion of 7%, p = 0.000.

The assessment of awareness by student type was investigated using chi-square test for association. The specific hypotheses were; student type (medical student or paramedical student) and knowledge that part of eye is removed are statistically independent, student type and awareness of donation is statistically independent, and student type and the importance of blood group limitation are statistically independent (Table 3).

Only student type and general awareness of donation were significantly associated at 0.05 alpha level (p = 0.04).

Student type and willingness to donate eyes was not statistically associated, χ(1) = 3.295, p = 0.06.

Table 4. Chi-square table for willingness across student type.

Variable pair Test Chi square value p-value
Willingness to donate and student type Test for association χ(1) = 3.295 0.069
Willingness to donate to relatives and student type Test for association χ(1) = 2.895 0.089

Table 5. Chi-square table of willingness and awareness.

Variable pair Test Chi square value p-value
Willingness to donate eyes and awareness Test for association χ(1) = 0.213 0.644

Pearson chi-square test for association indicated that willingness to donate eyes to relatives and student type were not statistically significantly associated, χ(1) = 2.895, p = 0.089, as shown in Table 4.

Willingness to donate eyes and awareness are statistically independent, χ(1) = 0.213, p = 0.644 (Table 5).


Discussion

The present research findings showed that eye donation awareness and willingness to donate are generally low in Saudi Arabia. These findings resonate with the statistics from the Saudi Centre for Organ Transplantation [8]. Rumsey and Cole [10] investigated the reasons for low awareness and low willingness, and revealed that cultural practices were among the reasons. The fear of unknown as depicted in the works of Hameed et al. [11] could also possibly explain the low awareness and willingness to donate eyes. The finding of Hameed [11], that less than 35.8% of students in the medical course were aware of eye transplant, was confirmed in the present paper by 95% CI for population proportion.

The present paper found less than 7% medical students to have knowledge of existence of eye banks. The inference of the present paper estimates the proportion of medical students who were aware of the existence of eye banks were between 0.4% and 3.3% with 95% CI.


Conclusion

The study findings indicate that organ donation and particularly eye donation is still low in Saudi Arabia. The finding of the absence of association between the awareness of eye transplant and the willingness to donate indicates that just because one is aware that eyes can be donated does not mean they will or are likely to donate.


List of Abbreviations

CI Confidence interval

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

Ethical approval was sought from Ethics committee, Faculty of Medicine, Skaka University.


Author details

Kholoud Hamdan Alruwaili1, Thamer Abdullah Alanazy1, Khaled Abdelsalam Zaki2, Kholoud khulaif Alruwaili1, Tayf Muhammad Alhamad1, Meshari Owaid Alanazi1

  1. Medical student, Jouf University, Skaka , Saudi Arabia
  2. Associate professor, department of ophthalmology, Jouf University, Skaka , Saudi Arabia

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How to Cite this Article
Pubmed Style

AlRuwaili KH, Alanazy TA, Zaki KA, AlRuwaili KK, Alhamad TM, Alanazi MO. Awareness, knowledge, and attitudes regarding eye donation and corneal transplantation among medical and paramedical students. IJMDC. 2019; 3(11): 889-893. doi:10.24911/IJMDC.51-1559497693


Web Style

AlRuwaili KH, Alanazy TA, Zaki KA, AlRuwaili KK, Alhamad TM, Alanazi MO. Awareness, knowledge, and attitudes regarding eye donation and corneal transplantation among medical and paramedical students. https://www.ijmdc.com/?mno=51543 [Access: October 15, 2021]. doi:10.24911/IJMDC.51-1559497693


AMA (American Medical Association) Style

AlRuwaili KH, Alanazy TA, Zaki KA, AlRuwaili KK, Alhamad TM, Alanazi MO. Awareness, knowledge, and attitudes regarding eye donation and corneal transplantation among medical and paramedical students. IJMDC. 2019; 3(11): 889-893. doi:10.24911/IJMDC.51-1559497693



Vancouver/ICMJE Style

AlRuwaili KH, Alanazy TA, Zaki KA, AlRuwaili KK, Alhamad TM, Alanazi MO. Awareness, knowledge, and attitudes regarding eye donation and corneal transplantation among medical and paramedical students. IJMDC. (2019), [cited October 15, 2021]; 3(11): 889-893. doi:10.24911/IJMDC.51-1559497693



Harvard Style

AlRuwaili, K. H., Alanazy, . T. A., Zaki, . K. A., AlRuwaili, . K. K., Alhamad, . T. M. & Alanazi, . M. O. (2019) Awareness, knowledge, and attitudes regarding eye donation and corneal transplantation among medical and paramedical students. IJMDC, 3 (11), 889-893. doi:10.24911/IJMDC.51-1559497693



Turabian Style

AlRuwaili, Kholoud Hamdan, Thamer Abdullah Alanazy, Khaled Abdelsalam Zaki, Kholoud Khuliaf AlRuwaili, Tayf Muhammad Alhamad, and Meshari Owaid Alanazi. 2019. Awareness, knowledge, and attitudes regarding eye donation and corneal transplantation among medical and paramedical students. International Journal of Medicine in Developing Countries, 3 (11), 889-893. doi:10.24911/IJMDC.51-1559497693



Chicago Style

AlRuwaili, Kholoud Hamdan, Thamer Abdullah Alanazy, Khaled Abdelsalam Zaki, Kholoud Khuliaf AlRuwaili, Tayf Muhammad Alhamad, and Meshari Owaid Alanazi. "Awareness, knowledge, and attitudes regarding eye donation and corneal transplantation among medical and paramedical students." International Journal of Medicine in Developing Countries 3 (2019), 889-893. doi:10.24911/IJMDC.51-1559497693



MLA (The Modern Language Association) Style

AlRuwaili, Kholoud Hamdan, Thamer Abdullah Alanazy, Khaled Abdelsalam Zaki, Kholoud Khuliaf AlRuwaili, Tayf Muhammad Alhamad, and Meshari Owaid Alanazi. "Awareness, knowledge, and attitudes regarding eye donation and corneal transplantation among medical and paramedical students." International Journal of Medicine in Developing Countries 3.11 (2019), 889-893. Print. doi:10.24911/IJMDC.51-1559497693



APA (American Psychological Association) Style

AlRuwaili, K. H., Alanazy, . T. A., Zaki, . K. A., AlRuwaili, . K. K., Alhamad, . T. M. & Alanazi, . M. O. (2019) Awareness, knowledge, and attitudes regarding eye donation and corneal transplantation among medical and paramedical students. International Journal of Medicine in Developing Countries, 3 (11), 889-893. doi:10.24911/IJMDC.51-1559497693