4.1. Consent to Being a Donor
A positive attitude of medical students towards organ donation and transplantation and their future function as a role model for patients are of key importance in convincing patients and their relatives. Therefore, identifying the opinions of medical students regarding organ donation is crucial.
The present study showed that most of the respondents would consent to receive an organ from a family member. A large proportion of students discussed the possibility of donating their organs to family members and friends. The majority of students declared the possibility of organ donation in the future. Additionally, one third of students held an organ donor card. On the grounds of the meta-analysis by Iniesta-Sepúlveda M et al. [
6], it was demonstrated that approx. 70% students was willing to donate organs after death.
Numerous factors affect the decision on organ donation in the future such as the geographical area (the continent) or cultural background, among others. The studies concerning this issue were mostly conducted in Latin (82%), Western (70.6%), followed by Muslim (57.7%) and Oriental cultural backgrounds (54.4%), the latter showing the lowest figures. The meta-analysis by Mekkodathil et al. [
9] concerning the public opinion in Muslim countries revealed that the total percentage of individuals in favour of organ donation was less than 50%. The analysis of the population of Asia by Li et al. [
10] identified a reduced ratio in terms of the willingness to donate organs and register as organ donors among students, health care workers, and the general population. However, the study by Tackmann et al. [
11] demonstrated that active and passive acceptance for post-mortem organ donation was high among health care students and trainees in Germany. Most of the surveyed individuals held a written declaration of intent and had it documented in their electronic health card. Most would also agree to organ donation on behalf of their family members. Additionally, Terbonssen et al. [
12] identified a significant willingness on the part of medical students to document their intention regarding organ donation after death in the form of the organ donation card. The studies by Ozturk et al. [
2] found that the majority of students believed that organ transplant saves lives, and that 73.4% of students considered organ donation. The willingness to donate organs identified by Bilgel et al. [
13] amounted to 58.4%. In turn, Naçar et al. [
14] found that the differences in terms of the willingness to donate organs in the future were dependent on the year of study and amounted to 45.4% (first year) and 58.8% (sixth year), respectively. Similar results were obtained by Akkas et al. [
15], who reported a willingness indicator at 40% (first year) and 60% (sixth year), respectively. The literature review showed a significant differences in terms of willingness to donate organs between medical students in different countries [
16].
4.2. Factors Affecting the Decision on Organ Donation
The review of the literature on the subject indicates that there are many factors that could significantly affect the decision on potential organ donation [
17]. Therefore, given the vast differences in willingness indicator between different countries and social groups, the researchers decided to conduct an assessment regarding the way in which socio-cultural background affects the decision-making process regarding organ donation. Indeed, it was found that many students who refused to donate organs after death could not state the reason for their unfavourable attitude.
However, according to the present study, students who declared unfavourable attitude towards transplantation stated post-mortem body mutilation as the reason. As far as medical students in Muslim countries are concerned, the decision regarding organ donation is determined by the importance of body preservation after death [
18]. The studies conducted in Iran revealed that the main reasons for negative attitude towards donating their organs were their religious beliefs and the idea of the violation of the body’s integrity [
19]. In turn, the percentage of students concerned with post-mortem body mutilation was found to be markedly lower in Western [
16] and Latin [
19] cultural backgrounds. The study by Rios et al. [
20] demonstrated that individuals accepting body mutilation when in need of transplantation (OR = 2.958) were much more willing to donate organs. According to the studies by Burra et al. [
17], medical students are against organ donation mainly because of their reluctance to accept the validity of the adopted brain death criteria and does not consider them to be philosophical, moral, or ethical.
Numerous studies have reported the significant effect of religion and individual attitudes of the respondents on their decisions concerning organ donation. Our own studies have shown that the religion of the respondents had a statistically significant effect on the decision to donate organs in future, whereas agnostics and atheists showed a greater willingness to be an organ donor. This is in line with the studies by Rios et al. [
20] (OR = 1.766). Ozturk et al. [
2] observed that 50.4% of the surveyed students claimed that their religious beliefs had no negative effect on their attitude towards organ transplantation. The literature review, however, indicates that attitudes and religious beliefs affect the decisions concerning organ transplant among medical students [
20]. Tumin et al. [
21] noted that medical students whose religion allows organ transplant expressed favourable opinions on organ donation. The studies conducted in Saudi Arabia, Turkey, and Iran showed that some students ignored the fact of whether their religion allows organ donation and transplantation [
18,
22]. In turn, since the introduction of the Islamic concept of allowing organ donation to a wider group of recipients, a marked increase in the willingness indicator has been observed [
23].
However, another important factor affecting the decision to donate organs among medical students was the opinions of their family members concerning transplantation. Additionally, the role of the family in the decision-making process in terms of transplantation can be considered as controversial, for example, in Poland, the system of organ procurement operates under a model of presumed consent with an active objection of the relatives. Our own studies identified that 33.31% of fathers, 47.03% of mothers, and 31.16% of partners of the respondents declared a positive attitude towards organ transplantation. Rios et al. [
20] reported that a positive opinion of the father (OR = 1.841), the mother (OR = 2.538), and the partner (OR = 2.192) concerning organ donation had a positive effect on the respondents’ decision regarding transplantation. According to De Ohwaki et al. [
24], more than 65% of medical students declared that their family members would not consent to organ donation. The studies by Rydzewska et al. [
25] found that 26.4% of students believed that family and friends should have a deciding vote in the process of organ procurement. Trompeta et al. [
26] suggested that discussion among family members was a factor that significantly affected the decision to donate organs. This was confirmed by Shumin et al. [
27], who emphasised the importance of discussing the issue with family members who were often against post-mortem organ donation as they did not know the intention of their relative in a state of brain death. In turn, Smith et al. [
28] demonstrated that the willingness to donate organs increased from 47% to 93%, provided that the family was aware of their relative’s intention. Significant differences observed in the cultures of the East stem from traditional values that place emphasis on family interest rather than that of an individual [
29]. In contrast, in Western culture, the opinion of the family had a positive effect on the willingness to donate organs and the share of students discussing organ transplants with their families was found to be significantly higher [
25,
30]. Moreover, it was found that in Western countries, a higher proportion of medical students believed their parents’ opinion to be favourable [
16]. The studies by Ozturk et al. [
2] revealed that a markedly increased number of students were willing to donate their organs if their family members were also organ donors. This is in line with the results presented by Rios et al. [
20].
The present study did not show a relationship between age and the possibility of donating one’s organs. The meta-analysis by Iniesta-Sepúlveda M et al. [
6] demonstrated that age was positively correlated with the percentage of students having a favourable opinion on organ donation. However, it is worth noting that the said relationship may be due to the changing level of education rather than the age of the respondents, given the significant differences between the willingness reported by the students in the first and in the sixth year of study. This was also shown in the studies by Rios et al. [
20]. In conclusion, both the appropriate training acquired while studying as well as contact with transplant patients or donors, may have a positive effect on attitudes towards organ donation [
16].
The present study did not reveal a relationship between sex and the percentage of students in favour of transplantation, which is consistent with the results by Iniesta-Sepúlveda et al. [
6] or El-Agroudy A et al. [
31]. However, there have been studies reporting that women show greater willingness towards organ donation than men [
2,
13,
17,
32].
It was demonstrated herein that the respondents would consent to receiving an organ from a family member. In turn, as presented by Ozturk et al. [
2], 83.8% of the respondents provided an affirmative answer to the question of whether they or members of their immediate family would be willing to receive an organ from another person when in need. Similar results were obtained by Gizibara et al. [
33], who showed that over 85% of the surveyed students reported that, when in need, they would consent to receiving organs or tissue from another donor. In addition, it is worth noting that students demonstrated a humanistic approach to organ donation, as most stated that the issue of the identity of the recipient was in fact irrelevant, and they were willing to donate organs to any individual and not just to a family member [
16]. Nevertheless, some studies indicated that most students would first donate organs to their family members, relatives, or friends [
19].
The present study conducted on medical students indicates that the most frequently reported sources of positive information on organ transplant were the Internet, books and brochures, and school. Most studies reported that the main source of information on organ donation and transplantation was family and friends [
2,
34,
35] as well as educational programmes [
36]. Moreover, it was found that students who had knowledge of organ donation and transplantation were more interested in donating their organs [
33].
In conclusion, it transpires that despite the awareness and favourable attitude towards organ donation and transplantation among medical students, the number of students registered as organ donors was found to be low. It is therefore suggested that efficient methods such as training or courses are implemented, in order to change the students’ attitude towards organ donation.