Knowledge and attitudes of students at the President Stanisław Wojciechowski University of Kalisz towards transplantology

Introduction

Transplantology is an extremely important method of treatment that saves the lives of patients with end-stage organ failure. Nowadays, the concept of transplantology is defined as the procedure of transferring a cell, tissue or an organ through a surgical intervention to restore lost bodily functions. The continuous development in this field of medicine translates into an increase in the number of transplants, which, unfortunately, is still insufficient in relation to the existing needs. In Poland, a total of 1,897 organs from both deceased and living donors were transplanted in 2023. Scientists have long focused on understanding the factors that influence negative decisions and behaviors related to organ donation. Literature analysis confirms that most societies have limited knowledge of legal regulations regarding organ transplantation, incorrectly define brain death, distrust medical staff, and harbor fears about transplants.
Systematically analyzing the level of knowledge and behaviors regarding transplantology among various social groups can contribute to the development of more effective treatment strategies. Moreover, understanding the factors limiting organ donation will enable the creation of educational programs addressed to a specific group of recipients [1–4].
The aim of the study was to assess the level of knowledge and attitudes of students regarding selected aspects of transplantology.

Material and methods

The research was conducted between April and June 2024 among 205 students from medical and non-medical faculties at the President Stanisław Wojciechowski University of Kalisz. A questionnaire was used for the study (with the consent of Marta Perkowska). The survey consisted of 34 questions that concerned the socio-demographic and health situation of the respondents, the level of their knowledge as well as attitudes towards transplantology. The research was voluntary; students agreed to participate in an anonymous survey. The statistical analysis was performed using the Kolmogorov-Smirnov, Mann-Whitney U and the Kruskal-Wallis tests. The value of p<0.05 was considered statistically significant. The calculations were statistically carried out using the Statistica 10 PL statistical software package.

Results

In the study group of 205 students, women represented 82.4%, and men constituted 17.6%. 70.2% of the respondents were aged 18–22, 60.0% were rural inhabitants, 62% were unmarried, and 87.3% had no children. More than half (57.5%) were studying at medical faculties, while the remainder represented non-medical fields of study. 81.5% of the participants came from complete families, and 93.2% had siblings. 82.9% declared the Catholic faith, while 11.2% were non-believers (Table 1). Similarly, their parents’ religious affiliation was also predominantly Catholic: 90.2% of fathers and 93.7% of mothers. The respondents reported that their mothers most often had secondary education (44.4%), followed by vocational (24.9%) and higher education (24.4%). In contrast, the fathers’ education levels were predominantly vocational (43.4%), followed by secondary (26.8%) and higher education (20.5%). The life attitudes of the studied group were mostly shaped by family (mean 3.45 ±0.90) and peers (mean 2.64 ±0.98), followed by the university (mean 2.15 ±1.11), the media (mean 2.06 ±1.07), and their faith (mean 1.23 ±1.28). The most significant contributions in this process were made by: the mother (mean 3.18 ±1.06), the father (mean 2.70 ±1.27), and the female and male friends (mean 2.17 ±1.01) (Table 2).
The research assessed the students’ knowledge of selected issues related to transplantology. In response to the question “Who do you think can be a donor of organs, tissues and cells?”, 62.0% of respondents correctly answered “Every living person who has expressed such a will,” 48.3% correctly chose “Every deceased person who did not express their objection during their lifetime,” and 46.8% selected “A living person, related in a direct line to the potential recipient.” Conversely, the incorrect answer “Organs, tissues and cells can be taken from any deceased person if the family of the deceased decides so” was chosen by 56.1% of respondents. When asked “When do you think a person is considered dead?”, the most frequently selected correct response was “Doctors declared them brain dead,” chosen by 73.7% of students. However, several incorrect answers were also selected: “The person is unconscious with atrophy of cardiovascular function” (45.9%), “The person is unconscious with loss of respiratory function” (14.1%), and “The person is unconscious and his/her body temperature has decreased” (14.1%). In response to the question “What actions do you think should be taken by a person who wants to become an organ, tissue and cell donor after death?”, the most frequently chosen correct answers were: “Inform your family/relatives about this decision” (66.8%) and “Sign a declaration of will and carry it with you at all times” (52.7%). The level of students’ knowledge about transplantology was below average, scoring 4.40 ±1.81 points. However, self-assessment results revealed that 54.1% of the students rated their knowledge of transplantology as satisfactory, 24.4% as unsatisfactory, 18.5% as good, and 2.9% as very good. The primary source of knowledge about organ transplantation was the Internet, cited by 79.0% of respondents, followed by academic teachers (23.9%) and television (21.5%). The majority of participants (78%) stated that having knowledge in the field of transplantology does not influence the decision to become a donor. The results of the study did not reveal a relationship between the level of knowledge and the gender, place of residence, marital status, or educational background of the respondents’ parents (p > 0.05). On the other hand, a significant difference was found between the level of knowledge of medical and non-medical students, with greater knowledge among students of medical faculties (mean 4.71 ±1.81; p = 0.0032) (Table 3). In addition, a correlation was found between the impact of the level of knowledge of students about transplantology and their feelings related to the decision to be a living organ recipient. Furthermore, respondents who had a sufficient level of knowledge significantly more often indicated the answer “I feel gratitude towards a potential donor” (p = 0.0434).
The results of the research into students’ attitudes towards transplantology confirmed that the study group accepted the removal of organs from deceased people in order to save the life or health of others (90.2%), while 70.2% declared support for organ harvesting from living people. In addition, medical students more often than non-medical students accepted the removal of organs from deceased people in order to save the life or health of others (p = 0.0019). When asked “How do you feel about yourself as a future living and post-mortem donor of organs, tissues and cells?”, the respondents expressed different opinions. When thinking about themselves as future living donors, the respondents most often felt happy that they could save someone else’s life or health (46.3%). In contrast, when considering themselves as future posthumous donors, the most common feeling was joy at the thought that their organs could save someone’s life or health (50.2%). On the other hand, when asked: “How do you feel about yourself as a future living recipient of organs, tissues, cells?”, the respondents most frequently felt gratitude towards a potential donor (56.1%). In a life/health threatening situation, students would most often agree to receive a transplant from a deceased donor (mean 4.26 ±0.81) and from an unrelated living donor (mean 4.06 ±0.87). In addition, when asked about agreeing to save life/health by performing a transplant on a close person, the study group would most often agree to receive a transplant from a related living donor (mean 4.47 ±0.79). The results also revealed that, in a life/health-threatening situation involving a close person, women were more likely to consent to saving their life through a transplant from a deceased donor (p = 0.0186) and, subsequently, from an unrelated living donor (p = 0.0035). Medical students, in the indicated situation, were more likely to accept a transplant from an unrelated living donor (p = 0.0085).
Furthermore, the analysis of the results revealed that if the subjects’ life or health was at risk, women were more often ready to receive a transplant from a deceased donor (p = 0.0009). On the other hand, rural residents were more likely to accept transplant from an unrelated living donor (p = 0.0204). Additionally, medical students, compared to non-medical students, were more likely to receive a transplant from a deceased donor (p < 0.0001) and a related living donor (p = 0.0114). Significant differences were also found in the level of consent for transplantation from a related living donor (p = 0.0435): the average consent for transplantation was the highest among students of the Catholic faith (Table 4).
The results revealed statistically significant relationships and correlations between the selected variables and the subjects’ feelings about themselves as future post-mortem organ donors. In the group of women, anxiety was more frequently observed than in the group of men (p = 0.0223). Non-medical students were more likely than medical students to choose the responses “I am afraid” (p = 0.0177) and “I am terrified that I may experience pain related to the removal of cells, tissues, or organs” (p = 0.0011). On the other hand, students of medical faculties more often than non-medical students marked the answer “I feel joy at the thought that my organs will save someone’s life/health” (p = 0.0293) (Table 5).
The average influence of “Family” on life attitudes was greater among students who did not select the response “I am terrified that I may experience pain related to the removal of organs” (p = 0.0184). However, when thinking about themselves as a future living donor, women more often than men chose the answer: “I am glad that thanks to me it will be possible to save the life/health of another person” (p < 0.0001). Most city dwellers selected the answer “I am terrified that I may feel pain related to the removal of cells, tissues, organs” (p = 0.0423). Positive emotions related to being a living donor were dominant in the group of medical students, and they were more likely to select the response “I feel like a better person” (p = 0.0244). Statistically significant relationships were also revealed between the selected variables and the feelings about oneself as a future living organ recipient. The statement “I feel gratitude towards a potential donor” was more often chosen by women than men (p < 0.0001). On the other hand, non-medical students more often indicated an increased level of anxiety (p = 0.0007) (Table 6).

Discussion

The issue of transplantology has been the subject of interest of representatives of various social and professional groups for many years. Despite the enormous development in this discipline of medicine, scientific reports still indicate a general lack of knowledge and negative attitudes towards organ transplantation. The analysis of the results of the primary research conducted in a group of 205 students of medical and non-medical faculties revealed that the level of knowledge of the respondents about organ transplantation was unsatisfactory and below the average (4.40 ±1.81 points). Students of medical faculties demonstrated greater knowledge than non-medical students (mean 4.71 ±1.81) (p = 0.0032). In addition, more than half of the students (54.1%) assessed their knowledge as satisfactory. The primary source of information about transplantology for the students was the Internet (79.0%). The majority of respondents confirmed that having knowledge in the field of transplantology is not important in making a decision about being an organ donor. Research by Smoleń et al., conducted among 325 students of medical and non-medical faculties, revealed that nearly half of the respondents (48.3%) assessed their knowledge of transplantation as at least good, while 43.7% were unable to evaluate it. The surveyed students obtained information on transplantation from the Internet (36%), university classes (33.5%), and television programs (31.7%) [5]. The level of students’ knowledge about organ transplantation was also the subject of research by Ayala-Garcia et al., conducted among 3,214 medical students in Mexico. The results confirmed the low level of knowledge of the respondents in the field of transplantation, scoring 4.02 on a scale from 0 to 10 (standard deviation 0.03) [6]. In the study conducted by Wojczyk in a group of 100 students of medical and non-medical faculties, it was revealed that all the students were familiar with the concept of transplantation, whereas 94% of medical students and 84% of non-medical students knew the declaration of will. In addition, 66% of students from medical and sports fields as well as 56% from humanities, social sciences, and technical fields declared their willingness to donate organs after death [7]. Similarly, the results of the primary research revealed that 90.2% of students accepted the removal of organs from deceased people in order to save the life or health of others, while 70.2% approved of donation from living donors. On the other hand, research by Akbulut et al., conducted among 950 medical students, confirmed the students’ insufficient knowledge about organ transplantation and positive attitudes and behaviors towards transplantation [8].
The analysis of the level of knowledge was reflected in the research conducted by Lisowska et al., among 355 students of medical and non-medical faculties. Students most often defined transplantation as “A method of therapy when others do not bring improvement” (47.9%), “An expression of human solidarity” (27%), and “A noble gesture of the donor” (23.9%). Most of the respondents (85.4%) considered organ transplantation to be a method of saving lives. The respondents displayed a relatively low level of knowledge about transplantation, with medical students presenting greater knowledge. Additionally, the respondents expressed their opinion on the factors affecting the lack of consent to harvesting organs for transplantation. They mentioned, among other things, the superficial knowledge of society about transplantation in relation to living donors and deceased people (45.6%), shock after the death of a family member (44.8%), and lack of prior consent of patients in cases of brain death (43.9%). The study revealed that men more often indicated the influence of their religion on the lack of consent to transplantation (p = 0.002) [9]. Similar issues were verified by research conducted by Alwahaibi et al. in a group of 2,125 students. Most respondents displayed a low level of knowledge about transplantation, with only 7.53% understanding the essence of the concept of brain death. The most common reason for supporting organ donation in the study group was the need to save lives (76.8%). The main source of knowledge in the field of transplantology was the Internet and social media (84.13%) [10]. The aspect of knowledge and attitudes towards transplantology was also discussed in the study by Ścieranka et al., conducted among 355 students. The correct concept of a deceased person was known by 71.2% of medical students and 46.5% of non-medical students (p < 0.001). Lack of knowledge in this area was more frequently declared by non-medical students (15.5%) than medical students (1.4%) (p < 0.001). Knowledge of the definition of brain death was confirmed by 91.2% of respondents, with a higher proportion among medical students (95.8%) compared to non-medical students (84.5%) (p = 0.001) [11]. In the primary research, although the majority of respondents (73.7%) gave the correct answer regarding the recognition of a person as deceased, they simultaneously selected incorrect answers. Subsequently, the students correctly indicated a potential organ donor (62.0%) while simultaneously marking incorrect answers. The majority of respondents knew the procedures required for a person who wants to become a donor of organs, tissues, or cells after death. On the other hand, insufficient knowledge of transplantology issues among medical students was also revealed in the research of Dardavessis et al. conducted in Greece, in a group of 558 people. Lack of knowledge about legal regulations and organ donation was confirmed by 78.9% of students [12]. In turn, the results of El-Tantawa et al., conducted among 1,065 students, revealed an average level of students’ knowledge in the field of transplantology (55–75%) and a low level of positive practices and attitudes. Men, compared to women, showed a higher level of knowledge (0.3261 ±0.73305). However more favorable results in terms of positive practices were observed in the group of women (0.4952 ±0.86979). Medical students showed a higher level of knowledge than non-medical students (p = 0.005) [13]. The primary research revealed that the respondents, when thinking of themselves as future living organ donors, most often (46.3%) were happy that thanks to them it would be possible to save the life/health of another person. Subsequently, at the thought of themselves as future posthumous donors, they most often (50.2%) felt joy at the thought that their organs would save someone’s life/health. The surveyed students, thinking of themselves as future living organ recipients, most often (56.1%) felt gratitude towards a potential donor.
The aspect of knowledge about factors that influence making decisions to become an organ donor was addressed in a study by Majchrowicz, conducted on a randomly selected group of 500 people. It was revealed that 52.4% of respondents would agree to donate their organs after death to save other people’s lives, whereas the remaining group was opposed (n = 238). Among the reasons for not accepting posthumous organ donation, respondents mentioned lack of knowledge about medical issues, i.e. concerns over the dishonest use of donated organs (22%) and fear or anxiety (18.4%). As many as 82.0% of respondents opposed organ donation for transplantation during their lifetime [14]. Interesting opinions on becoming an organ recipient were revealed by the results of the primary research. It was found that students accepted receiving a transplant from a deceased donor in life-threatening or health-critical situations (mean 4.26 ±0.81), with slightly less approval expressed for transplants from unrelated living donors. On the other hand, in cases where the life or health of a close relative was at risk, the study group would most often agree to receive a transplant from a related living donor (mean 4.47 ±0.79), followed by a deceased donor (mean 4.39 ±0.76). A study by Ozturk Kaygusuz et al., conducted on a group of 395 medical students, revealed that 81.4% of the participants possessed an organ donor card, and 73.4% (n = 290) considered organ donation, with significantly higher percentages among women and sixth-year students (p < 0.005). In addition, it was revealed that 38.7% of students did not have sufficient knowledge about transplantology, 47.8% said they had some knowledge, and 61.8% did not have any knowledge about brain death [15]. Attitudes of medical students toward transplantation were examined in a study by Mikla et al., conducted on a group of 1,530 medical students. The vast majority of respondents declared willingness to donate their organs in the future (86.60%), while 31.71% possessed an organ donor card [16]. Strząska-Kliś, in a study conducted among 501 nursing students, found that 81.8% of respondents accepted organ donation from living donors, whereas 81.6% admitted that they would accept donation from deceased donors. Additionally, 81.9% of students stated they would agree to donate their organs after death. Moreover, 78.8% of respondents accepted the possibility of organ donation after the death of their relatives. A sufficient level of knowledge in transplantation was confirmed by 52.3% of the respondents [17]. Tackmann et al. conducted a study in a group of 209 students, which revealed that knowledge of brain death was demonstrated by 56.3% of medical students, 50.9% of nursing trainees and 25.7% of health science students [18]. On the other hand, in the research conducted by Kamińska and Daszuta in a group of 80 people studying in various fields, it was revealed that 76.2% of the respondents accepted the idea of organ transplantation. Most students (60%) would agree to have their organs donated after death and 77.5% of the respondents would consent to organ donation after a close relative’s death if that person did not object during their lifetime. In turn, 60% of the subjects possessed knowledge about brain death [19].
The opinions and attitudes toward transplantation were examined in a study by Humańska and Dudek, conducted on a group of 120 students. The results revealed that 90% of respondents accepted organ donation from deceased people, and 93.3% stated they would accept an organ transplant in a life-threatening situation and when performing a transplant would be necessary. The majority of respondents expressed willingness to be living organ donors (70.8%), while 75% of students would agree to donate their organs posthumously for transplantation purposes [20]. Interesting results were obtained in the Milaniak survey, conducted in a group of 191 respondents including students, teachers, and nurses. The vast majority of subjects accepted the transplantation of cells, tissues, and organs from living donors as a method of treatment and saving lives (97.3%), and similarly from deceased donors (95.5%). It is worth noting that the fact of the declaration of will to be an organ donor, which is in force in the Polish legislation, was known to 94.1% of the respondents; 65.4% would sign a consent form, while only 7.3% had already done that. Knowledge of the so-called implied consent in transplantology was declared by 39.8% of the respondents, and direct consent by 25.1%. The results of the study revealed that more than half of the respondents (67%) would agree to have organs transplanted during their lifetime to help people in need, and 78.5% would make the above declaration posthumously. The most important argument that would prompt the respondents to donate organs during their lives was the possibility of helping other people (56%). In contrast, fear of medical procedures was dominant among reasons for refusal (17.3%). In the case of posthumous donation, the most cited reason was the ability to help other people (64.9%) [21]. It is worth mentioning that the subject of the primary research was the assessment of students’ feelings related to the thought of themselves as a future living and post-mortem organ donor. In both situations, the respondents most frequently expressed a positive feeling of joy that they would be able to save the life/health of another person. In both situations, the respondents most frequently expressed a positive feeling of joy that they would be able to save the life/health of another person. On the other hand, when thinking about themselves as future living recipients, they most often expressed gratitude toward potential donors. Medical students more often than non-medical students accepted the organ harvesting from the deceased in order to save the life or health of others (p = 0.0019). The results of the research by Hryciuk et al., involving a group of 1000 adults, revealed that the vast majority of the respondents had heard of the declaration of will (70.9%) and expressed their willingness to sign the document (64.7%). 33% of respondents were familiar with the legal regulations on organ donation, while 36.1% admitted lack of knowledge in this area [22]. Ruszkowski et al., in a survey conducted among 1000 residents of Gdańsk, found that 64.2% of respondents accepted organ harvesting from deceased individuals, while 50% participants approved of donation during their lifetime. In the case of the death of a close person, 78.8% of respondents would not object to organ removal [23]. The research carried out by Serzysko et al., in a group of 309 inhabitants of the Silesian Voivodeship, confirmed that the respondents’ knowledge was at a moderate or good level and depended on their age and education. Younger individuals (below 40 years old) demonstrated greater knowledge than older subjects (p = 0.025). In turn, the higher the education level of the surveyed people was, the more extensive was the knowledge they displayed (p = 0.0000) [24]. Research conducted by Makara-Studzińska et al., in a group of 100 randomly selected nurses, revealed a correlation between the place of employment of the respondents and the knowledge they possessed about the types of death and being a potential organ donor. Nurses employed in the gynecology ward showed a complete lack of knowledge in the above-mentioned area, while only 16% of respondents from the orthopedic and anesthesiology departments gave the correct answer in choosing “individual” death [25]. The results of the research conducted by Feliksiak, analyzing the knowledge and attitudes of Polish society towards organ transplantation, indicated that 80% of the respondents would agree to have their organs harvested after death. On the other hand, 70% of respondents had not talked to their relatives about donating their organs after death, and only 20% of the respondents were aware of the principle of implied consent regarding organ harvesting [26].

Conclusions

The surveyed group of students presented an unsatisfactory, below average level of knowledge about transplantology. Medical students possessed greater knowledge and demonstrated more positive practices toward transplantation compared to non-medical students. The respondents accepted the removal of organs from the deceased and from living donors. Shaping correct attitudes towards human life and developing positive practices related to organ donation ought to take place in the family and in educational institutions.

Disclosures

1. Institutional review board statement: Resolution No. 7/2025 of the Bioethics Committee of the University of Kalisz of April 1, 2025.
2. Assistance with the article: None.
3. Financial support and sponsorship: None.
4. Conflicts of interest: None.

References