Assessment of Awareness, Knowledge and Attitudes about the Importance of Cadaver and Cadaver Donation: Report of Izmir, Turkey
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Int. J. Morphol.,
38(4):831-837, 2020.
Assessment of Awareness, Knowledge and Attitudes about
the Importance of Cadaver and Cadaver Donation:
Report of Izmir, Turkey
Evaluación de la Conciencia, el Conocimiento y las Actitudes sobre la Importancia
del Cadáver y la Donación de Cadáveres: Informe de Izmir, Turquía
Kübra Erdogan1; Kemal Emre Özen1; Hayrullah Yildiz2 & Mehmet Ali Malas1
ERDOGAN, K.; ÖZEN, K. E.; YILDIZ, H. & MALAS, M. A. Assessment of awareness, knowledge and attitudes about the importance
of cadaver and cadaver donation: Report of Izmir, Turkey. Int. J. Morphol., 38(4):831-837, 2020.
SUMMARY: The aim of this study was to evaluate the awareness, knowledge level and attitudes of the community in I˙zmir/
Turkey about cadaver donation in medical education. A cross-sectional study was carried out. Randomly chosen 245 participants answered
twenty items in the questionnaire providing information about their demographics (5 items), awareness and knowledge (10 items), and
attitudes (5 items) about body donation. The questionnaire was applied face-to-face. Descriptive statistics presented. Student T test and
One-Way ANOVA test were used for statistical analysis. 123 (50.2 %) participants were male and 159 (64.9 %) were between 30 to 59
years old. 185 (75.5 %) respondents knew what the word “cadaver” means. When asked where they would apply if they decided to
donate their body, 104 (42.4 %) of the participants gave the answer "state hospital". The mean score of awareness and knowledge about
importance of cadaver and body donation (AWKL-Score) was 0.41±0.24 (min:0.00, max:0.90). AWKL-Score was statistically higher in
the youngest (18-29 y) and oldest (>60 y) compared to the other age groups (F:4.115; p:0.007). AWKL-Score increased as the level of
education increased. The highest AWKL-Score was at post-graduate level (Level 7,8) (F:22.997; pERDOGAN, K.; ÖZEN, K. E.; YILDIZ, H. & MALAS, M. A. Assessment of awareness, knowledge and attitudes about the importance of cadaver and cadaver donation: Report of Izmir, Turkey.
Int. J. Morphol., 38(4):831-837, 2020.
America is quite high, unfortunately this number is very low The population of Izmir in 2015 is 4,168,415 and Izmir's
in our country. Accordingly, the number of cadavers obtained population aged 18 and over is estimated approximately
from voluntary donors in medical education is extremely 3,334,732. As considering unknown prevalence in general
low (Gürses et al.). Undoubtedly, these difficulties in medical population, 50 % prevalence, 95 % confidence interval and
education on cadavers can be overcome by increasing the 6 % margin of error were accepted for sample size
number of body donors. It is very important to investigate calculating. Thus, the sample size was calculated as 196.
the reasons for not increasing the number of cadaver donors For the research, people living in the center of Izmir were
in the society and to propose solutions in this regard (Wight randomly reached in crowded bazaars and shopping centers.
et al., 2000; Dinsmore et al., 2001; Gürses et al.). This study A sample group was formed with 245 people who agreed to
aimed to assess the awareness, knowledge and attitudes about participate in the study with verbal consent. The
the importance of cadaver in medical education and cadaver questionnaire was applied to the participants by face to face
donation. interview technique. Each interview lasted approximately
15-20 minutes.
MATERIAL AND METHOD The data were analyzed using IBM SPSS Statistics
v25 (SPSS Inc, Chicago, IL) software package. Descriptive
statistics (frequencies and percentages) were used to des-
A cross-sectional study was conducted in 2015 and cribe the obtained results. When comparing mean scores
2016. The data of the study was collected with a for groups two-tailed paired-sample t-test (when comparing
questionnaire form prepared by the researchers in accordance two groups’ means) was used. One–way Analysis of
with the purpose of the study and the literature (Emson, 1987; Variance (ANOVA) test was used to compare the means
Kleinman & Lowy, 1989; Wight et al.; Dinsmore et al.; Bøgh for more than two groups and post hoc analysis was
& Madsen, 2005; Mekahli et al., 2009; da Rocha et al., 2013; performed in paired comparisons. Statistical significance
Caplan, 2014; Gatica-Araneda & Alfaro-Toloza, 2014; Dalal, was set at pERDOGAN, K.; ÖZEN, K. E.; YILDIZ, H. & MALAS, M. A. Assessment of awareness, knowledge and attitudes about the importance of cadaver and cadaver donation: Report of Izmir, Turkey.
Int. J. Morphol., 38(4):831-837, 2020.
Tabla I. Questionnarie on awareness, knowledge and attitude about the importance of cadaver and cadaver donation
1 . Gender
( ) Female ( ) Male
2 . Age
( ) 18-29 ( ) 30-44 ( ) 45-59 ( ) ≥60
3 . Level of education
( ) Literate (Level 1)
( ) Primary School (Less then high school diploma) (Level 2-3)
( ) Hig h School or equivalent degree (Level 4-5)
( ) Bachelor's or equivalent degree (Level 6)
( ) Master's Degre e + Doctorate (Level 7-8)
4 . Marital Status
( ) Married ( ) Single / Widowed / Divorced
5 . Occupation
( ) Public emp loyee ( ) Private sector ( ) Self-employment
( ) Retired ( ) Tradesman-Artisan ( ) Student ( ) Other
6 . Do you know what the word “cadaver” means?
( ) Yes, I do ( ) No, I don’t
7 . Do you know that you can donate your body as cadaver?
( ) Yes, I do ( ) No, I don’t
8 . Are you aware of the cadaver donation campaigns?
( ) Yes ( ) No
9 . Did you coincide with the news about the cadaver in print and visual media?
( ) Yes ( ) No
1 0. Do you know that medical faculties in our country suffer from cadaver suppl y?
( ) Yes ( ) No
1 1. Do you know that Turkish Universities import donated cadavers from abroad and pay transfer fees?
( ) Yes ( ) No
1 2. Do you think that medical education is possibl e without cadaver?
( ) Yes ( ) No
1 3. Do you know that there is a certain per iod of use of cadavers?
( ) Yes ( ) No
1 4. If you donate your body as a cadaver , do you know that it is delivered to your relatives or buried in accordance with your request after the
s cientific s tudy (dissection) is finished?
( ) Yes ( ) No
1 5. Are you aware of the fatwa of the Presidency of Religi ous Affairs regarding th e body donation is permissibl e in S haria (Islamic law)?
( ) Yes ( ) No
1 6. Wh ere do you apply when you decide to donate your body?
( ) State hospital ( ) Family doctor ( ) Private hospitals ( ) University hospitals
1 7. Do you think body donation is permiss ible in Sharia (Islamic law)?
( ) I agree wit h t he fat wa of the Presidency of Religi ous Affairs of Turkey, i t is permiss ible.
( ) I do not agree with the fatwa of the Presidency of Religious Aff airs Turkey, it is not permissible
( ) no idea
1 8. Wh at would be your reaction if a member of your family donated his body as a cadaver?
( ) I encourage
( ) I do not i nterfere. This is his free decision.
( ) I object
1 9. Wo uld you consider donating your body as a cadaver after death?
( ) Yes, I do
( ) Never thought, I have no idea
( ) No, I don't want to donate
2 0. Wo uld you please explain why you do not want t o donate your body as a cadaver?
( ) Unanswered
( ) My family does not want
( ) I thi nk it is not appropriate for my religion
( ) I thi nk today's technology makes medical education possible without cadavers.
( ) I do not t hink there i s a problem in the supply of cadavers in our country
( ) Personal reasons
The AWKL-Score of the all participants was groups were 0.49±0.22 and 0.48±0.26, respectively, and were
0.41±0.24 (min:0.00, max:0.90). The AWKL-Scores for the significantly higher (F:4.115; p:0.007) than the other age
youngest (18y-29 y) and the oldest (60 y and older) age groups. The AWKL-Score was 0.39±0.25 in males and
833ERDOGAN, K.; ÖZEN, K. E.; YILDIZ, H. & MALAS, M. A. Assessment of awareness, knowledge and attitudes about the importance of cadaver and cadaver donation: Report of Izmir, Turkey.
Int. J. Morphol., 38(4):831-837, 2020.
0.44±0.23 in females, and no statistically Table II. Sociodemographic characteristics of participants.
significant difference was found between Sociodemographic characteristics (n = 245) n (%)
the genders (t:1.451; p:0.184). The Age (years)
highest AWKL-Score was at the group 18-29 60 24.5 %
of master's degree or doctorate (Level 7- 30-44 79 32.2 %
8) (F:22.997; pERDOGAN, K.; ÖZEN, K. E.; YILDIZ, H. & MALAS, M. A. Assessment of awareness, knowledge and attitudes about the importance of cadaver and cadaver donation: Report of Izmir, Turkey.
Int. J. Morphol., 38(4):831-837, 2020.
Table IV. Awareness and Knowledge Level Scores (AWKL-Score) of the participants about the importance of cadaver and cadaver
donation according to some sociodemographic factors.
Awareness and knowledge
S ociodemographic Characteristics Statistical Analysis
score
t score / F statistic ; p
Mean±SD
Age (years)
18-29 0.49±0.22
30-44 0.38±0.25 4.115 ; 0.007
45-59 0.38±0.23
≥60 0.48±0.26
Gender
Male 0.39±0.25 1.451 ; 0.184
Female 0.44±0.23
Level of education
Literate (Level 1) 0.12±0.04
Primary School (Less then high school diploma) (Level 2-3) 0.22±0.23
High School or equivalent degree (Level 4-5) 0.41±0.22 22.977 ;ERDOGAN, K.; ÖZEN, K. E.; YILDIZ, H. & MALAS, M. A. Assessment of awareness, knowledge and attitudes about the importance of cadaver and cadaver donation: Report of Izmir, Turkey.
Int. J. Morphol., 38(4):831-837, 2020.
DISCUSSION for cadavers is increasing in the fields of anatomy and medical
research. Various methods are used in cadaver procurement in
different countries and medical schools (Kleinman & Lowy,
Awareness and knowledge level of the individuals are Mekahli et al.; Subasinghe & Jones). In the literature, from an
important factors for developing positive attitudes towards body ethical and broad perspective, it is suggested that cadavers
donation. Therefore, encouraging works will have a positive obtained from donations will be more appropriate (Emson;
effect on the cadaver donation and increase the donation rate Caplan). Throughout the history of anatomy and medicine,
(Bamaç et al.). "Yes" answers with a rate of 75.5 % to the obtaining cadavers for education has been an important
question "Do you know what the word cadaver means?" does problem. As a result of ethical discussions, the most accurate
not mean that the participants have a high level of knowledge. method for cadaver procurement was considered to be
Because “yes” answer to the other questions in the questionnaire voluntary donation of the human body or part of it (Bøgh &
measuring the knowledge level of the participants varies just Madsen; Dalal). Today, cadavers used in medical schools in
between 17.6 % and 66.9 %. These results show that the almost all developed countries are the corpses of people who
participants have accurate information about cadaver donation voluntarily donated their bodies to science. The number of
at a maximum level of two thirds, which should be interpreted donations has increased in these countries in recent years and
as an insufficient level. has exceeded the storage and/or usage capacity of laboratories.
Therefore, there are medical schools that suspend their donation
The proportion of the participants considering applying programs for a certain period. In addition, in the USA, the
to the state hospital and family physician (42.40 % and 13.98 donation programs of scientific institutions for the procurement
%, respectively) for body donation shows that the personnel of cadavers to medical studies or the provision of services from
working in these institutions should be informed about body private supply companies are being discussed (Wingfield). It
donation and related procedures. is reported that strong body donation programs are needed in
countries where there the body donations are not at desired
The percentage (39.2 %) of the answer “no idea” to the level (Gatica-Araneda & Alfaro-Toloza).
question "Do you think body donation is permissible in Sharia
(Islamic law)?" provides evidence that the activities of the There is inadequate published information about body
Presidency of Religious Affairs of Turkey have not yet achieved donation programs. There are studies showing that donation
the desired level. rates have increased five times in four years through successful
programs, mass media, distribution of posters and brochures,
When the educational level of the participants was seminars and incentive visits to the anatomy museums (da
evaluated, it was observed that the level of knowledge of the Rocha et al.). It is reported that there is a gap between
group of literate and primary school degree was inadequate. knowledge and motivation for organ and body donation, which
When the education level group was evaluated in terms of should be filled with an appropriate guidance program and
awareness and knowledge level score (AWKL-Score), it was education (Saha et al.). The results of previous surveys show
determined that as the level of education increases, knowledge that ignorance is the main reason for the reluctance of body
level score increases. In addition, it was determined that the donation (Abbasi Asl et al.; Bamaç et al.; Ciliberti et al.).
knowledge level of the self-employed group was quite low in
the occupational groups. Therefore, it was concluded that these Limitations. This study has some limitations. First, this is a
groups should be informed about body donation. cross-sectional study. The questionnaire form was developed
by the researchers and no validity-reliability tests were
Low body donation rates determined in this study shows performed. The study population consisted of 245 people and
that, in Turkey, making significant progress is needed. may not be considered as representative of Izmir province.
However, results of the study offers evidence will provide
The participants' awareness and knowledge level insight on the subject in Izmir and Turkey.
(AWKL-Scores) about cadaver and cadaver donation was
evaluated as quite low (0.41±0.24). From this, it was concluded
that the community should be informed about body donation. CONCLUSIONS
When the relationship between AWKL-Scores and age was
evaluated, it was observed that the middle age group should
be informed more than the younger (18-29 y) and 60 and older The importance of cadaver in medical education and
age group. the awareness and knowledge level of the individuals in the
society about cadaver donation are very important. The results
In parallel with the advancement of medicine, the need in our survey was interpreted as indicators of the lack of
836ERDOGAN, K.; ÖZEN, K. E.; YILDIZ, H. & MALAS, M. A. Assessment of awareness, knowledge and attitudes about the importance of cadaver and cadaver donation: Report of Izmir, Turkey.
Int. J. Morphol., 38(4):831-837, 2020.
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