Copyright © 2022 The Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original author and source are credited

Issam Jandou^1,2,3, Alafifi Rania ⁴, Adil Kbirou^1,2, Alafifi Mahmoud ^1,2, Amine Moataz ^1,2, Mohammed Dakir^1,2, Adil Debbagh^1,2, Rachid Aboutaieb^1,2, Samira Hassoune ³

1 Department of Urology, University Hospital Center IbnRochd Casablanca, Morocco

2 Sexual and Reproductive Health Laboratory, Faculty of Medicine and Pharmacy Casablanca, Morocco

3 Laboratory of Epidemiology - Faculty of Medicine and Pharmacy of Casablanca Morocco

4 Department of Nephrology, University Hospital Center IbnRochd Casablanca, Morocco

Article Info:

________________________________________

Article History:

Received 18 December 2021

Reviewed 23 January 2022

Accepted 29 January 2022

Published 15 February 2022

________________________________________

Cite this article as:

Jandou I, Rania A, Kbirou A, Mahmoud A, Moataz A, Dakir M, Debbagh A, Aboutaieb R, Hassoune S,The role of the general practitioner in promoting organ donation, Journal of Drug Delivery and Therapeutics. 2022; 12(1-s):42-45

DOI: http://dx.doi.org/10.22270/jddt.v12i1-s.5314

________________________________________

*Address for Correspondence:

Issam Jandou, Department of Urology, University Hospital Center IbnRochd Casablanca, Morocco

Abstract

______________________________________________________________________________________________________________

Introduction: The effectiveness of a health system is based on primary care, the conductor of which is the general practitioner, who is also an integral part of the organ donation promotion chain. At present, as the indications for transplantation are more and more widespread, an immense shortage of organs is declared. This pushes more than ever to multiply creative tactics to reduce the gap between the number of high demand and stingy supply.

The main objective of this work is to particularize the involvement of the general practitioner in this process of encouraging donation, as well as to highlight his attitudes and his motivation during the consultation, and to identify the possible obstacles to the donation. Information and patient education on organ and tissue donation.

Material and method: A quantitative descriptive cross-sectional study, based on a questionnaire with 20 closed questions, self-administered, sent by email address, completed anonymously and voluntarily intended for the general practitioner of the region of Casablanca. Questionnaire data were collected, coded, and analyzed using SPSS-PC (Version 21.0).

Results: In total, 200 general practitioners were targeted by our study. 165 responded to the questionnaire, which gives an overall response rate of 82.5%. 35.5% of the participants were women, the duration of exercise varies between 1 and 40 years, 65% of the doctors practiced in the urban environment and approximately 59.5% worked in the liberal sector. 87% of the doctors questioned were in favor of organ donation. only 38% of doctors have already discussed this subject with their patients, of whom more than 64% were following the sole initiative of the patient himself and in none of the cases was awareness-raising through posters in the waiting room.

Conclusion: The general practitioner is a cornerstone of the success of public health programs. Continuous training of this category of doctors ensures better promotion of organ and tissue donation in Morocco.

Keywords: tissue donation, blood donation, donors and non-donors of the without, federating donors, Morocco

Nowadays, organ transplants have a prominent place in the treatment of still fatal conditions. In Morocco, organ and tissue transplantation are lagging and the number of transplants performed in our context does not exceed a rate of 10 transplants/year / million inhabitants. The shortage of organs and tissues limits the number of transplants and tissue transplants which are initially a project of the Ministry of Health.

The general practitioner, the first link in the medical chain. In addition to his solitary exercise of medical care, his role, already, is to ensure several missions of public health in particular in the field of the prevention and detection of diseases as well as the promotion of the disease. organ and tissue donation.

To assess the level of involvement and the degree of commitment of general practitioners in the promotion of organ donation, we conducted a quantitative cross-sectional study through a questionnaire. This work has enabled us to collect demographic and professional information and to learn about the practices, attitudes, and knowledge of general practitioners regarding organ donation.

A quantitative descriptive cross-sectional study, based on a questionnaire with 20 closed questions, self-administered, sent by email address, completed anonymously and voluntarily intended for the general practitioner of the region of Casablanca. Questionnaire data were collected, coded, and analyzed using SPSS-PC (Version 21.0).

In total, 200 general practitioners were targeted by our study. 165 responded to the questionnaire, which gives an overall response rate of 82.5%. 35.5% of the participants were women, the average age was 34.22, the duration of exercise varies between 1 and 40 years with an estimated average of 11 years, 65% of the doctors practiced in the urban environment and approximately 59.5% worked in the liberal sector.

87% of the doctors questioned were in favor of organ donation and 13% were against organ donation for which the religious cause represented 78% and 16% refused for medical reasons, 54.5% of them did not even discuss the subject with their relatives, and 80.5% of practitioners declared having a patient waiting or who had received an organ transplant, only 38% of doctors have already discussed this subject with their patients, of whom more than 64% were following the sole initiative of the patient himself and in none of the cases was awareness-raising through posters in the waiting room.

However, 74% see themselves in the obligation to ask the patient to take a position on organ donation, only 1.5% of the participants had brochures on organ donation in their waiting rooms and more than 87% thought that television broadcasts in waiting rooms are a good means of information and awareness.

However, more than 81% do not have the information on the additional examinations necessary for the confirmation of the state of encephalic death, 75% declared that they had not approached the subject of organ donation during their studies. Medical studies and 80% of doctors thought they needed additional information on the concept of organ donation and 50% declared the need for its introduction into the normal course of medicine, and 50% were for continuing training in the field of organ donation in the form of a hands-on workshop and 21% preferred journals and documents.

Content

N (%)

Are you in favor of organ donation?

• Yes

• No

174(87)

26(13)

If you are against donation, what are your reasons?

• Religious causes

• Medical causes

• Legislative causes

• Personal causes

78 (39)

16 (8)

0 (0)

106 (53)

Do you know someone close to you who has received or is awaiting a transplant?

• Yes

• No

59 (29.5)

141 (70.5)

Have you already started this topic with your family?

• Yes

• No

91 (45.5)

109 (54.5)

Are you following a patient who has received or is awaiting an organ or tissue transplant?

• Yes

• No

161 (80.5)

39 (19.5)

Do you ever talk to your patients about organ donation?

• Yes

• No

If yes :

• At your initiative

• At the initiative of the patient

• By posting in your waiting room

76 (38)

124 (62)

71 (35.5)

129 (64.5)

0 (0)

Are you ready to ask your patients to take a stand on organ donation?

• Yes

• No

148 (74)

52 (26)

Do you have brochures on the topic of organ and tissue donation in your waiting room?

• Yes

• No

3 (1.5)

197 (98.5)

Do you think a TV show in the waiting room is a good source of information?

• Yes

• No

175 (87.5)

25 (12.5)

Would you be prepared to ask the question "are you a donor?" »To your patients during your consultations?

• Yes

• No

125 (62.5)

75 (37.5)

If you were asked questions, did you feel in your role as a general practitioner?

• Yes, I am comfortable with the subject

• I lack knowledge on the subject

104 (52)

96 (48)

Do you know the additional examinations that confirm the clinical EME?

• Yes

• No

37 (18.5)

163 (81.5)

For your daily practice, do you think you need more information on: The notion of brain death?

• Yes

• No

161 (80.5)

39 (19.5)

You think you need more information, on the concept of brain death, on organ donation in which medium (s) do you prefer?

• Practical training

• Review, documentation and brochures

• Internet website

• Mandatory in the medical training course

101 (50.5)

21 (10.5)

14 (7)

64 (32)

During your studies or during your continuing education, did you address the issue of organ donation?

• Yes

• No

49 (24.5)

151 (75.5)

Transplantation has become one of the best, and sometimes the only effective, treatments for many advanced diseases ¹, improving survival rates and the quality of life it provides. It thus constitutes an incomparable therapeutic solution. The need for organ transplants has increased, while the number of donors remains limited; consequently, the demand for organs exceeds the supply.

This situation is mainly due to a lack of awareness and knowledge about organ donation according to Haustein and Sellers ². To increase the number of available transplants, it is therefore essential to encourage people to express their choice about organ donation during their lifetime and to share it with their loved ones.

In the day-to-day of his consultations, the general practitioner is a privileged interlocutor for all categories of the population. It could indeed easily initiate the patient's reflection on this question of donation and act on the percentage of refusals by relatives. This study shows a real motivation of the majority of general practitioners to invest in this process, 87% of the doctors questioned were in favor of organ donation.

Despite this motivation, 54.5% of these doctors have never discussed the subject with their relatives. In another French study by N. Messaadi et al. ³, it has been shown that half of the doctors (48.92%) did not know the law on organ donation, while the decree ⁴ of 18/12/06 states that any attending physician must inform patients. ages 16 to 25. On the other hand, 13% of the doctors questioned were against organ donation; whose religious cause represented 78% and the remaining 16% refused for medical reasons.

In a Moroccan study ⁵, the causes of refusal were similar to those of our study, and the religious cause always stood out in the front line, but we find other causes including the problem of confidence in the health system, personal reasons, and also the absence of valid reasons. The most responsible reasons for this negative behavior towards organ donation are mainly ignorance and lack of information according to Félix et al ^{6, 7, 8, 9,10}

Hence the paramount interest of involving general practitioners in the promotion of organ donation, as more than 80.5% of practitioners declared that they had a patient waiting or who had received an organ transplant

The involvement of general practitioners begins with the awareness stage, which takes several auditory, visual, or audiovisual forms

For the auditory form, it is essentially based on the speech of the general practitioner who allows him to inform his patients, directly during his consultation through questions or radio podcasts. In our study, 38% of physicians have already initiated this subject with their patients, of which more than 64% was due to the sole initiative of the patient himself

While the visual form is manifested by the posters present in the office of the general practitioner or by the distribution of brochures in the office. In our study, 1.5% of participants had brochures on organ donation in their waiting rooms, in none of the cases the awareness was through posters in the waiting room.

For the last audiovisual form, it includes national and international awareness campaigns such as World Organ Donation and Transplant Day which takes place on October 17th of each year, and for which videos, television programs are broadcast and which GPs must share with his patients to disclose the information as much as possible. In our study, more than 87% thought that television shows in waiting rooms are a good means of information and awareness

A Swiss study had shown that 47% of GPs found it relevant to discuss this subject with their patients¹¹. Admittedly, the lack of time and information for treating physicians on the subject is a major obstacle to this process of promoting donation.

An American study shows that treating physicians who have received training in the subject of organ donation, or who easily discuss end-of-life, significantly increase the opportunities to talk about organ donation with their patient, compared to those who have not been trained ¹².

75% declared that they had not broached the subject of organ donation during their medical studies and 80% of doctors thought they needed additional information on the concept of organ donation and 50% declared the need for its introduction into the normal course of medicine, and 50% favored continuing education in the field of organ donation in the form of a practical workshop and 21% preferred journals and documents.

In Morocco, if all brain-dead patients were removed, the organ transplant needs would be practically covered. This shortage is mainly caused by a large number of family refusals. We have observed through this work that only a small number of general practitioners dare to discuss organ donation with their patients, as a result, there has also been a significant deficit in the continuing education of doctors in the field of transplantation and donation. organ. Similar and larger studies can be a guiding principle in tackling this shortage and improving the promotion of organ donation.

1. Wolfe RA, Ashby VB, Milford EL, et al. Comparison of mortality in all patients on dialysis awaiting transplantation, and recipients of first cadaveric transplant. N Engl J Med. 1999; 341:1725e1730. https://doi.org/10.1056/NEJM199912023412303

2. Haustein SV, Sellers MT: Factors associated with (un)willingness to be an organ donor: importance of public exposure and knowledge. Clin Transplant 18:193, 2004 https://doi.org/10.1046/j.1399-0012.2003.00155.x

3. Organ donation: Point of view of private practice physicians in the region Nord-Pas de Calais in France N. Messaadi et al. / Revue d'épidémiologie et de Santé Publique 2011; 59:143-147 https://doi.org/10.1016/j.respe.2010.12.010

4. Décret n82006-1620 du 18/12/06 relatif a' l'information par les médecins des personnes âgées de 16 a' 25 ans sur les modalités de consentement au don d'organes a' fins de greffe et modifiant le code de la santé publique (dispositions réglementaires)

6. Cantarovich F, Heguilen R, Abbud Filho M, et al. An international opinion poll of well-educated people regarding awareness and feelings about organ donation for transplantation. Transplant International. 2007; 20(6):512-551 https://doi.org/10.1111/j.1432-2277.2007.00473.x

7. Bardell T, Hunter DJ, Kent WD, Jain MK. Do medical students have the knowledge needed to maximize organ donation rates ? Canadian Journal of Surgery. 2003; 46(6):453-457

8. Liu H, Peng X, Zhang S, Qiao X, Hao Y. Posthumous organ donation beliefs of college students: A qualitative syudy.

9. Chung CK, Ng CW, Li JY et al. Attitudes, knowledge, and actions with regard to organ donation among Hong Kong medical students. Hong Kong Medical Journal. 2008; 14(4):278-285

10. Makara-Studziñska M, Kowalska A, Wdowiak A, Krys-Noszczyk K. Knowledge and opinions of nurses about organ transplantation in Polish hospital. Journal of Pre-Clinical and Clinical Research. 2013; 7(1):48-52 https://doi.org/10.26444/jpccr/71435

11. Costa, A. Gentet, S. Hornung, S. et al (poster) Pénurie d'organes solides en Suisse: Quelle place pour une information à la population sur le don d'organes par le généraliste ? Juillet 2012, congrès médecine générale

12. Daryl, J. Thornton et al Primary care physicians'attitudes and practices regarding discussing organ donation with their patients. J Natl Med Assoc 2010; 102:52-58 https://doi.org/10.1016/S0027-9684(15)30478-8