Currently, there are more than 113,000 people in the United States who are waiting for a lifesaving organ transplant (United Network for Organ Sharing, 2019). Every 10 minutes, a new name is added to the waiting list, and an average of 20 people die each day from the lack of available organs for transplant (American Transplant Foundation, 2019). Despite large public support (95% “support” or “strongly support”) for organ donation (Gallup, 2013), only 54% of American adults have registered as organ donors (Donate Life America, 2017).
As the largest group of health care professionals in the United States, nurses play a major role in the organ donation process. Patients and their families often look to nurses for education and guidance in making decisions pertaining to organ donation (Anker et al., 2009). Although nurses do not formally request consent for organ donation from family members of deceased patients (Anker & Feeley, 2011), they often are called on to answer family members' questions about organ donation and educate patients on topics such as brain death and the transplantation process (Anker et al., 2009). Despite the vital role that nurses play in the organ donation process, research suggests nurses may lack essential knowledge about organ donation. Specifically, research has found nurses often lack knowledge on topics such as donor eligibility, the specificities of brain death testing, and organ donation legislation (Collins, 2005; Ingram et al., 2002; Mathur et al., 2008).
If nurses are to make a difference in combating the existing organ shortage in the United States, it is important for nurses to be sufficiently educated on the topic. Although nursing students represent the next generation of nurses, few studies have examined nursing students' knowledge of organ donation (Jones-Riffell & Stoeckle, 1998; Kurz, 2014; Potenza et al., 2015). A recent study by Kurz (2014) found that nursing students had knowledge deficits in three specific areas, including mistakenly believing that 1) many major religions discourage or prohibit organ donation, 2) most Americans do not support organ donation for their family members, and 3) individuals from minority groups comprise less than half of the candidates on the transplant waiting list. Much of the existing research on nursing students' knowledge of organ donation is limited by the age of the study (e.g., Jones-Riffell & Stoeckle, 1998), the use of small samples (e.g., Kurz, 2014), or the research having been conducted outside the United States (e.g., Potenza et al., 2015).
The purpose of the current study was to examine nursing students' knowledge about organ donation. Previous work on this topic primarily has examined nursing students' factual knowledge about organ donation and the transplantation process (Jones-Riffell & Stoeckle, 1998; Kurz, 2014). The current study specifically examined nursing students' knowledge of eight common myths and misconceptions related to organ donation (Morgan et al., 2008). These included issues related to mistrust of medical providers (e.g., doctors are “vultures” who are eager to declare a patient as brain dead to “steal” their organs [Quick et al., 2014]), mistrust of the medical system (e.g., the myth that there is a black market for organ donation in the United States [Morgan et al., 2007]), misconceptions about donor eligibility (e.g., the misconception that there is an age limit to donation [Downing & Jones, 2008]), and misconceptions about brain death (e.g., the misconception that people who are brain dead can recover from their injuries [Morgan et al., 2009]). Given the prevalence of these myths and misconceptions, both in the minds of the American public (Feeley et al., 2014; Morgan et al., 2008) and in entertainment media portrayals of organ donation (Morgan et al., 2007, 2009), the current study sought to better understand nursing students' knowledge of these specific myths and misconceptions.
Participants (N = 232) were nursing students recruited at a medium-sized southern university. Participants ranged in age from 19 to 28 years (M = 20.88, SD = 0.96), and the majority were female (90.5%). Most participants reported their race or ethnicity as White or Caucasian (90.9%), followed by Asian (3.9%); Hispanic, Latino, or Spanish origin (3.4%); African American or Black (2.2%); American Indian or Alaskan Native (0.9%); or some other race (4.7%). All of the participants were either juniors (39.2%) or seniors (60.8%). Most of the participants were registered organ donors (75.4%). Approximately one third of the participants (29.7%) personally knew someone who had received an organ transplant, and the majority of the participants (58.6%) personally knew someone who had donated their organs. Institutional review board approval was obtained from James Madison University for this study.
Participants completed an anonymous survey online. Eight true/false questions were used to assess participants' knowledge of organ donation. Knowledge questions were adapted from previous studies (Feeley et al., 2017; Harrison et al., 2008; Kurz, 2014; Morgan et al., 2009) and addressed eight common myths and misconceptions (American Transplant Foundation, 2019; Health Resources & Services Administration, 2019; Mayo Clinic, 2019) about organ donation (e.g., “rich and famous people are able to get an organ transplant sooner” or “being an organ donor means you can't have an open casket funeral”) (Table 1).
Participants answered an average of 5.55 (SD = 1.30) questions correctly. Two questions were answered correctly by nearly all of the participants: “Medical providers (e.g., doctors and nurses) will not try to save the life of a patient if they know they are an organ donor” (false; 97% correct), and “Being an organ donor means you can't have an open casket funeral” (false; 94.8% correct). Three questions were answered correctly by the majority of participants: “People who are brain dead can recover from their injuries” (false; 86.6% correct), “Rich or famous people are able to get an organ transplant sooner” (false; 78.5% correct), and “There is no financial cost to donors or their families for organ donation” (true; 66.4% correct). Two questions were answered correctly by approximately half of the participants: “Most major religions support organ donation” (true; 52.6% correct) and “There is an age limit to register as an organ donor” (false; 47.6% correct). One question, “People can buy organs on the black market in the United States” (false) was answered correctly by only 31.5% of participants.
This study examined nursing students' knowledge about organ donation. In particular, eight common myths and misconceptions about organ donation were examined via true/false questions. Identifying what nursing students do (and do not) know about organ donation is critical information for educators preparing the next generation of nurses to competently discuss organ donation with patients and their families. Overall, results revealed that nursing students did not believe many of the common myths and misconceptions surrounding organ donation, answering an average of 69.3% of the questions correctly (5.55 of 8).
Mistrust in medical providers and the medical establishment is a widespread barrier to organ donation among the public generally (Feeley et al., 2014; Morgan et al., 2008; Quick et al., 2014; Reynolds-Tylus et al., 2019) and among racial and ethnic minorities in particular (Reinhart & Lilly, 2019; Williamson et al., 2017, 2019). Given their career choice, it is unsurprising that nursing students did not buy into this mistrust of medical providers. Nearly all of the participants (97%) believed that medical providers would not let a patient die if they knew the patient was an organ donor. Nursing students also were well educated on the fact that organ donation does not preclude someone from having an open casket funeral, with 94.8% answering this question correctly. Given that both of these misconceptions are common among the public (e.g., Feeley et al., 2014), nursing students appear to be well prepared to correct these misconceptions should they arise in conversations with patients and family members.
Overall, nursing students were well acquainted with the concept of brain death, with the majority (86.6%) of participants answering correctly that people who are brain dead cannot recover from their injuries. A few nursing students (21.5%) believed the so-called “rich and famous” myth—the mistaken belief that those with celebrity status or financial resources are privileged in the organ allocation system (Morgan et al., 2007, 2009; Quick, 2009). Given that media portrayals often reinforce both of these misconceptions (Morgan et al., 2007, 2009; Quick, 2009), the relatively high number of nursing students in the current study who answered these questions correctly suggests most nursing students are prepared to address these misconceptions if brought up by patients and their family members.
The current study identified several areas in which nursing students have a deficit in knowledge concerning organ donation. Reflecting the common misconception that there is a financial cost to donors or their families (American Transplant Foundation, 2019; Health Resources & Services Administration, 2019; Mayo Clinic, 2019), only two thirds of participants (66.4%) answered this question correctly. In line with previous research (Kurz, 2014), many nursing students did not know that most major religions support organ donation, with only 52.6% answering this question correctly. Slightly less than half of the participants (47.6%) knew there is no age limit to register as an organ donor. Research has found that this “age myth” is a major barrier to organ donation among older adults (Downing & Jones, 2008; Quick et al., 2016). Accordingly, results from the current study suggest many nursing students may be ill equipped to deal with these common misunderstandings from patients and their families.
The most interesting result was that a majority (68.5%) of nursing students believed the myth that there is a black market for organ donation in the United States. The source of this misinformation is unclear and warrants further study. Research on media portrayals of organ donation have found entertainment narratives involving organ donation often reinforce the myth that there is a black market for organs in the United States (Morgan et al., 2007, 2009). In their framing analysis of entertainment portrayals of organ donation, Morgan et al. (2007) found that a common theme is the “moral corruption of the powerful,” whereby corrupt individuals (e.g., unethical or immoral doctors) are shown to work within a corrupt system (e.g., black market organ sales). However, considering that almost no participants in the current study expressed mistrust in medical providers (5%), the finding that so many nursing students believed there was a black market for organs in the United States is especially befuddling. One potential explanation for this finding is that some participants may have misread or misunderstood the question (i.e., participants may have thought the question referred to the existence of a black market for organs outside of the United States). Future research using qualitative methods (e.g., focus groups or interviews) is recommended to elucidate the underlying rationale for nursing students' belief in a U.S. black market for organ donation.
Limitations and Future Directions
The current study had several limitations. First, the sample was largely composed of white, female nursing students at a single southern university. Future research would benefit from surveying a more diverse sample of nursing students from an array of different states, universities, and nursing programs (e.g., associate degree and accelerated curriculum). Second, given that the online survey was distributed anonymously, it is impossible to rule out that some participants may have searched for answers to the knowledge questions online. Therefore, the results likely represent a conservative estimate of how knowledgeable nursing students are about organ donation. Future research could address this limitation by recruiting nursing students for a laboratory study or by using a pen-and-paper (rather than online) survey. Third, participants in this study were recruited for a study on “organ donation.” Therefore, it is possible that students who were more knowledgeable about organ donation may have self-selected into the study. Future research could address this limitation by masking the intent of the study in recruitment materials.
Given the important role that nurses play in educating the public about organ donation, the current study sought to better understand nursing students' knowledge of several common myths and misconceptions about organ donation. Overall, nursing students were quite knowledgeable about organ donation, particularly in regard to the myths and misconceptions about the trustworthiness of medical providers and the ability of organ donors to have an open casket funeral. However, several areas where nursing students had a deficit in knowledge were identified. Shockingly, a majority of nursing students believed the myth that there is a black market for organ donation in the United States. The results of the current study have clear implications for nurse educators preparing the next generation of nurses to be knowledgeable and competent communicators on this critical issue.
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|Question [Answer]||% Correct|
|Medical providers (e.g., doctors, nurses) will not try to save the life of patients if they are an organ donor. [False]||97|
|Being an organ donor means you can't have an open-casket funeral. [False]||94.8|
|People who are brain dead can recover from their injuries. [False]||86.6|
|Rich or famous people are able to get an organ transplant sooner. [False]||78.5|
|There is no financial cost to donors or their families for organ donation. [True]||66.4|
|Most major religions support organ donation. [True]||52.6|
|There is an age limit to register as an organ donor. [False]||47.6|
|People can buy organs on the black market in the United States. [False]||31.5|