Perceptual Factors Related to register as Organ Do-nors among Iranian Medical College Student

One of the major treatments for many diseases is organ transplantation. The objective of this study was to determine factors related to register as organ donors among Iranian college student based on the theory of planned behavior. This cross-sectional study was conducted on 320 college students in Hamadan University of medical sciences. Participants filled out a standard self-administered questionnaire including the expanded theory of planned behavior components. Data were analyzed by SPSS version 21 using correlation, linear and logistic regression statistical tests at 95% significant level. Our result showed 6.6% of participants reported registered as an organ donor card. The most of participants have reported save people life most effective factor that motivation them to register as an organ donor card. The TPB variable, accounted for 33% of the variation in the outcome measure of the intention to organ donor card registered. The best predictor for organ donor card registered was subjective norm with odds ratio estimate of 1.23 [95% CI: 1.04, 1.44]. Comprehensive educational programs need to emphasize on psychological factors that mediate and predict behaviors. According to the results, donor organ associated with subjective norms in community; It seems special attention to importance culture in the organ donation to save human lives utilizes by influence persons at community, could be benefit results.


INTRODUCTION
rain death is the unalterable end of brain activity (including involuntary activity necessary to sustain life) due to total necrosis of the cerebral neurons following loss of brain oxygenation (1). Brain death can be caused by any injury that stops blood and oxygen from reaching the brain. Heart attacks, strokes, brain tumor, die as a result of head injuries, blood clots and infections (2). Considering the high rate of accidents in Iran, which the ten accident one person is dead, and also in every hundred deaths one of them is brain death, we witnessed the highest numbers of brain death in Iran as compared to other countries (3). Organ donation is the process of surgically removing an organ or tissue from one person (the organ donor) and placing it into another person (the recipient). Organ transplantation is one of the great advances in modern medicine, and display a noteworthy improvement in current medical science, and it has B ···················································································································································································· 29 J. Biol. Today's World. 2014 Feb; 3 (2): 28-32 promoted several patients with organ defeat (4). Currently, organ transplant, one of the most effective treatments and sometimes that is only cure for many of advanced disease; however unfortunately depending on the disease approximately 10-25% of patients who needing a transplants, without getting organ died on the waiting list (5). In addition, unfortunately, the need for organ donors is much greater than the number of people who actually donate. Every day in the United States 18 people die waiting for an organ and more than 117,000 men, women, and children await life-saving organ transplants (6). Generally amount of family consent in brain dead patients to organ donation is different in various countries; these amount during 2007 in some countries such as Hungary, Ireland, Poland, Spain, Cuba, less than 20%, and in some of countries such as Bulgaria, Estonia, Italy, Argentina, Uruguay, Greece, between 20-50 percent, and in Panama, America, Britain, and Turkey more than 50 percent were reported (5).Understanding the factors related to register as organ donors among various social groups could be appropriate to enhance organ donation card register is effective. In this regard, two main methods have been approved to understand the factors influencing communication of the organ donation decision. One method has focused on identifying individual background factors predicting willingness to register and discuss the donation decision. The second method is the development of predictive models designed to account for variability in registration and discussion decisions (7). In this regard, several research was conducted based on theory of planned behavior to predicting factors related to register as organ donors (7,8). Regarding confined of studies in our country, our TPB based study focused on exploring cognitive factors related to the register as organ donors in a sample of medical college students in Iran.

Participants and Procedure
This cross-sectional study was conducted on 320 college students aged 18 to 30 years old in Hamadan University of Medical Sciences, the west of Iran, during 2012. The sample size was calculated at 95% significant level according to the results of a pilot study and a sample of 320 was estimated. Of the population of 320, 302 (94.3%) signed the consent form and voluntarily agreed to participate in the study, which has been approved by the research institute of behavioral disorders and substance abuse of Hamadan University of Medical Sciences, Iran. Data collection conducted after receiving approval from the relevant university ethics committee, this project was carried out and the volunteers were given the selfquestionnaire.

Measure
Prior to conducting the main project, a pilot study was carried out. Initially the relevant questionnaires were administered to 30 students who were similar to study population in order to estimate the duration of the study conduction and to evaluate the reliability of the questionnaire. Estimated reliability using alpha Cronbach coefficient for each TPB constructs questionnaire were as follows: attitude (α = 0.73); subjective norms (α = 0.67); perceived behavior control (α = 0.74) and behavioral intention (α = 0.79). The variables assessed in this study included: Background data collected were: age (years), level of education (BSc, MSc, MD or MDD), marital status (single or married), Job (just student or employee), Live in Dormitory (yes or no), Native of Hamadan (yes or no).

Theoretical Framework
The theory of planned behavior (TPB) was proposed by were designed to perceived behavioral control toward to register as organ donors (e.g., I am confident that I could talk to my family about my donation decision). Four items were designed to evaluate intention toward to register as organ donors (e.g., I intend to register as an organ donor card in the next months). In order to facilitate participants' responses to the items, all items were standardized to a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree). Data were analyzed by SPSS version 21 using appropriate statistical tests including Correlation, linear and logistic regression at 95% significant level.

RESULTS AND DISCUSSION
The mean age of respondents was 21.33 years [SD: 2.30], ranged from 18 to 30 years. More details of demographic characteristics of the participants are shown in Table 1.  A hierarchical multiple regression analysis was performed to explain the variation in intention to organ donor card registered, using the TPB variables of perceived behavioral control, attitudes, and subjective norms. As can be seen in Table 3, were statistically significant predictors of the outcome measure. Collectively, they were accounted for 33% of the variation in intention to organ donor card registered. According to the logistic regression analysis, subjective norms and behavioral intention were the most influential predictors on registered as an organ donor card (Table 4). Annually over than ten thousand of brain death occurs due to accidents in Iran. That is much higher than other countries; however, today, one of the most effective and sometimes the only treatment of incurable diseases is organ transplant (5).
Thus, identify and analyzing factors associated with registration as organ donor among various groups is very important.
Present study is discussed about factors associated with registration as organ donor among medical students using the theory of planned behavior. Our findings indicated that 6.6% of the participants were registered as organ donor. That is much lower in comparison with other countries. Hyde et al in their study which was conducted among students in Australia reported that 61% of them have donor card registration (7). showed that 24% of participants have at least one previous donation (11). Logistic regression revealed that the subjective norms and behavioral intention constructs are the strong predictors of registration as organ donor. Several studies have also shown that subjective norms are strong predictors of registration as organ donor, which is consistent with our study (12,13).

CONCLUSION
According to the study, subjective norms and behavioral intention were strong predictors of registration as organ donor among college students. The constructs of the theory of planned behavior could predict 33% of the variance in behavioral intention in registration as organ donor.

AUTHORS CONTRIBUTION
This work was carried out in collaboration between all authors.