If you are affiliated with a medical school, or are in some way
interested or involved with organ transplantation, I would greatly appreciate
it if you were to read over this questionnaire. We are going to distribute it
among the medical students here at SUNY Stony Brook this fall. If it could be
distributed at other medical schools as well it would greatly increase it's
applicability.
Since the numbers show that the main problem in obtaining organ donors
is the lack of sufficient concern in the medical community we decided to try
attacking the problem at the bud: in the medical school. We hope that this
survey will identify what the attitudes are among tommorrow's medical
professionals that might make it difficult for them to participate in
organ donation. Better than half of all potential donors are lost either
because brain death was not declared or because no one approached the next of
kin (despite the fact that hospitals are required by law to do so).
Any comments or help in distribution are greatly needed and
appreciated.
Organ donation and transplantation questionnaire
Directions: Please circle the best answer from the list
below each question.
Indicate your current year in medical school.
1 2 3 4
Indicate your age group.
less than 22
23-25 26-30 31-40
greater than 41
Indicate the annual income range of the household in which
you grew up.
less than 15,000 15-30,000
31-50,000 50-100,000 100,000-200,000
greater than 200,000
Indicate your sex.
M F
Do you know a transplant recipient?
yes no
Have you heard through the popular media about organ
donation/transplantation?
yes no
If your answer is yes to the above question, how did you
hear of it?
radio television
newspaper other
Have you known anyone waiting for a transplant?
yes no
If the answer to the above question is yes, what organ was
involved?
kidney liver
heart other
Do you believe that organ transplantation is an effective
treatment?
never sometimes often
most of the time all the time
Is liver transplantation an effective treatment?
never sometimes often most of the time
all the time
Is kidney transplantation an effective treatment?
never sometimes often most of the time
all the time
How do you feel about the possibility of your own organs
being used for transplants in the event of your death?
would not want to donate
might want to donate
would want to donate
would donate only under some other special circumstance
Have you signed an organ donor card (or driver's license
organ donation consent)?
yes no
Would you consider signing an organ donor card?
yes no not sure need more information
How likely is it that your family would allow your organs
to be used for transplants?
likely possible unlikely never
To your knowledge how effective are the present efforts
toward obtaining donors?
very effective
effective most of the time
partially effective
not very effective
Are people who need an organ transplant likely to have a
donor found for them?
likely possible
unlikely never
How closely would the demand for organs match the supply
if all potential donors were properly identified and
consent for donation obtained?
demand would far exceed supply
demand would exceed supply
demand would be roughly the same as supply
demand would be less than supply
demand would be far less than supply
How would you rank the importance of ethical issues in
considering the use of any medical technology?
very important important to some degree
not important
How would you rank the importance of ethical issues in
considering the use of organ transplants?
very important important to some degree
not important
Do you believe that there is a danger that donated organs
could be misused or misappropriated?
never sometimes often
most of the time all the time
Should the cost of an organ transplant be used as a
criteria for prescribing it as a treatment?
never sometimes often most of the time
all the time
If you were caring for a patient who was a potential
donor, would you discuss organ donation with the patient's
next of kin?
never sometimes often
most of the time all the time
How important is the determination of brain death to
identifying a potential donor?
very important
important to some degree not important
Do you know the criteria for brain death?
yes no
Could there be any situation in which you yourself would
be reluctant to make a determination of brain death?
never sometimes often most of the time
all the time
If you thought that a patient's next of kin did not
understand the concept of brain death to what degree would
this affect your willingness to discuss organ donation
with them?
greatly to some degree never
As a physician, would you see yourself as being
responsible for identifying potential organ donors?
never sometimes often most of the time
all the time
