Rajiv Gandhi University of Health Sciences s188

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAK PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. NAME OF THE CANDIDATE : Mr. EBENEZER AND ADDRESS M.Sc NURSING 1ST YEAR H.K.E.S COLLEGE OF NURSING BASAVESHWAR HOSPITAL CAMPUS, SEDAM ROAD, GULBARGA - 585105

2. NAME OF THE INSTITUTION : H.K.E.S COLLEGE OF NURSING BASAVESHWAR HOSPITAL CAMPUS, SEDAM ROAD, GULBARGA -585105

3. COURSE OF STUDY AND : M.SC NURSING, 1ST YEAR SUBJECT MEDICAL – SURGICAL NURSING

4. DATE OF ADMISSION : 22/07/2011

5. TITLE OF THE : “ A STUDY TO ASSESS THE TOPIC KNOWLEDGE & ATTITUDE REGARDING ORGAN DONATION AMONG DEGREE STUDENTS IN SELECTED COLLEGES AT GULBARGA IN VIEW TO DEVELOP INFORMATION BOOKLET”

1 6. BRIEF RESUME OF THE INTENDED WORK INTRODUCTION “To the world you may be one person, but to the one person you may be the world.” – Anonymous

Organ donation means that a person pledges during his lifetime that after death, organs from his/her body can be used for transplantation to help terminally ill patients and giving them a new lease of life1. An organ transplant is the transplantation of a whole or partial organ from one body to another (or from a donor site on the patient's own body), for the purpose of replacing the recipient's damaged or failing organ with a working one from the donor site2. Organs which can be donated are solid organs (kidney, heart, lung, liver pancreas) and tissues which includes (cornea, skin, cartilage, tendon, bone. heart valves)3.

There are two ways of Organ donation the first is, living related donors: only immediate blood relations (brother, sister, parents & children) can donate as per the Transplantation of Human Organ Act 1994. Living donor can donate only few organs, one kidney (as one kidney is capable of maintaining the body functions), a portion of pancreas (as half of the pancreas is adequate for sustaining pancreatic functions) and part of the liver (as the few segments that are donated will regenerate after a period of time) can be donated and second is cadaver Organ donor can donate all organs after brain death1.

Life is too precious to be lost to an organ failure. But millions have lost their lives when a vital organ failed to function in their body. The fact is, medical advances in the field of transplant immunology, surgical management and organ preservation have made the transplantation of vital organs possible. Thus providing a viable approach to the management of diseases that cause irreversible organ failure1.

Organ transplant were first attempted a hundred years ago, but early efforts failed because of rejection - the body sees new tissue as ‘foreign’ and the immune system destroy it4.

The first successful human organ transplant in the United States was the performed on December 24, 1954 between two living twins. The identical physiology of the person allowed for kidney transplant to be successful5. Liver, heart and pancreas were first transplanted in 1960’s. By 1980’s lung and intestinal transplant were being performed. Today many other body parts can be used in transplants like corneas, heart valves, nerves, bones, skin and cartilages6. Currently organ donation can be termed as “crisis with a cure”7

When considering donation, many people think only about the major organs, such as heart, liver or kidney. However there are more than 25 different transplantable organs and tissues in human body8. Experts say that the organs from one donor can save or help as many as 50 people9.

6.1 Need for the study

Medical Science is expanding its horizons by leaps and bounds and edging towards newer successes by unveiling God’s miraculous mystery – Human being and primarily human body. In case any of the organs of the human body fails to function, medical science can extend its functioning for some time, but when an end stage failure is reached, just like a machine whose parts are changed, the failed organ needs to be replaced. One of the miraculous discoveries of medical science has brought a ray of hope in the lives of these needy patients by transplanting these functioning organs from the bodies of brain dead patients to these patients. This is cadaver organ transplantation10.

2 Each day a lucky 55 people (or so) receive an organ transplant, but another 55,000 are on the waiting list.10 people on the waiting list die each day, because not enough organs are available. Four thousand of them die each year while waiting. Every 16 minutes a new name is added to the National Organ Transplant waiting list11.

Transplantation in India faces significant challenges with respect to the large burden of end-stage organ failure in the country, a lack of necessary infrastructure, organization and coordination of health services, low awareness and negative attitudes toward organ donation, and the costs of treatment. The incidence of end-stage kidney disease in India is estimated to be 150 to 175 per million population per year (or between 150,000 and 175,000 cases) and is attributable to diabetes in 30 to 40% of patients

India has 180 renal centers, 25 liver centers, and 10 cardiac centers for transplantation, staffed with 160 renal surgeons, 25 liver surgeons, and few cardiac surgeons. Of these facilities, approximately two thirds are located in South India, and 80% are in the private sector.

India passed the Transplantation of Human Organs Act (THOA) in 1994. Currently, India performs approximately 4000 kidney transplants per year, 250 liver transplants, 10 heart transplants, and 25,000 corneal transplants. Kidney transplantation activity is predominantly based on living donors12.

There are estimated 45 million blind people and 135 million visually impaired people worldwide. The global prevalence of childhood blindness is thought to be around 0.07%, or approximately one tenth of the prevalence of blindness in adults. An estimated 3.1% of deaths worldwide are directly or indirectly due to cataract, glaucoma, trachoma and onchocerciasis. The prevalence of bilateral blindness in developing countries in Asia ranges from 0.3% of 4.4%., in 2001, an estimated 6.8 million people in India had corneal blindness in at least one eye 13. Corneal blindness is one of the most common causes of blindness in India . India shoulders the largest burden of global blindness , about 3.5 million across the country with 30000 new cases being added each year. A t present approximately 35,000 corneas are collected in the country every year, whereas 150000 are required annually to combat corneal blindness14.

Prevalence of chronic kidney disease (2010): More than 10 percent of people, or more than 20 million, ages 20 years and older in the United States have CKD. Prevalence end–stage renal disease (2008): 547,98215. Worldwide, the number receiving renal replacement therapy (RRT) is estimated at more than 1.4 million, with incidence growing by approximately 8% annually. Driving this increase are population ageing, type 2 diabetes mellitus and hypertension, key risk-factors for chronic kidney disease16.

A study conducted in Spain on four-hundred and fifty-five undergraduate students, 26 MBA students, and 465 people from the surrounding community responded to 21 true/false questions regarding factual knowledge about organ donation. The mean number of correct answers was 74.6%. The correct response rate, however, varied widely over questions. Four questions with very large error rates suggest possible 'barriers to donation'. Specifically, these questions concerned religious support for organ donation, the concept of brain death, the normally rigid separation of physician teams who are primarily responsible for the welfare of the donor and donee, and a mistaken belief that to be valid an organ donor card must be filed with the U.S. Department of Health and Human Services. Knowledge of organ donation facts was found to be related to whether subjects carried or requested an organ donor card, their attitude towards organ donation and their willingness to donate their own organs or the organs of a deceased loved one. These findings suggest strategies for raising public support for organ donation17.

Teenagers represent the future of the community and their opinion directly affects family members and friends. Therefore, teenagers who are in favour of donation become promoters of organ donation in their area of influence. A study was conducted on 15-19 year old adolescents according to gender and geographical location to assess the attitude towards organ donation using the questionnaire on psychosocial aspects of donation .The variables were grouped into socio-personal, donation awareness , social interaction , pro social activities and 3 attitude towards the body. Seventy-three per cent of teenagers have a favorable attitude towards organ donation. Twenty-seven per cent are undecided or have negative attitudes; the main reason given is fear of apparent death (48%). Variables with statistical significance, which are against donation, are a low level of education, no previous experience with organ donation, no knowledge of the brain death concept and refusal to accept cadaver manipulation. Today in our country these questions are biggest challenges on adolescents as well as other age groups, these questions need to be addressed properly to increase knowledge and attitude regarding organ donation and to save the life of the needy patients who die due to end stage organ failure18.

India has Blindness problem which is of a very high magnitude. Two to three decades back, Trachoma was one of the major cause of preventable Blindness along with cataract. Hence Govt., of India launched National Trachoma Control Programme during 1976. Later on in 1978, it was modified as the National Programme for Control of Blindness. The Programme aims at reduction in the incidence of the blindness from 1.78% to 0.3% by 2010 A.D. The main cause of blindness are cataract which covers 69%, Refractive Errors 19.7%, Corneal Blindness- 0.9%, Glaucoma-5.8%, Surgical Complications-1.2%, Posterior Segment Disorders 4.7% and others-5.0%. The population of Karnataka is 5.20crores. The incidence rate in Karnataka is 1.29%. The estimated prevalence is above 4.8 lakhs19.

Hence there is a discrepancy between demand and supply of donor’s organs for transplantation of eye and kidney in our country and worldwide. Studies reveal the complexity of individual’s attitude toward organ donation such as, social norms, existing legislation and individual factors like attitude, belief , fear , ignorance and lack of public support to it In advance countries their attitude about organ donation and tissue donation are changing. Remember “Organs wasted are lives lost”. So, researcher felt to assess the knowledge and attitude among degree students regarding organ donation.

6.2 Review of literature

The literature reviewed for this study is organized and presented under the following headings,

6.2.1 Studies related to awareness on eye donation.

6.2.2 Studies related to knowledge and attitude regarding organ donation.

6.2.3 Studies related to kidney transplantation.

6.2.1 Studies related to awareness on eye donation. A cross-sectional study was conducted to assess the awareness and perception of 188 first- and second-year nursing students towards eye donation in Bangalore. A pretested, semi-structured questionnaire method used. And results revealed that , The majority (96.8%) of students knew that eyes can be donated after death but only 38.2% knew that the ideal time of donation was within 6 hours of death. Most participants (85.1%) were either willing or had already donated their eyes. Nobility in the act of eye donation was the main motivational force for eye donation according to 85.6% of students. Perceived reasons for not pledging eyes by the students were: the unacceptable idea of separating the eyes from the body (67.9%), lack of awareness (42.8%), objection by family members (28.5%), and unsuitability to donate because of health problem (10.7%)20.

A study to assess awareness of eye donation and willingness to pledge eyes for donation in the urban population of Hyderabad, India, A total of 2522 subjects of all ages, representative of the Hyderabad population, participated in the Andhra Pradesh Eye Disease Study. Subjects over 15 years old were interviewed regarding awareness of eye donation and willingness to pledge eyes for donation. And results revealed that, Age-gender- adjusted prevalence of awareness of eye donation was 73.8% (95% CI: 66.5-81.0%) but only 1.9% (95% CI: 0.16- 4 3.66%) had pledged eyes. With multivariate analysis, significantly less awareness of eye donation was found in illiterate subjects (OR 0.1; 95% CI: 0.1-0.14), subjects > or =70 years old (OR 0.3; 95% CI: 0.2-0.6), subjects of lower socio-economic status (OR 0.4; 95% CI: 0.3-0.6), females (OR 0.6; 95% CI: 0.5-0.8) and Muslims (OR 0.7; 95% CI: 0.6-0.9). Media was the major source of information about eye donation. Of those aware of eye donation, 44.9% were willing to pledge eyes. Willingness to pledge eyes for donation was significantly lower in Muslims (OR 0.18; 95% CI: 0.13-0.24) than in Hindus and in subjects > or =60years old (OR 0.3; 95% CI: 0.2-0.5)21.

A study to determine the "awareness of eye donation" and "willingness to pledge eyes for donation" in the rural population of Andhra Pradesh, southern India. A total of 7,775 subjects of all ages, representative of the rural population of Andhra Pradesh, participated in the Andhra Pradesh Eye Disease Study (APEDS). Subjects older than 15 years were interviewed regarding awareness of eye donation and willingness to pledge eyes for donation And result revealed that, Age-gender adjusted prevalence of awareness of eye donation in this population was 30.7% (95% CI: 29.5-31.9) but only 0.1% (age-gender adjusted prevalence) (95% CI: 0.05-0.25) had pledged eyes. On multivariate analysis the awareness of eye donation was significantly less in those subjects > or = 70 years old (OR 0.7; 95% CI: 0.6-0.8), illiterates (OR 0.2; 95% CI: 0.1-0.2), females (OR 0.8; 95% CI: 0.7-0.9), lower socioeconomic status group (OR 0.4; 95% CI: 0.4-0.5) and Christians (OR 0.2; 95% CI: 0.1-0.6). Media comprised the major source of information about eye donation. Of those aware of eye donation, 32.9% were willing to pledge eyes, and 50.6% needed more information to decide whether or not to pledge their eyes22.

6.2.2 Studies related to knowledge and attitude regarding organ donation. An opinion poll was done to study a random sample in two geographical areas (urban and rural). Assessment was made of attitudes towards donation of one's own organs as a living donor to an unknown person, as a living donor to a relative and/or close acquaintance and, as a cadaveric donor, and of the different psycho-social variables that may influence this attitude. The objective of this study was to determine public attitudes towards living donation compared with cadaveric donation, and to analyze psycho-social factors that may influence this attitude. And results indicated that, In the urban setting, 60% had a favorable response towards cadaveric donation; 29% were in favour of living kidney donation to an unknown person, a percentage which increased to 89% for donation to a relative or a friend. These rates were lower for liver (21 and 74%, respectively). When asked if they would accept an organ donated by a relative or a friend, 67% would accept a kidney and 60% a liver. Attitude towards living donation to an unknown person is more positive among those in favour of cadaveric donation and those who have had previous experience of donation. With respect to level of education, university students are more undecided about living donation to an unknown person than the other groups. In terms of attitude towards donation to relatives and/or friends, there is also the influence of social factors (sex, marital status). However, if the living donation is intended for oneself, there is no variable with which to associate this attitude. In the rural setting, 56% of the respondents refused to complete the survey due to fear of living donation. No statistical study was conducted due to the bias of the rural sample23. A total of 1061 critical care staff from 28 hospitals in four separate regions of the United States completed a questionnaire that assessed (1) factual knowledge about organ donation, (2) understanding of brain death, (3) previous training in procedures for requesting donations, and (4) comfort levels with the donation process. The objective of the study was to assess the readiness of critical care staff to successfully handle requests for organ donation And results revealed that, Staff training in effective procedures for requesting organ donations was significantly correlated with hospitals' donation rates. Less than a third of respondents, however, had received training in explaining brain death to and requesting organ donation from a grieving family. In hospitals with high rates of organ donation, 52.9% of staff had received training; in hospitals with low rates of organ donation, 23.5% of staff had received training. Levels of factual knowledge about organ donation and brain death were unexpectedly low but were not significantly related to hospitals' rates of organ donation24.

A study conducted to examine the knowledge and attitudes of rural critical care nurses regarding organ donation. Forty-six critical care nurses from a southwestern medical center provided data for this study. Self- 5 reported knowledge and attitudes were measured using the Organ Donor Attitude Questionnaire and compared with respondents' demographic characteristics. And results revealed that, Knowledge scores were found to be average (74% correct). Attitude scores reflected a strongly positive attitude toward organ donation. Increased knowledge of organ donation was not found to be related to a positive attitude. However, both attitude and knowledge were found to be positively correlated with previous experience in caring for either organ donors or recipients. Results were compared with data collected in an urban setting and found to be similar25.

6.2.3 Studies related to kidney transplantation

A single-center retrospective study to evaluate the impact of DGF on controlled (Maastricht category III) DCD donor kidney transplant outcomes. And result revealed that, From 10/01 to 6/08, 578 adult deceased donor kidney transplants were performed including 70 (12%) from DCD and 508 (88%) from DBD donors. Mean follow- up was 36 months. DCD donor kidney transplants had significantly greater rates of DGF (57% DCD vs. 21% DBD, p < 0.0001)) and acute rejection (29% DCD vs. 16% DBD, p = 0.018) compared to DBD donor kidney transplants, but patient and graft survival rates were similar. DBD donor kidney transplants with DGF (n = 109) had significantly greater rates of death-censored graft loss (12.5% DCD vs. 31% DBD), primary non-function (0 DCD vs. 10% DBD) and higher 2 year mean serum creatinine levels (1.4 DCD vs. 2.7 mg/dL DBD) compared to DCD donor kidney transplants with DGF (n = 40, all p < 0.04). On univariate analysis, the presence of acute rejection and older donor age were the only significant risk factors for death-censored graft loss in DCD donor kidney transplants, whereas DGF was not a risk factor26.

A single-center, retrospective cohort study was performed to determine race, age, and gender differences in LDKT, donor recruitment, and donor conversion. And result revealed that, Of 1617 kidney transplant candidates, 791 (48.9%) recruited at least one potential living donor, and 452 (28.0%) received LDKTs. Black transplant candidates, versus non-blacks, were less likely to receive LDKTs (20.5% versus 30.6%, relative risk [RR] = 0.67), recruit potential living donors (43.9% versus 50.7%, RR = 0.86), and receive LDKTs if they had potential donors (46.8% versus 60.3%, RR = 0.78). Transplant candidates ≥60 years, versus candidates 18 to <40 years old, were less likely to receive LDKTs (15.1% versus 43.2%, RR = 0.35), recruit potential living donors (34.0% versus 64.6%, RR = 0.53), and receive LDKTs if they had potential donors (44.5% versus 66.8%, RR = 0.67). LDKT and donor recruitment did not differ by gender. Race and age differences persisted in multivariable logistic regression models. Among 339 candidates who recruited potential donors but did not receive LDKTs, blacks (versus non-blacks) were more likely to have potential donors who failed to donate because of a donor-related reason (86.9% versus 72.5%)27.

6.3 STATEMENT OF PROBLEM “ A CO-RELATIONAL STUDY TO ASSESS THE KNOWLEDGE & ATTITUDE REGARDING ORGAN DONATION AMONG DEGREE STUDENTS IN SELECTED DEGREE COLLEGES AT GULBARGA IN VIEW TO DEVELOP INFORMATION BOOKLET” 6.4 OBJECTIVES OF THE STUDY

 To assess the knowledge regarding organ donation among degree students by structured questionnaire.

 To assess the attitude regarding organ donation among degree students by attitude scale.

 To determine the co- relation between knowledge & attitude regarding organ donation among degree students.

 To find out association between knowledge & attitude regarding organ donation with their selected demographic variables viz. Age, Gender, Religion etc.

6  To Develop & distribute information booklet regarding organ donation among degree students.

6.5 Operational definitions Correlation: It refers to examine the strength and relationships between two variables that is knowledge regarding organ donation and attitude regarding organ donation. Correlations may be either positive or negative Knowledge: It refers to the amount of information and understanding about the organ donation in degree students as measured by structured questionnaire schedule. Further the knowledge level arbitrarily divided into very good, good average and poor. Attitude: It refers to the opinion or feeling that degree students have about organ donation and the way they behave towards organ donation as measured by attitude scale. Further the knowledge level arbitrarily divided into positive or negative. Organ donation: Organ donation means that a person pledges during his lifetime that after death, organs from his/her body can be used for transplantation to help terminally ill patients and giving them a new lease of life. Degree students: In this study degree students are those students who are studying in a degree college under a recognized university. Information booklet: Information booklet containing the meaning, importance of organ donation, need for organ donation, and source of organ donation living and cadaver donor etc. 6.6 Assumptions 1. The degree students may have moderate level of knowledge but, may not have favourable attitude towards organ donation. 6.7 Delimitations 1. The sample size is limited to 100 degree students. 2. The study is limited to selected colleges of Gulbarga. 3. Only educated degree students. 4. The data collected through structured knowledge questionnaire and structured attitude scale. 6.8 Hypothesis

H01: There will be no significant co relational between knowledge and the attitude regarding organ donation among degree students.

H02: There will be no significant association between knowledge and attitude regarding organ donation with their selected demographic variables among degree students.

7 6.9 Reaearch variables

Independent variable: Organ Donation

Dependent variable : Knowledge and attitude regarding organ donation

Associate variables : Age, gender, income, type degree, religion etc. 7. MATERIALS AND METHODS

RESEARCH DESIGN : The research design adopted for this study is

co – relational descriptive survey. 7.1 SOURCE OF DATA COLLECTION; SETTING : Selected degree colleges of Gulbarga POPULATION : The population included in this study is degree students. 7.2 METHODS OF DATA COLLECTION Data Collection Methods : Structured knowledge questionnaire and attitude scale. SAMPLE AND SAMPLING CRITERIA; Inclusive criteria:

 Degree students particularly of arts, science and commerce.

 Both male and female.

 Those who are willing to participate in the study.

 Those who are present during study Exclusive criteria;

 Those who are not willing to participate in the study.

 Those who are absent during study.

SAMPLING TECHNIQUE: Systematic random sampling technique will be used. SAMPLE SIZE : The sample size for this study is 100.

Data collection instruments:

8 Part I : Demographic data. Part II : Structured knowledge questionnaire. Part III : Structured Attitude scale.

Plan of data analysis: Frequency and percentage distribution. Both descriptive and inferential statistics. Mean median, range and S.D. Chi square test 7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY.

- Yes – A formal prior informed consent will be taken from the degree students. 7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3? - Yes - a. Permission will be obtained from the concerned person and ethical committee of H.K.E.S. College Of Nursing b. Concerned authority of selected colleges. c. Consent from all the participants

9 8. LIST OF REFERENCES

1. Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, INDIA. About organ donation htpp://www.sgrh.com/subcat.aspx?id=51 2. Science Daily. Your source for the latest research news. Full article at Wikipedia.org,

http://www.sciencedaily.com/articles/o/organtransplant.htm

3. Nursing times , July 9 2002, Volume 98, No 28.

4. Introduction to organ donation. Organ transplantation is a routine, life-saving procedure, but demand for organs far outstrips supply. www.wellcomecollection.org/what-on/events/in-or-out/organ- doantion.aspx 5. Bradley Y. Higginbotham. An examination of the impact of the organ donation breakthrough collaborative on kidney transplant activity. M.sc [thesis]. Auburn: Auburn University : August 2009 6. The need for organ Donation- health news story- WSOC- charlotte. http://www.wsoctv.com/health/5355218/detail.htm 7. A. Porkodi, Reader, Department of Medical-surgical Nursing, SRU, Porur, Chennai. Nightingale Nursing Times. August 2011: Volume 7, Number 5,page no 24-26. 8. American Osteopathic Association. AOA. Giving the Gift of Life at the End of Life. http://www.oestopathic.org/oesteopathic-health/about-your-health/health-condition-library/general- health/pages/organ-donation.aspx. 9. National Women's Health Information Center. A service of U.S National library of medicine, NIH. http://www.nim.nih.gov/medlineplus/organdonation.html. 10. Dr. Vatsala Trivedi M S, M.Ch.,FR.C.H.,. Organ Donation Noble Donation. www.karmayog.org/.../bodyorgan/organ%20donation%20noble%20... 11. Ways of Remembering . To Remember Me - Organ Donation. Journey of Hearts A Healing Place in CyberSpace. http://www.journeyofhearts.org/kirstimd/remember.htm 12. Dr Rakesh kumar srivastava, Director General of Health Services, Ministry of Health and Family Welfare, Government Of India. Transplantation Volume 91, November 11S, June 15, 2011. 13. Unite for sight. Global eye health statistics. http://www.uniteforsight.org/eye stats.php 14. Netra daan The greatest gift of all. Blind statistics in India Eye donation. http://www.netradaan.com/blindstatistics-India.php 15. Kidney and Urologic Diseases Statistics for the United States page – National Kidney and Urologic Disease Information Clearinghouse (NKDIC). A service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) 16. Sarah LWhite,Stevens J Chadban, Stephen Jan,Jeremy R Chapaman,Alan Cass. Bulletin of the World Health Organisation. www.who.int/entity/bulletin/volumes/86/3/07-041715/en/ - 56k. 17. Horton RL, Horton PJ Knowledge regarding organ donation: Identifying and overcoming barriers of organ donation. PUBMED Soc Sci med 1990:31(7) 791-800

10 18. Catalina Conesa et.al. Socio-personal profile of teenagers opposed to organ donation. Oxford Journal, Nephrology Dialysis Transplantation, November 26, 2003. Volume 19, Issue 5, pages 1269-1275. 19. Government of Karnataka, Directorate of Health and Family Welfare. http://stg2.kar.nic.in/healthnews/NRHM/Blindness.aspx. 20. Anita Gupta, Sudhir Jain,tanu Jain,KaranGupta. Awareness and perception regarding eye donation in students of a nursing college in Bangalore. Indian Journal Of Community Medicine Year 2009 : Volume 34 , Issue 2 ,Page 122-125.

21. Rakhi Dandona BOptom et.al. Awareness of eye donation in the urban population of India. Australian and New Zealand Journal of Opthamology, Volume 27, Issue 3-4, pages 166-169. June 1999. Article first published online 22 July, 2008. 22. S Krishnaiah et.al. Awareness of eye donation in the rural population of India. Community eye care.Indian Journal of Ophthalmology (2004) Volume 52, Issue 1, pages 73-78. 23. Catalina Conesa et.al. Socio-personal factors influencing public health attitude towards living donation in south-eastern Spain. Oxford Journal, Medicine, Nephrology Dialysis Transplantation, year 2004:Volume 19, Issue 11, pages 2874-2882. 24. Evanisko MJ et.al. Readiness of critical care physicians and nurses to handle requests for organ donation. American Journal of critical care and official publication American Association of critical Nurses(1998), Volume 7, Issue 1, Pages 1-12. 25. LK McCoy and SK Bell. Organ donation and rural critical care nurse. American journal of critical care. December 1, 1994, Volume 3, No 6, 473-475 26. Rajinder P. Singh et.al. kidney transplantation from donation after cardiac death donors: lack of impact of delayed graft function on post-transplant outcomes. Clinical Transplantation. Volume 25, Issue 2, pages 255-264, March/April 2011. 27. Francis L. Weng, Peter P, Reese, Shamkant Mulgaonkar, Anup M.patel. Barriers to Living Donor Kidney Transplantation among Black or Older Transplant Candidates.Clinical journal of the American society of Nephrology. December 2010, Volume 5, No 12, page 2338-2347.

11 9 SIGNATURE OF CANDIDATE :

10 REMARK OF GUIDE :

11 11.1 NAME AND DESIGNATION : OF THE GUIDE

11.2 SIGNATURE :

11.3 CO-GUIDE (IF ANY) :

11.4 SIGNATURE :

: 11.5 HEAD OF THE DEPARTMENT

11.6 SIGNATURE :

12 12 12.1 REMARKS OF THE : CHAIRMAN AND PRINCIPAL

12.2 SIGNATURE :