Effects of Theoretical and Clinical Education on Nursing Students’ Knowledge and Attitude Toward the Organ Donation Process

1. INTRODUCTION

Organ transplantation is a preferred treatment for patients with chronic organ failure, involving the transfer of a healthy organ from a donor [1]. It is one of the great advances in modern medicine that improves the quality of life and increases life expectancy for the person receiving the organ [2]. The World Health Organization (WHO) defines brain death for organ donation based on neurological criteria, while circulatory arrest is assessed using cardiopulmonary criteria [3]. With the development of special care and resuscitation techniques, patients with cardiorespiratory arrest can be rescued, so currently, donation after brain death is the standard strategy for organ transplantation [4, 5]. The prevalence of organ transplantation requirements is about 25000 per year in Iran [2, 6]. However, according to the latest studies, about 5 to 8 thousand brain deaths occur annually in Iran, but only 30% of patients receive organs [7]. The organ donation rate is 43.4 per million in Spain and between 20 and 30 per million in the United States. However, in Iran, the organ donation rate was about 14.34 per million in 2019, which ranked Iran in 21st place in the world [8, 9].

Identifying the obstacles and misconceptions surrounding organ donation is essential to save lives and enhance the willingness to donate organs [10]. Among these factors are religious beliefs [11, 12], level of education [13], and finally, making the deceased person's organ donation subject to the consent of his family and not paying attention to the legal effects of the organ donation card issued to the person [2]. According to reports from the Organ Donation Center, there is a 27.7% chance that a potential organ donor converts into an actual donor [5]. As a result, it is necessary to train specialists to convince families of brain-dead individuals to donate the organs of the deceased. Physicians and nurses have more significant roles in achieving this goal [14]. Nurses are among the most critical members of the donation team, and they have a positive attitude and good knowledge that can facilitate the organ donation process [15]. Based on a previous study, the knowledge and attitude of nurses working in the intensive care units (ICU), especially nurses with organ donation cards, can play an influential role in encouraging the families of brain-dead patients toward organ donation [16]. A study indicated that staff in emergency and specialty care departments require educational programs to improve their understanding of brain death and organ donation. It is better to start training at the university level, and such efforts will significantly improve the positive attitudes toward organ donation in Iran [7, 17].

Since enhancing organ donation is a key treatment priority, increasing knowledge and fostering a positive attitude among nurses can empower them to persuade the families of deceased individuals to donate organs, thereby addressing the shortage of available organs. Workshops, educational booklets, and clinical training are among the best ways to increase nurses' knowledge of this goal. The training can start from various educational and occupational levels [14]. Training nursing students is viewed as a vital strategy to boost future organ donations in Iran, which can help ensure that necessary organs are available for patients in need [18, 19]. However, despite the recognized importance of education, few studies in Iran have directly compared the effects of different educational approaches—such as theoretical instruction alone versus combined theoretical and clinical training—on nursing students’ knowledge and attitudes toward organ donation. Most existing studies have focused on practicing nurses rather than nursing students, leaving a gap in understanding how early educational interventions can shape future nurses’ readiness to promote organ donation [20].

Therefore, the unique contribution of this study lies in evaluating and comparing the impact of theoretical and combined (theoretical plus clinical) training on nursing students’ knowledge and attitudes regarding organ donation. This approach provides evidence on the most effective educational strategy to cultivate positive attitudes among future nurses, who will play a key role in advocating for organ donation in clinical settings [14, 20].

Based on this objective, the study tests the following hypotheses:

H1: Theoretical training significantly increases nursing students’ knowledge of organ donation compared with the control group.

H2: Combined theoretical and clinical training significantly improves nursing students’ attitudes toward organ donation compared with both theoretical training alone and the control group.

Consequently, this study seeks to examine the impact of theoretical training, as well as a combination of theoretical and clinical training, on nursing students' attitudes and knowledge regarding organ donation, and to compare these outcomes with those of a control group.

2. MATERIALS AND METHODS

3. RESULTS

Demographic data are presented in Table 1. The average age of the participants was 23.07 ± 2.38 years, with 61.1% being female. Table 1 also includes additional information regarding marital status, familiarity with the donation card unit, history of blood donation, social activities, and training.

Table 2 compares the pre-and post-intervention mean scores of knowledge and attitude among the three groups. The results indicate a significant difference among the three groups in both pre-and post-tests (p < 0.05). The results of ANOVA showed that after controlling for pre-scores, there was a significant difference between the three groups (p <0.001).

The results of the post hoc test for multiple comparisons are shown in Table 3. There was a significant difference in the knowledge scores between the theoretical training and combined theoretical-clinical training groups compared to the control group (p < 0.001), while no significant difference (p = 0.664) was found between the knowledge scores of the two intervention groups (Table 3). However, the attitude scores among all three groups showed significant differences. These findings are summarized in Table 3.

4. DISCUSSION

The present study aimed to assess the effects of theoretical training and a combination of theoretical and clinical training on the knowledge and attitudes of nursing students at Mashhad University of Medical Sciences regarding organ donation from 2021 to 2022. The results indicated that training enhances nursing students' knowledge and positively alters their attitudes. Initially, there was a difference in average knowledge and attitude scores between the intervention and control groups. This finding may have been influenced by various factors, such as the severity of the diseases of patients visited by nursing students, socioeconomic status, or workload. However, following the intervention, the mean scores for knowledge and attitude improved in both intervention groups.

The study revealed no significant difference in knowledge gain between the theoretical-only group and the combined theoretical-clinical training group. This outcome implies that the addition of brief clinical exposure, on its own, may not substantially enhance learning when theoretical teaching is already thorough and well-structured. One plausible reason is that the students’ time in the clinical setting was short and primarily observational, offering limited opportunity to apply or internalize theoretical concepts. It is also possible that, during their encounters with brain-dead patients, the students concentrated more on the emotional and ethical dimensions of the situation rather than on its procedural or technical aspects, which could explain the modest improvement in measured knowledge.

Abbasi Dolatabadi and colleagues reported similar findings in Tehran [20]. Additionally, Manzari and colleagues noted an increase in nurses' knowledge, attitudes, and performance regarding the organ donation process after implementing an indigenous model focused on continuous improvement and assurance in the organ donation process. They also advocated for the use of educational workshops and materials [21].

In a 2020 study involving 384 medical students in Mexico, Marvan and colleagues found that students, particularly nursing students, exhibited a lack of knowledge and negative attitudes toward organ donation. Some participants believed that recovery was possible after brain death, while others mistakenly thought there was an age limit for organ donation [22]. Almutairi and colleagues conducted research with 467 students from medicine, dentistry, nursing, physiotherapy, and paramedicine to assess their knowledge, attitudes, and willingness to donate organs in their final year of study. The findings revealed low scores across all fields, except for medicine and physiotherapy students. Additionally, female students outperformed male students in all three areas [23]. Valiee and colleagues investigated nurses' knowledge and attitudes regarding organ donation, discovering that most participants lacked a donation card and that overall knowledge and attitudes were low [17]. The results of various studies indicate that nurses play a crucial role in promoting organ donation and that training significantly enhances their knowledge and attitudes [14].

In the current study, prior to the intervention, all students exhibited positive attitudes toward organ donation. However, only a small number of students possessed an organ donation card or had a history of blood donation. This finding reflects the persistent gap between attitude and behavioral intention. Taghiabadi and colleagues found similar results, noting that while nursing students held a positive attitude toward organ donation, only a few had an organ donation card [24]. Furthermore, Chen and colleagues demonstrated that individuals with a history of blood donation were more inclined to donate organs [25].

Amani and colleagues found that 68% of students received information about organ donation from the media [26]. This highlights the importance of mass media and social campaigns in shaping public and professional awareness. Consequently, raising public knowledge by honoring donor families at ceremonies featuring artists and religious leaders on television could enhance families' understanding of the importance and moral significance of organ donation.

Both theoretical training and combined theoretical–clinical training in the current study increased knowledge and attitude levels, although the change in attitude was less pronounced than that in knowledge. This outcome suggests that attitude modification requires sustained reinforcement through repeated exposure, discussion, and role modeling rather than short-term instruction.

Currently, there is no educational program within the nursing curriculum that addresses organ donation topics. In line with DÜKEN and YAYAN, who explored the long-term psychosocial impacts on organ recipients, it becomes clear that nursing education should go beyond the technical and procedural aspects of organ donation. The findings of the present study can inform curriculum development by integrating teaching materials that address not only the organ donation process but also the psychosocial challenges faced by recipients and their families, including post-transplant adjustment and the need for family support. Such holistic training can prepare nursing students to handle the emotional and ethical complexities of transplantation, ultimately improving patient and family care outcomes.

5. LIMITATIONS AND RECOMMENDATIONS

This study has several limitations that should be acknowledged. The first relates to the sample size and selection. The research involved 90 nursing students from two universities, which limits the generalizability of the findings. A small and geographically restricted sample reduces statistical power and may not represent the broader nursing student population across diverse cultural or institutional settings.

The composition of the control group also warrants attention. The control participants were drawn from a different university, introducing potential variability in academic standards, curriculum exposure, and learning environments. Such institutional differences may have influenced baseline knowledge or attitudes, thereby affecting the comparability of groups and the internal validity of the findings.

Another limitation involves the use of self-reported questionnaires to measure knowledge and attitudes. Although convenient, self-reports are prone to social desirability and recall biases, meaning participants may have provided responses they perceived as favorable rather than reflecting their actual understanding or beliefs.

Additionally, the study did not examine how socioeconomic, cultural, or religious factors might shape students’ perceptions and willingness to donate. Neglecting these contextual influences may have limited the depth of interpretation, as such factors can play a pivotal role in shaping ethical decision-making and personal attitudes toward organ donation [17].

Future studies should aim to address these limitations by employing larger, more diverse samples and utilizing randomized controlled trial (RCT) designs within a single academic institution to reduce confounding effects. Incorporating mixed-method approaches—combining quantitative assessments with qualitative interviews—could provide richer insight into how education influences both cognitive and emotional dimensions of attitude change. Moreover, future educational interventions should integrate structured reflection and cultural sensitivity components to more effectively translate knowledge gains into sustained attitudinal and behavioral changes.

CONCLUSION

This research underscores the important role that education plays in shaping nursing students' understanding and attitudes toward organ donation. The study found that both theoretical training and a combination of theoretical and clinical experiences significantly improved students' knowledge and perspectives compared to those who did not receive any training.

The results clearly indicate that well-structured educational programs can enhance nursing students' knowledge and positively influence their attitudes, which is crucial as these future professionals often engage with families during sensitive moments regarding organ donation decisions.

While both training interventions were effective in enhancing attitudes, the improvement was more pronounced in the combined training group, highlighting the potential benefits of clinical exposure. These results underscore the importance of integrating practical experiences into nursing education to foster positive attitudes toward organ donation.

However, it is essential to note that changes in attitude do not necessarily translate to behavioral changes in real-world scenarios. Future research should focus on longitudinal studies to evaluate the lasting effects of such educational interventions and their impact on actual organ donation rates.

REFERENCES