Age |
Years |
Sex |
a) Male |
b) Female |
Education (Highest level achieved) |
a) Less than high school graduate |
b) High school or associate bachelor's degree |
c) College graduate |
d) Postgraduate degree |
Occupation |
a) Student |
b) Professional/employee |
c) Business |
d) Unemployed/Retired/Housewife |
Marital status |
a) Single |
b) Married |
Do you agree to have your organs donated after death |
a) Yes, I agree |
b) Un-decisive |
c) No, I don't agree |
If you disagreed to donate your organs after death, what could be the reason? |
a) I do not have enough knowledge about the importance of deceased organ donation. |
b) I am not certain about the religious standpoint. |
c) I feel uneasiness about the idea of corpse manipulation. |
d) I would like my body to be buried intact. |
e) I believe that retrieving organs from dead bodies is ethically unsound. |
f) I never thought about organ donation before. |
g) I do not wish to give a reason. |
h) I have other reasons. Please specify …………. |