The public's attitudes toward incentives for organ donation

Beliefs and Intention to Organ Donation: A Household Survey

Background

Organ transplantation is considered as the last therapeutic option for the treatment for end-stage organ failure. However, the gap between the demand and supply of transplantable organs is still wide. Extensive researches have been conducted to understand this gap, and many countries have introduced Opt-out laws and have started targeted awareness programs. We aimed to assess, among the household residents, the normative behavior and beliefs and its correlation to intentions toward becoming organ donors.

Subjects and Methods

A household survey with the resident population of Qatar was conducted from October 2016 to November 2016. A sample of 1044 individuals aged 18 and above, residing in eight municipalities within the country, was selected using a two-stage systematic random sampling method to understand the relationship between organ donation intentions and behavioral, normative, and control beliefs. Independent female enumerators collected data on electronic tablets and exported to SPSS for data analysis.

Results

Data from 930/1044 (89%) individuals responded to the intention-related questions were taken for final analysis. Multivariate analysis brought out that behavioral beliefs (standardized beta coefficient = 0.25, t = 6.5, P = 0.001) and normative beliefs (standardized beta coefficient = 0.32, t = 8.4, P = 0.001) were significant contributors to intention to donate organs whereas control beliefs (standardized beta coefficient = -0.07, t = -2.3, P = 0.02) were negatively associated to organ donation intention.

Conclusions

Findings indicate that behavioral and normative beliefs play a very important role in contributing to the intention of the individual toward organ donation.

Filling the Organ Donor Pool by Giving Priority

CONTEXT

Many of the alternatives for procuring donor organs are considered either ineffective, unethical, or illegal. One possibility that may not face such challenges is a priority system whereby individuals who register as an organ donor are given priority to receive an organ over those who have not registered. However, providing extrinsic rewards can sometimes paradoxically reduce the target behavior, especially for those who are more altruistically motivated.

METHODS

Two behavioral experiments were employed and data were analyzed using regressions as well as examining open-ended responses.

FINDINGS

The results suggest that giving priority to receive an organ to those who register to donate postmortem could increase overall registration rates. Further, the effect of providing priority appears to work by inducing anticipated regret, which can be used to overcome common obstacles to registration. Finally, it was found that a priority system is most effective in increasing donor rates for those individuals who are less altruistically motivated and does not reduce registration rates for those who are more altruistically motivated.

CONCLUSIONS

Given the unabated shortage of transplant organs, the finding that a priority system could increase the willingness to register as a donor without crowding out altruistically motivated individuals is highly encouraging.

Educate, Re-educate, Then Re-educate: Organ Donation-centered Attitudes Should Be Established in Society

OBJECTIVE

The objectives of the study are to evaluate knowledge and attitudes toward organ and tissue donation, to pursue a deeper understanding of attitudes toward organ donation, and to gain an understanding of the underlying, personal reasoning for the desired action in organ donation among the adult population.

METHODS

Four thousand people were interviewed who were selected by the simple random sample type. A survey was conducted by voluntary, face-to-face interviews using a printed 25-item questionnaire form presented to street-recruited individuals over 18 years of age.

RESULTS

In the study, where male/female distribution was represented equally, the majority of participants consisted of young and middle-aged, primary school graduates between the ages of 25 to 44 years. Although 91.1% of the respondents stated that they support organ donation, only 75.3% stated they wanted to donate organs. Organ donation-centeredness rates were low in those who did not finish a primary school education, people with a low household income, and those ≥65 years age group. A majority of the respondents (91.2%) were found to be against financial incentives for organ donation. Although 91.4% of the participants stated that organ donation is important if the recipient is a relative, this ratio decreased to 86.7% for a nonrelative. In our study, the level of accepting an organ as a recipient from an unknown person was 9.1% higher than the rate of willingness to donate to an unknown person. Surprisingly, despite 84% saying their religion is not against organ donation, 38.4% of the respondents cited religious concerns as the main reason for unwillingness and 58% of them indicated that they were reluctant to donate organs due to religious beliefs.

CONCLUSIONS

It is important to know that it is not certain that anyone who is hypothetically in favor of organ donation will donate when faced with a real choice. Increasing the number of donors is the most important issue in order to benefit more patients in transplantation, which has achieved a very important success level through serious efforts. The majority of Turkey's population know about organ donation, support transplantation, and would be willing to donate their organs. Most of the respondents find it religiously correct and believe that it is an acceptable lifesaving procedure. However, a high percentage did not know how to donate, and they indicated that the information available on the subject is insufficient. Mass media campaigns and educational activities could resolve this matter and increase organ donation. According to the results of our study, when considering the number of patients who died while waiting for transplantation, organ donation awareness projects that are focused on converting knowledge to behavior are believed to be very critical. It is important to provide organ donation-oriented training at every educational level.

Priority in Organ Allocation to Previously Registered Donors: Public Perceptions of the Fairness and Effectiveness of Priority Systems

A priority system is one in which previously registered donors receive a preference in the allocation of organs for transplant ahead of those who have not registered. Supporters justify these systems on the basis that they are fair and will encourage donor registration. This article reviews existing studies of public reactions to priority systems, as well as studies of the extent to which the moral principle of reciprocity affects decision making in organ donation. The role of reciprocity in the public discourse surrounding the enactment of priority systems in Singapore and Israel is described. One factor that seems to have been relevant in these countries is the existence of a religious minority that is perceived as willing to take an organ but not to donate one. Although this perception may have fueled a resentment of perceived “free-riders,” concerns were raised about the social divisiveness of priority systems. In sum, people appear to be sensitive to the principle of reciprocity in the context of organ donation, but this sensitivity does not always translate into support for priority systems. Further research into whether public messaging about organ donation could be modified to encourage registration by appeal to the golden rule would be worthwhile.

Attitudes toward strategies to increase organ donation: views of the general public and health professionals

BACKGROUND AND OBJECTIVE

The acceptability of financial incentives for organ donation is contentious. This study sought to determine (1) the acceptability of expense reimbursement or financial incentives by the general public, health professionals involved with organ donation and transplantation, and those with or affected by kidney disease and (2) for the public, whether financial incentives would alter their willingness to consider donation.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Web-based survey administered to members of the Canadian public, health professionals, and people with or affected by kidney disease asking questions regarding acceptability of strategies to increase living and deceased kidney donation and willingness to donate a kidney under various financial incentives.

RESULTS

Responses were collected from 2004 members of the Canadian public October 11-18, 2011; responses from health professionals (n=339) and people with or affected by kidney disease (n=268) were collected during a 4-week period commencing October 11, 2011. Acceptability of one or more financial incentives to increase deceased and living donation was noted in >70% and 40% of all groups, respectively. Support for monetary payment for living donors was 45%, 14%, and 27% for the public, health professionals, and people with or affected by kidney disease, respectively. Overall, reimbursement of funeral expenses for deceased donors and a tax break for living donors were the most acceptable.

CONCLUSION

The general public views regulated financial incentives for living and deceased donation to be acceptable. Future research needs to examine the impact of financial incentives on rates of deceased and living donors.

In defense of a regulated system of compensation for living donation

PURPOSE OF REVIEW

The organ shortage is the major problem in kidney transplantation today. Despite aggressive organ procurement efforts, the supply of donated kidneys, living and deceased, has not matched the growing demand; as a consequence, more and more qualified candidates are suffering on dialysis and then dying before being transplanted. Herein, we provide justification for a regulated system of compensation for donation.

RECENT FINDINGS

The main argument in favor of compensation is simple-financial incentives will increase donation, so fewer transplant candidates will suffer and die while waiting. In addition, development of a regulated system of compensation is the most effective means of crippling the core economic support for transplant tourism. Because dialysis is so much more expensive than a transplant, compensated donation could be cost-neutral to the healthcare system. Importantly, opinion polls suggest that the public would support compensation. As uncompensated kidney donation is widely accepted, persuasive arguments against compensation must explain why such a system would be morally distinguishable from uncompensated donation.

SUMMARY

We suggest that the potential advantages of a regulated system of compensation for donation far outweigh any potential disadvantages. It is time to advocate for a change in the law so that trials can be done.

Knowledge, attitudes, and behaviors of officials of religion about organ donation in Kahramanmaras, an eastern Mediterranean city of Turkey

OBJECTIVE

To establish the knowledge, attitudes, and behaviors of the officials of religion, a group with potentially powerful influence on the society, in particular regarding organ donation.

METHODS

This study, performed in Kahramanmaras Province, Turkey, included 416 of 641 officials of religion (64.9%): 295 of 492 imams (59.9%) and 121 of 149 Koran course educators (81.2%).

RESULTS

The mean (SD) age of the study group was 37.2 (8.2) years. Only 1.4% had stated that carried organ donation cards. Of participants who had not donated organs asked whether they thought of donation, 14.1% answered yes, 17.1% answered no, and 68.8% were undecided. Of the study group, 88.2% considered organ donation appropriate according to their religion. The imams compared with Koran course educators, and men compared with women demonstrated higher rates of considering organ donation appropriate according to their religion (P < .05). Among participants who stated they had knowledge about organ donation, the 3 leading information sources were television, newspapers or journals, and in-service training by the Directorate of Religious Affairs. The 3 primary organs the study group stated they were aware of being transplanted were kidneys, liver, and heart.

CONCLUSION

Although 88.2% of religious officials in the present study stated that organ donation was appropriate according to their religion, only 1.4% agreed to donate organs. Officials of religion hold an important place in society, and should be well informed and educated about organ donation via in-service training courses, and encourage organ donation by members of society.

Regulated payments for living kidney donation: an empirical assessment of the ethical concerns

BACKGROUND

Although regulated payments to encourage living kidney donation could reduce morbidity and mortality among patients waiting for a kidney transplant, doing so raises several ethical concerns.

OBJECTIVE

To determine the extent to which the 3 main concerns with paying kidney donors might manifest if a regulated market were created.

DESIGN

Cross-sectional study of participants' willingness to donate a kidney in 12 scenarios.

SETTING

Regional rail and urban trolley lines in Philadelphia County, Philadelphia, Pennsylvania.

PARTICIPANTS

Of 550 potential participants, 409 completed the questionnaire (response rate, 74.4%); 342 of these participants were medically eligible to donate.

INTERVENTION

Across scenarios, researchers experimentally manipulated the amount of money that participants would receive, the participants' risk for subsequently developing kidney failure themselves, and who would receive the donated kidney.

MEASUREMENTS

The researchers determined whether payment represents an undue inducement by evaluating participants' sensitivity to risk in relation to the payment offered or an unjust inducement by evaluating participants' sensitivity to payment as a function of their annual income. The researchers also evaluated whether introducing payment would hinder altruistic donations by comparing participants' willingness to donate altruistically before versus after the introduction of payments.

RESULTS

Generalized estimating equation models revealed that participants' willingness to donate increased significantly as their risk for kidney failure decreased, as the payment offered increased, and when the kidney recipient was a family member rather than a patient on a public waiting list (P < 0.001 for each). No statistical interactions were identified between payment and risk (odds ratio, 1.00 [95% CI, 0.96 to 1.03]) or between payment and income (odds ratio, 1.01 [CI, 0.99 to 1.03]). The proximity of these estimates to 1.0 and narrowness of the CIs suggest that payment is neither an undue nor an unjust inducement, respectively. Alerting participants to the possibility of payment did not alter their willingness to donate for altruistic reasons (P = 0.40).

LIMITATION

Choices revealed in hypothetical scenarios may not reflect real-world behaviors.

CONCLUSION

Theoretical concerns about paying persons for living kidney donation are not corroborated by empirical evidence. A real-world test of regulated payments for kidney donation is needed to definitively show whether payment provides a viable and ethical method to increase the supply of kidneys available for transplantation.

PRIMARY FUNDING SOURCE

None.

Knowledge and attitude of donor cardholders toward organ and tissue donation and transplantation in an Iranian tissue bank: a case-control study

BACKGROUND

Cadaveric organ shortage is the most important obstacle to more widespread provision of transplants. Many factors influence the donation rate: social factors, religion, familial relations, and especially knowledge and attitudes toward organ and tissue donation and transplantation. Increasing public awareness can reform the incorrect beliefs and myths about donation and transplantation. This study investigated knowledge and attitudes of donor cardholders toward organ and tissue donation as well as transplantation.

METHODS

This case-control study was performed in 2006 among 178 donor cardholders and the same number of a control group who completed a questionnaire including 23 questions and demographic information.

FINDINGS

Knowledge and attitude among the cardholder was significantly greater than the control group (P < .05). We observed a inverse correlation between age and a positive attitude toward donation and transplantation among cardholders.

CONCLUSION

This study suggested that the main reasons for refusal to donate organ and tissue were insufficient knowledge and negative attitudes due to misinformation regarding donation and transplantation. We believe that educating and motivating the public via the mass media can increase the rate of consent for organ and tissue donation and transplantation.

A household study to determine attitudes and beliefs related to organ transplantation and donation: a pilot study in Yapracik Village, Ankara, Turkey

Rural areas display adverse attitudes toward organ donation. Through a population-based cross-sectional study of people 18 years of age or older in the rural area of Ankara, Yapracik Village, Turkey, we identified the attitudes and beliefs of people related to organ transplantation and organ donation. The research universe included 87 people in 75 households. The research instrument was a questionnaire. None of the respondents had been involved in organ donation. The percentage of willingness to donate an organ was 47% which was significantly associated with younger age, including 34.4% who expressed willingness while alive. Twenty-five percent believed that their religion is adverse to transplantation, 28% thought it would create pain in death, 20% were afraid, and 83% believed in life afterwards, 15% said that their custom and usage were adverse to organ donation, 50% stated that they can accept organ donation from other races, and 65% stated that they can request organs from their friends. Eighty percent thought that organ donation is a gift given to a human; 34% of them stated that they can be a donor while they are alive. Fifty-four percent of respondents stated that they wanted to get information about organ donation and transplantation. Therefore basic educational campaigns targeting the increase of knowledge about organ donation are warranted in the rural population. There is a need to increase awareness about organ donation and transplantation. Findings like those in this study will help campaigns conducted for organ donation.

Do incentives matter? Providing benefits to families of organ donors

Whether the number of organs available for transplant would be positively or negatively affected by providing benefits to families of organ donors has been debated by policymakers, ethicists and the transplant community at large. We designed a telephone survey to measure public opinion regarding the use of benefits in general and of five types in particular: funeral benefits, charitable contributions, travel/lodging expenses, direct payments and medical expenses. Of the 971 adults who completed the survey (response rate = 69%), all were from Pennsylvania households, 45.6% were registered organ donors, and 51.7% were nonwhite. Although 59% of respondents favored the general idea of incentives, support for specific incentives ranged from 53% (direct payment) to 84% (medical expenses). Among those registered as donors, more nonwhites than whites supported funeral benefits (88% vs. 81%; p = 0.038), direct payment (63% vs. 41%; p < 0.001) and medical expenses (92% vs. 84%; p = 0.013). Among those not registered as donors, more nonwhites supported direct payment (64% vs. 46%; p = 0.001). Most respondents believed that benefits would not influence their own behavior concerning donation but would influence the behavior of others. While benefits appear to be favored, their true impact can only be assessed through pilot programs.

Public Knowledge and Attitudes Toward Organ Donation and Transplantation: A Cross-Cultural Study

OBJECTIVE

The aim of this study was to determine the knowledge, attitudes, awareness, and determinants of organ donation and transplantation in a Qatari population.

DESIGN

This is a cross-sectional study to determine the knowledge and attitude toward organ donation in a Peninsula Arabian Gulf country.

SETTING

The setting was Primary Health Care (PHC) Centers and community-based study in Qatar.

SUBJECTS

A multistage sampling design was used in a representative sample of 1600 Qataris and non-Qataris, including males and females of at least 17 years of age, from October 2003 to May 2004. In this study a 1305 (81.5%) subjects participated, each giving consent for the study.

MEASUREMENTS

Participants completed a questionnaire assessing their knowledge, attitudes, and awareness for organ donation.

RESULTS

Of 1305 samples, 637 (48.8%) males and 668 females (51.2%) living in urban and semiurban areas agreed to participate and complete the questionnaire. Of these, 762 (58.4%) were Qataris. There was a significant difference between Qataris and non-Qataris with respect to their age, educational level, monthly income, and occupation. In this study, 31.6% of Qataris and 29.8% of non-Qataris had no idea about the organ donation; 37.8% of Qataris and 32.8% of non-Qataris were willing to donate their organs. The majority of subjects preferred donating organs to their close relatives and friends. However, 83.8% of the studied subjects did not agree with an incentive-based approach for donating organs.

CONCLUSION

This study showed that people should not be blamed for not being willing to participate in organ donation, but the health system and health education providers are responsible. A more effective approach should be tried regarding health education.

Altruism, Incentives, and Organ Donation

OBJECTIVES

This study investigated the attitudes of the transplant community toward the current policy of altruistic organ donation and 6 alternative policies offering incentives to the donor family.

METHODS

Two hundred forty-nine transplant surgeons, 143 transplant coordinators, and 134 critical-care nurses rated the moral appropriateness and success of the current policy of altruistic donation, rated the moral appropriateness of the alternative policies, judged whether donation would increase or decrease under each alternative policy, and decided whether each alternative policy should be put into effect.

RESULTS

All 3 professions believed the current policy of altruistic organ donation to be morally appropriate and most of the alternative policies to be morally appropriate or morally neutral. All 3 professions believed the current policy to be at best only moderately successful and judged most or all of the alternative policies to be likely to increase donation. All 3 professions favored implementing a policy offering donor recognition; approximately one half of the surgeons and one half of the coordinators also advocated implementing a policy offering 1500 US dollars toward funeral expenses. In all 3 professions, respondents' decisions to implement the alternative policies were more frequently related to those policies' moral appropriateness than to their likelihood of increasing organ donation.

CONCLUSIONS

Specific incentives varied in their acceptability to the transplant community. Attitudes of the transplant community toward incentives were not in accord with published criticisms of incentives.

Commodifying life? A pilot study of opinions regarding financial incentives for organ donation

In recent years many policy proposals have been put forward to create financial incentives to encourage families to allow the harvesting of organs from their deceased relatives. While research has focused on whether these policies would actually increase the supply of organs, no research has focused on testing the ethical concerns about such policies. This article presents the findings of a pilot study conducted to determine whether people think that families should end life support of a family member in order to harvest organs if various incentive policies are in place. While the findings do not suggest a direct effect of these inducements, they do indicate that the amount of money received from organ donation is a consideration in making the decision whether to end life support. The implications of this finding for ethical debates and health policy are reviewed.