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Shepherd L, O’Carroll RE, Ferguson E. Assessing the influence of affective attitudes, demography and blood donor status on organ donor registration active decisions in opt-out systems. J Health Psychol 2024; 29:825-835. [PMID: 37968921 PMCID: PMC11264565 DOI: 10.1177/13591053231208531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
In contrast to opt-in systems, relatively little is known about what influences whether or not people register a decision about organ donation in opt-out systems. We address this gap in the literature. Participants (N = 756) living in a country with opt-out consent (Wales, UK) provided information on demographics and blood donor status. Participants indicated whether they had opted-in or opted-out (i.e. active decision), or not registered a decision under the assumption of deemed consent. Subsequently, their negative emotional beliefs (or affective attitudes) towards organ donation were measured. Opting-in was associated with being younger, having donated blood and holding superstitious beliefs about donation (jinx). Disgust (ick factor) deterred opting-in, and bodily integrity concerns increased opting-out. Positive affective attitudes increased opting-in and deterred opting-out. Actively opting-in increases the likelihood of organs being transplanted, thus, modifying affective attitudes and targeting blood donors should enhance the number of donors available under opt-out systems.
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Affiliation(s)
| | | | - Eamonn Ferguson
- University of Nottingham, UK
- Department of Public Health and Primary Care, National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, UK
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2
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Södereld T, Engström Å, Lindgren K, Forsberg A. Organ Donation: Behaviour and Beliefs in Sweden. SAGE Open Nurs 2024; 10:23779608241257011. [PMID: 38800088 PMCID: PMC11119402 DOI: 10.1177/23779608241257011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 04/14/2024] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Barely one-fifth of people in Sweden have expressed their will regarding organ donation in the national Swedish Donor Registry, and the number of organ donations in Sweden remains low. Objective The aim of this study was to map behaviour and beliefs regarding organ donation in Sweden. Methods In a descriptive cross-sectional survey following a quantitative approach and 600 questionnaires were issued to randomly selected individuals across Sweden. Of them, 206 (36.3%) were completed. Data were analysed using descriptive statistics and presented as frequencies and percentages. Analytical statistical testing involved Pearson chi-square tests, Mann-Whitney U tests, and Kruskal-Wallis tests. Results The results indicate a discrepancy between positive opinion about organ donation in Sweden and the number of people enrolled in the Swedish Donation Registry. The most common argument for not wanting to donate organs was the notion of being too old to. Although self-rated knowledge about organ donation was admittedly low, so was interest in interest in learning more about it. Younger patients more frequently wanted information than older patients did. Conclusion Not wanting to donate organs due to age and/or illness may indicate a misconception. Making one's will known does not involve assessing one's health status or age but solely concerns the wish to do so. The findings thus raise an important question: How can people's interest in learning more about organ donation be induced in ethical ways?
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Affiliation(s)
- Theres Södereld
- Lulea University of Technology, Department of Health, Education and Technology, Division of Nursing and Medical Technology, Luleå, Sweden
- Intensive Care Unit 57, Sunderby Hospital, Luleå, Sweden
| | - Åsa Engström
- Lulea University of Technology, Department of Health, Education and Technology, Division of Nursing and Medical Technology, Luleå, Sweden
| | | | - Angelica Forsberg
- Lulea University of Technology, Department of Health, Education and Technology, Division of Nursing and Medical Technology, Luleå, Sweden
- Intensive Care Unit 57, Sunderby Hospital, Luleå, Sweden
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3
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Isenor C, Weiss MJ, Beed S, Urquhart R, Tennankore K, Lucas A, Tomblin-Murphy G, Krmpotic K, Dhanani S, Sullivan V, West Oc LJ, Gongal P, Hartell D, Simpson C, James L, Landry A, Dirk J. Development of a consortium to examine organ donation legislative and system reforms: A report from the LEADDR consortium. Healthc Manage Forum 2023; 36:357-363. [PMID: 37253083 DOI: 10.1177/08404704231175024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In April 2019, the province of Nova Scotia became the first jurisdiction in North America to pass legislation that incorporated deemed consent for deceased organ donation. The reform included many other important updates, including the hierarchy for consent, enabled donor and recipient contact, and mandatory referral of potential deceased donors. Additionally, system reforms were implemented to improve the deceased donation system in Nova Scotia. A collection of national colleagues identified the magnitude of the opportunity to develop a comprehensive strategy to measure and evaluate the impact of the legislative and system reforms. This article describes the successful development of a consortium from both national and provincial jurisdictions that included experts from a variety of backgrounds and clinical and administrative disciplines. In describing the creation of this group, we hope to offer our case example as a model for the evaluation of other health system reforms from a multidisciplinary perspective.
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Affiliation(s)
- Cynthia Isenor
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Matthew J Weiss
- Transplant Québec, Montréal, Québec, Canada
- CHU de Québec-Université Laval Research Center, Laval, Québec, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Stephen Beed
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robin Urquhart
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Karthik Tennankore
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | - Kristina Krmpotic
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Sonny Dhanani
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | | | - Lori J West Oc
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
- University of Alberta, Edmonton, Alberta, Canada
| | - Patricia Gongal
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
- University of Alberta, Edmonton, Alberta, Canada
| | - David Hartell
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Christy Simpson
- Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Lee James
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Alain Landry
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Jade Dirk
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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Cowie S, Choy SH, Shah DM, Gomez MP, Yoong BK, Koong JK. Healthcare System Impact on Deceased Organ Donation and Transplantation: A Comparison Between the Top 10 Organ Donor Countries With 4 Countries in Southeast Asia. Transpl Int 2023; 36:11233. [PMID: 37711402 PMCID: PMC10498995 DOI: 10.3389/ti.2023.11233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/11/2023] [Indexed: 09/16/2023]
Abstract
The need for organ donation is constantly increasing. Some countries have made improvements, while others, such as countries in Southeast Asia (SEA), have some of the lowest rates of deceased donors (pmp). This review aims to compare 14 countries with regards to many variables related to healthcare systems. Countries leading in deceased organ donation spend more on health and education, which is associated with increased potential for deceased organ donation. Out-of-pocket expenditure, is also associated with a decrease in deceased organ donation. Countries in SEA are lacking in healthcare resources such as workforce and materials, which are both necessary for a successful transplant program. Most countries in SEA have an excellent foundation for successful organ donation systems, including proper legislation, government support, and brain death laws along with an overall acceptance of brain death diagnosis. Priorities should include improving coordination, donor identification, and healthcare worker education. Countries in SEA have a lot of potential to increase deceased organ donation, especially by investing in healthcare and education. There is no one size fits all for organ donation programs and countries in SEA should focus on their strengths and take cultural differences into consideration when planning interventions.
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Affiliation(s)
- Sandra Cowie
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Seow-Huey Choy
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | - Boon-Koon Yoong
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jun-Kit Koong
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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van Oosterhout SPC, van der Niet AG, Abdo WF, Boenink M, Cherpanath TGV, Epker JL, Kotsopoulos AM, van Mook WNKA, Sonneveld HPC, Volbeda M, Olthuis G, van Gurp JLP. How clinicians discuss patients' donor registrations of consent and presumed consent in donor conversations in an opt-out system: a qualitative embedded multiple-case study. Crit Care 2023; 27:299. [PMID: 37507800 PMCID: PMC10375668 DOI: 10.1186/s13054-023-04581-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The Netherlands introduced an opt-out donor system in 2020. While the default in (presumed) consent cases is donation, family involvement adds a crucial layer of influence when applying this default in clinical practice. We explored how clinicians discuss patients' donor registrations of (presumed) consent in donor conversations in the first years of the opt-out system. METHODS A qualitative embedded multiple-case study in eight Dutch hospitals. We performed a thematic analysis based on audio recordings and direct observations of donor conversations (n = 15, 7 consent and 8 presumed consent) and interviews with the clinicians involved (n = 16). RESULTS Clinicians' personal considerations, their prior experiences with the family and contextual factors in the clinicians' profession defined their points of departure for the conversations. Four routes to discuss patients' donor registrations were constructed. In the Consent route (A), clinicians followed patients' explicit donation wishes. With presumed consent, increased uncertainty in interpreting the donation wish appeared and prompted clinicians to refer to "the law" as a conversation starter and verify patients' wishes multiple times with the family. In the Presumed consent route (B), clinicians followed the law intending to effectuate donation, which was more easily achieved when families recognised and agreed with the registration. In the Consensus route (C), clinicians provided families some participation in decision-making, while in the Family consent route (D), families were given full decisional capacity to pursue optimal grief processing. CONCLUSION Donor conversations in an opt-out system are a complex interplay between seemingly straightforward donor registrations and clinician-family interactions. When clinicians are left with concerns regarding patients' consent or families' coping, families are given a larger role in the decision. A strict uniform application of the opt-out system is unfeasible. We suggest incorporating the four previously described routes in clinical training, stimulating discussions across cases, and encouraging public conversations about donation.
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Affiliation(s)
- Sanne P C van Oosterhout
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Kapittelweg 54, 6525 EP, Nijmegen, The Netherlands.
| | - Anneke G van der Niet
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Kapittelweg 54, 6525 EP, Nijmegen, The Netherlands
| | - W Farid Abdo
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marianne Boenink
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Kapittelweg 54, 6525 EP, Nijmegen, The Netherlands
| | - Thomas G V Cherpanath
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jelle L Epker
- Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Angela M Kotsopoulos
- Department of Intensive Care, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Walther N K A van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hans P C Sonneveld
- Department of Intensive Care Medicine, Isala Hospital, Zwolle, The Netherlands
| | - Meint Volbeda
- Department of Critical Care, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Gert Olthuis
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Kapittelweg 54, 6525 EP, Nijmegen, The Netherlands
| | - Jelle L P van Gurp
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Kapittelweg 54, 6525 EP, Nijmegen, The Netherlands
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Toews M, Chandler JA, Pope T, Pape R, Weiss M, Sandiumenge A. Legislation and Policy Recommendations on Organ and Tissue Donation and Transplantation From an International Consensus Forum. Transplant Direct 2023; 9:e1395. [PMID: 37138556 PMCID: PMC10150854 DOI: 10.1097/txd.0000000000001395] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/12/2022] [Accepted: 08/25/2022] [Indexed: 05/05/2023] Open
Abstract
There is a shared global commitment to improving baseline donation and transplantation performance metrics in a manner consistent with ethics and local cultural and social factors. The law is one tool that can help improve these metrics. Although legal systems vary across jurisdictions, our objective was to create expert, consensus guidance for law and policymakers on foundational issues underlying organ and tissue donation and transplantation (OTDT) systems around the world. Methods Using the nominal group technique, a group composed of legal academics, a transplant coordinator/clinician, and a patient partner identified topic areas and recommendations on foundational legal issues. The recommendations were informed by narrative literature reviews conducted by group members based on their areas of expertise, which yielded a range of academic articles, policy documents, and sources of law. Best practices were identified from relevant sources in each subtopic, which formed the basis of the recommendations contained herein. Results We reached consensus on 12 recommendations grouped into 5 subtopics: (i) legal definitions and legislative scope, (ii) consent requirements for donation' (iii) allocation of organs and tissue' (iv) operation of OTDT systems' and (v) travel for transplant and organ trafficking. We have differentiated between those foundational legal principles for which there is a firm basis of support with those requiring further consideration and resolution. Seven such areas of controversy are identified and discussed alongside relevant recommendations. Conclusions Our recommendations encompass some principles staunchly enshrined in the OTDT landscape (eg, the dead donor rule), whereas others reflect more recent developments in practice (eg, mandatory referral). Although some principles are widely accepted, there is not always consensus as to how they ought to be implemented. As the OTDT landscape continues to evolve, recommendations must be reconsidered for the law to keep pace with developments in knowledge, technology, and practice.
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Affiliation(s)
- Maeghan Toews
- University of Adelaide, Law School, Adelaide, SA, Australia
| | - Jennifer A. Chandler
- Faculty of Law and Centre for Health Law, Policy and Ethics, University of Ottawa, Ottawa, ON, Canada
| | - Thaddeus Pope
- Mitchell Hamline School of Law, Saint Paul, MN
- Fulbright Canada Research Chair in Health Law, Policy and Ethics, University of Ottawa, Ottawa, ON, Canada
| | - Roger Pape
- National Institutes for Health Research/NHS Blood and Transplant Research Unit, University of Cambridge and Newcastle University, Cambridge and Newcastle, UK
| | - Matthew Weiss
- Transplant Québec, Montréal, QC, Canada
- Division of Critical Care, Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, Québec, QC, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Alberto Sandiumenge
- Transplant Coordination Department, University Hospital Vall d'Hebron, Organ, Tissue and Cell Donation and Transplantation Research Group, Vall d'Hebron Research Instititute (VHIR), Barcelona, Spain
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Facial Allograft Donation: An Interpretative Phenomenological Analysis of the Experiences of Family Members. J Craniofac Surg 2023; 34:942-948. [PMID: 36744885 DOI: 10.1097/scs.0000000000009156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/24/2022] [Indexed: 02/07/2023] Open
Abstract
Facial allograft transplantation can be regarded as a particular and complex type of donation because of its perceptibility and the importance of the face as an identity characteristic. As research on this topic is currently lacking, the objective of this study is to explore the experiences of the family members of the donor in facial allograft donation. In-depth, semi-structured interviews were conducted separately with the donor's family members and analyzed using interpretative phenomenological analysis. Six themes were identified: (1) Contrasting facial donation to that of more commonly donated organs; (2) Consenting to facial donation; (3) Expectations towards the recipient of the facial graft; (4) Expectations and consequences of restoration of the donor's face; (5) Relationship with the medical team during the process; and (6) Media attention. The findings of our study help to better support donor families through the facial donation process and to improve facial transplantation procedures.
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8
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Assessing the factors that influence the donation of a deceased family member's organs in an opt-out system for organ donation. Soc Sci Med 2023; 317:115545. [PMID: 36436261 DOI: 10.1016/j.socscimed.2022.115545] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 10/20/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022]
Abstract
RATIONALE Family, and sometimes longstanding friends, have considerable influence over organ donation, through agreeing or disagreeing to the donation of a deceased individual's organs. To date, most research has been undertaken within opt-in systems. OBJECTIVE This study advances on previous research by assessing next-of-kin approval under opt-out legislation. We tested whether next-of-kin approval varies when the deceased is a registered donor (opted-in), registered non-donor (opted-out) or has not registered a decision under an opt-out policy (deemed consent). We also tested if the deceased's wishes influenced next-of-kin approval through relatives anticipating regret for not donating and feelings of uncertainty. Finally, we assessed whether next-of-kin's own beliefs about organ donation influenced whether they followed the deceased's wishes. METHODS Participants (N = 848) living in a country with opt-out legislation (Wales, UK) were asked to imagine a relative had died under an opt-out system and decided if their relatives' organs should be donated. Participants were randomly allocated to imagine the deceased had either (i) opted-in, (ii) opted-out or (iii) not registered a decision (deemed consent). The outcome variable was next-of-kin approval, with uncertainty and anticipated regret as potential mediators and next-of-kin's beliefs about organ donation as moderators. RESULTS Next-of-kin approval was lower when the deceased had opted-out than under deemed consent. This was due to next-of-kin anticipating more regret for not donating under deemed consent than opt-out. Further analyses revealed the deceased's wishes influence next-of-kin approval, via anticipated regret, when next-of-kin did not hold negative beliefs about organ donation. CONCLUSIONS The deceased's wishes were less likely to be followed when next-of-kin had negative beliefs towards donation. Developing large-scale campaigns to improve these beliefs in the general public should make people more likely to follow the deceased's wishes. As a result, these campaigns should improve the availability of donor organs.
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Marcon AR, Wagner DN, Rachul C, Weiss MJ. Analyzing online public commentary responding to the announcement of deemed consent organ donation legislation in the Canadian province of Nova Scotia. PLoS One 2022; 17:e0278983. [PMID: 36520833 PMCID: PMC9754165 DOI: 10.1371/journal.pone.0278983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The Canadian province of Nova Scotia recently became the first jurisdiction in North America to pass deemed consent organ donation legislation. The announcement of this legislation generated substantial online discussion, which we analyzed to provide insights on public perception. METHODS We performed directed content analysis on 2663 user-generated comments appearing on two widely-shared Canadian Broadcasting Company (CBC) articles published online in April 2019. We determined levels of support and opposition in comments and described the specific rhetoric used for doing so. We also performed one-way ANOVA and Pearson chi-square tests to determine how the comments were being received and engaged by other users. RESULTS A range of commentary was present in both support and opposition to the changes in legislation. There were more negative than positive comments, and negative commentary generated more replies. Positive comments were received more positively by other users while negative comments were received more negatively. The total sum of negative comments was greatly influenced by a small number of very active participants. Negative commentary focused more on broad concepts and principles related to government, power, and individual rights rather than specific issues in the Nova Scotian context. Substantial issues of trust in the government and healthcare system were evident. CONCLUSIONS There were strong positive and negative sentiments expressed in the comments, but the total sum of negativity in the comments was significantly influenced by a small number of commentators. Analysis on the presumed consent concerns can be helpful to inform public outreach efforts.
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Affiliation(s)
- Alessandro R. Marcon
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, AB, Canada
| | - Darren N. Wagner
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, AB, Canada
| | - Christen Rachul
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MN, Canada
| | - Matthew J. Weiss
- FRCPC, Transplant Québec, Montréal, QC, Canada
- CHU de Québec, Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, Québec, QC, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
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Molina-Pérez A, Werner-Felmayer G, Van Assche K, Jensen AMB, Delgado J, Flatscher-Thöni M, Hannikainen IR, Rodriguez-Arias D, Schicktanz S, Wöhlke S. Attitudes of European students towards family decision-making and the harmonisation of consent systems in deceased organ donation: a cross-national survey. BMC Public Health 2022; 22:2080. [PMCID: PMC9664433 DOI: 10.1186/s12889-022-14476-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
European countries are increasingly harmonising their organ donation and transplantation policies. Although a growing number of nations are moving to presumed consent to deceased organ donation, no attempts have been made to harmonise policies on individual consent and the role of the family in the decision-making process. Little is known about public awareness of and attitudes towards the role of the family in their own country and European harmonisation on these health policy dimensions. To improve understanding of these issues, we examined what university students think about the role of the family in decision-making in deceased organ donation and about harmonising consent policies within Europe.
Methods
Using LimeSurvey© software, we conducted a comparative cross-sectional international survey of 2193 university students of health sciences and humanities/social sciences from Austria (339), Belgium (439), Denmark (230), Germany (424), Greece (159), Romania (190), Slovenia (190), and Spain (222).
Results
Participants from opt-in countries may have a better awareness of the family’s legal role than those from opt-out countries. Most respondents opposed the family veto, but they were more ambivalent towards the role of the family as a surrogate decision-maker. The majority of participants were satisfied with the family’s legal role. However, those who were unsatisfied preferred to limit family involvement. Overall, participants were opposed to the idea of national sovereignty over consent policies. They favoured an opt-out policy harmonisation and were divided over opt-in. Their views on harmonisation of family involvement were consistent with their personal preferences.
Conclusions
There is overall division on whether families should have a surrogate role, and substantial opposition to granting them sole authority over decision-making. If European countries were to harmonise their policies on consent for organ donation, an opt-out system that grants families a surrogate decision-making role may enjoy the widest public support.
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Molina-Pérez A, Rodríguez-Arias D, Delgado J. Differential impact of opt-in, opt-out policies on deceased organ donation rates: a mixed conceptual and empirical study. BMJ Open 2022; 12:e057107. [PMID: 36441113 PMCID: PMC9462118 DOI: 10.1136/bmjopen-2021-057107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To increase postmortem organ donation rates, several countries are adopting an opt-out (presumed consent) policy, meaning that individuals are deemed donors unless they expressly refused so. Although opt-out countries tend to have higher donation rates, there is no conclusive evidence that this is caused by the policy itself. The main objective of this study is to better assess the direct impact of consent policy defaults per se on deceased organ recovery rates when considering the role of the family in the decision-making process. This study does not take into account any indirect effects of defaults, such as potential psychological and behavioural effects on individuals and their relatives. DESIGN Based on previous work regarding consent policies, we created a conceptual model of the decision-making process for deceased organ recovery that included any scenario that could be directly influenced by opt-in or opt-out policies. We then applied this model to internationally published data of the consent process to determine how frequently policy defaults could apply. MAIN OUTCOME MEASURES We measure the direct impact that opt-in and opt-out policies have per se on deceased organ recovery. RESULTS Our analysis shows that opt-in and opt-out have strictly identical outcomes in eight out of nine situations. They only differ when neither the deceased nor the family have expressed a preference and defaults therefore apply. The direct impact of consent policy defaults is typically circumscribed to a range of 0%-5% of all opportunities for organ recovery. Our study also shows that the intervention of the family improves organ retrieval under opt-in but hinders it under opt-out. CONCLUSIONS This study may warn policy makers that, by emphasising the need to introduce presumed consent to increase organ recovery rates, they might be overestimating the influence of the default and underestimating the power granted to families.
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Affiliation(s)
- Alberto Molina-Pérez
- Instituto de Estudios Sociales Avanzados (IESA), Consejo Superior de Investigaciones Científicas (CSIC), Cordoba, Spain
- FiloLab-UGR Scientific Unit of Excellence, Department of Philosophy 1, University of Granada, Granada, Spain
- Ethical, Legal and Psychosocial Aspects of Transplantation (ELPAT), European Society for Organ Transplantation, Padua, Italy
| | - David Rodríguez-Arias
- FiloLab-UGR Scientific Unit of Excellence, Department of Philosophy 1, University of Granada, Granada, Spain
- Ethical, Legal and Psychosocial Aspects of Transplantation (ELPAT), European Society for Organ Transplantation, Padua, Italy
| | - Janet Delgado
- FiloLab-UGR Scientific Unit of Excellence, Department of Philosophy 1, University of Granada, Granada, Spain
- Ethical, Legal and Psychosocial Aspects of Transplantation (ELPAT), European Society for Organ Transplantation, Padua, Italy
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12
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Ethical Solutions to the Problem of Organ Shortage. Camb Q Healthc Ethics 2022; 31:297-309. [PMID: 35899548 DOI: 10.1017/s0963180121000955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Organ shortage is a major survival issue for millions of people worldwide. Globally 1.2 million people die each year from kidney failure. In this paper, we critically examine and find lacking extant proposals for increasing organ supply, such as opting in and opt out for deceased donor organs, and parochial altruism and paired kidney exchange for live organs. We defend two ethical solutions to the problem of organ shortage. One is to make deceased donor organs automatically available for transplant without requiring consent from the donor or their relatives. The other is for society to buy nonvital organs in a strictly regulated market and provide them to people in need for free.
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Evaluating Organ Donation Decision in ICU Patients’ Families by Analytic Network Process Approach. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:9969604. [PMID: 35463662 PMCID: PMC9033390 DOI: 10.1155/2022/9969604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 01/28/2022] [Accepted: 03/14/2022] [Indexed: 11/22/2022]
Abstract
The imbalance between supply and demand for organs has been a global crisis, despite the efforts of transplant coordinators from healthcare institutions to promote donor registration. Because the patient's family has legal rights over the patient's remains, they can easily undermine any efforts spent on organ procurement by simply refusing the patient's consent before death in practice. Most related studies seldom mention the decision-making on organ donation from patients' families. The objectives of this study are to find what are the priorities of those factors acting as the pillars of organ donation by patients' families. This study applied the analytic network process (ANP) to the prioritization factors contributing toward the willingness of families to donate organs of intensive care unit patients. The purposive sampling method used structured questionnaires and ANP questionnaires to enroll 180 patients' families from five intensive care units who met the criteria in the regional teaching hospital of southern Taiwan. Through the ANP analysis, it was found that when family members made organ donation decisions, the weights of the four domains are as follows: psychology—47.6%, externality—20.3%, spirituality—19.7%, and physiology—12.3%. The main decision-making factors that influenced the weighting factors were “attitude” (31.5%), “physician's experience” (0.88%), “religion” (19.3%), and “organ selection” (31.9%). These results could assist organ donation teams to take the best strategies for persuading people to agree with organ donation and formulating an individual organ donation plan.
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14
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Luo A, He H, Xu Z, Ouyang W, Chen Y, Li K, Xie W. A Qualitative Study in Family Units on Organ Donation: Attitude, Influencing Factors and Communication Patterns. Transpl Int 2022; 35:10411. [PMID: 35401037 PMCID: PMC8983816 DOI: 10.3389/ti.2022.10411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/24/2022] [Indexed: 11/13/2022]
Abstract
This study aimed to analyze the attitude, influencing factors and communication patterns of organ donation in Chinses families. We conducted in-depth interviews with 97 participants from 26 families in China from August 2018 to October 2020. Interviews were audio-recorded, transcribed by the researchers. Thematic analysis was used to analyze the data and Nvivo 12 was used to catalog coded data. Thirty-eight participants indicated that they would like to be a donor while the majority were unlikely to donate. Among those who were willing to donate, some disagreed with family members to donate organs. Themes found included attitude, the timing of thinking, taboo and fear, traditional beliefs, ethics and family communication patterns. Lack of knowledge, fear, taboo, some traditional beliefs and mistrust may discourage donation. Altruism and policy which is good for the family seem to encourage donation. We also constructed three family communication patterns to provide a deeper understanding of the family in China. This is the first qualitative study that analyzed attitude, influencing factors and communication patterns based on family units in China mainland. Our findings showed that family comes first in Chinese. We suggest that family-based consent and incentives are more suitable for the Chinese social context.
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Affiliation(s)
- Aijing Luo
- The Third Xiangya Hospital of Central South University, Changsha, China.,Second Xiangya Hospital of Central South University, Changsha, China.,Key Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, China
| | - Haiyan He
- The Third Xiangya Hospital of Central South University, Changsha, China.,Key Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, China.,School of Life Sciences, Central South University, Changsha, China
| | - Zehua Xu
- The Third Xiangya Hospital of Central South University, Changsha, China.,Key Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, China.,Public Health College of Central South University, Changsha, China
| | - Wei Ouyang
- The Third Xiangya Hospital of Central South University, Changsha, China.,Key Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, China.,School of Life Sciences, Central South University, Changsha, China
| | - Yang Chen
- School of Life Sciences, Central South University, Changsha, China
| | - Ke Li
- The Third Xiangya Hospital of Central South University, Changsha, China.,Key Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, China.,School of Life Sciences, Central South University, Changsha, China
| | - Wenzhao Xie
- The Third Xiangya Hospital of Central South University, Changsha, China.,Key Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, China.,School of Life Sciences, Central South University, Changsha, China
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15
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Díaz-Cobacho G, Cruz-Piqueras M, Delgado J, Hortal-Carmona J, Martínez-López MV, Molina-Pérez A, Padilla-Pozo Á, Ranchal-Romero J, Rodríguez-Arias D. Public Perception of Organ Donation and Transplantation Policies in Southern Spain. Transplant Proc 2022; 54:567-574. [PMID: 35303996 DOI: 10.1016/j.transproceed.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 01/26/2022] [Accepted: 02/01/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND This research explores how public awareness and attitudes toward donation and transplantation policies may contribute to Spain's success in cadaveric organ donation. MATERIALS AND METHODS A representative sample of 813 people residing in Andalusia (Southern Spain) were surveyed by telephone or via Internet between October and December 2018. RESULTS Most participants trust Spain's donation and transplantation system (93%) and wish to donate their organs after death (76%). Among donors, a majority have expressed their consent (59%), and few nondonors have expressed their refusal (14%). Only a minority are aware of the presumed consent system in force (28%) and feel sufficiently informed regarding the requirements needed to be an organ donor (16%). Participants mainly consider that relatives should represent the deceased's preferences and be consulted when the deceased's wishes are unknown, as is the case in Spain. CONCLUSION Public trust in the transplant system may contribute to Spain's high performance in organ donation. High levels of societal support toward organ donation and transplantation do not correspond with similar levels of public awareness of donation and transplantation policies in Spain.
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Affiliation(s)
- Gonzalo Díaz-Cobacho
- Department of Philosophy 1, University of Granada, Granada, Spain; FiloLab-UGR Scientific Unit of Excellence, University of Granada, Spain
| | | | - Janet Delgado
- Department of Philosophy 1, University of Granada, Granada, Spain; ELPAT-ESOT Public Issues Working Group, European Society of Organ Transplantation, Padova, Italy; FiloLab-UGR Scientific Unit of Excellence, University of Granada, Spain
| | - Joaquín Hortal-Carmona
- Department of Philosophy 1, University of Granada, Granada, Spain; Centro de salud Albayzín, Servicio Andaluz de Salud, Granada, Spain
| | - M Victoria Martínez-López
- Department of Philosophy 1, University of Granada, Granada, Spain; ELPAT-ESOT Public Issues Working Group, European Society of Organ Transplantation, Padova, Italy; FiloLab-UGR Scientific Unit of Excellence, University of Granada, Spain
| | - Alberto Molina-Pérez
- Department of Philosophy 1, University of Granada, Granada, Spain; ELPAT-ESOT Public Issues Working Group, European Society of Organ Transplantation, Padova, Italy; FiloLab-UGR Scientific Unit of Excellence, University of Granada, Spain; Institute for Advanced Social Studies, Spanish National Research Council (IESA-CSIC), Córdoba, Spain
| | - Álvaro Padilla-Pozo
- Department of Political and Social Sciences, University Pompeu Fabra, Barcelona, Spain
| | - Julia Ranchal-Romero
- Institute for Advanced Social Studies, Spanish National Research Council (IESA-CSIC), Córdoba, Spain
| | - David Rodríguez-Arias
- Department of Philosophy 1, University of Granada, Granada, Spain; ELPAT-ESOT Public Issues Working Group, European Society of Organ Transplantation, Padova, Italy; FiloLab-UGR Scientific Unit of Excellence, University of Granada, Spain.
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16
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Baumann A, Thilly N, Joseph L, Claudot F. Ethical reflection support for potential organ donors' relatives: A narrative review. Nurs Ethics 2022; 29:660-674. [PMID: 35172649 DOI: 10.1177/09697330211015274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Even in countries with an opt-out or presumed consent system, relatives have a considerable influence on the post-mortem organ harvesting decision. However, their reflection capacity may be compromised by grief, and they are, therefore, often prone to choose refusal as default option. Quite often, it results in late remorse and dissatisfaction. So, a high-quality reflection support seems critical to enable them to gain a stable position and a long-term peace of mind, and also avoid undue loss of potential grafts. In practice, recent studies have shown that the ethical aspects of reflection are rarely and often poorly discussed with relatives and that no or incomplete guidance is offered. No review of the literature is available to date, although it could be of value to improve the quality of the daily practice. OBJECTIVES The objective was to review and synthesize the main concepts and approaches, theories and practices of ethical reflection support of the relatives or surrogates of potential post-mortem organ donors. RESEARCH DESIGN A narrative review was performed in the medical, psychological and ethical fields using PubMed, PsycArticles and Web of Science databases (1980-2020). RESULTS Out of 150 papers, 25 were finally retained. Four themes were drawn: the moral status of the potential post-mortem organ donor, the principlistic approach with its limits and critics, the narrative approach and the transcendental approach. DISCUSSION This review suggests an extension of psychological support towards ethical reflection support. The process of helping relatives in their ethical exploration of post-mortem organ donation is psychologically and morally characterized. The need for specialized professionals educated and experienced both in clinical psychology and in health ethics to carry out this task is discussed. PRACTICAL IMPACT This review could contribute to optimize the quality of the ethical reflection support by initiating an evolution from an empirical, partial and individual-dependent support to a more systematized, professionalized and exhaustive support.
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Affiliation(s)
- Antoine Baumann
- Assistance Publique - Hôpitaux de Paris, France; Université de Lorraine, France
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17
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Then SN, Martin DE. Transitions in decision-making authority at the end of life: a problem of law, ethics and practice in deceased donation. JOURNAL OF MEDICAL ETHICS 2022; 48:112-117. [PMID: 33246994 DOI: 10.1136/medethics-2020-106572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 06/12/2023]
Abstract
Where a person is unable to make medical decisions for themselves, law and practice allows others to make decisions on their behalf. This is common at the end of a person's life where decision-making capacity is often lost. A further, and separate, decision that is often considered at the time of death (and often preceding death) is whether the person wanted to act as an organ or tissue donor. However, in some jurisdictions, the lawful decision-maker for the donation decision (the 'donation decision-maker') is different from the person who was granted decision-making authority for medical decisions during the person's life. To date, little attention has been given in the literature to the ethical concerns and practical problems that arise where this shift in legal authority occurs. Such a change in decision-making authority is particularly problematic where premortem measures are suggested to maximise the chances of a successful organ donation. This paper examines this shift in decision-making authority and discusses the legal, ethical and practical implications of such frameworks.
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Affiliation(s)
- Shih-Ning Then
- Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Queensland, Australia
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18
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Bailey PK, Lyons H, Caskey FJ, Ben-Shlomo Y, Al-Talib M, Babu A, Selman LE. Expectations of a new opt-out system of consent for deceased organ donation in England: A qualitative interview study. Health Expect 2021; 25:607-616. [PMID: 34951093 PMCID: PMC8957744 DOI: 10.1111/hex.13394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/03/2021] [Accepted: 10/10/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction In 2020 England moved to an opt‐out deceased donation law. We aimed to investigate the views of a mixed stakeholder group comprising people with kidney disease, family members and healthcare practitioners towards the change in legislation. We investigated the expected impacts of the new legislation on deceased‐donor and living‐donor transplantation, and views on media campaigns regarding the law change. Methods We undertook in‐depth qualitative interviews with people with kidney disease (n = 13), their family members (n = 4) and healthcare practitioners (n = 15). Purposive sampling was used to ensure diversity for patients and healthcare practitioners. Family members were recruited through snowball sampling and posters. Interviews were audio‐recorded and transcribed verbatim. Transcripts were analysed using thematic analysis. Results Three themes with six subthemes were identified: (i) Expectations of impact (Hopeful patients; Cautious healthcare professionals), (ii) Living‐donor transplantation (Divergent views; Unchanged clinical recommendations), (iii) Media campaigns (Single message; Highlighting recipient benefits). Patients expected the law change would result in more deceased‐donor transplant opportunities. Conclusions Clinicians should ensure patients and families are aware of the current evidence regarding the impact of opt‐out consent: expectations of an increased likelihood of receiving a deceased‐donor transplant are not currently supported by the evidence. This may help to prevent a decline in living‐donor transplantation seen in other countries with similar legislation. Media campaigns should include a focus on the impact of organ receipt. Patient or Public Contribution Two patient representatives from the Kidney Disease Health Integration Team, Primrose Granville and Soumeya Bouacida, contributed to the content and design of the study documents.
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Affiliation(s)
- Pippa K Bailey
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Renal Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Hannah Lyons
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Leeds School of Medicine, University of Leeds, Leeds, UK
| | - Fergus J Caskey
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Renal Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mohammed Al-Talib
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Renal Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Adarsh Babu
- Department of Renal Medicine, Gloucestershire Royal Hospital, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Lucy E Selman
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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19
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Molina-Pérez A, Delgado J, Frunza M, Morgan M, Randhawa G, de Wijdeven JRV, Schicktanz S, Schiks E, Wöhlke S, Rodríguez-Arias D. Should the family have a role in deceased organ donation decision-making? A systematic review of public knowledge and attitudes towards organ procurement policies in Europe. Transplant Rev (Orlando) 2021; 36:100673. [PMID: 34864448 DOI: 10.1016/j.trre.2021.100673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
GOAL To assess public knowledge and attitudes towards the family's role in deceased organ donation in Europe. METHODS A systematic search was conducted in CINHAL, MEDLINE, PAIS Index, Scopus, PsycINFO, and Web of Science on December 15th, 2017. Eligibility criteria were socio-empirical studies conducted in Europe from 2008 to 2017 addressing either knowledge or attitudes by the public towards the consent system, including the involvement of the family in the decision-making process, for post-mortem organ retrieval. Screening and data collection were performed by two or more independent reviewers for each record. RESULTS Of the 1482 results, 467 studies were assessed in full-text form, and 33 were included in this synthesis. When the deceased has not expressed any preference, a majority of the public support the family's role as a surrogate decision-maker. When the deceased expressly consented, the respondents' answers depend on whether they see themselves as potential donors or as a deceased's next-of-kin. Answers also depend on the relationship between the deceased and the decision-maker(s) within the family, and on their ethnic or cultural background. CONCLUSIONS Public views on the authority of the family in organ donation decision-making requiere further research. A common conceptual framework and validated well-designed questionnaires are needed for future studies. The findings should be considered in the development of Government policy and guidance regarding the role of families in deceased organ donation.
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Affiliation(s)
- Alberto Molina-Pérez
- Institute for Advanced Social Studies, Spanish National Research Council, Cordoba, Spain; Public Issues working group, ELPAT-ESOT, Padova, Italy.
| | - Janet Delgado
- Public Issues working group, ELPAT-ESOT, Padova, Italy; Department of Philosophy 1, University of Granada, Granada, Spain
| | - Mihaela Frunza
- Department of Philosophy, Faculty of History and Philosophy, Babes-Bolyai University of Cluj, Cluj, Romania
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, United Kingdom
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, England, United Kingdom
| | | | - Silke Schicktanz
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Eline Schiks
- Department of Policy, Dutch Transplant Foundation, Leiden, the Netherlands
| | - Sabine Wöhlke
- Department of Health Sciences, HAW-Hamburg, Hamburg, Germany
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20
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Vela RJ, Pruszynski J, Mone T, Niles P, Peltz M. Differences in Organ Donation and Transplantation in States Within the United States and in European Countries: Is There a Benefit to Opting Out? Transplant Proc 2021; 53:2801-2806. [PMID: 34802724 DOI: 10.1016/j.transproceed.2021.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Organ donation in the United States currently requires explicit consent by an "opt-in" approach. Some European countries have reported an increase in donation rates with an "opt-out" strategy. We hypothesized that regional differences in decision making affect organ donation rates in different countries and suggest no single approach will reliably increase organ donation rates. METHODS Donation and transplantation rates in European countries and states within the United States with populations of >10 million and a minimum organ donation rate of 10 donors per million were compared. 2016 International Registry in Organ Donation and Transplantation data and the 2016 Scientific Registry of Transplant Recipients annual report were used for European countries and US states, respectively. Comparisons by region and donation model were made. RESULTS Deceased organ donor rates and transplants did not differ between opt-in and opt-out models. Living donation was increased in all opt-in entities. When comparing European countries, there was a trend toward higher organ donation rates in opt-out countries than in opt-in countries. Donation and transplantation rates of US states were higher than both European opt-in and opt-out countries. CONCLUSION There were no differences in deceased donor organ donation when considering the donation consent model. These data do not support that an opt-out approach will increase the number of transplants in the United States.
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Affiliation(s)
- Ryan J Vela
- Department of Cardiovascular & Thoracic Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, United States.
| | - Jessica Pruszynski
- Department of Cardiovascular & Thoracic Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Tom Mone
- OneLegacy, Los Angeles, California, United States
| | - Patricia Niles
- Southwest Transplant Alliance, Dallas, Texas 75231, United States
| | - Matthias Peltz
- Department of Cardiovascular & Thoracic Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
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21
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Hyde MK, Masser BM, Edwards ARA, Ferguson E. Australian Perspectives on Opt-In and Opt-Out Consent Systems for Deceased Organ Donation. Prog Transplant 2021; 31:357-367. [PMID: 34806919 DOI: 10.1177/15269248211046023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: As many countries change to opt-out systems to address organ shortages, calls for similar reform in Australia persist. Community perspectives on consent systems for donation remain under-researched, therefore Australian perspectives on consent systems and their effectiveness in increasing donation rates were explored. Design: In this descriptive cross-sectional study, participants completed a survey presenting opt-in, soft opt-out, and hard opt-out systems, with corresponding descriptions. Participants chose the system they perceived as most effective and described their reasoning. Results: Participants (N = 509) designated soft opt-out as the most effective system (52.3%; hard opt-out 33.7%; opt-in 13.7%). Those who identified with an ethnic/cultural group or were not registered had greater odds of choosing opt-out. Six themes identified in thematic analysis reflected their reasoning: (1) who decides (individual, shared decision with family); (2) right to choose; (3) acceptability (ethics, fairness); and utility in overcoming barriers for (4) individuals (apathy, awareness, ease of donating, fear/avoidance of death); (5) family (easier family experience, family veto); (6) society (normalizing donation, donation as default, expanding donor pool). Choice and overcoming individual barriers were more frequently endorsed themes for opt-in and opt-out, respectively. Discussion: Results suggested the following insights regarding system effectiveness: uphold/prioritize individual's recorded donation decision above family wishes; involve family in decision making if no donation preference is recorded; retain a register enabling opt-in and opt-out for unequivocal decisions and promoting individual control; and maximize ease of registering. Future research should establish whether systems considered effective are also acceptable to the community to address organ shortages.
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Affiliation(s)
- Melissa K Hyde
- 1974The University of Queensland, Brisbane, QLD, Australia
| | - Barbara M Masser
- 1974The University of Queensland, Brisbane, QLD, Australia.,Australian Red Cross Lifeblood, Sydney, NSW, Australia
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22
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Muthiah MD, Chua MSH, Griva K, Low I, Lim WH, Ng CH, Hwang JYF, Yap JCH, Iyer SG, Bonney GK, Anantharaman V, Huang DQ, Tan EXX, Lee GH, Kow AWC, Tai BC. A Multiethnic Asian Perspective of Presumed Consent for Organ Donation: A Population-Based Perception Study. Front Public Health 2021; 9:712584. [PMID: 34676192 PMCID: PMC8525798 DOI: 10.3389/fpubh.2021.712584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/06/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Organ shortage is still a world-wide problem, resulting in long waiting lists for kidney, liver, and heart transplant candidates across many transplant centers globally. This has resulted in the move toward presumed consent to increase deceased organ donation rates. However, there remains a paucity of literature on public attitude and barriers regarding the opt-out system, with existing studies limited to Western nations. Therefore, this study aimed to understand public sentiment and different barriers toward organ donation from the perspective of Singapore, a highly diverse and multiethnic Asian society. Methods: A cross-sectional community semi-structured interview was conducted in a public housing estate in Singapore. Pilot test was undertaken before participants were interviewed face-to-face by trained personnel. All statistical evaluations were conducted using Stata. The χ2-test compared subgroups based on patient characteristics while multivariable logistic regression identified predictors of willingness to donate/ assent. Effect estimates were quantified using odds ratio (OR). Findings: Out of 799 individuals, 85% were agreeable to organ donation after death and 81% were willing to assent to donations of family members' organs, which declined by 16% (p < 0.001) after a clinical scenario was presented. Demographic factors including ethnicity, education, marital, and employment status affected willingness to donate and assent. Knowledge correlated significantly with willingness to donate and assent. In particular, knowledge regarding brain death irreversibility had the strongest correlation (AOR 2.15; 95% CI 1.60–2.89). Conclusions: Organ donation rates remain low albeit presumed consent legislation, due to patient-level barriers, including but not limited to knowledge gaps, cultural values, religious backgrounds, and emotional impact at relatives' death. To effectively boost donor rates, it is crucial for policy makers to invest in public education and improve transplant provisions and family protocols.
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Affiliation(s)
- Mark D Muthiah
- Division of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Melissa Sin Hui Chua
- Division of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Konstadina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ivan Low
- Division of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jeff Y F Hwang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jason C H Yap
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Shridhar G Iyer
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Hepatobiliary and Pancreatic Surgery, National University Health System, Singapore, Singapore
| | - Glenn K Bonney
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Hepatobiliary and Pancreatic Surgery, National University Health System, Singapore, Singapore
| | - Vathsala Anantharaman
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Nephrology, National University Health System, Singapore, Singapore
| | - Daniel Q Huang
- Division of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Eunice Xiang-Xuan Tan
- Division of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Guan-Huei Lee
- Division of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Alfred W C Kow
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Hepatobiliary and Pancreatic Surgery, National University Health System, Singapore, Singapore
| | - Bee Choo Tai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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23
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Disparities in Deceased Organ Donor Research Authorization: Experience at One Organ Procurement Organization and Call for National Conversations. Kidney Int Rep 2021; 6:2331-2337. [PMID: 34514194 PMCID: PMC8419128 DOI: 10.1016/j.ekir.2021.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/22/2021] [Accepted: 06/15/2021] [Indexed: 02/04/2023] Open
Abstract
Introduction Research with deceased donor organs can provide an important platform for studying interventions to improve organ use and outcomes after authorization from the next-of-kin (NOK) or before death by the decedent (i.e., first-person authorization [FPA]). To date, information on authorization rates across donor subgroups is lacking. Methods We performed a retrospective chart review of all 690 deceased organ donors from January 2017 to December 2019 at a midsized Midwestern organ procurement organization (OPO). Multivariable logistic regression was used to assess associations between donor factors and research decline (adjusted odds ratio [aOR], 95% confidence interval [CI]). Results Electronic records for all 690 deceased donors were reviewed. Of these, 659 (95.5%) yielded at least one transplanted organ. Overall, research was declined in 10.8% of donations. Compared to White donors, research decline was higher for Black (16.0% vs. 8.9%; aOR, 1.87; 95% CI, 1.03-3.40; P = 0.04) and other non-White donors (24.0% vs. 8.9%; aOR, 4.21; 95% CI, 1.02-17.39; P = 0.05). Unadjusted research decline trended higher for Hispanic donors versus non-Hispanic donors (23.1% vs. 10.5%; P = 0.14). Compared to donors age <40 years, research decline trended higher for donors age ≥65 years (16.7% vs. 11.8%; aOR, 4.87; 95% CI, 1.12-21.05; P = 0.03), whereas research decline was 55% lower when donors provided FPA (7.3% vs 15.0%; aOR, 0.45; 95% CI, 0.27-0.76; P = 0.003). Conclusions Deceased donor research authorization decline is higher for Black, other non-White, and older donors, but lower when the descendent provides FPA. Identification of disparities in research authorization may stimulate educational strategies to reduce barriers to scientific investigations directed at optimizing the outcomes of organ donation.
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Viñuela-Prieto JM, Escarpa Falcón MC, Candel FJ, Mateos Rodríguez A, Torres González JI, Del Río Gallegos F. Family Refusal to Consent Donation: Retrospective Quantitative Analysis of Its Increasing Tendency and the Associated Factors Over the Last Decade at a Spanish Hospital. Transplant Proc 2021; 53:2112-2121. [PMID: 34419253 DOI: 10.1016/j.transproceed.2021.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Organ and tissue recovery remains limited by several factors. This study retrospectively analyzes the factors associated with family refusal to consent to donation at a high-donor-volume Spanish hospital. METHODS Data regarding the annual number of potential donors and family refusal rates at hospital and regional levels were retrieved from 2008 to 2017. Descriptive, bivariate, and multivariate analyses were performed to detect those factors independently associated with family refusal. Results were cross-validated using the data from years 2018 and 2019 as the validation group. To explore potential inter-relations between factors a Multiple Correspondence Analysis was performed. RESULTS A total of 601 family interviews for petition of consent were conducted between 2008 and 2017, 531 (88.4%) resulted in acceptance and 70 (11.6%) resulted in refusal of the donation. Lesser experience of the interviewers (odds ratio [OR], 2.980; P = .001), donation after brain death (OR, 2.485; P = .013), number of interviews conducted per family (OR, 1.892; P < .001), age of the main decision maker (OR, 1.025; P = .045), and high or middle attributed cultural levels (OR, 0.142; P < .001 and OR, 0.199; P < .001 respectively) were observed to be independently associated with the family final decision. The logistic regression model displayed good predictive power for both derivation and validation cohorts, with an overall predictive accuracy of 80.9% (95% confidence interval, 0.747-0.870; P < .001) and 74.4% (95% confidence interval, 0.635-0.854; P = .001), respectively. CONCLUSIONS Transplant coordination team members having a thorough knowledge of the family decision mechanisms may be a key factor in donation process optimization.
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Affiliation(s)
- José Manuel Viñuela-Prieto
- Transplant Coordination Department, Hospital Clínico San Carlos, Madrid, Spain; Neurosurgery Department, University Hospital La Paz, Madrid, Spain.
| | | | - Francisco Javier Candel
- Transplant Coordination Department, Hospital Clínico San Carlos, Madrid, Spain; Health Research Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Alonso Mateos Rodríguez
- Regional Organization for Transplant Coordination (ORCT), Community of Madrid Health Service (SERMAS), Madrid, Spain; School of Medicine, Francisco de Vitoria University, Madrid, Spain
| | - Juan Ignacio Torres González
- Regional Organization for Transplant Coordination (ORCT), Community of Madrid Health Service (SERMAS), Madrid, Spain; Nursing, Physiotherapy and Podiatry School, Complutense University, Madrid, Spain
| | - Francisco Del Río Gallegos
- Transplant Coordination Department, Hospital Clínico San Carlos, Madrid, Spain; Regional Organization for Transplant Coordination (ORCT), Community of Madrid Health Service (SERMAS), Madrid, Spain
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Tennankore KK, Klarenbach S, Goldberg A. Perspectives on Opt-Out Versus Opt-In Legislation for Deceased Organ Donation: An Opinion Piece. Can J Kidney Health Dis 2021; 8:20543581211022151. [PMID: 34188947 PMCID: PMC8212358 DOI: 10.1177/20543581211022151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Karthik K Tennankore
- Department of Medicine (Division of Nephrology), Dalhousie University, Halifax, NS, Canada
| | | | - Aviva Goldberg
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
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Pan XT, Ji-Ma, Liu W, Bai ZC, Dai ZF, Huang JT, Lin JF. Investigation and Strategic Analysis of Family Barriers to Organ Donation in China. Transplant Proc 2021; 53:513-519. [PMID: 33293039 DOI: 10.1016/j.transproceed.2020.09.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/21/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Families play a prominent role in the eventual organ donation decision. Because the deceased cannot directly express their wishes, their families become the actual decision makers. In China, families are permitted to make decisions regarding organ donation that may not be in accordance with the wishes of the deceased family member, and objections by families are a main bottleneck in the donation process. METHODS Face-to-face questioning was conducted with organ procurement organization coordinators. At the same time, questionnaires were distributed in 11 cities in Zhejiang Province. RESULTS Of the respondents, 69.9% considered family consent necessary and 77.1% thought that the view of their family had a great, even decisive, influence on them to decide to become donors. If the deceased family member had registered as an organ donor, 65.2% of families decided that they would respect the wishes of the deceased person. Adult children (58.6%) were more likely to donate than parents (37.4%; χ2 = 123.009, P < .001). Those born after 2000 and after 1990 (62.5% and 52.8%, respectively) were much more likely to donate than those born after 1960 (18.1%; χ2 = 191.485, P < .001). The interviews indicated that there were high rates of donation refusals within potential donation families. Most donor families chose to make hidden donations, and the majority of donor families had a simple family structure. CONCLUSIONS To promote organ donation, China needs to reconsider the role of families in the decision-making process. It is essential to increase organ donation awareness within the younger generation and encourage them to discuss with their families their willingness to donate.
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Affiliation(s)
- Xiao-Ting Pan
- The First Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang Province, China; The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
| | - Ji-Ma
- The First Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Wei Liu
- The First Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Zi-Cheng Bai
- The First Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Zhen-Feng Dai
- The First Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Jun-Ting Huang
- The First Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Jian-Feng Lin
- The First Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
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Ma J, Zeng L, Li T, Tian X, Wang L. Experiences of Families Following Organ Donation Consent: A Qualitative Systematic Review. Transplant Proc 2021; 53:501-512. [PMID: 33483168 DOI: 10.1016/j.transproceed.2020.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/21/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This systematic review synthesizes qualitative evidence on the experiences of donor families after consent to organ donation. METHODS This robust, qualitative systematic review included an exhaustive search of electronic databases, including PubMed, Scopus, EBSCO PsycINFO, and CINAHL Complete. Manual searches of reference lists and gray literature were conducted to achieve a comprehensive identification of all relevant research. A qualitative study design served to capture the experiences of donor families after organ donation consent. RESULTS A total of 6 articles that met the eligibility criteria were identified and included in this review. Three key themes emerged from the primary research: 1. family members were ambivalent about consent due to the ambiguity of brain death; 2. conversations about donation requirements proved uncomfortable; and 3. support is needed after donation. CONCLUSIONS Family members demonstrated ongoing ambivalence and distress that lasted for weeks after organ donation due to the ambiguity of brain death. Some family members were unhappy with having been approached for a conversation about organ donation. Donor families were not always able to deal with the difficulties they faced after their decision about organ donation. Health care professionals should provide ongoing care and updated information to family members. This review helped to identify family members' needs for both psychological and financial assistance.
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Affiliation(s)
- Juanjuan Ma
- Nursing Department, Shenzhen Shekou People's Hospital, Shenzhen, China
| | - Li Zeng
- Nursing Department, Shenzhen Shekou People's Hospital, Shenzhen, China.
| | - Tingjun Li
- The Second People's Hospital of Futian District, Shenzhen, China
| | - Xiaofei Tian
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Lili Wang
- Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, China
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Soria-Oliver M, Aramayona B, López JS, Martín MJ, Martínez JM, Sáenz R, García-Sánchez R. Grief Reactions of Potential Organ Donors' Bereaved Relatives: An Observational Study. Am J Crit Care 2020; 29:358-368. [PMID: 32869074 DOI: 10.4037/ajcc2020960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Most family members of potential organ donors experience the death of their relative in an intensive care unit. While under an emotional burden, bereaved relatives must make a decision that will affect the life of other patients. A better understanding of grief within the context of organ donation will help intensive care unit staff better support families during this process. OBJECTIVES To empirically describe the emotional reactions of potential organ donors' family members facing a loved one's death and analyze the relationship of these reactions to factors that occur in the process of illness and death. METHODS A prospective observational study was conducted in 16 Spanish hospitals for 36 months. Data of 421 relatives of potential organ donors, collected through a previously validated instrument, included relatives' emotional responses, deceased's and relatives' characteristics, circumstances of death, and behavior of health care staff. RESULTS Unexpected deaths were linked to more intense emotional reactions and less acceptance of death than were anticipated deaths. Additional stressors, such as perception of poor treatment by hospital staff, perception of deficient medical care, and poor relationships among family members, were associated with stronger reactions. CONCLUSIONS Observation and analysis of the factors studied may help hospital staff members anticipate bereaved relatives' emotional reactions and provide better support during the grieving process, increasing family members' well-being and facilitating a better-informed organ donation decision.
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Affiliation(s)
- María Soria-Oliver
- María Soria-Oliver is an associate professor of social psychology and vice-dean of the Faculty of Health Sciences, UNIR–International University of La Rioja, Spain
| | - Begoña Aramayona
- Begoña Aramayona is an undergraduate fellow, María J. Martín and José M. Martínez are associate professors, and Rubén García-Sánchez is an assistant professor in the Department of Social Psychology and Methods, Faculty of Psychology, Autonomous University of Madrid, Spain
| | - Jorge S. López
- Jorge S. López is an associate professor in the Faculty of Health Sciences, Public University of Navarre, Spain, and a member of the IdiSNA, Navarre Institute for Health Research
| | - María J. Martín
- Begoña Aramayona is an undergraduate fellow, María J. Martín and José M. Martínez are associate professors, and Rubén García-Sánchez is an assistant professor in the Department of Social Psychology and Methods, Faculty of Psychology, Autonomous University of Madrid, Spain
| | - José M. Martínez
- Begoña Aramayona is an undergraduate fellow, María J. Martín and José M. Martínez are associate professors, and Rubén García-Sánchez is an assistant professor in the Department of Social Psychology and Methods, Faculty of Psychology, Autonomous University of Madrid, Spain
| | - Raquel Sáenz
- Raquel Sáenz is an assistant professor in the Faculty of Health Sciences, Public University of Navarre
| | - Rubén García-Sánchez
- Begoña Aramayona is an undergraduate fellow, María J. Martín and José M. Martínez are associate professors, and Rubén García-Sánchez is an assistant professor in the Department of Social Psychology and Methods, Faculty of Psychology, Autonomous University of Madrid, Spain
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A Systematic Review of Opt-out Versus Opt-in Consent on Deceased Organ Donation and Transplantation (2006-2016). World J Surg 2020; 43:3161-3171. [PMID: 31428836 DOI: 10.1007/s00268-019-05118-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Significant numbers of patients in the USA and UK die while waiting for solid organ transplant. Only 1-2% of deaths are eligible as donors with a fraction of the deceased donating organs. The form of consent to donation may affect the organs available. Forms of consent include: opt-in, mandated choice, opt-out, and organ conscription. Opt-in and opt-out are commonly practiced. A systematic review was conducted to determine the effect of opt-in versus opt-out consent on the deceased donation rate (DDR) and deceased transplantation rate (DTR). METHODS Literature searches of PubMed and EMBASE between 2006 and 2016 were performed. Research studies were selected based on certain inclusion criteria which include USA, UK, and Spain; compare opt-in versus opt-out; primary data analysis; and reported DDR or DTR. Modeled effect on US transplant activity was conducted using public data from Organ Procurement and Transplantation Network and Centers for Disease Control WONDER from 2006 to 2015. RESULTS A total of 2400 studies were screened and six studies were included. Four studies reported opt-out consent increases DDR by 21-76% over 5-14 years. These studies compared 13-25 opt-out countries versus 9-23 opt-in countries. Three studies reported opt-out consent increases DTR by 38-83% over 11-13 years. These studies compared 22-25 opt-out versus 22-28 opt-in countries. Modeled opt-out activity on the USA resulted in 4753-17,201 additional transplants annually. CONCLUSION Opt-out consent increases DDR and DTR and may be useful in decreasing deaths on the waiting list in the USA and other countries. REGISTRATION NUMBER PROSPERO CRD42019098759.
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El-Menyar A, Al-Thani H, Mehta T, Varughese B, Al-Maslamani Y, Mekkodathil AA, Singh R. Beliefs and Intention to Organ Donation: A Household Survey. Int J Appl Basic Med Res 2020; 10:122-127. [PMID: 32566529 PMCID: PMC7289197 DOI: 10.4103/ijabmr.ijabmr_108_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/01/2019] [Accepted: 01/17/2020] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Ayman El-Menyar
- Department of Surgery, Trauma and Vascular Surgery, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma and Vascular Surgery, Doha, Qatar
| | - Tulika Mehta
- Department of Surgery, Trauma Surgery, Psychology, Hamad Medical Corporation, Doha, Qatar
| | - Betsy Varughese
- Department of Medicine, Research Section, Hamad Medical Corporation, Doha, Qatar
| | - Yousuf Al-Maslamani
- Department of Surgery, Transplant Section, Hamad General Hospital, Doha, Qatar
| | | | - Rajvir Singh
- Cardiology Research Center, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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Krmpotic K, Isenor C, Beed S. Deceased organ donation in Nova Scotia: Presumed consent and system transformation. Healthc Manage Forum 2020; 33:210-213. [PMID: 32323580 DOI: 10.1177/0840470420919129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In recent years, rates of deceased organ donation in Nova Scotia have remained stagnant, falling behind provinces that have invested in their organ donation programs. The Nova Scotia provincial government has recently committed to health system transformation, which will include enactment of presumed consent legislation in 2020. Although impressive rates of deceased organ donation are often observed in countries with presumed consent legislation, improvements in performance can more often be attributed to the accompanying health system transformation. Key components of high performing deceased organ donation systems include highly trained organ donation specialists, practice guidelines, healthcare professional education, performance metric reviews, accountability frameworks, and public awareness campaigns in addition to adequate legislation. For Nova Scotia's organ donation program to succeed, the provincial government must also invest the frontline financial resources required to develop and maintain adequate program infrastructure and implement key strategies to support a culture of donation.
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Affiliation(s)
- Kristina Krmpotic
- 3688Dalhousie University, Halifax, Nova Scotia, Canada.,432234Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Cynthia Isenor
- 432234Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Stephen Beed
- 3688Dalhousie University, Halifax, Nova Scotia, Canada.,432234Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.,3688Dalhousie University, Halifax, Nova Scotia, Canada
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The Role of the Family in Deceased Organ Procurement: A Guide for Clinicians and Policymakers. Transplantation 2019; 103:e112-e118. [PMID: 31033855 DOI: 10.1097/tp.0000000000002622] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Families play an essential role in deceased organ procurement. As the person cannot directly communicate his or her wishes regarding donation, the family is often the only source of information regarding consent or refusal. We provide a systematic description and analysis of the different roles the family can play, and actions the family can take, in the organ procurement process across different jurisdictions and consent systems. First, families can inform or update healthcare professionals about a person's donation wishes. Second, families can authorize organ procurement in the absence of deceased's preferences and the default is not to remove organs, and oppose donation where there is no evidence of preference but the default is to presume consent; in both cases, the decision could be based on their own wishes or what they think the deceased would have wanted. Finally, families can overrule the known wishes of the deceased, which can mean preventing donation, or permitting donation when the deceased refused it. We propose a schema of 4 levels on which to map these possible family roles: no role, witness, surrogate, and full decisional authority. We conclude by mapping different jurisdictions onto this schema to provide a more comprehensive understanding of the consent system for organ donation and some important nuances about the role of families. This classificatory model aims to account for the majority of the world's consent systems. It provides conceptual and methodological guidance that can be useful to researchers, professionals, and policymakers involved in organ procurement.
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Miller J, Currie S, O'Carroll RE. 'If I donate my organs it's a gift, if you take them it's theft': a qualitative study of planned donor decisions under opt-out legislation. BMC Public Health 2019; 19:1463. [PMID: 31694604 PMCID: PMC6836540 DOI: 10.1186/s12889-019-7774-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 10/14/2019] [Indexed: 11/25/2022] Open
Abstract
Background There is a worldwide shortage of donor organs for transplantation. To overcome this, several countries have introduced an opt-out donor consent system. This system, soon planned for Scotland and England means individuals are automatically deemed to consent for organ donation unless they register an opt-out decision. This study was designed to explore the reasons underpinning donor choices for people who plan to actively opt-in to the register, take no action and be on the register via deemed consent, opt-out, and those who are unsure of their decision. Methods This study reports the analysis of free-text responses obtained from a large survey of intentions towards opt-out legislation in Scotland, England and Northern Ireland (n = 1202). Of the n = 1202 participants who completed the questionnaire, n = 923 provided a free text response explaining their views. Thematic analysis was used to explore the reasons why participants plan to: opt-in (n = 646), follow deemed consent (n = 205), opt-out (n = 32) and those who were not sure (n = 40). Results A key theme for people planning to opt-in is that it ensures one’s donor choice is explicitly clear and unequivocal. Some regarded deemed consent as unclear and open to ambiguity, thus actively opting-in was viewed as a way of protecting against family uncertainty and interference. For the deemed consent group, a key theme is that it represents a simple effortless choice. This is important from both a pragmatic time-saving point of view and because it protects ambivalent participants from making a challenging emotive choice about organ donation. Key themes for those planning to opt-out relate to fears around medical mistrust and bodily integrity. Notably, both participants who plan to opt-out and opt-in perceived presumed consent as “authoritarian” and a method of increasing Government control of organs. In response, registering an active decision protected their freedom of choice. Conclusions The findings highlight the importance of registering deliberate active consent for people who choose opt-in, due to concerns over possible family refusal under deemed consent. These findings could inform the development of communication campaigns that encourage family communication before the implementation of opt-out legislation.
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Affiliation(s)
- Jordan Miller
- Faculty of Natural Sciences, Division of Psychology, University of Stirling, Stirling, FK9 4LA, Scotland.
| | - Sinéad Currie
- Faculty of Natural Sciences, Division of Psychology, University of Stirling, Stirling, FK9 4LA, Scotland
| | - Ronan E O'Carroll
- Faculty of Natural Sciences, Division of Psychology, University of Stirling, Stirling, FK9 4LA, Scotland
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Fan R, Wang M. Family-Based Consent and Motivation for Cadaveric Organ Donation in China: An Ethical Exploration1. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2019; 44:534-553. [PMID: 32479624 PMCID: PMC7263308 DOI: 10.1093/jmp/jhz022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This essay indicates that Confucian family-based ethics is by no means a stumbling block to organ donation in China. We contend that China should not change to an opt-out consent system in order to enhance donation because a "hard" opt-out system is unethical, and a "soft" opt-out system is unhelpful. We argue that the recently-introduced familist model of motivation for organ donation in mainland China can provide a proper incentive for donation. This model, and the family priority right that this model supports, is ethically justifiable in terms of Confucian family-based ethics.
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Affiliation(s)
- Ruiping Fan
- City University of Hong Kong, Hong Kong, PRC
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Process evaluation of specialist nurse implementation of a soft opt-out organ donation system in Wales. BMC Health Serv Res 2019; 19:414. [PMID: 31234832 PMCID: PMC6591913 DOI: 10.1186/s12913-019-4266-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 06/17/2019] [Indexed: 11/23/2022] Open
Abstract
Background Wales introduced a soft opt-out organ donation system on 1st December 2015 with the aim of improving consent rates. In the first 18 months consent rates improved but the difference could not solely be attributed to the soft opt-out system when compared with similar improvements in consent rates in other UK nations. Methods We conducted an 18 month post-intervention qualitative process evaluation involving 88 family members of 60/211 potential organ donor cases, and 19 professionals. Views and experiences of Specialist Nurses in Organ Donation who implemented the new system and family members who were involved in decision making were collected to see how their respective behaviours impacted on implementation. Data collection included interviews, focus groups and qualitative questionnaire data. Results Implementation was considered a success by Specialist Nurses in Organ Donation. The bespoke retraining programme and responsive approach to addressing initial implementation issues were identified as examples of best practice. Specialist Nurses in Organ Donation were valued by family members. Six implementation issues had an impact on consent rates – the media campaign had gaps, the system was more complex, challenges in changing professional behaviours, inability to obtain the required standard of evidence from family members to overturn a donation decision, increased complexity of consent processes, and additional health systems issues. Conclusion This is the first comprehensive process evaluation of implementing a soft opt-out system of organ donation. Specific elements of good implementation practice (such as investment in the retraining programme and the responsiveness of Specialist Nurses in Organ Donation and managers to feedback) were identified. The key message is that despite retraining, nursing practice did not radically change overnight to accommodate the new soft opt-out system. Policy makers and health service managers should not assume that nurses simply need more time to implement the soft-out as intended. Additional responsive modification of processes, ongoing training and support is required to help with implementation as originally intended. Scotland, England and the Netherlands are introducing soft opt-out systems. There is an opportunity to learn from initial implementation in Wales, by acknowledging gaps, good practice and opportunities to further improve processes and nursing practices. Electronic supplementary material The online version of this article (10.1186/s12913-019-4266-z) contains supplementary material, which is available to authorized users.
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Poppe C, Akum S, Crombez G, Rogiers X, Hoste E. Evaluation of the quality of the communication and emotional support during the donation procedure: The use of the donor family questionnaire (DFQ). J Crit Care 2019; 53:198-206. [PMID: 31271955 DOI: 10.1016/j.jcrc.2019.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/26/2019] [Accepted: 06/14/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE A multi-centric study in Intensive Care units (ICU) and Emergency departments (ED) was designed to evaluate whether the provided communication and emotional support to the family in the context of organ donation met the international recommendations of the European Donor Hospital Education Program (EDHEP). MATERIALS AND METHODS Using a participatory approach and focus groups, a questionnaire was constructed: Donor Family questionnaire (DFQ). The questionnaire was distributed to 203 families. The data were analysed on item level. RESULTS Sixty-four families participated, and 89% considered the communication as tactful. Only 24.1% had a separate conversation about passing and donation, which is the recommendation. 88.5% reported they could count on emotional support in the first phase on the ICU/ED. This dropped during the parting phase and the aftercare. The physician is perceived as the most active caregiver in the emotional support during the entire procedure. CONCLUSIONS The DFQ is a useful instrument to evaluate the donor procedure. The physician is important in the first phases of the donor procedure for the medical explanation. Other disciplines could be more involved in the following phases to assure enough emotional support, but this issue requires further exploration.
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Affiliation(s)
- Carine Poppe
- Department of Internal Medicine and Pediatrics, Ghent University, Belgium.
| | - Sandra Akum
- Department of Internal Medicine and Pediatrics, Ghent University, Belgium
| | - Geert Crombez
- Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | - Xavier Rogiers
- Department of Hepato-billiary surgery, Ghent University, Belgium
| | - Eric Hoste
- Departement of Intensive care Medicine, Belgium and Research Foundation-Flanders, Ghent University, Brussels, Belgium
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Prabhu PK. Is presumed consent an ethically acceptable way of obtaining organs for transplant? J Intensive Care Soc 2019; 20:92-97. [PMID: 31037100 PMCID: PMC6475984 DOI: 10.1177/1751143718777171] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The near-universal acceptance of cadaveric organ donation has been based on the provision of explicit consent by the donor while alive, either in the form of a formal opt-in or informal discussion of wishes with next of kin. Despite the success of transplantation programmes based on explicit consent, the ongoing imbalance between demand and supply of organs for transplantation has prompted calls for more widespread introduction of laws validating presumed consent with facility for opt-out as a means of increasing organ availability. The Department of Health (UK) has recently concluded a consultation on the introduction of such a law for England. This article explores the debate on presumed consent from an ethical point of view and summarises the key arguments on both sides of the ethical divide.
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Presumed Consent: A Potential Tool for Countries Experiencing an Organ Donation Crisis. Dig Dis Sci 2019; 64:1346-1355. [PMID: 30519849 DOI: 10.1007/s10620-018-5388-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/20/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is currently an inadequate supply of allografts to meet the number of transplant candidates worldwide. A number of controversial policies, including implementation of a presumed consent organ donation system, have been considered to rectify the organ donation crisis. AIMS A secondary retrospective data analysis aimed to assess the impact of switching to a presumed consent organ donation model on organ donation rates. METHODS Deceased organ donation rates were compared before and after countries adopted presumed consent. RESULTS Six countries met entry criteria. All six countries had an increase in liver donation rates, while 4 out of the six countries had an increase in kidney donation rates. The overall mean (± SD) liver donation rate was 3.23 (± 0.97) per million population (pmp) before the transition and 6.46 (± 1.81) pmp after the transition (p < 0.0001). The overall mean (± SD) kidney donation rate was 17.94 (± 3.34) pmp before the transition and 26.58 (± 4.23) pmp after the transition (p < 0.0001). The percentage increase in liver and kidney donation rates varied among countries, ranging from 28 to 1186%. CONCLUSION The transition from explicit to presumed consent was associated with a significant increase in liver donation rates in all countries that met our criteria, while the effect on kidney donation rates was partially realized. Although presumed consent alone is unlikely to explain the increase in donation rates, the adoption of such a policy may prove to be a worthwhile risk for countries experiencing consistently low organ donation rates.
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Kentish-Barnes N, Siminoff LA, Walker W, Urbanski M, Charpentier J, Thuong M, Sarti A, Shemie SD, Azoulay E. A narrative review of family members’ experience of organ donation request after brain death in the critical care setting. Intensive Care Med 2019; 45:331-342. [DOI: 10.1007/s00134-019-05575-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/19/2019] [Indexed: 11/27/2022]
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Agrawal M, Aggarwal L, Mishra S, Shah D. Impact of single classroom-based peer-led organ donation education exposure on high-school students and their families. INDIAN JOURNAL OF TRANSPLANTATION 2019. [DOI: 10.4103/ijot.ijot_24_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Molina-Pérez A, Rodríguez-Arias D, Delgado-Rodríguez J, Morgan M, Frunza M, Randhawa G, Reiger-Van de Wijdeven J, Schiks E, Wöhlke S, Schicktanz S. Public knowledge and attitudes towards consent policies for organ donation in Europe. A systematic review. Transplant Rev (Orlando) 2019; 33:1-8. [DOI: 10.1016/j.trre.2018.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/21/2018] [Accepted: 09/14/2018] [Indexed: 11/26/2022]
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Tumin M, Tafran K, Mohd Satar NH, Peng NK, Manikam R, Yoong TL, Chan CM. Factors Associated with Health Care Professionals' Attitude Toward the Presumed Consent System. EXP CLIN TRANSPLANT 2018; 17:1-5. [PMID: 29766774 DOI: 10.6002/ect.2017.0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES This paper explores health care professionals' potential attitude toward organ donation if the presumed consent system were to be implemented in Malaysia, as well as factors associated with this attitude. MATERIALS AND METHODS We used self-administered questionnaires to investigate the attitude of 382 health care professionals from the University of Malaya Medical Center between January and February 2014. The responses were analyzed using logistic regression. RESULTS Of the 382 respondents, 175 (45.8%) stated that they would officially object to organ donation if the presumed consent system were to be implemented, whereas the remaining 207 (54.2%) stated that they would not object. The logistic regression showed that health care professionals from the Malay ethnic group were more likely to object than those from Chinese (adjusted odds ratio of 0.342; P = .001) and Indian and other (adjusted odds ratio of 0.341; P = .003) ethnic groups. Health care professionals earning 3000 Malaysian Ringgit or below were more likely to object than those earning above 3000 Malaysian Ringgit (adjusted odds ratio of 1.919; P = .006). Moreover, respondents who were initially unwilling to donate organs, regardless of the donation system, were more likely to object under the presumed consent system than those who were initially willing to donate (adjusted odds ratio of 2.765; P < .001). CONCLUSIONS Health care professionals in Malaysia have a relatively negative attitude toward the presumed consent system, which does not encourage the implementation of this system in the country at present. To pave the way for a successful implementation of the presumed consent system, efforts should be initiated to enhance the attitude of health care professionals toward this system. In particular, these efforts should at most target the health care professionals who are Malay, earn a low income, and have a negative default attitude toward deceased donation.
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Affiliation(s)
- Makmor Tumin
- From the Department of Administrative Studies and Politics, University of Malaya, Kuala Lumpur, Malaysia
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López JS, Martínez JM, Soria-Oliver M, Aramayona B, García-Sánchez R, Martín MJ, Almendros C. Bereaved relatives' decision about deceased organ donation: An integrated psycho-social study conducted in Spain. Soc Sci Med 2018; 205:37-47. [DOI: 10.1016/j.socscimed.2018.03.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 03/15/2018] [Accepted: 03/26/2018] [Indexed: 12/31/2022]
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López JS, Soria-Oliver M, Aramayona B, García-Sánchez R, Martínez JM, Martín MJ. An Integrated Psychosocial Model of Relatives' Decision About Deceased Organ Donation (IMROD): Joining Pieces of the Puzzle. Front Psychol 2018; 9:408. [PMID: 29692744 PMCID: PMC5902731 DOI: 10.3389/fpsyg.2018.00408] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 03/12/2018] [Indexed: 11/13/2022] Open
Abstract
Organ transplantation remains currently limited because the demand for organs far exceeds the supply. Though organ procurement is a complex process involving social, organizational, and clinical factors, one of the most relevant limitations of organ availability is family refusal to donate organs of a deceased relative. In the past decades, a remarkable corpus of evidence about the factors conditioning relatives' consent has been generated. However, research in the field has been carried out mainly by means of merely empirical approaches, and only partial attempts have been made to integrate the existing empirical evidence within conceptual and theoretically based frameworks. Accordingly, this work articulates the proposal of an Integrated Psychosocial Model of Relatives' Organ Donation (IMROD) which offers a systematic view of the factors and psychosocial processes involved in family decision and their interrelations. Relatives' experience is conceptualized as a decision process about the possibility of vicariously performing an altruistic behavior that takes place under one of the most stressful experiences of one's lifetime and in the context of interaction with different healthcare professionals. Drawing on this, in the proposed model, the influence of the implied factors and their interrelations/interactions are structured and interpreted according to their theoretically based relation with processes like rational/heuristic decision-making, uncertainty, stress, bereavement, emotional reactions, sense of reciprocity, sense of freedom to decide, and attitudes/intentions toward one's own and the deceased's organ donation. Our model also develops a processual perspective and suggests different decisional scenarios that may be reached as a result of the combinations of the considered factors. Each of these scenarios may imply different balances between factors that enhance or hinder donation, such as different levels of uncertainty and potential decisional conflict. Throughout our work, current controversial or inconsistent results are discussed and interpreted on the basis of the relationships that are posited in the proposed model. Finally, we suggest that the structure of the relationships and interactions contained in our model can be used by future research to guide the formulation of hypotheses and the interpretation of results. In this sense, specific guidelines and research questions are also proposed.
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Affiliation(s)
- Jorge S López
- Departamento de Psicología y Pedagogía, Universidad Pública de Navarra, Pamplona, Spain.,Departamento de Psicología Social y Metodología, Universidad Autónoma de Madrid, Madrid, Spain
| | - Maria Soria-Oliver
- Facultad de Ciencias de la Salud, UNIR-Universidad Internacional de la Rioja, Logroño, Spain
| | - Begoña Aramayona
- Departamento de Psicología Social y Metodología, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rubén García-Sánchez
- Departamento de Psicología Social y Metodología, Universidad Autónoma de Madrid, Madrid, Spain
| | - José M Martínez
- Departamento de Psicología Social y Metodología, Universidad Autónoma de Madrid, Madrid, Spain
| | - María J Martín
- Departamento de Psicología Social y Metodología, Universidad Autónoma de Madrid, Madrid, Spain
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Tackmann E, Dettmer S. [Acceptance of post-mortem organ donation in Germany : Representative cross-sectional study]. Anaesthesist 2017; 67:118-125. [PMID: 29230502 DOI: 10.1007/s00101-017-0391-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/04/2017] [Accepted: 11/15/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The German post-mortem organ donation rate has dropped by one third since 2010. Furthermore, 958 patients died in 2015 in Germany while waiting for an organ. To decrease organ shortage, an amendment of the transplantation law was established in 2012. An information package including an organ donor card is sent to all German citizens via the postal service. A voluntary national transplantation register was introduced in 2016 to improve transparency in the organ donation process. The influence of several transplantation scandals starting in 2012 on organ donation rates is in question. Therefore, the objective of this article is to discuss approval and objections to post-mortem organ donation among the next of kin of potential donors and the general public in Germany. METHODS Binary logistic regression of data from the 2014 survey by the Federal Centre for Health Education on attitudes towards organ and tissue donation in Germany was conducted, aiming to identify influencing factors on the likelihood of organ donor card possession. Additionally, data of the German Organ Transplantation Foundation on post-mortem organ donations in Germany in 2014 were studied to highlight reasons for approval and objections by next of kin of potential and explanted post-mortem organ donors. Methods of documentation of the deceased's will according to data of the German Organ Transplantation Foundation were analyzed. RESULTS Male gender and lack of knowledge about organ donation decrease the likelihood of having an organ donor card. Of the respondents in the survey of the Federal Centre for Health Education 71.0% would donate their own organs, whereas only one third possess an organ donor card. Health insurances and physicians are the most important providers of organ donor cards in Germany. An increase in the percentage of organ donor card possession following the amendment of the transplantation law could not be observed by 2016. Fear of organ trade and unjust organ allocation are the main reasons for rejecting organ donation among the general public. Previous transplantation scandals are a primary reason for a negative change in attitudes. Main reasons for objection among the next of kin of potential organ donors are known objections of the deceased and the lack of knowledge about the will of the deceased. In addition, only 58.1% of all explanted organ donors documented their will in written or verbal form. CONCLUSION Education on organ donation can be a means to increase organ donation rates. The effects of the change in legislation and the establishment of the transplant register need to be evaluated. Further research regarding the influence of religion, especially among religious minorities, on organ donation rates in Germany needs to be conducted to identify possible obstacles. Moreover, the use of social networks to address potential organ donors has proven to increase registration numbers and could easily be implemented in Germany.
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Affiliation(s)
- E Tackmann
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - S Dettmer
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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Michaut C, Baumann A, Gregoire H, Laviale C, Audibert G, Ducrocq X. An assessment of advance relatives approach for brain death organ donation. Nurs Ethics 2017. [PMID: 28643577 DOI: 10.1177/0969733017708331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Advance announcement of forthcoming brain death has developed to enable intensivists and organ procurement organisation coordinators to more appropriately, and separately from each other, explain to relatives brain death and the subsequent post-mortem organ donation opportunity. RESEARCH AIM: The aim was to assess how potentially involved healthcare professionals perceived ethical issues surrounding the strategy of advance approach. RESEARCH DESIGN: A multi-centre opinion survey using an anonymous self-administered questionnaire was conducted in the six-member hospitals of the publicly funded East of France regional organ and tissue procurement network called 'Prélor'. PARTICIPANTS: The study population comprised 460 physicians and nurses in the Neurosurgical, Surgical and Medical Intensive Care Units, the Stroke Units and the Emergency Departments. ETHICAL CONSIDERATIONS: The project was approved by the board of the Lorraine University Diploma in Medical Ethics and the Prélor Network administrators. MAIN FINDINGS: A slight majority of 53.5% of respondents had previously participated in an advance relatives approach: 83% of the physicians and 42% of the nurses. A majority of healthcare professionals (68%) think that the main justification for advance relatives approach is the comprehensive care of the dying patient and the research of his or her most likely opinion (74%). The misunderstanding of the related issues by relatives is an obstacle for 47% of healthcare professionals and 51% think that the answer given by the relatives regarding the most likely opinion of the person regarding post-mortem organ donation really corresponds to the person opinion in only 50% of the cases or less. CONCLUSION: Time given by advance approach should be employed to help and enable relatives to authentically bear the values and interests of the potential donor in the post-mortem organ donation discussion. Nurses' attendance of advance relatives approach seems necessary to enable them to optimally support the families facing death and post-mortem organ donation issues.
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Affiliation(s)
| | | | | | | | | | - Xavier Ducrocq
- Université de Lorraine, France; Metz Regional Hospital, France
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Stoler A, Kessler JB, Ashkenazi T, Roth AE, Lavee J. Incentivizing Organ Donor Registrations with Organ Allocation Priority. HEALTH ECONOMICS 2017; 26:500-510. [PMID: 27125490 DOI: 10.1002/hec.3328] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 01/22/2016] [Accepted: 01/28/2016] [Indexed: 06/05/2023]
Abstract
How donor organs are allocated for transplant can affect their scarcity. In 2008, Israel's Parliament passed an Organ Transplantation Law granting priority on organ donor waiting lists to individuals who had previously registered as organ donors. Beginning in November 2010, public awareness campaigns advertised the priority policy to the public. Since April 2012, priority has been added to the routine medical criteria in organ allocation decisions. We evaluate the introduction of priority for registered organ donors using Israeli data on organ donor registration from 1992 to 2013. We find that registrations increased when information about the priority law was made widely available. We find an even larger increase in registration rates in the 2 months leading up to a program deadline, after which priority would only be granted with a 3-year delay. We also find that the registration rate responds positively to public awareness campaigns, to the ease of registration (i.e. allowing for registering online and by phone) and to an election drive that included placing registration opportunities in central voting locations. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Avraham Stoler
- Department of Economics, DePaul University and Coherent Economics, Highland Park, IL, USA
| | - Judd B Kessler
- The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Alvin E Roth
- Department of Economics, Stanford University, Stanford, CA, USA
| | - Jacob Lavee
- Tel Aviv University Faculty of Medicine and the Heart Transplantation Unit, Sheba Medical Center, Ramat Gan, Israel
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Murakami M, Fukuma S, Ikezoe M, Iizuka C, Izawa S, Yamamoto Y, Yamazaki S, Fukuhara S. Effects of structured education program on organ donor designation of nursing students and their families: A randomized controlled trial. Clin Transplant 2016; 30:1513-1519. [DOI: 10.1111/ctr.12845] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Minoru Murakami
- Department of Healthcare Epidemiology School of Public Health in the Graduate School of Medicine Kyoto University Kyoto Japan
- Department of Nephrology Saku Central Hospital Nagano Japan
| | - Shingo Fukuma
- Department of Healthcare Epidemiology School of Public Health in the Graduate School of Medicine Kyoto University Kyoto Japan
- Institute for Advancement of Clinical and Translational Science (iACT) Kyoto University Hospital Kyoto Japan
- Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE) Fukushima Medical University Fukushima Japan
| | - Masaya Ikezoe
- Department of Nephrology Saku Central Hospital Nagano Japan
| | | | | | - Yosuke Yamamoto
- Department of Healthcare Epidemiology School of Public Health in the Graduate School of Medicine Kyoto University Kyoto Japan
- Institute for Advancement of Clinical and Translational Science (iACT) Kyoto University Hospital Kyoto Japan
| | - Shin Yamazaki
- Department of Healthcare Epidemiology School of Public Health in the Graduate School of Medicine Kyoto University Kyoto Japan
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology School of Public Health in the Graduate School of Medicine Kyoto University Kyoto Japan
- Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE) Fukushima Medical University Fukushima Japan
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Li AHT, Lam NN, Dhanani S, Weir M, Prakash V, Kim J, Knoll G, Garg AX. Registration for deceased organ and tissue donation among Ontario immigrants: a population-based cross-sectional study. CMAJ Open 2016; 4:E551-E561. [PMID: 28443265 PMCID: PMC5396453 DOI: 10.9778/cmajo.20160024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Canada has low rates of deceased organ and tissue donation. Immigrants to Canada may differ in their registered support for deceased organ donation based on their country of origin. METHODS We used linked administrative databases in Ontario (about 11 million residents aged ≥ 16 yr) to study the proportion of immigrants and long-term residents registered for deceased organ and tissue donation as of October 2013. We used modified Poisson regression to identify and quantify predictors of donor registration. RESULTS Compared with long-term residents (n = 9 244 570), immigrants (n = 1 947 646) were much less likely to register for deceased organ and tissue donation (11.9% v. 26.5%). Immigrants from the United States, Australia and New Zealand had the highest registration rate (40.0%), whereas immigrants with the lowest registration rates were from Eastern Europe and Central Asia (9.4%), East Asia and Pacific (8.4%) and sub-Saharan Africa (7.9%). The largest numbers of unregistered immigrants were from India (n = 202 548), China (n = 186 678) and the Philippines (n = 125 686). Characteristics among the immigrant population associated with a higher likelihood of registration included economic immigrant status, living in a rural area (population < 10 000), living in an area with a lower ethnic concentration, less material deprivation, a higher education, ability to speak English and French, and more years residing in Canada. INTERPRETATION Immigrants in Ontario were less likely to register for deceased organ and tissue donation than long-term residents. There is a need to better understand reasons for lower registration rates among Canadian immigrants and to create culture-sensitive materials to build support for deceased organ and tissue donation.
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Affiliation(s)
- Alvin Ho-Ting Li
- Department of Epidemiology and Biostatistics (Li, Weir, Garg), Western University, London, Ont.; Division of Nephrology (Lam), University of Alberta, Edmonton, Alta.; Trillium Gift of Life Network (Dhanani, Prakash), Toronto, Ont.; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ont.; Division of Nephrology (Weir, Garg), Western University, London, Ont.; Division of Nephrology (Kim), Department of Medicine, University of Toronto, Toronto, Ont.; Division of Nephrology and Ottawa Hospital Research Institute (Knoll), The Ottawa Hospital and University of Ottawa, Ottawa, Ont.; Institute for Clinical Evaluative Sciences (Garg), London, Ont
| | - Ngan N Lam
- Department of Epidemiology and Biostatistics (Li, Weir, Garg), Western University, London, Ont.; Division of Nephrology (Lam), University of Alberta, Edmonton, Alta.; Trillium Gift of Life Network (Dhanani, Prakash), Toronto, Ont.; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ont.; Division of Nephrology (Weir, Garg), Western University, London, Ont.; Division of Nephrology (Kim), Department of Medicine, University of Toronto, Toronto, Ont.; Division of Nephrology and Ottawa Hospital Research Institute (Knoll), The Ottawa Hospital and University of Ottawa, Ottawa, Ont.; Institute for Clinical Evaluative Sciences (Garg), London, Ont
| | - Sonny Dhanani
- Department of Epidemiology and Biostatistics (Li, Weir, Garg), Western University, London, Ont.; Division of Nephrology (Lam), University of Alberta, Edmonton, Alta.; Trillium Gift of Life Network (Dhanani, Prakash), Toronto, Ont.; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ont.; Division of Nephrology (Weir, Garg), Western University, London, Ont.; Division of Nephrology (Kim), Department of Medicine, University of Toronto, Toronto, Ont.; Division of Nephrology and Ottawa Hospital Research Institute (Knoll), The Ottawa Hospital and University of Ottawa, Ottawa, Ont.; Institute for Clinical Evaluative Sciences (Garg), London, Ont
| | - Matthew Weir
- Department of Epidemiology and Biostatistics (Li, Weir, Garg), Western University, London, Ont.; Division of Nephrology (Lam), University of Alberta, Edmonton, Alta.; Trillium Gift of Life Network (Dhanani, Prakash), Toronto, Ont.; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ont.; Division of Nephrology (Weir, Garg), Western University, London, Ont.; Division of Nephrology (Kim), Department of Medicine, University of Toronto, Toronto, Ont.; Division of Nephrology and Ottawa Hospital Research Institute (Knoll), The Ottawa Hospital and University of Ottawa, Ottawa, Ont.; Institute for Clinical Evaluative Sciences (Garg), London, Ont
| | - Versha Prakash
- Department of Epidemiology and Biostatistics (Li, Weir, Garg), Western University, London, Ont.; Division of Nephrology (Lam), University of Alberta, Edmonton, Alta.; Trillium Gift of Life Network (Dhanani, Prakash), Toronto, Ont.; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ont.; Division of Nephrology (Weir, Garg), Western University, London, Ont.; Division of Nephrology (Kim), Department of Medicine, University of Toronto, Toronto, Ont.; Division of Nephrology and Ottawa Hospital Research Institute (Knoll), The Ottawa Hospital and University of Ottawa, Ottawa, Ont.; Institute for Clinical Evaluative Sciences (Garg), London, Ont
| | - Joseph Kim
- Department of Epidemiology and Biostatistics (Li, Weir, Garg), Western University, London, Ont.; Division of Nephrology (Lam), University of Alberta, Edmonton, Alta.; Trillium Gift of Life Network (Dhanani, Prakash), Toronto, Ont.; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ont.; Division of Nephrology (Weir, Garg), Western University, London, Ont.; Division of Nephrology (Kim), Department of Medicine, University of Toronto, Toronto, Ont.; Division of Nephrology and Ottawa Hospital Research Institute (Knoll), The Ottawa Hospital and University of Ottawa, Ottawa, Ont.; Institute for Clinical Evaluative Sciences (Garg), London, Ont
| | - Greg Knoll
- Department of Epidemiology and Biostatistics (Li, Weir, Garg), Western University, London, Ont.; Division of Nephrology (Lam), University of Alberta, Edmonton, Alta.; Trillium Gift of Life Network (Dhanani, Prakash), Toronto, Ont.; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ont.; Division of Nephrology (Weir, Garg), Western University, London, Ont.; Division of Nephrology (Kim), Department of Medicine, University of Toronto, Toronto, Ont.; Division of Nephrology and Ottawa Hospital Research Institute (Knoll), The Ottawa Hospital and University of Ottawa, Ottawa, Ont.; Institute for Clinical Evaluative Sciences (Garg), London, Ont
| | - Amit X Garg
- Department of Epidemiology and Biostatistics (Li, Weir, Garg), Western University, London, Ont.; Division of Nephrology (Lam), University of Alberta, Edmonton, Alta.; Trillium Gift of Life Network (Dhanani, Prakash), Toronto, Ont.; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ont.; Division of Nephrology (Weir, Garg), Western University, London, Ont.; Division of Nephrology (Kim), Department of Medicine, University of Toronto, Toronto, Ont.; Division of Nephrology and Ottawa Hospital Research Institute (Knoll), The Ottawa Hospital and University of Ottawa, Ottawa, Ont.; Institute for Clinical Evaluative Sciences (Garg), London, Ont
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Stoler A, Kessler JB, Ashkenazi T, Roth AE, Lavee J. Incentivizing Authorization for Deceased Organ Donation With Organ Allocation Priority: The First 5 Years. Am J Transplant 2016; 16:2639-45. [PMID: 27013023 DOI: 10.1111/ajt.13802] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/25/2016] [Accepted: 03/13/2016] [Indexed: 01/25/2023]
Abstract
The allocation system of donor organs for transplantation may affect their scarcity. In 2008, Israel's Parliament passed the Organ Transplantation Law, which grants priority on waiting lists for transplants to candidates who are first-degree relatives of deceased organ donors or who previously registered as organ donors themselves. Several public campaigns have advertised the existence of the law since November 2010. We evaluated the effect of the law using all deceased donation requests made in Israel during the period 1998-2015. We use logistic regression to compare the authorization rates of the donors' next of kin in the periods before (1998-2010) and after (2011-2015) the public was made aware of the law. The authorization rate for donation in the period after awareness was substantially higher (55.1% vs. 45.0%, odds ratio [OR] 1.43, p = 0.0003) and reached an all-time high rate of 60.2% in 2015. This increase was mainly due to an increase in the authorization rate of next of kin of unregistered donors (51.1% vs. 42.2%). We also found that the likelihood of next-of-kin authorization for donation was approximately twice as high when the deceased relative was a registered donor rather than unregistered (89.4% vs. 44.6%, OR 14.27, p < 0.0001). We concluded that the priority law is associated with an increased authorization rate for organ donation.
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Affiliation(s)
- A Stoler
- Department of Economics, DePaul University, Chicago, IL.,Coherent Economics, Highland Park, IL
| | - J B Kessler
- Department of Business Economics and Public Policy, The Wharton School at the University of Pennsylvania, Philadelphia, PA
| | - T Ashkenazi
- Israel National Transplant Center, State Ministry of Health, Tel-Aviv, Israel
| | - A E Roth
- Department of Economics, Stanford University, Stanford, CA
| | - J Lavee
- Heart Transplantation Unit, Department of Cardiac Surgery, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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