An international opinion poll of well-educated people regarding awareness and feelings about organ donation for transplantation

Medical students' education on organ donation and its evaluation during six consecutive years: results of a voluntary, anonymous educational intervention study

BACKGROUND

One of the main reasons for organ shortage is insufficient education on organ donation. Knowledgeable medical students could share the information with friends and families resulting in a positive attitude to organ donation of the general public.

METHODS

During six consecutive years (2009 to 2014), we conducted a voluntary, anonymous educational intervention study on organ donation among fourth year medical students in the course of the main surgery lecture at the University of Essen, Germany.

RESULTS

Questionnaires of 383 students were analyzed. Prior to the specific lecture on organ donation, 64% of the students carried a signed organ donor card with the intention to donate. Further information regarding organ donation was required by 37% of the students. The request for further information was statistically significantly higher among students without a donor card compared to organ donor card carriers (P < 0.0001). After the lecture, the number of students requiring further information decreased statistically significantly to 19% (P < 0.0001).

CONCLUSIONS

Already a 45-minute lecture for fourth year medical students significantly decreases their request for further information on organ donation and improves their attitude to organ donation. Continued training on organ donation will help medical students to become disseminators for this important topic in our society.

Policy perspectives: international survey of nephrologists' perceptions of and attitudes towards rewards and compensation for kidney donation

The challenge to resolve the gap between supply and demand for organs is a global phenomenon. The possible solutions can invariably involve a range of ethical and moral dilemmas. This is certainly the case when considering rewards and compensation for kidney donation. In their thought provoking study, Ghahramami et al. provide the perspectives of medical professionals on these issues. The views of nephrologists concerning rewards and compensation chime with views of the public, which have been highlighted in many previous studies. Rewards and compensation for organ donation are perceived, by some, as barriers to successful organ donation transplant programmes; whereas others view them as potential facilitators to increasing organ donation rates. It is interesting to note that two-thirds of survey respondents believe that introducing some kind of reward or offering compensation would lead to an increase in organ donation. This finding is not unique to this study and is evident in many public surveys where respondents have expressed a belief that offering some form of incentive would have a positive impact on organ donation rates. Disappointingly, the debates concerning the type of reward or compensation and its potential impact on donation rates continue to take place in a relatively 'evidence base-free' vacuum. What is abundantly clear is that many lives continue to be lost in many countries due to a lack of suitable organs for transplant. What is less clear is which forms of reward and compensation actually have an impact on donation rates and whether they positively impact the life experiences of donors, recipients and their families. This level of evidence- base is urgently required.

Predictors of consent in tissue donation: interpersonal aspects and information provision during requests by phone

OBJECTIVE

To examine whether interpersonal behavior and provision of key information by tissue requesters (TRs) during phone requests for tissue donation with initially undecided next-of-kin (NOK) predict consent/refusal to donate.

METHODS

The sample consisted of 102 TR-NOK dyads in which NOK reported that they were initially undecided about their intentions to donate their loved ones' tissue. Audiorecordings of requests, gathered from a national sample of tissue banks, were coded to assess for interpersonal behavior of each interactant. The effects of TR and NOK interpersonal behavior as well as information provision by the TR on consent/refusal were examined.

RESULTS

Expressions of disapproval by the TR strongly predicted NOK donation decision. Predictors of consent included fewer questions asked and more supportive statements made by the TR, as well as reassurance from the TR that donation would not lead to disfigurement or affect the appearance of the body.

CONCLUSION

Aspects of the communication process between TR and NOK during requests for tissue donation significantly predict consent to donate among initially undecided NOK.

PRACTICE IMPLICATIONS

TR trainings aimed at improving interpersonal skills and provision of key information could potentially increase tissue donation consent rates.

Public attitudes to financial incentive models for organs: a literature review suggests that it is time to shift the focus from 'financial incentives' to 'reciprocity'

Waiting lists for organs have stimulated interest in the use of financial incentives for organ donation (FIs), but the literature does not contain an adequate overview of studies of public attitudes toward this mode of procurement. We conducted a literature review of international peer-reviewed research published between 2002 and 2012 on how members of the public position themselves toward FIs. We identified and analyzed 23 studies using MEDLINE, PsycINFO, Sociological Abstracts and cross-reference search. The search included whole organs, donation, quantitative and empirical qualitative social scientific studies on, public attitudes (excluding professionals and medical students). The review reveals a broad divergence of public opinions on financial incentives. However, quantitative studies showed a low overall level of acceptance of payment for organs in living donation (LD); only a slightly higher one for deceased donation (DD); and a general preference for alternative forms, such as removal of disincentives or expressions of social reciprocity. Across different national and methodological settings we observed a considerable preference of noncommercial forms. This does not preclude the opportunity to consider various types of acknowledgement of economic value given in return for the organ. This provides reason to shift the focus from incentives to reciprocity.

First global forum on education on organ donation and transplantation for schools

The Transplantation Society, in collaboration with the Canadian Society of Transplantation, organized a forum on education on ODT for schools. The forum included participants from around the world, school boards, and representatives from different religions. Participants presented on their countries' experience in the area of education on ODT. Working groups discussed about technologies for education, principles for sharing of resources globally, and relationships between education, and health authorities and non-governmental organizations. The forum concluded with a discussion about how to best help existing programs and those wishing to start educational programs on ODT.

Laypeople's ethical concerns about a New Israeli organ transplantation prioritization policy aimed to encourage organ donor registration among the public

A new policy recently enacted in Israel promises preferred status in receiving organs for transplantation to individuals who register to be organ donors and to their close family members. Proponents believe it will increase the supply of organs for transplantation from the deceased. Ethical issues were raised in government committees appointed to discuss the policy before its approval, but discussions among laypeople were not solicited. This study aimed to elicit laypeople's views about the policy by conducting thirteen group interviews and thirty-six individual interviews. Participants included religious and nonreligious people, immigrants, and Arabs. Some participants thought the law would contribute to fairness by prioritizing those willing to give, but others articulated ethical concerns that were not emphasized by scholars, in particular that the policy would add to the erosion of social solidarity, increase divisiveness, and enable people to abuse the system. Mistrust in the health care system emerged as a prominent reason for not registering as an organ donor. Implications about the importance of transparency in the organ transplantation system as a basis for an information campaign, social norms regarding organ donation, and the public's involvement in policy issues on organ donation are discussed.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

A profile of Australian adults who have discussed their posthumous organ donation wishes with family members

Next of kin who are aware of the deceased's organ donation wishes usually will honor those wishes, while next of kin who are unaware of these wishes typically withhold consent for posthumous donation. Encouraging individuals to communicate or register their organ donation wishes is therefore important. Using a sample of 409 participants, the current study sought to develop a profile of Australian adults who had communicated their organ donation wishes to family members. Christian participants and those who had a higher income were more likely to have communicated their donation wishes. Conversely, participants were less likely to have communicated their donation wishes if they were unregistered and undecided/opposed to organ donation, unregistered but willing to donate, or fearful of death. Finally, whether participants had communicated, registered, or communicated and registered their donation wishes was associated with their age, religion, attitude toward organ donation, and recall of media content about organ donation. Messages encouraging the communication of organ donation wishes to family members should therefore be targeted toward those individuals who are most likely to be receptive toward enacting this behavior.

Enforcement of presumed-consent policy and willingness to donate organs as identified in the European Union Survey: the role of legislation in reinforcing ideology in pluralistic societies

To increase the supply of transplantable organs, some European Union (EU) countries have begun implementing and enforcing presumed consent policies for organ donation. Mossialos and colleagues performed an analysis of samples of citizens in 15 EU countries and found that legislation, enforcement, and awareness of presumed consent policies for organ donation increase people's willingness to donate their own organs and those of a deceased relative. The authors concluded that, in countries with enforced presumed consent, citizens are willing to donate because they accept organ donation as an ideology. This ideology originates in the thinking that organ donation is an implicit communal contract i.e., a mechanism by which individuals pay back society for the inclusion and social support that they have already experienced and hope to experience in the future. Acceptance of this ideology enhances people's willingness to donate organs and the efficiency in pursuing this collective action, thus, paving the way toward increased paternalism in society. We highlight some potential biases that may have been incorporated in the survey design and in Mossialos et al.'s conclusions, including (1) how the survey questions were constructed, (2) whether sufficient information was communicated about organ procurement practices in heart-beating and non-heart-beating donation before participants responded to the survey, and (3) whether respondents' knowledge about donation legislation can be equated with understanding of processes involved in organ donation. We address the consequences of using legislative authority to enforce the ideology of organ donation, thereby superseding the varying moral values, beliefs, and attitudes about human life and culture that are inherent in multicultural societies.

Experience of donation and quality of life in living kidney and liver donors

Italian guidelines on living donation demand that we ascertain the donor's free and informed consent. Assessments to do so have to be conducted by an independent 'third party' who has nothing to do with the medical team treating the recipient. From February 2002 to December 2006, the Veneto Regional Authority's Third Party Commission evaluated 201 living liver and kidney donors. A sample of these were contacted after their surgery to assess their living donation experience and quality of life (QoL); 81 were eligible for the assessment and 69 (85.2%) responded. All donors involved in the study completed an anonymous document that included the SF-36 and a questionnaire on their donation experience. The majority (96%) of the sample expressed a positive global opinion of the experience. We concluded that the donation had positive effects on their QoL and that family support had a fundamental influence on their general well-being, and their psychic balance in particular. Some crucial issues emerged, however, i.e. 11% of donors judged the information received before the operation inadequate, 17% reported a subjective perception of bodily changes after the operation and 14% were concerned about their current health: these findings emphasize the importance of informing potential donors thoroughly before they submit to surgery.