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Pekmezaris R, Cigaran E, Patel V, Clement D, Sardo Molmenti CL, Molmenti E. Randomized intervention to assess the effectiveness of an educational video on organ donation intent among Hispanics in the New York metropolitan area. World J Transplant 2023; 13:190-200. [PMID: 37388392 PMCID: PMC10303414 DOI: 10.5500/wjt.v13.i4.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/04/2023] [Accepted: 05/23/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The Hispanic community has a high demand for organ donation but a shortage of donors. Studies investigating factors that could promote or hinder organ donation have examined emotional video interventions. Factors acting as barriers to organ donation registration have been classified as: (1) Bodily integrity; (2) medical mistrust; (3) “ick”-feelings of disgust towards organ donation; and (4) “jinx”-fear that registration may result in one dying due to premeditated plans. We predict that by providing necessary information and education about the donation process via a short video, individuals will be more willing to register as organ donors.
AIM To determine perceptions and attitudes regarding barriers and facilitators to organ donation intention among Hispanic residents in the New York metropolitan area.
METHODS This study was approved by the Institutional Review Board at Northwell Health. The approval reference number is No. 19-0009 (as presented in Supplementary material). Eligible participants included Hispanic New York City (NYC) residents, 18 years of age and above, who were recruited voluntarily through Cloud Research and participated in a larger randomized survey study of NYC residents. The survey an 85-item Redcap survey measured participant demographics, attitudes, and knowledge of organ donation as well as the intention to register as an organ donor. Attention checks were implemented throughout the survey, and responses were excluded for those who did fail. Participants were randomly assigned two-between subject conditions: To view a short video on organ donation and then proceed to complete the survey (i.e., video first) and view the same video at the end of the survey (video last). No intra-group activities were conducted. This study utilized an evidenced-based emotive educational intervention (video) which was previously utilized and was shown to increase organ donation registration rates at the Ohio Department of Motor Vehicles. Results were analyzed using Jamovi statistical software. Three hundred sixty-five Hispanic individuals were included in the analysis. Once consent was obtained and participants entered the survey (the survey sample is presented in Supplementary material), participants were asked to report on demographic variables and their general impression of organ donation after death. The video depicted stories regarding organ donation after death from various viewpoints, including from the loved ones of a deceased person who died waiting for a transplant; from the loved ones of a deceased person whose organs were donated upon death; and, from those who were currently waiting for a transplant.
RESULTS Using a binomial logistic regression, the analysis provides information about the relationship between the effects of an emotive video and the intention to donate among Hispanic participants who were not already registered as donors. The willingness to go back and register was found to be significantly more probable for those who watched the emotive video before being asked about their organ donation opinions (odds ratio: 2.05, 95% confidence interval: 1.06-3.97). Motivations for participation in organ donation were also captured with many stating the importance of messages coming from “people like me” and a message that highlights “the welfare of those in need”. Overall, the findings suggest that using an emotive video that addresses organ donation barriers to prompt organ donation intentions can be effective among the Hispanic populous. Future studies should explore using targeted messaging that resonates with specific cultural groups, highlighting the welfare of others.
CONCLUSION This study suggests that an emotive educational intervention is likely to be effective in improving organ donation registration intent among the Hispanic population residing in NYC.
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Affiliation(s)
- Renee Pekmezaris
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, United States
| | - Edgardo Cigaran
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, United States
| | - Vidhi Patel
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, United States
| | - Damian Clement
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, United States
| | | | - Ernesto Molmenti
- Department of Nephrology, Northwell Health/Zucker School of Medicine at Hosftra, Manhasset, NY 11030, United States
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Molmenti EP, Finuf KD, Patel VH, Molmenti CL, Thornton D, Pekmezaris R. A Randomized Intervention to Assess the Effectiveness of an Educational Video on Organ Donation Intent. KIDNEY360 2021; 2:1625-1632. [PMID: 35372974 PMCID: PMC8785782 DOI: 10.34067/kid.0001392021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/15/2021] [Indexed: 11/27/2022]
Abstract
BackgroundThe primary objective of this study was to evaluate the effectiveness of an emotive educational video on organ donation intent in New York City. The secondary study objective was to determine if the educational video affected various factors associated with organ donation.MethodsNew York City residents were recruited via a crowdsourcing online platform and randomized to one of two groups, with exposure to viewing (1) an educational video before completing an 81 question survey on organ donation (“video first” condition) or (2) after completing the survey (“video last” condition). Logistic regression analysis compared organ donation intent (i.e., “how likely are you to become an organ donor”) between the two groups. Additional variables related to organ donation (e.g., religious beliefs, financial incentives) were also evaluated between the two groups. Analyses were adjusted for organ donation registration status.ResultsIn total, 1905 participants were randomized. We observed a statistically significant increased odds of organ donation intent among those randomized to the video first condition compared with those randomized to the video last condition (odds ratio [OR], 1.70; 95% confidence interval [95% CI], 1.29 to 2.24). Differences regarding both educational effect on nondonors and racial differences such that there was a decreased odds of organ donation intent among those who identified as Black compared with those who were White (OR, 0.66; 95% CI, 0.47 to 0.92). Black participants were also more likely to report bodily integrity and differential treatment by doctors compared with White participants.ConclusionOur findings suggest that future interventions to increase organ donation registration among ethnically diverse populations could be effective if sufficient information is presented before decision making to addresses potential concerns.
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Nguyen NT, Maxwell AP, Donnelly M, O'Neill C. The role of motivational and legal contexts in understanding support for tissue donation across 27 European countries. Eur J Public Health 2021; 31:259-264. [PMID: 33024999 DOI: 10.1093/eurpub/ckaa148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There is a mismatch between attitudinal support for tissue donation and its translation into behavioural action (i.e. become registered donor). The legal and motivational context around tissue donation may contribute to better understanding of this mismatch. METHODS Data were extracted from the Eurobarometer 82.2 survey (2014). Data included socio-demographic characteristics, motivations underlying attitudes to tissue donation and the legal context within which donation was considered (opt-in and opt-out consent). The sample was partitioned based on contextual information and seemingly unrelated bivariate probit regressions were used to explore the relationship between passive and active support for tissue donation. RESULTS Approximately 56% of 25 879 respondents stated a willingness to donate tissue after death (passive support) and 9.1% reported that they were a registered donor (active support). We found evidence of unobserved heterogeneity between active and passive support across contexts. Our findings suggest that contexts in which altruistic motives can be supported by self-interest may increase the probability of converting passive to active support. Factors associated with increased support for tissue donation included: higher levels of education; good knowledge of the healthcare system; confidence in the safety of tissue donation; readiness to be a tissue recipient and knowing a recipient of donated tissue. CONCLUSIONS Our findings demonstrate the value of examining active and passive support for tissue donation together within specific contexts. This more nuanced approach affords clearer insights that may help to guide policy makers confronted with apparently conflicting evidence around strategies intended to promote organ and tissue donation.
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Affiliation(s)
- Nga Tq Nguyen
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Alexander P Maxwell
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,Regional Nephrology Unit, Belfast City Hospital, Belfast, UK
| | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Ciaran O'Neill
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Metwally AM, Abdel-Latif GA, Eletreby L, Aboulghate A, Mohsen A, Amer HA, Saleh RM, Elmosalami DM, Salama HI, Abd El Hady SI, Alam RR, Mohamed HA, Badran HM, Eltokhy HE, Elhariri H, Rabah T, Abdelrahman M, Ibrahim NA, Chami N. Egyptians' social acceptance and consenting options for posthumous organ donation; a cross sectional study. BMC Med Ethics 2020; 21:49. [DOI: https:/doi.org/10.1186/s12910-020-00490-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 06/03/2020] [Indexed: 10/31/2023] Open
Abstract
Abstract
Background
Organ donation has become one of the most effective ways to save lives and improve the quality of life for patients with end-stage organ failure. No previous studies have investigated the preferences for the different consenting options for organ donation in Egypt. This study aims to assess Egyptians’ preferences regarding consenting options for posthumous organ donation, and measure their awareness and acceptance of the Egyptian law articles regulating organ donation.
Methods
A cross sectional study was conducted among 2743 participants over two years. Each participant was required to rank eleven consenting options from 1 (most preferred) to 11 (least preferred), and to report his awareness and acceptance of the seven articles of the Egyptian law of organ donation.
Results
47% of the participants expressed willingness to donate their organs after death. This percentage increased to 78% when consenting options were explained to participants. “Informed consent by donor only” was the most preferred type of consent for one third of respondents. Awareness of the law articles regulating organ donation was relatively low ranging from 56% to 23%.
Conclusion
Currently, around half of the Egyptian population agree to posthumous organ donation. This percentage could be increased significantly by raising the awareness about how the process of donation could be regulated and how the patient’s right of decision could be protected.
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Opt-out policy and the organ shortage problem: Critical insights and practical considerations. Transplant Rev (Orlando) 2020; 35:100589. [PMID: 33232867 DOI: 10.1016/j.trre.2020.100589] [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: 08/20/2020] [Revised: 11/09/2020] [Accepted: 11/14/2020] [Indexed: 10/22/2022]
Abstract
The legal shift to an opt-out system of consent for deceased organ donation is now official in England, Wales and Scotland. While it is commendable that national governments across the United Kingdom have publicly signalled their serious engagement with organ donation, it remains questionable that opt-out policy can in and of itself solve the public health issue of organ shortage. Opt-out policy risks becoming a futile solution if it fails to attend to key factors in clinical practice. Thus, this article provides critical insights and practical considerations in order to work towards increasing the availability of organs for transplantation: 1) organ donation specialists on their own are not enough, a collaborative hospital culture of donation is also needed; 2) investment in innovative perfusion technologies is fundamental to increase both the quantity and quality of organs utilised for transplants; and 3) opt-out does not solve the enduring problem of consent or authorization for donation, rather than hoping that opt-out will shift the societal culture of donation and make donation the default choice, it is necessary to acknowledge that families' authorization remains essential and their emotional experience can neither be minimized nor excluded altogether. Importantly, consent rates are not the only factor to account for overall deceased donation rates. The organ shortage cannot be solely attributed to a matter of negative public attitudes reversible by law. Doing that does a disservice to the public and diverts strategic attention and resources from fostering the organizational and technological enablers of organ donation in clinical practice.
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Bea S. Assembling organ donation: situating organ donation in hospital practice. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:1934-1948. [PMID: 32856332 DOI: 10.1111/1467-9566.13177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/03/2020] [Accepted: 07/28/2020] [Indexed: 06/11/2023]
Abstract
In this article I argue for the need to situate deceased organ donation in and as a hospital practice. This study puts the spotlight on the practical conditions that enable and emplace organ donation in the hospital setting. The analytical move serves the political purpose to inform and interrogate dominant policy framings intended to address the problem of organ shortage. I present an ethnographic investigation that draws upon a Science and Technology Studies (STS) approach to make visible the sociomaterial arrangements that bring together people, things and politics in the assembling of organ donation at a Catalan hospital. A progressive and indeterminate process which might fall through and become disassembled at any given time. This, as I explain, challenges current opt-out policy that unnecessarily reduces donation to an individual choice to be decided upon in life. Instead, and drawing on ethnographic materials, I propose a situated and relational understanding of organ donation: an embedded health care and procurement practice enacted as a collective accomplishment. I conclude that (more) responsible donation policies need to be informed by, and attuned to, the situated practicalities and enduring tensions that condition and constrain the assembling of organ donation at the hospital setting.
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Affiliation(s)
- Sara Bea
- Department of Global Health and Social Medicine, School of Global Affairs, Faculty of Social Science & Public Policy, King's College London, London, UK
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7
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Metwally AM, Abdel-Latif GA, Eletreby L, Aboulghate A, Mohsen A, Amer HA, Saleh RM, Elmosalami DM, Salama HI, Abd El Hady SI, Alam RR, Mohamed HA, Badran HM, Eltokhy HE, Elhariri H, Rabah T, Abdelrahman M, Ibrahim NA, Chami N. Egyptians' social acceptance and consenting options for posthumous organ donation; a cross sectional study. BMC Med Ethics 2020; 21:49. [PMID: 32539704 PMCID: PMC7296756 DOI: 10.1186/s12910-020-00490-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 06/03/2020] [Indexed: 12/03/2022] Open
Abstract
Background Organ donation has become one of the most effective ways to save lives and improve the quality of life for patients with end-stage organ failure. No previous studies have investigated the preferences for the different consenting options for organ donation in Egypt. This study aims to assess Egyptians’ preferences regarding consenting options for posthumous organ donation, and measure their awareness and acceptance of the Egyptian law articles regulating organ donation. Methods A cross sectional study was conducted among 2743 participants over two years. Each participant was required to rank eleven consenting options from 1 (most preferred) to 11 (least preferred), and to report his awareness and acceptance of the seven articles of the Egyptian law of organ donation. Results 47% of the participants expressed willingness to donate their organs after death. This percentage increased to 78% when consenting options were explained to participants. “Informed consent by donor only” was the most preferred type of consent for one third of respondents. Awareness of the law articles regulating organ donation was relatively low ranging from 56% to 23%. Conclusion Currently, around half of the Egyptian population agree to posthumous organ donation. This percentage could be increased significantly by raising the awareness about how the process of donation could be regulated and how the patient’s right of decision could be protected.
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Affiliation(s)
- Ammal M Metwally
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID:60014618), P.O.12622, Doki, Giza, Egypt.
| | - Ghada A Abdel-Latif
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID:60014618), P.O.12622, Doki, Giza, Egypt
| | - Lobna Eletreby
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID:60014618), P.O.12622, Doki, Giza, Egypt
| | - Ahmed Aboulghate
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID:60014618), P.O.12622, Doki, Giza, Egypt
| | - Amira Mohsen
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID:60014618), P.O.12622, Doki, Giza, Egypt
| | - Hala A Amer
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID:60014618), P.O.12622, Doki, Giza, Egypt.,Infection Control Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Rehan M Saleh
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID:60014618), P.O.12622, Doki, Giza, Egypt
| | - Dalia M Elmosalami
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID:60014618), P.O.12622, Doki, Giza, Egypt
| | - Hend I Salama
- Egyptian Liver Research Institute And Hospital, Mansoura, Egypt
| | | | - Raefa R Alam
- Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | | | - Hanan M Badran
- Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | | | - Hazem Elhariri
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID:60014618), P.O.12622, Doki, Giza, Egypt
| | - Thanaa Rabah
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID:60014618), P.O.12622, Doki, Giza, Egypt
| | - Mohamed Abdelrahman
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID:60014618), P.O.12622, Doki, Giza, Egypt
| | - Nihad A Ibrahim
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID:60014618), P.O.12622, Doki, Giza, Egypt
| | - Nada Chami
- Community Medicine Research Department, Medical Research Division, National Research Centre (ID:60014618), P.O.12622, Doki, Giza, Egypt
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Rasiah R, Naghavi N, Mubarik MS, Nia HS. Can financial rewards complement altruism to raise deceased organ donation rates? Nurs Ethics 2020; 27:1436-1449. [PMID: 32410486 DOI: 10.1177/0969733020918927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Organ supply-demand in developing countries worldwide has continued to widen. Hence, using a large survey (n ¼ 10,412), this study seeks to investigate whether human psychology could be used to inculcate philanthropy to raise deceased organ donation rates. METHODS Three models were constructed to examine multidimensional relationships among the variables. Structural equation modeling was applied to estimate the direct and indirect influence of altruism, financial incentives, donation perception, and socioeconomic status simultaneously on willingness to donate deceased organs. ETHICAL CONSIDERATIONS The study was approved by the University of Malaya ethics committee. RESULTS The results show that altruism amplifies the impact of socioeconomic status and donation perception on willingness to donate. Also, the results show that financial incentives cannot complement altruism to raise organ donation rates. Hence, investing in education and public awareness enhances altruism in people, which then increases the propensity to donate. CONCLUSION Evidence suggests that governments should allocate resources to increase public awareness about organ donation. Awareness programs about the importance of philanthropic donations and the participation of medical consultants at hospitals in the processes form the foundation of such a presumptive approach.
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Hammami MM, Hammami MB, Aboushaar R. Modeling Lay People's Ethical Attitudes to Organ Donation: A Q-Methodology Study. Patient Prefer Adherence 2020; 14:173-189. [PMID: 32099336 PMCID: PMC6996217 DOI: 10.2147/ppa.s230286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 12/18/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Organ donation is commonly evaluated by biomedical ethicists based largely on principlism with autonomy at the top of the "moral mountain." Lay people may differ in the way they invoke and balance the various ethical interests. We explored lay people's ethical attitudes to organ donation. METHODS Respondents (n=196) ranked 42 opinion-statements on organ donation according to a 9-category symmetrical distribution. Statements' scores were analyzed by averaging-analysis and Q-methodology. RESULTS Respondents' mean (SD) age was 34.5 (10.6) years, 53% were women, 69% Muslims (30% Christians), 29% Saudis (26% Filipinos), and 38% healthcare-related. The most-agreeable statements were "Acceptable if benefit to recipient large," "Explicit donor consent and family approval for live donation," "Acceptable if directed to family member," and "Explicit donor consent and family approval for postmortem donation." The most-disagreeable statements were "Donor consent and family approval not required for postmortem donation," "Acceptable with purely materialistic motivation," and "Only donor no-known objection for postmortem donation." Women, Christians, and healthcare respondents gave higher rank to "Explicit donor consent and family approval for live donation," "Only donor family consent required for postmortem donation," and "Acceptable if organ distribution equitable," respectively, and Muslims gave more weight to donor/family harm (p ≤0.001). Q-methodology identified various ethical resolution models that were associated with religious affiliation and included relatively "motives-concerned," "family-benefit-concerned," "familism-oriented," and "religious or non-religious altruism-concerned" models. Of 23 neutral statements on averaging-analysis, 48% and 65% received extreme ranks in ≥1 women and men Q-methodology models, respectively. CONCLUSION 1) On average, recipient benefit, requirement of both explicit donor consent and family approval, donor-recipient relationship, and motives were predominant considerations; 2) ranking of some statements was associated with respondents' demographics; 3) Q-methodology identified various ethical resolution models that were partially masked by averaging-analysis; and 4) strong virtue and familism approaches in our respondents provide some empirical evidence against principlism adequacy.
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Affiliation(s)
- Muhammad M Hammami
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Alfaisal University College of Medicine, Riyadh, Saudi Arabia
- Correspondence: Muhammad M Hammami Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh11211, Saudi ArabiaTel +966-11-442-4527Fax +966-11-442-7894 Email
| | - Muhammad B Hammami
- Division of Gastroenterology, Department of Medicine, John Hopkins University, Baltimore, MD, USA
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Arshad A, Anderson B, Sharif A. Comparison of organ donation and transplantation rates between opt-out and opt-in systems. Kidney Int 2019; 95:1453-1460. [PMID: 31010718 DOI: 10.1016/j.kint.2019.01.036] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/10/2018] [Accepted: 01/10/2019] [Indexed: 12/16/2022]
Abstract
Studies comparing opt-out and opt-in approaches to organ donation have generally suggested higher donation and transplantation rates in countries with an opt-out strategy. We compared organ donation and transplantation rates between countries with opt-out versus opt-in systems to investigate possible differences in the contemporary era. Data were analysed for 35 countries registered with the Organisation for Economic Co-operation and Development (17 countries classified as opt-out, 18 classified as opt-in) and obtained organ donation and transplantation rates for 2016 from the Global Observatory for Donation and Transplantation. Compared to opt-in countries, opt-out countries had fewer living donors per million population (4.8 versus 15.7, respectively) with no significant difference in deceased donors (20.3 versus 15.4, respectively). Overall, no significant difference was observed in rates of kidney (35.2 versus 42.3 respectively), non-renal (28.7 versus 20.9, respectively), or total solid organ transplantation (63.6 versus 61.7, respectively). In a multivariate linear regression model, an opt-out system was independently predictive of fewer living donors but was not associated with the number of deceased donors or with transplantation rates. Apart from the observed difference in the rates of living donation, our data demonstrate no significant difference in deceased donation or solid organ transplantation activity between opt-out versus opt-in countries. This suggests that other barriers to organ donation must be addressed, even in settings where consent for donation is presumed.
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Affiliation(s)
- Adam Arshad
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Benjamin Anderson
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Adnan Sharif
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK; Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
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Effects of phased education on attitudes toward organ donation and willingness to donate after brain death in an Asian country. Asian J Surg 2019; 42:256-266. [DOI: 10.1016/j.asjsur.2018.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/15/2018] [Accepted: 04/20/2018] [Indexed: 11/21/2022] Open
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Awareness of legislation moderates the effect of opt-out consent on organ donation intentions. Transplantation 2013; 95:1058-63. [PMID: 23416684 DOI: 10.1097/tp.0b013e318284c13f] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND With the worldwide shortage of organs to meet the demand for transplants, many countries are considering whether introducing opt-out consent would increase the availability of donor organs. This research assessed whether people's willingness to donate their organs for transplant purposes was greater in opt-out than opt-in countries and whether such effects were moderated by people's awareness of their nation's legislative system. METHODS Using secondary data from the 2010 Eurobarometer (n=29,288), this study compared people's willingness to donate their organs in a representative sample from 19 opt-out and 10 opt-in consent countries from across Europe. RESULTS The majority of participants (66.04%) stated that they were willing to donate their organs for transplant purposes. The proportion of people who were willing to donate their organs did not differ between opt-in (65.97%) and opt-out (66.37%) countries. However, the effect of consent on willingness to donate was moderated by people's awareness of their nation's organ donation legislation. When people were aware of their nation's legislation, the proportion of people who were willing to donate their organs was greater in opt-out (85.26%) than opt-in (80.72%) countries. By contrast, when people were not aware of their nation's legislation, there was no difference in people's willingness to donate their organs in opt-in (58.63%) and opt-out (59.23%) countries. CONCLUSIONS Opt-out consent countries should increase people's awareness of their legislation to improve donor rates. Further research is needed to understand the factors that moderate the effect of opt-out consent legislation on organ donation.
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Chan TK, Cowling BJ, Tipoe GL. A public opinion survey: is presumed consent the answer to kidney shortage in Hong Kong? BMJ Open 2013; 3:bmjopen-2012-002013. [PMID: 23293247 PMCID: PMC3549202 DOI: 10.1136/bmjopen-2012-002013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To project the impact of an opt-out system (presuming consent) in Hong Kong on the likelihood that a potential donor donates his or her kidneys after death and the likelihood of violating a potential donor's autonomy. SETTING Cross-sectional population-based anonymous telephone survey. PARTICIPANTS Random sample of 802 adults aged between 18 and 64. MAIN OUTCOME MEASURE Willingness to donate their own kidneys after death and their willingness to donate the kidneys of a deceased family member in different hypothetical situations under the current opt-in system and under our proposed soft version of an opt-out system. RESULTS When the wish of the deceased is unknown, 72.6% (n=583) of the respondents said that under the proposed opt-out system, they would definitely or likely consent to donating the kidneys of a deceased family member, significantly more than under the current opt-in system (OR 2.53, 95% CI 2.06 to 3.11). An opt-out system could significantly improve the projected overall donation potential from 0.631 to 0.771 (OR 1.97, 95% CI 1.58-2.45) and reduce the projected overall chance of violating the autonomy of a potential donor from 0.292 to 0.127 (OR 0.35, 95% CI 0.27 to 0.45). CONCLUSIONS A switch to an opt-out system in Hong Kong would likely result in the wishes of more people being followed and raise the overall cadaveric kidney donation rate.
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Affiliation(s)
- Tak Kwong Chan
- Department of Anatomy, University of Hong Kong, Hong Kong, Hong Kong
| | - Benjamin John Cowling
- Department of Community Medicine, School of Public Health, University of Hong Kong, Pokfulam, Hong Kong
| | - George Lim Tipoe
- Department of Anatomy, University of Hong Kong, Hong Kong, Hong Kong
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Hammami MM, Abdulhameed HM, Concepcion KA, Eissa A, Hammami S, Amer H, Ahmed A, Al-Gaai E. Consenting options for posthumous organ donation: presumed consent and incentives are not favored. BMC Med Ethics 2012; 13:32. [PMID: 23173834 PMCID: PMC3519501 DOI: 10.1186/1472-6939-13-32] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 11/15/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Posthumous organ procurement is hindered by the consenting process. Several consenting systems have been proposed. There is limited information on public relative attitudes towards various consenting systems, especially in Middle Eastern/Islamic countries. METHODS We surveyed 698 Saudi Adults attending outpatient clinics at a tertiary care hospital. Preference and perception of norm regarding consenting options for posthumous organ donation were explored. Participants ranked (1, most agreeable) the following, randomly-presented, options from 1 to 11: no-organ-donation, presumed consent, informed consent by donor-only, informed consent by donor-or-surrogate, and mandatory choice; the last three options ± medical or financial incentive. RESULTS Mean(SD) age was 32(9) year, 27% were males, 50% were patients' companions, 60% had ≥ college education, and 20% and 32%, respectively, knew an organ donor or recipient. Mandated choice was among the top three choices for preference of 54% of respondents, with an overall median[25%,75%] ranking score of 3[2,6], and was preferred over donor-or-surrogate informed consent (4[2,7], p < 0.001), donor-only informed consent (5[3,7], p < 0.001), and presumed consent (7[3,10], p < 0.001). The addition of a financial or medical incentive, respectively, reduced ranking of mandated choice to 7[4,9], p < 0.001, and 5[3,8], p < 0.001; for donor-or-surrogate informed consent to 7[5,9], p < 0.001, and 5[3,7], p = 0.004; and for donor-only informed consent to 8[6,10], p < 0.001, and 5[3,7], p = 0.56. Distribution of ranking score of perception of norm and preference were similar except for no-organ donation (11[7,11] vs. 11[6,11], respectively, p = 0.002). Compared to females, males more perceived donor-or-surrogate informed consent as the norm (3[1,6] vs. 5[3,7], p < 0.001), more preferred mandated choice with financial incentive option (6[3,8] vs. 8[4,9], p < 0.001), and less preferred mandated choice with medical incentive option (7[4,9] vs. 5[2,7], p < 0.001). There was no association between consenting options ranking scores and age, health status, education level, or knowing an organ donor or recipient. CONCLUSIONS We conclude that: 1) most respondents were in favor of posthumous organ donation, 2) mandated choice system was the most preferred and presumed consent system was the least preferred, 3) there was no difference between preference and perception of norm in consenting systems ranking, and 4) financial (especially in females) and medical (especially in males) incentives reduced preference.
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Affiliation(s)
- Muhammad M Hammami
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh, 11211, Saudi Arabia
- Alfaisal University college of Medicine, Riyadh, Saudi Arabia
| | - Hunaida M Abdulhameed
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh, 11211, Saudi Arabia
| | - Kristine A Concepcion
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh, 11211, Saudi Arabia
| | - Abdullah Eissa
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh, 11211, Saudi Arabia
| | - Sumaya Hammami
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh, 11211, Saudi Arabia
| | - Hala Amer
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh, 11211, Saudi Arabia
| | - Abdelraheem Ahmed
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh, 11211, Saudi Arabia
| | - Eman Al-Gaai
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh, 11211, Saudi Arabia
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Coppen R, Friele RD, van der Zee J, Gevers SK. The potential of legislation on organ donation to increase the supply of donor organs. Health Policy 2010; 98:164-70. [DOI: 10.1016/j.healthpol.2010.05.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 05/31/2010] [Accepted: 05/31/2010] [Indexed: 11/15/2022]
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Coppen R, Friele RD, Gevers SKM, Van Der Zee J. Donor education campaigns since the introduction of the Dutch organ donation act: increased cohesion between campaigns has paid off. Transpl Int 2010; 23:1239-46. [DOI: 10.1111/j.1432-2277.2010.01139.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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A Colloquium on the Congress “A Gift for Life. Considerations on Organ Donation”. Transplantation 2009; 88:S108-58. [DOI: 10.1097/tp.0b013e3181b66576] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Thomas SL, Milnes S, Komesaroff PA. Understanding organ donation in the collaborative era: a qualitative study of staff and family experiences. Intern Med J 2008; 39:588-94. [DOI: 10.1111/j.1445-5994.2008.01826.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Human rights and presumed consent for organ donation in the U.K. THE ULSTER MEDICAL JOURNAL 2008; 77:206. [PMID: 18956806 PMCID: PMC2604481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
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Abstract
BACKGROUND The organ donor shortfall in the UK has prompted calls to introduce legislation to allow for presumed consent: if there is no explicit objection to donation of an organ, consent should be presumed. The current debate has not taken in account accepted meanings of presumption in law and science and the consequences for rights of ownership that would arise should presumed consent become law. In addition, arguments revolve around the rights of the competent autonomous adult but do not always consider the more serious implications for children or the disabled. DISCUSSION Any action or decision made on a presumption is accepted in law and science as one based on judgement of a provisional situation. It should therefore allow the possibility of reversing the action or decision. Presumed consent to organ donation will not permit such reversal. Placing prime importance on the functionality of body organs and their capacity to sustain life rather than on explicit consent of the individual will lead to further debate about rights of ownership and potentially to questions about financial incentives and to whom benefits should accrue. Factors that influence donor rates are not fully understood and attitudes of the public to presumed consent require further investigation. Presuming consent will also necessitate considering how such a measure would be applied in situations involving children and mentally incompetent adults. SUMMARY The presumption of consent to organ donation cannot be understood in the same way as is presumption when applied to science or law. Consideration should be given to the consequences of presuming consent and to the questions of ownership and organ monetary value as these questions are likely to arise should presumed consent be permitted. In addition, the implications of presumed consent on children and adults who are unable to object to organ donation, requires serious contemplation if these most vulnerable members of society are to be protected.
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Affiliation(s)
- Barbara K Pierscionek
- Department of Biomedical Sciences, University of Ulster, Cromore Road, Coleraine, BT52 1SA, UK.
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Borry P, Van Reusel W, Roels L, Schotsmans P. Donation after uncontrolled cardiac death (uDCD): a review of the debate from a European perspective. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2008; 36:752-610. [PMID: 19094003 DOI: 10.1111/j.1748-720x.2008.00334.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Presumed consent alone will not solve the organ shortage, but it will create an ethical and legal context that supports organ donation, respects individuals who object to organ donation, relieves families from the burden of decision making, and can save lives.
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Affiliation(s)
- Pascal Borry
- Centre for Biomedical Ethics and Law, K.U. Leuven, Belgium
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