To Be a Donor or Not to Be? Applying an Extended Theory of Planned Behavior to Predict Posthumous Organ Donation Intentions

Using a theory of planned behavior (TPB) perspective, individual intentions to register and discuss the decision of organ donation with significant others were examined. In addition to standard TPB variables (attitude, subjective norm, and perceived behavioral control [PBC]), self-identity and moral norm were incorporated into the TPB as predictors. Australian university students ( N  = 303) completed a survey comprising standard and additional TPB constructs. Separate analyses were conducted for both registered and nonregistered participants. In general, results provide support for the extended TPB model in predicting intentions to register and discuss the donation decision, with the exceptions that self-identity did not predict discussion intentions for either registered or nonregistered participants, and PBC did not predict discussion intentions for nonregistered participants.     

Cognitive obstacles against organ donation: The influence of negative attitudes,norms, and traditional beliefs on Chinese people's intention to donate organs after death

In China, the organ supply is severely insufficient to cover all people on the waiting list for donated organs, and numerous patients die awaiting transplant. To achieve a better understanding of cadaveric organ donation in Chinese culture, this study examined 300 Chinese adults, in both Fujian Province and Macao, regarding attitudes towards organ donation, subjective norms about organ donation and traditional beliefs about the body and death, examining the influences of these factors on respondents' donation intentions. Multiple hierarchical regression results suggest that more negative attitudes, unfavourable norms and traditional beliefs lead to lower donation intentions. Copyright © 2010 John Wiley & Sons, Ltd.     

Real Donors, Real Consent: Testing the Theory of Reasoned Action on Organ Donor Consent

In an attempt to apply the theory of reasoned action (TRA) to the process underlying organ donor consent, participants completed questionnaires concerning their affective responses to organ donation, as well as their intentions to donate. Participants were given the opportunity to sign an organ donor card. Those who chose to sign the card had more positive attitudes about donation, perceived donation as something that their reference group would encourage, and had stronger intentions to consent to signing a card. The current investigation extends the organ donor literature by using a true behavioral outcome measure indicating consent. Moreover, the pattern of results between attitudes, norms, intention, and behavior illustrates the usefulness of applying the TRA to yet another health-related behavior.     

From a terror management perspective: The efficacy of self-affirmation on organ donation-related thoughts and intentions in China

ABSTRACT

In 2015, the Chinese government officially abolished the practice of harvesting organs from executed prisoners. However, the voluntary donor registration rate among the Chinese population is approximately 2% as of January 2020. Guided by self-affirmation theory and terror management theory, the present investigation examined a number of variables that may be related to donor registration intentions and a method to mitigate death thoughts and misconceptions. An online experiment was conducted in which 352 Chinese participants were randomly assigned to either a self-affirmation (i.e., affirming values that are important to the participants) or a no-affirmation condition. Results revealed that self-affirmation lowered death thoughts among the participants, which in turn were positively related to organ donation misperceptions. Inconsistent with terror management theory, the level of death thoughts was not directly related to participants’ intentions to register as organ donors. Instead, the relationship between the two was mediated by misperceptions toward organ donation.     

Intentions to participate in counselling among front-line,at-risk Irish government employees: an application of the theory of planned behaviour

ABSTRACT

The study set out to examine intentions to engage in counselling among at-risk Irish government employees and the differential utility of two alternative theory of planned behaviour (TPB) models of behaviour to explain intentions to participate in counselling. Individuals (N=259) employed in a front-line, at-risk occupation for the Irish government completed a TPB-based questionnaire. Quantitative analyses revealed that participants held positive to neutral intentions to participate in counselling, irrespective of gender. The original TPB model explained 49.9% of variance in intentions whereas an alternative TPB model, splitting the perceived behavioural control (PBC) construct between its internal and external control components, explained a further 8.9% of variance. Furthermore, self-efficacy was found to be the strongest predictor of intentions. This study therefore supports the use of the TPB in understanding counselling-seeking behaviour.     

Organ donation intentions and behaviors: application and extension of the theory of planned behavior

Organ donation intentions and behaviors were investigated using a traditional and extended theory of planned behavior (TPB). In study 1, attitudes, subjective norms, and perceived behavioral control were associated with intentions to engage in donation behaviors in a student sample (all p ≤ .02), and intentions significantly predicted behavior 2 months later (p < .001). Study 2 utilized a community sample of Catholic, Jewish, and Muslim individuals. Measures of affect and religious attitudes were added to the traditional TPB, increasing the variance in intentions accounted for by the model, F(7, 181) = 6.94, p < .001. The studies support the use of an extended TPB in predicting donation‐related intentions and behaviors and suggest potential targets of interventions to promote donation.     

Individualism–collectivism and organ donation intentions

This article investigates the impact of individualism–collectivism on a person's willingness to donate organs. In Study 1, an online survey showed that individualism–collectivism was significantly and positively associated with participants' willingness to register as organ donors while perceived benefit mediated this relationship. Study 2 demonstrated the causal effect of individualism–collectivism on organ donation intentions using a priming technique. Participants primed with collectivism were more likely to register as organ donors than those primed with individualism. Our findings provide unique insights into whether cultural values (i.e., individualism–collectivism) can predict people's organ donation intentions.     

Knowledge and attitudes of Polish university students toward organ donation and transplantation

Although the number of patients needing organ transplantation systematically increases, recent years have seen a considerable shortage of donors. The level of knowledge and attitudes toward donation are critical factors in achieving the required balance between supply and demand. This pilot study assessed the knowledge, opinions, and behaviors related to organ donation and transplantation among 625 students representing eight different fields of study from the University of Rzeszow in south-eastern Poland. Although the participants provided evidence of knowledge about human organ donation and transplantation, they were aware of the main organs of the human body for potential transplants, and generally showed positive attitudes; only 24% of the subjects indicated their willingness to register as a donor; only 3% stated that they had already registered and had a donor card. The findings suggest that good intentions do not translate into action and that Poland needs to develop a nation-wide, up-to-date, and youth-oriented health education program that builds on favorable attitudes toward organ donation and transplantation.     

Earning points for moral behavior: organ allocation based on reciprocity

Anticipating the reevaluation of the Dutch organ procurement system, in late 2003 the Rathenau Institute published a study entitled 'Gift or Contribution?' In this study, the author, Govert den Hartogh, carries out a thorough moral analysis of the problem of organ shortage and fair allocation of organs. He suggests there should be a change in mentality whereby organ donation is no longer viewed in terms of charity and the volunteer spirit, but rather in terms of duty and reciprocity. The procurement and allocation of donor organs should be seen as a system of mutually assured help. Fair allocation would imply to give priority to those who recognize and comply with their duty: the registered donors. The idea of viewing organ donation as an undertaking involving mutual benefit rather than as a matter of charity, however, is not new. Notwithstanding the fact that reference to charity and altruism is not required in order for the organ donation to be of moral significance, we will argue against the reciprocity-based scenario. Steering organ allocation towards those who are themselves willing to donate organs is both an ineffective and morally questionable means of attempting to counter organ shortage.     

Predictors of willingness to register as an organ donor among dutch adolescents

Abstract

In order to identify relevant determinants of organ donor registration among Dutch adolescents, a school-based cross-sectional survey was conducted among 145 high school students. Fifty-one percent of respondents indicated they were willing to register as organ donors and 80% reported a positive general attitude towards registration. Various misconceptions about the registration and donation procedure were identified. On average only moderate knowledge levels related to organ donation were found. In order of strongest association, negative outcome expectancies, past behaviour and experience, positive outcome expectancies, and social outcome expectancies proved to be significant predictors of willingness to register as organ donors. Self-efficacy was indirectly associated with willingness via outcome expectancies. Knowledge about organ donation was not significantly associated with willingness. The results suggest that in order to persuade adolescents to register as organ donors, refutational messages will have to be developed to counterargue the prevailing negative outcome expectancies related to organ donation and registration as an organ donor.     

Similarities and Differences Between African Americans’ and European Americans’ Attitudes,Knowledge, and Willingness to Communicate About Organ Donation1

While little is known about African Americans’ attitudes and knowledge about organ donation, even less is known about how African Americans’ attitudes, values, and beliefs affect their behavior and behavioral intentions regarding organ donation; or how African Americans’ views are similar to or different from those of European Americans. Adults working 2 sites of a national corporation were randomly selected to complete a survey about organ donation willingness, intention to sign an organ donor card, knowledge and attitudes toward organ donation, and level of altruism. Results indicate that African Americans differ significantly from Whites on several individual attitude and knowledge items. However, the basic relationship between knowledge, attitudes, values, and behaviors regarding organ donation between the 2 groups appears the same. Furthermore, these results indicate that future organ donation promotion campaigns must focus on increasing basic knowledge and countering myths about organ donation for both populations.     

Attitudes toward posthumous organ donation and commitment to donate

The medical need for human organs suitable for use as transplants far exceed the supply, and is growing. More favorable attitudes about organ donation would increase people's willingness to sign posthumous donation pledges. But effective educational programs require information about the public's present views. Verbal attitude scales were constructed and administered to 110 adults, resulting in reliable measurement of two independent dimensions, prodonation and antidonation (r = .003). Cluster analysis of the instrument revealed that the positive dimension involves belief in the humanitarian benefits of organ donation and feelings of pride experienced by the donor. The negative dimension reflects fears of body mutilation and of receiving inadequate medical treatment when one's life is at risk. Pro and anti scores in combination predicted willingness to sign a donor card. A 2 X 2 analysis of variance (High-Low Positive X High-Low Negative) revealed significant main effects for both positive and negative attitude. Also, a significant interaction effect was obtained. Those subjects who had both strong positive attitudes and weak negative attitudes were especially willing to sign donor cards. Suggestions for designing educational campaigns to promote organ donation are offered.     

Recovery of transplantable organs after cardiac or circulatory death: Transforming the paradigm for the ethics of organ donation

Organ donation after cardiac or circulatory death (DCD) has been introduced to increase the supply of transplantable organs. In this paper, we argue that the recovery of viable organs useful for transplantation in DCD is not compatible with the dead donor rule and we explain the consequential ethical and legal ramifications. We also outline serious deficiencies in the current consent process for DCD with respect to disclosure of necessary elements for voluntary informed decision making and respect for the donor's autonomy. We compare two alternative proposals for increasing organ donation consent in society: presumed consent and mandated choice. We conclude that proceeding with the recovery of transplantable organs from decedents requires a paradigm change in the ethics of organ donation. The paradigm change to ensure the legitimacy of DCD practice must include: (1) societal agreement on abandonment of the dead donor rule, (2) legislative revisions reflecting abandonment of the dead donor rule, and (3) requirement of mandated choice to facilitate individual participation in organ donation and to ensure that decisions to participate are made in compliance with the societal values of respect for autonomy and self-determination.     

To share or not to share: A theoretically guided investigation of factors predicting intentions to use fully automated shared passenger shuttles

This study applied the Theory of Planned Behaviour (TPB) to assess individuals’ intentions to use fully automated shared passenger shuttles when they become publicly available. In addition, perceived trust was assessed to examine the extent to which this variable could account for additional variance in intentions above the TPB constructs of attitudes, subjective norms, and perceived behavioural control (PBC). Further, and also guided by the TPB, the study explored the differences in behavioural, normative, and control beliefs between individuals who reported high intentions to use automated passenger shuttles in the future (high intenders) and individuals who reported low intentions to use fully automated shared passenger shuttles in the future (low intenders). Participants (N = 438; 64% female) aged between 17 and 84 years (Mage = 35.42 years) were asked to complete an online questionnaire which took approximately 15 min. The findings revealed that attitudes, subjective norms, and PBC were significant positive predictors of intentions to use fully automated shared passenger shuttles when they become publicly available. When perceived trust was added to the hierarchical regression, this variable was shown to account for additional significant variance in intentions above the TPB constructs and was shown to be a significant positive predictor of intentions. Further, the results revealed significant differences in beliefs held by high and low intenders. Specifically, high intenders held significantly more positive beliefs towards fully automated shared passenger shuttles than low intenders. In turn, low intenders held significantly more negative beliefs towards these vehicles than high intenders. Overall, these findings provide support for the utility of the TPB in examining individuals’ intentions to use fully automated shared passenger shuttles when they become publicly available.     

Framing Posthumous Organ Donation in Terms of Reciprocity: What Are the Emotional Consequences?

Posthumous organ donation was framed in terms of reciprocity by asking young participants to respond to another person who was or was not registered as an organ donor, while simultaneously manipulating participants' own registration status. Participants were additionally required to adopt the perspective of a potential donor or recipient of organs. The influence of these variables on self-reported anger, fear, pity, guilt, gratitude, and positive self-feelings is systematically described. The results illustrate the relative independence of self-preservational and altruistic motives in organ donation. Practical implications are discussed.     

Religion and the decision to donate organs: Exploring the potential role of religious leaders

The two‐step flow model of communication (Katz, 1957 ) suggests opinion leaders obtain critical information from the mass media and, in turn, communicate this information to interpersonal contacts such as friends, family and co‐workers. It is suggested that religious leaders (RLs) may serve as opinion leaders on the topic of organ donation by debunking donation myths, promoting donation during worship services, or communicating the benefit of donation to families faced with the opportunity to participate in living or cadaveric donation. The current study examined the personal knowledge, experiences, and willingness to communicate about organ donation in a sample of RLs (N = 59) in Rochester, New York. Structured interviews were conducted in summer and fall of 2009 with a random sample of RLs. Results indicate a disparity between RLs' expressed personal support for donation and their engagement in donor registration. Approximately one‐quarter of RLs have spoken about donation during a religious service and many indicate their knowledge is not sufficient to discuss organ donation in detail. Results elaborate on how RLs may be trained to serve as opinion leaders in the promotion of organ donation. Copyright © 2010 John Wiley & Sons, Ltd.     

Living donation and cosmetic surgery: a double standard in medical ethics?

The commitment of transplant physicians to protect the physical and psychological health of potential donors is fundamental to the process of living donor organ transplantation. It is appropriate that strict regulations to govern an individual's decision to donate have been developed. Some may argue that adherence to such regulations creates a doctor-patient relationship that is rooted in paternalism, which is in drastic contrast with a doctor-patient relationship that is rooted in patients' autonomy, characteristic of most other operative interventions. In this article we analyze the similarities between cosmetic plastic surgery and living donor surgery as examples of surgeries governed by different ethical principles. It is interesting that, while the prevailing ethical approach in living donor surgery is based on paternalism, the ethical principle guiding cosmetic surgery is respect for patients' autonomy. The purpose of this article is not to criticize either practice, but to suggest that, given the similarities between the two procedures, both operative interventions should be guided by the same ethical principle: a respect for patients' autonomy. We further suggest that if living organ donation valued donors' autonomy as much as cosmetic plastic surgery does, we might witness a wider acceptance of and increase in living organ donation.     

论开展亲属活体供肾移植的风险与对策

肾脏移植是救治终末期肾功能衰竭的最佳手段。亲属活体捐献肾脏是扩大供肾来源的有效手段。当前国内开展亲属肾移植存在伦理、法律和健康风险,主要来自供体和医疗两方面。为防范风险,医务人员应严格审查供受者的血缘关系,签署完整规范的法律文书,进行全面细致的术前评估,制定完善的手术方案。     

Cultural Diversity and Patients with Reduced Capacity: The Use of Ethics Consultation to Advocate for Mentally Handicapped Persons in Living Organ Donation

Theoretical Medicine and Bioethics - Living organ donation will soon become the source of the majority of organs donations for transplant. Should mentally handicapped people be allowed to donate,...