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.     

The role of affect in attitudes toward organ donation and donor-relevant decisions

We argue that affect plays a vital role in attitudes toward organ donation and that reluctance to become an organ donor is likely to be related to the experience of affective ambivalence. Assessing the affect associated with organ donation could help to predict donor-relevant decisions. Results of a confirmatory factor analysis on 464 students showed that affective evaluations can be distinguished both from cognitive evaluations and from overall evaluations. As expected, affective evaluations revealed ambivalence (using the ‘Griffin’ measure of ambivalence) toward organ donation, whereas the two other types of evaluations did not. Results of a follow-up study using logistic regression (n?=?85), showed that affective evaluations predicted donor-relevant decisions six months later. The present findings support the proposal to include separate affective evaluations in measures of attitudes to organ donation. More general implications for the measurement and structure of attitudes in health related domains are discussed.     

Blood and organ donation: health impact,prevalence, correlates,and interventions

Abstract

Objective: Without a supply of blood, health services could not meet their clinical needs. Similarly, organs for transplantation save and transform lives. Donations are acts of generosity that are traditionally seen as altruistic, and accordingly, interventions to recruit and retain blood and organ donors have focused on altruism. We review the predictors, prevalence and correlates of these two behaviours, how effective interventions have been, and draw common themes.

Design: Narrative review.

Results: We highlight that both recipients and donors benefit, and as such neither blood nor organ donation is purely altruistic. We also highlight health problems associated with both types of donation. In evaluating interventions, we highlight that a move to an opt-out policy for organ donation may not be the simple fix it is believed to be, and propose interventions to enhance the effectiveness of an opt-in policy (e.g. social media updates). We show that incentives, text messaging, feedback and a focus on prosocial emotions (e.g. ‘warm-glow’, ‘gratitude’) may be effective interventions for both blood and organ donation. Interventions designed to reduce fainting (e.g. water pre-loading) are also effective for blood donation.

Conclusions: We conclude that affect is key to understanding both types of donation and in designing effective interventions.     

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.     

Caring for Bereaved Families: Self-Efficacy in the Donation Request Process

Motivated by an organ shortage, a primary objective of professionals involved with organ and tissue donation is to identify and modify key factors that facilitate or impede family consent. Procedural factors associated with the donation request process have been highlighted as target areas for change. Several studies have demonstrated that family consent rates increase when specific procedural knowledge and skills are incorporated into agency protocols and health care professionals become proficient with these procedures. Thus, training of these professionals heavily emphasizes development of procedural competencies, with relatively little time allocated to fostering affective helping skills or competencies. Given the lack of attention to affective competencies, this study was designed to examine perceived procedural and affective self-efficacy among health care professionals receiving training as designated requestors. Findings suggest trained requestors report greater confidence in their ability to perform procedural tasks associated with the donation request process than in their ability to manage affective or emotion-laden issues related to the process.     

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.     

移植协调员在DCD工作中的角色和作用

器官捐献是器官移植事业发展的基石,而协调员在器官捐献工作中则有着举足轻重的地位和作用。自2010年3月我国推行人体器官捐献试点工作以来,适合中国国情的DCD工作成为器官捐献工作的重中之重。如何充分发挥协调员在DCD工作中的作用,提高DCD捐献率和供体转化率,以有效地促进和推动DCD工作,是急待探讨和解决的问题。本文结合...     

我国人体器官捐赠移植立法问题研究

通过对我国人体器官捐赠移植立法的必要性和立法模式问题,以及我国人体器官捐赠移植法的体系和基本原则进行深入研究,指出我国人体器官捐赠移植立法宜采用统一立法模式,并遵循知情同意、人民健康第一、效用与公平、规范程序与便于操作、违法必究五项原则。     

Resolving the theory of planned behaviour's ‘expectancy-value muddle’ using dimensional salience

The theory of planned behaviour is one of the most widely used models of decision-making in the health literature. Unfortunately, the primary method for assessing the theory's belief-based expectancy-value models results in statistically uninterpretable findings, giving rise to what has become known as the ‘expectancy-value muddle’. Moreover, existing methods for resolving this muddle are associated with various conceptual or practical limitations. This study addresses these issues by identifying and evaluating a parsimonious method for resolving the expectancy-value muddle. Three hundred and nine Australian residents aged 18–24 years rated the expectancy and value of 18 beliefs about posthumous organ donation. Participants also nominated their five most salient beliefs using a dimensional salience approach. Salient beliefs were perceived as being more likely to eventuate than non-salient beliefs, indicating that salient beliefs could be used to signify the expectancy component. The expectancy-value term was therefore represented by summing the value ratings of salient beliefs, an approach that predicted attitude (adjusted R ²?=?0.21) and intention (adjusted R ²?=?0.21). These findings suggest that the dimensional salience approach is a useful method for overcoming the expectancy-value muddle in applied research settings.     

Death anxiety,altruism, self‐efficacy,and organ donation intention among Japanese college students: A moderated mediation analysis

The shortage of organs for transplantation in Japan has alerted health professionals to the low organ donation rate among Japanese people. The unique cultural view of death and altruism has been suggested leading to their low intent to donate cadaveric organs. A cross‐sectional survey was conducted in Japan to investigate the interplay of death anxiety, altruism, and self‐efficacy in influencing Japanese college students' intention to sign donor cards, in order to mobilise this large potential source of organ donors in the future. Six hundred and seven Japanese non‐donor card signers voluntarily completed a self‐administered questionnaire. The results of mediation and moderated mediation analyses with bootstrap approach suggest that death anxiety indirectly hinders Japanese people's intention to become a donor card signer through lowering of self‐efficacy, while altruism intensifies the positive impact of self‐efficacy on signing intention. These findings provide useful insights for organ procurement organisations seeking behavioural change not only in Japan but also in multi‐ethnic societies with a substantial Japanese population.     

国外器官捐献评估方法介绍

器官移植已成为医学上应用越来越广泛的手段之一。器官移植中器官捐献的分析评估体系作为成熟器官移植系统不可或缺的一部分,能够对器官捐献水平和做出客观的评估,包括捐献潜力,即潜在捐献者率（Potential Donors rate,,PDr）和捐献有效力,即实际捐献者率（Actual Donors rate,ADr）（单位：per million population,pmp）。本文将介绍通过对多国器官捐献评估方法进行分析、总结得出器官捐献中供体评估的主体方法,包括流程、分析方法、适用范围及其积极意义等,希望可以利于我国研究。     

When is the gift given? Organ donation,social representations,and an opportunity to register

The gift of life doctrine underpins Australia's approach to organ donation: in legislation, clinical practice, community awareness campaigns, and educational activities. In this paper, we present an approach that situates an understanding of organ donation within a social representation framework as a system of values, ideas, and practices. In cadaveric donation, the final giving‐of‐the‐gift can never be by the donor, leading us to ask where the potential donor's decision to give the gift really lies. We present research from three studies that explored the relationship between what was socially understood about organ donation and the registration of donation intent. Drawing from three socially and culturally diverse populations, we asked people working in a corporate city institution and those attending two football matches in the outer city area to complete a word‐association task and Likert‐scale belief questions about organ donation—followed by an opportunity to register immediately on the Australian Organ Donor Register. Driven by the interdependent themata of life/death and self/other, the gift of life doctrine is inextricably linked with the loss of life emerging as both positive and negative beliefs allowing their relationship to actual registration behaviour to be observed. Our findings suggest that in many instances, the potential donor's genuine desire to give the gift lies in the tension between positive and negative beliefs, manifesting as a consent registration when the positive beliefs about donation prevail and an immediate opportunity to register is available.     

Sequential Requests and Organ Donation

Abstract

The author investigated the effectiveness of the foot-in-the-door technique as a method of increasing participants' intention to become organ donors. The participants who agreed to a 1st request were presented with a larger request either immediately or 3 days later. The 2nd request was presented either by the same requester or by a different requester. Compared with a control group receiving only the 2nd request, a significant foot-in-the-door effect emerged in all conditions except 1 (same requester-immediate request), in which the participants showed neither more nor less intention to become organ donors than did the control group.     

Who shall be Allowed to Give? Living Organ Donors and the Concept of Autonomy

Free and informed consent is generally acknowledged as the legal andethical basis for living organ donation, but assessments of livingdonors are not always an easy matter. Sometimes it is necessary toinvolve psychosomatics or ethics consultation to evaluate a prospectivedonor to make certain that the requirements for a voluntary andautonomous decision are met. The paper focuses on the conceptualquestions underlying this evaluation process. In order to illustrate howdifferent views of autonomy influence the decision if a donor's offer isethically acceptable, three cases are presented – from Germany, theUnited States, and India. Each case features a person with questionabledecision-making capacity who offered to donate a kidney for a siblingwith severe renal insufficiency. Although the normative framework issimilar in the three countries, different or sometimes even contraryarguments for and against accepting the offer were brought forward. Thesubsequent analysis offers two explanations for the differences inargumentation and outcome in spite of the shared reference to autonomyas the guiding principle: (1) Decisions on the acceptability of a livingdonor cannot simply be deducted from the principle of autonomy but needto integrate contextual information; (2) understandings of the wayautonomy should be contextualized have an important influence on theevaluation of individual cases. Conclusion: Analyzing the conceptualassumptions about autonomy and its relationship to contextual factorscan help in working towards more transparent and better justifieddecisions in the assessment of living organ donors.     

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.     

THE INTERPLAY BETWEEN RELIGIOUS LEADERS AND ORGAN DONATION AMONG MUSLIMS

Bioethics and health researchers often turn to Islamic jurisconsults (fuqahā’) and their verdicts (fatāwā) to understand how Islam and health intersect. Yet when using fatwā to promote health behavior change, researchers have often found less than ideal results. In this article we examine several health behavior change interventions that partnered with Muslim religious leaders aiming at promoting organ donation. As these efforts have generally met with limited success, we reanalyze these efforts through the lens of the theory of planned behavior, and in light of two distinct scholarly imperatives of Muslim religious leaders, the ?ilmī and the islāhī. We argue for a new approach to health behavior change interventions within the Muslim community that are grounded in theoretical frameworks from the science of behavior change, as well the religious leadership paradigms innate to the Islamic tradition. We conclude by exploring the implications of our proposed model for applied Islamic bioethics and health research.     

捐献骨髓的态度及对白血病人的移情反应的研究

本研究采用AB两种问卷测查在职员工和大学生对骨髓捐献的态度以及对白血病患者的情感反应,AB卷的差异主要在于：B卷中增加了骨髓移植和骨髓捐献的一些基本知识。研究结果显示,捐献骨髓的意向在AB卷、男女性、在校学生和在职员工等几个方面均无显著差异;但在捐献检测费意向上,A卷和B卷、男性和女性之间存在显著差异,从捐献骨髓和捐献检测费的各种原因中可以了解到骨髓捐献中遇到的一些问题。此外,人们在不同故事情境中所唤起的移情反应的程度是不同的,研究结果显示,对幼儿和青少年主人公,人们的情感反应的程度更高些。     

助推爱心：利用默认选项促进捐赠行为

本研究采用实验室和现场实验的方法检验了默认选项的助推策略是否能够促进慈善捐赠行为。结果发现：（1）相较于把被试费的“保留选项”设置为默认,把“捐献选项”设置为默认时,被试捐献的概率和金额更高;（2）在多个捐款选项情景中,默认选项的设置总体上提高了默认选项被选择的概率;将最大金额选项设置为默认选项有助于提高被试平均捐赠额。这些发现表明,应用默认选项的助推策略能够有效促进人们的捐赠行为。本研究结果对减少募捐成本、提高募捐效率有所启示。     

The Seminal Contribution of Rabbi Moshe Feinstein to the Development of Modern Jewish Medical Ethics

The purpose of this essay is to show how, on a wide variety of issues, Rabbi Moshe Feinstein broke new ground with the established Orthodox rabbinic consensus and blazed a new trail in Jewish medical ethics. Rabbi Feinstein took power away from the rabbis and let patients decide their treatment, he opened the door for a Jewish approach to palliative care, he supported the use of new technologies to aid in reproduction, he endorsed altruistic living organ donation and recognized brain death (thus laying the groundwork for Orthodox Jewish acceptance of heart transplantation), he downplayed the value of social worth in triage decisions, and was a fierce defender of the rights of the fetus. I develop broader theological principles from Rabbi Feinstein's ethical positions and compare them to those of his Jewish and Christian contemporaries.