Barriers Preventing and Motivators Encouraging Posthumous Organ Donation in the Kingdom of Saudi Arabia

Abstract

Organ and tissue transplantations have become one of the most effective lifesaving and life enhancing procedures for people with end-stage organ failure. However, given that the demand for organ transplants has reached a critical stage and has increased beyond supply, many patients die whilst waiting for the required organs. Therefore, there is a pressing need to bridge the gap between organ supply and demand for transplantation. In an attempt to achieve a more nuanced understanding of the psychological factors that influence individual intention to sign donor cards or discuss donation wishes with the family and significant others, the current study proposes a comprehensive theoretical framework that combines the social cognitive model, namely, the Theory of Planned Behaviour (TPB) with the Organ Donation Model (ODM), which is a behavioural model with an added emphasis on emotional factors. The general aim of this research is to improve knowledge and foster a deeper understanding of various aspects influencing posthumous organ donation. This study seeks to understand Saudi Arabians’ motives and barriers towards donation in order to gain formative research insights that can be used to design individually focused social marketing campaigns, and ultimately increase participation in organ donation. Exploring the full gamut of factors influencing organ donation is critical in facilitating the organ donation consent process. Moreover, this information could be used to effectively narrow the gap between organ supply and demand, thereby improving the quality of life of patients who are waiting to benefit from donors’ affirmative donation decisions. In the current study, five research questions were proposed: 1) To what extent do factors such as fear of death, disgust sensitivity ‘ick factors’, medical mistrust, fear of body mutilation and bodily integrity act as barriers towards organ donation?, 2) To what extent do factors such as altruism and solidarity, and perceived benefits act as motivators towards organ donation?, 3) To what extent do factors such as religiosity and subjective norms act as conflicting influences towards organ donation?, 4); To what extent does factual knowledge about posthumous organ donation influence individuals to donate organs?, and 5) What is the factual and objective knowledge that distinguishes donors and non-donors? The data were gathered from a convenience sample of 1022 Saudis citizens via an online questionnaire, which was posted on social media websites, namely, Facebook and Twitter. These websites were used for collecting the data in order to capture a broad and diverse range of participants; for example, those with different age ranges, gender, educational levels, and from different geographical locations, as the aim was to achieve a sample that is representative of the Kingdom of Saudi Arabia. Structural Equation Modelling (SEM) was used to test the hypothesised relationships using Analysis of Moment Structure (AMOS). This thesis has addressed a number of criticisms within the existing organ donation literature, such as the absence of using a strong and well-validated underlying theoretical framework, the lack of considering important cognitive and emotional influences and the dearth of research in the Saudi context. To overcome the limitations of existing organ donation research, this thesis presents a comprehensive methodology, a well-established theoretical framework, a representative study population, and findings relevant to local and national health policy. Overall, the findings of this research make a significant contribution to the existing understanding and knowledge of organ donation and its role in influencing pro-social behaviour. From a theoretical perspective, this study contributes to the extant literature by proposing a comprehensive theoretical framework that integrates the Theory of Planned Behaviour (TPB) with the Organ Donation Model (ODM) and incorporates additional influences (fear of death and religiosity), to explicate the relationship between people’s positive attitudes and low rates of registration and donation preference discussions with family and significant others. Augmented TPB with ODM constructs provided further clarification about the reasoned, linear and rational thought processes, as well as the emotional reasoning and irrational forces governing organ donation decisions. From a practical perspective, the findings of this thesis help in the development of effective interventions designed to encourage and educate people and ultimately increase organ donation participation. The significance of this research is defined by its potential to guide and assist social marketing communicators, academics and educationalists to design and implement culturally appropriate strategies to promote acceptance of posthumous organ donation in Saudi society, with the hope of increasing the number of organ donors. Importantly, this research derives a number of practical implications for government policy-makers, social marketing practitioners and educationalists, which could be used to promote discussion and registration rates. This research guides policymakers to target communications toward citizens and promote donations by developing more audience-oriented programs. Hence, this research is not limited to providing a purely academic contribution; it will also make a valued contribution in communities.