Knowing a donor and identifying as one: Determinants of people's willingness for related and anonymous living donation in Australia

Abstract

Although living related donation (LRD) (living donation to a genetically/emotionally related recipient) is well established in Australia, living anonymous donation (LAD) to a stranger is rare. Given the increasing use of LAD overseas, Australia may likely follow suit. Understanding the determinants of people's willingness for LAD is essential but infrequently studied in Australia. Consequently, we compared the determinants of people's LRD and LAD willingness, and assessed whether these determinants differed according to type of living donation. We surveyed 487 health students about their LRD and LAD willingness, attitudes, identity, prior experience with blood and organ donation, deceased donation preference, and demographics. We used structural equation modelling (SEM) to identify the determinants of willingness for LRD and LAD and paired sample t-tests to examine differences in LRD and LAD attitudes, identity, and willingness. Mean differences in willingness (LRD 5.93, LAD 3.92), attitudes (LRD 6.43, LAD 5.53), and identity (LRD 5.69, LAD 3.58) were statistically significant. Revised SEM models provided a good fit to the data (LRD: χ2 (41) = 67.67, p = 0.005, comparative fit index (CFI) = 0.96, RMSEA = 0.04; LAD: χ2 (40) = 79.64, p < 0.001, CFI = 0.95, RMSEA = 0.05) and explained 45 and 54% of the variation in LRD and LAD willingness, respectively. Four common determinants of LRD and LAD willingness emerged: identity, attitude, past blood donation, and knowing a deceased donor. Religious affiliation and deceased donation preference predicted LAD willingness also. Identifying similarities and differences in these determinants can inform future efforts aimed at understanding people's LRD and LAD willingness and the evaluation of potential living donor motives. Notably, this study highlights the importance of people's identification as a living donor as a motive underlying their willingness to donate their organs while living.