Support Organ Donation Research Articles

Exploring the motives of Israeli Jews who were living kidney donors to strangers.

Non-directed living donors are individuals who donate a kidney to a recipient with whom they have neither a genetic nor emotional relationship. Israel legalized this type of donation in 2008. After this law was implemented, living donations significantly expanded. The aim of this article was to determine the motivations, characteristics, and perioperative experiences of non-directed living donors in Israel. Three online questionnaires (own questionnaire, Rosenberg Self-Esteem Scale (RSES), Rushton Self-Report Altruism Scale) were distributed to 180 Jewish kidney donors with the help of Matnat Chaim organization. One hundred and fifteen responses were received (69.3% response rate). The motivation for most donors (60%) was a strong willingness to help and a desire to do good. The majority of donors (78.3%) reported their health status as unchanged after donation; however, 16.5% experienced clinical problems (eg, wound infection, more pain than expected), and 5.2% experienced psychological complications. About 18% reported their health to improve after donation. Most (80%) inspired someone else to also become a kidney donor. This study breaks the myth that Jews do not support organ donation. In fact, their high level of altruism and their positive experience with donation has propelled the practice of non-directed donation in Israel.

Games supporting organ donation: an interview with Dr Ka-foon Chau.

Games supporting organ donation: an interview with Dr Ka-foon Chau.

'It's like being conscripted, one volunteer is better than 10 pressed men': A qualitative study into the views of people who plan to opt-out of organ donation.

ObjectivesTo overcome the shortage of organ donors, Scotland and England are introducing an opt‐out organ donor registration system in 2020. This means individuals will be automatically considered to consent for donation unless they actively opt‐out of the register. Research has found that emotional barriers play a key role in donor decisions under opt‐in legislation, yet little is known about factors that influence donor decisions under opt‐out consent. Our objectives were to investigate attitudes towards organ donation and opt‐out consent from individuals who plan to opt‐out, and to explore the reasons why they plan to opt‐out.DesignQualitative interview study.MethodsSemi‐structured interviews were conducted with 15 individuals from Scotland (n = 14) and England (n = 1) who self‐reported the intention to opt‐out of the register following the legislative change to opt‐out. The interviews were transcribed verbatim and analysed using thematic analysis.ResultsThree main themes were identified: (1) consent versus coercion, which describes the perception of freedom of choice under an opt‐in system and fears of ‘government interference’ and threatened autonomy under opt‐out, (2) self‐protection, encompassing fears of medical mistrust, bodily integrity concerns, and apprehension regarding the recipient selection process, and lastly, (3) ‘riddled with pitfalls’, which includes the notion that opt‐out consent may increase susceptibility of stigma and reproach when registering an opt‐out decision.ConclusionsThis study reinforces existing opt‐in literature surrounding medical mistrust and bodily integrity concerns. A threat to one’s autonomous choice and heightened reactance arising from perceptions of unwarranted government control have emerged as novel barriers. Statement of contribution What is already known about this subject? Although around 90% of individuals in the United Kingdom support organ donation, just 40% are actively registered as donors. As part of measures to improve rates of organ transplantation, Scotland and England are moving to an opt‐out organ donation consent system in 2020.Existing research has shown that feelings and emotions are important factors that influence donor relevant decisions under the current opt‐in system, but little research has explored potential deterrents under the new plans for opt‐out consent.Minimizing the number of people opting out of the donor register is key to ensure sustained rates of transplantation. What does this study add? This study explored why people plan to opt‐out of the new system in Scotland and England.Medical mistrust and bodily integrity concerns remain as salient barriers under opt‐out laws.Fears of unwarranted government control and a perceived threat to one’s freedom of choice emerged as a novel barrier.

What are Chinese New Zealanders' organ donation attitudes

Introduction: Research indicates Chinese people have the lowest organ donation rates in the world. Meanwhile Chinese people have the highest demand for liver transplants in the world because of the prevalence of liver disease in Chinese. It is urgent to know Chinese New Zealanders’ organ donation attitudes. Objectives/Aims: Identify Chinese New Zealanders’ attitudes toward organ donation and to explore the barriers and facilitators of organ donation in Chinese New Zealanders. Methods: A cross sectional survey was undertaken. Chinese New Zealanders (=187) completed of a web-based or paper-based questionnaire, which included the organ donation attitude scale, knowledge scale and the Chinese death anxiety scale. Results: Of the respondents, 171 (91.9%) supported organ donation, 139 (75.9%) would like to donate their organs after death, 90 (49.4%) had signed an organ donor card or the back of their driver’s licenses, but only 40 (21.4%) had discussed their organ donation wishes with their family. Designated donors and non-designated donors in the knowledge scores and the death anxiety scores are significantly different. Cultural influence, knowing someone who donated an organ while living, knowledge, and receiving organ donation education were predictive of Chinese New Zealanders’ attitudes to organ donation. While death anxiety negatively influences Chinese New Zealanders’ organ donation attitudes; it is not a significant predictor of Chinese New Zealanders’ organ donation attitudes. Conclusion: This study demonstrates that many Chinese New Zealanders willing to donate organs. There is a huge discrepancy between the attitude displayed in surveys and the actual consent rate. Chinese culture is the strongest negative predictor of Chinese New Zealanders’ attitudes towards organ donation. They are also lack knowledge about organ donation such as donor criteria, donation process, and applicable laws. The major challenge is to improve the consent rate of Chinese New Zealander donors’ families

Knowledge and attitudes towards brain death and organ donation in hospitalized patients and their relatives

Aim: Organs are generally procured from cadavers in developed countries while they are mostly obtained from living donors in developing countries. Firstly, the diagnosis of brain death should be established in order to obtain organ from a cadaver. Secondly, the family or legal guardian should have to donate organs. The knowledge and attitudes of relatives of donor towards organ donation is important in a patient diagnosed as brain death. Thus, this study was performed to determine knowledge and attitudes towards brain death and organ donation in patients (their relatives) hospitalized in general surgery clinic where organ donation is performed. Material and Methods: The patients hospitalized in General Surgery Clinic, and their relatives (n=80) were included to the study. The clinic also performed renal transplantation. The questionnaires developed by researchers were used to collect data.Results: Of the subjects included, 75% were women while25% were men. Mean age was 40.71±15.53 years. Majority of subjects had inadequate knowledge about brain death or organ transplantation. Of subjects, 76.25% reported that they support organ donation. Only 2.5% had donated their organs. Subjects(n=19) reporting that they would not donate organ of their relative diagnosed as brain death proposed following reasons: religious thoughts(15.8%), refusal of disrupting body integrity(94.8%) and being blinded to decision of potential donor about organ donation.Conclusion: Although sample size is small in our study, it was shown that majority of individual have no sufficient information about brain death and organ transplantation and that organ donation rates are extremely in our society.

Knowledge and attitude toward organ donation among medical staff and outpatients at King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Organ transplantation is still the treatment of choice for end-stage organ failure. Despite the establishment of the Saudi Center for Organ Transplantation (SCOT), the organ supply still does not meet the increasing demand. This study aims to assess the knowledge of Saudis about organ donation both among the public and the medical staff and to assess the trend in the change from 1996 until now. A cross-sectional study was conducted among Saudis above the age of 18 years. A self-administered, 25-item, questionnaire was completed by participants including both outpatients and medical staff at King Abdulaziz Medical City using a convenient sampling technique. A total of 376 individuals answered the questionnaire; 238 (63.1%) heard about SCOT, of whom 124 (70.5%) were males. Health-care professionals had better attitude and knowledge on organ donation (P <0.05). Compared to the results from 1996to 2017, there was (51.22%) to (30.4%) decrease in people who allowed their families to donate their organs; on the other hand, there was an increase in the percentage of people who had the correct knowledge that Islam supports organ donation. Unsatisfactory levels of awareness impacted negatively on the knowledge and attitude of the population that is showed by the minor improvements over the years, and the slight proportion of participants who owned a donor card. Although 97.6% of the participants knew about the concept of organ donation, only 66.5% were familiar with the positive Islamic opinion. Based on the results of the comparison with the study in 1996, we conclude that more efforts from both the governmental and religious authorities are needed to increase awareness.

Educate, Re-educate, Then Re-educate: Organ Donation-centered Attitudes Should Be Established in Society

The objectives of the study are to evaluate knowledge and attitudes toward organ and tissue donation, to pursue a deeper understanding of attitudes toward organ donation, and to gain an understanding of the underlying, personal reasoning for the desired action in organ donation among the adult population. Four thousand people were interviewed who were selected by the simple random sample type. A survey was conducted by voluntary, face-to-face interviews using a printed 25-item questionnaire form presented to street-recruited individuals over 18 years of age. In the study, where male/female distribution was represented equally, the majority of participants consisted of young and middle-aged, primary school graduates between the ages of 25 to 44 years. Although 91.1% of the respondents stated that they support organ donation, only 75.3% stated they wanted to donate organs. Organ donation-centeredness rates were low in those who did not finish a primary school education, people with a low household income, and those ≥65 years age group. A majority of the respondents (91.2%) were found to be against financial incentives for organ donation. Although 91.4% of the participants stated that organ donation is important if the recipient is a relative, this ratio decreased to 86.7% for a nonrelative. In our study, the level of accepting an organ as a recipient from an unknown person was 9.1% higher than the rate of willingness to donate to an unknown person. Surprisingly, despite 84% saying their religion is not against organ donation, 38.4% of the respondents cited religious concerns as the main reason for unwillingness and 58% of them indicated that they were reluctant to donate organs due to religious beliefs. It is important to know that it is not certain that anyone who is hypothetically in favor of organ donation will donate when faced with a real choice. Increasing the number of donors is the most important issue in order to benefit more patients in transplantation, which has achieved a very important success level through serious efforts. The majority of Turkey's population know about organ donation, support transplantation, and would be willing to donate their organs. Most of the respondents find it religiously correct and believe that it is an acceptable lifesaving procedure. However, a high percentage did not know how to donate, and they indicated that the information available on the subject is insufficient. Mass media campaigns and educational activities could resolve this matter and increase organ donation. According to the results of our study, when considering the number of patients who died while waiting for transplantation, organ donation awareness projects that are focused on converting knowledge to behavior are believed to be very critical. It is important to provide organ donation-oriented training at every educational level.

MY PARENT’S BODY IS SACRED: LATINO PERSPECTIVES ON BRAIN DONATION FOR ALZHEIMER’S DISEASE RESEARCH

Brain donation is a critical part of advancing research addressing Alzheimer’s disease and related dementias (ADRD). Latinos are at a higher risk of developing ADRD compared to non-Latino Whites. However, there is limited knowledge regarding causes and mechanisms related to ADRD health disparities among Latinos partially due to lower research participation and brain donation rates. Family members play a pivotal role in increasing brain donation rates, particularly, among underrepresented groups. In this study, we examine the perceptions of brain donation among adult children of older Latinos. We invited Latino men and women (N=15) with a parental-figure who was 65 years and over to participate in one of three focus groups. During the focus groups, participants discussed the meaning of brain donation for research, reasons to donate or not, and their reactions to the possibility of their parental-figure being a brain donor. All focus groups were audio-recorded and transcribed with transcripts used for data analysis. We used a Grounded Theory Approach to analyze focus group data. Results yielded three themes: (1) social and cultural factors influencing a family’s willingness to support organ donation; (2) lack of knowledge about the brain donation process; and (3) recommendations for engaging more Latinos in ADRD research and brain donation. Findings provide insight into how family participation may facilitate increased brain donation rates in ADRD studies among older Latinos. A main recommendation for researchers is to adopt a family-centered approach throughout the research process with a focus on addressing information gaps - from recruitment to dissemination.

115.7: DTI Foundation collaboration with China: An educational and cooperation program.

Background: The involvement of DTI Foundation with the donation activity in China started in 2012 when the University of Barcelona awarded a research grant to a DTI expert to understand China. This initial interaction was the beginning of a strong commitment to train, advise and support organ donation professionals. The ultimate goal of this collaboration is the establishment of a self-sufficient organ donation and transplantation program for the Chinese people. Methods: The comprehensive program has two main components: the educational one and the consultancy one. • Educational program - The TPM courses methodology combined theoretical sessions and simulations in the main topics of the organ donation (OD) process. -The International Master in Donation and Transplantation of Organs, Tissues and Cells has been created following the European training framework and it is certified by the University of Barcelona. -The KeTLOD (Knowledge Transfer and Leadership in Organ Donation) Erasmus project is cofounded by the EU commission in collaboration with 13 partners from Europe and China. Its main aim is to design and implement a postgraduate program in OD in seven Chinese Universities partners. -The KeTLOD Bridge are scholarships to facilitate the transfer of knowledge and leadership in OD and transplantation from Europe to China. The KeTLOD Bridge include: 1.International Master 2.Postgraduate in OD and Transplantation, Management and Quality 3.Diploma in OD 4.Medical educational visitCooperation project with Kunming First People’s Hospital of Kunming City OPO The SEUSA methodology is followed for this program. It applies the best practices form the most successful OD programs in the world: Spain, Europe and USA. The SEUSA tools include: 1. Organ Donation Diagnosis survey (ODDS) 2. Deceased alert system (DAS) 3. Essentials in Organ Donation (EOD) The SEUSA main objectives are: 1. Increase donor referral 2. Improve conversion rate 3. Create UH-OPO structure Regular visits from DTI international experts to the Yunnan province hospitals have been organised to further strengthen the SEUSA efficacy. The information collected in the visits have facilitated recommendations regarding the establishment of in-hospital organ procurement units. Conclusions: The combination between a strong educational program, effective in-hospital structure, supportive regulatory system and governmental endorsement are fundamental pillars to build a self-sufficient and sustainable organ donation program.

The participation of religious organizations in formation of population attitude to transplantation of organs and tissues

The article discusses issue of possibility of influence of religious organizations on the attitude of population to issues of human organ transplantation. The attitude of followers of different religions to key issues of bioethics related to organ donation and transplantation is analyzed. It is concluded that there are no definite prohibitions on implementing this kind of medical intervention in modern religious regulations. The study of results of questionnaire survey of two groups of respondents revealed certain part of population, whose decision on the issues of posthumous organ donation would be influenced by the opinion of representative of religious organization. It is established that every tenth respondent appealed to the Orthodox priest when making decision to sign consent paper concerning posthumous exempt of organ from relatives. It is concluded that it is possible to affect the formation in certain part of population understanding of need to support organ donation and transplantation in case of active work in this direction of representatives of religious organizations.

Study to assess knowledge, attitude on organ donation among medical students in a medical college, Telangana, India

Background: Organ donation rate in India is only 0.26 per million. This is mainly due to lack of knowledge about the need of organ donation. Health care professionals play a vital role in imparting positive knowledge regarding organ donation.Methods: Institutional based cross sectional study was conducted among 1st year MBBS students (n=135). Data was collected and pre and post analysis was done using a pre-validated self-administered questionnaire. Data was entered in Ms Excel and analysed using SPSS 17 software.Results: Media was found to be most common source of information regarding organ donation. 91.1% support organ donation. 78.5% have not heard about donor card. Only 34.6% have heard about jeevandan scheme. 77.8% participants has knowledge that brain death is irreversible and 65.9% students believe that there is age limit for organ donation. 87.4% has adequate knowledge that single donor can donate to multiple recipients and 95.6% students believe that organs should not be donated from persons who has cancers or HIV.Conclusions: From the data analysed it is evident that there was a significant increase in knowledge following Awareness session on organ donation. Many have a positive attitude towards organ donation.

The Patients Save Lives Program to Facilitate Organ Donor Designation in Primary Care Offices.

There are about 120 000 people on the US waiting list for a solid organ transplant; nearly 22 people die every day who could be helped through organ donation. Joining a donor registry and informing one's family of one's preferences increases recovery rates and can avoid misunderstandings during an emotionally difficult time. Although the vast majority of people support organ donation, only about half of adults have joined a state donor registry. Methods. A 3-group design was used. Primary care physician offices were randomly assigned to either web-based training, in-person training, or a control condition. The control condition consisted of a poster and traditional brochure and donor form placed in the waiting room. In the 2 intervention groups, the Patients Save Lives form was distributed during the check-in process in addition to the poster. A total of 1521 physicians and office staff at 81 clinic sites (48 in-person and 33 web-based) received the training; there were 33 control locations. A total of 21 189 patients were exposed to the intervention over a 6-month period; 761 (8.1%) of 9428 people who were not already registered completed the designation form to be organ donors. There were no donor designations in the control group locations. Organ donor designation can be incorporated into the office check-in procedure without disrupting the workflow or burdening clinicians. The program is available online and can be sustained inexpensively with cooperation between primary care offices and regional Organ Procurement Organizations.

Australian perioperative nurses’ attitudes, levels of knowledge, education and support needs related to organ donation and procurement surgery: A national survey

Objectives: The aim of this study was to examine Australian perioperative nurses' self-reported knowledge, attitudes, levels of education and support in relation to their participation in organ donation and procurement surgery. Sample and setting: Data was collected from Australian perioperative nurses who are members of the peak national body Australian College of Perioperative Nurses (ACORN). Methods: An online survey was distributed to ACORN members on behalf of the researchers. The online survey comprised 67 items encompassing openand closed-ended questions along with graded Likert and ordinal multicategory scales. Results: Of ACORN's 4000 Australian members, 452 (11.3 per cent) responded to the survey. Participants were broadly represented via each state and territory across metropolitan, regional and rural settings with participation experiences in multi-organ procurement surgery (MOPS). A variety of perioperative nursing roles were represented with varying roles within MOPS. Overall, perioperative nurses reported familiarity with organ and tissue donation in Australia but felt that they required additional knowledge and education on aspects of MOPS. The majority of perioperative nurses supported organ donation and held positive attitudes and beliefs towards procurement surgical procedures; however, they felt they lacked support resources and access to relevant education. Conclusion: The findings detailed within this study provide a national insight and contribute new knowledge and understanding of Australian perioperative nurses' experiences, attitudes, education, knowledge and support needs when participating in organ procurement surgery. These findings have the potential to inform and influence the perioperative nursing profession, clinical initiatives, education delivery and wider health policy in relation to organ procurement services.

Psychological profile of teenagers toward organ donation: a multicentric study in Spain.

It is important for teenagers to have a favorable attitude toward organ donation and transplantation (ODT) in order to increase the number of future donors. To determine the attitude of teenagers in the South East of Spain toward ODT and to analyze the psychosocial variables related to this attitude. The study population consisted of young teenagers in the South East of Spain. A stratified sample was selected by geographical location, sex and age (n = 4, 117). Attitude was assessed using a validated questionnaire about ODT (PCID-ODT Ríos). Statistical analysis: Student's t-test, Chi-squared test and a multivariate analysis. The questionnaire completion rate was 87% (n = 3572). Attitude toward ODT was favorable in 46% of cases (n = 1633) and undecided in 43% (n = 1543). Several psychosocial variables had a favorable effect on donation: believing that one has good information about ODT (Odds Ratio [OR] 1.706); discussing the subject with the family (OR 1.543) and friends (OR 1.818); carrying out pro-social activities (OR 1.642); having a favorable attitude toward cremation (OR 1.466) and autopsy (OR 1.470); and, finally, not being afraid of scars (OR 4.184). Teenagers in the South East of Spain are not currently inclined to support organ donation. This attitude is related to many psychosocial factors, mainly connected to not having good information about the subject, not discussing it in social circles and the fear of body mutilation. It would be appropriate to create educational interventional strategies in this group to prevent a negative impact on future donation rates.

Perception and prejudice about organ donation among medical students in a tertiary healthcare, Mysuru

Background: Today, increase in deaths due to organ failure can be avoided if organ donors are available. Many states in India adopted the transplantation of human organs act and enthusiastic medical professionals and philanthropists joined hands to move the matter further forward. Lack of awareness about organ donation has been noted among the general public including medical professionals. Awareness can be promoted through medical students to bridge the gap of knowledge about organ donation and they can carry the message to the community. Hence an attempt has been made to probe this issue with objective to assess the perception and prejudice about organ donation among medical students.Methods: This cross-sectional study was conducted among medical students in a tertiary healthcare centre, Mysuru. A total of 201 students from 1st and 3rd term, consenting to participate were included in the study. A semi-structured self-administered questionnaire was used to collect data and was analysed using SPSS 22 version.Results: Knowledge about brain death was 73.1%, transplant of harvested organs was 59%, compatibility tests were 89% and organs donated by live donors were 89.6% for kidneys and 66.7% for cornea in cadaver donors. Regarding legal issues 73% knew that organ selling is criminal offence. 90% supported organ donation and related to prejudice 53% agreed that there are no religious constraints to donate organs.Conclusions: Knowledge and awareness regarding procedure, pre-requisites and legal issues related to organ donation needs to be improved among the medical students.

Organ donation within the intensive care unit: A retrospective audit

BackgroundDespite many Australians supporting organ donation, national posthumous organ donation rates have not increased as expected over the last three decades. Little is known about the barriers to organ donation for patients in intensive care that meet the criteria for organ donation. ObjectiveThe aim of this study was to describe the characteristics of patients identified as potentially suitable for organ donation and to explore the variables associated with the success, or failure, of solid organ donation within the context of an Australian public hospital intensive care unit (ICU). MethodsA retrospective audit examined electronic records of 280 potential organ donors aged 18–80 years, admitted into the ICU between 1 July 2012 and 30 June 2016. Data extracted from three separate electronic hospital databases were amalgamated for analysis. ResultsOf the 280 potential organ donors identified, conversations with families of 182 (65%) patients resulted in their agreement to organ donation. Consent to organ donation was most often provided by the patient's spouse (65, 35.7%); however, only 63.7% (n = 116) were successful organ donors. The remaining 36.3% (n = 66) of patients did not donate organs for medical reasons. Compared with those who did not donate, the typical organ donor was significantly younger (M 49.9 years, p = 0.020), Australian-born (p = 0.031), and had a shorter length of ICU stay (M 64.9 h, p = 0.002). The most frequently donated organs were kidneys (103, 88.8%), lungs (59, 50.9%), and livers (52, 44.8%). ConclusionThis study provided insights into patient, family, and organisational factors contributing to the success of organ donation outcomes in the ICU. Two factors that adversely impacted donation outcomes were the following: (1) the family did not consent to organ donation on behalf of the patient and (2) consent was provided, but donation did not proceed for medical reasons. Although the focus on the consenting process has been raised, this study highlights the additional impact of medical suitability on rates of organ donation. Family members may experience significant disappointment after consent that may have repercussions on their health and also future donation considerations. This study also highlighted some deficiencies in the databases that, if addressed, could better inform organisational processes in the consent and support of those making decisions about consent.

'What if I'm not dead?' - Myth-busting and organ donation.

ObjectivesIn the United Kingdom, three people die every day awaiting an organ transplant. To address this, Scotland and England plan to follow Wales and introduce opt‐out donor consent. However, emotional barriers, myths, and misconceptions may deter potential registrants. Our objectives were to estimate the number of people who plan to opt‐out of the donor register and to test whether emotional barriers (e.g., medical mistrust) differentiated participants within this group. Finally, in an experimental manipulation, we tested whether intention to donate decreased by making emotional barriers more salient and increased following a widely used myth‐busting intervention.DesignMixed between–within design.Methods UK residents (n = 1,202) were asked whether they would choose opt‐in, deemed consent, or opt‐out/not sure if legislation changes to opt‐out. Participants also completed measures of donor intentions at baseline, following a 12‐item emotional barriers questionnaire and again, following a 9‐item myth‐busting intervention.ResultsFindings indicate that 66.1% of participants selected to opt‐in to the donor register, 24.3% selected deemed consent, and 9.4% selected opt‐out/not sure. Emotional barriers, notably fears surrounding bodily integrity, were significantly elevated in participants who selected opt‐out/not sure. Increasing the salience of emotional barriers reduced donor intentions in the opt‐out/not sure group. However, dispelling organ donation myths did not increase intention within this group.ConclusionsIf opt‐out legislation is introduced in Scotland and England, approximately 10% of participants plan to opt‐out or are not sure. Dispelling organ donation myths with facts may not be the best method of overcoming emotional barriers and increasing donor intentions for those planning to opt‐out. Statement of contribution What is already known about this subject? In the United Kingdom, three people die every day waiting for an organ transplant. Although 90% of the UK population support organ donation, only 38% are registered donors. To address this, Scotland and England have recently proposed to introduce an opt‐out system of donor consent. To date, limited research has investigated public attitudes and intentions regarding opt‐out consent laws in Scotland and England.Emotional barriers (e.g., medical mistrust) are key factors that may deter potential registrants. However, no research has examined these barriers in relation to proposed opt‐out consent laws.Myth‐busting is widely used around the world as part of campaigns promoting organ donation. The NHS currently use a myth‐busting feature on their webpage to dispel harmful myths about organ donation; however, there is limited evidence of the impact this has on intentions to become an organ donor. What does this study add? Approximately 10% of UK participants plan to opt‐out or are unsure of their decision, if the law changes to opt‐out.Emotional barriers, notably, bodily integrity fears, are significantly elevated in people who plan to opt‐out.Increasing the salience of emotional barriers reduced donor intentions for people who plan to opt‐out.A myth‐busting intervention had no effect on donor intentions for people who plan to opt‐out of the donor register.

Crowd Sourcing for Organs: A Social Dilemma.

Crowd Sourcing for Organs: A Social Dilemma.

Factors Influencing Deceased Donor Consent Rates in Cape Town, South Africa

Introduction Deceased organ donation rates in South Africa are perceived to be very low with no published data available. There is no national coordinating body for transplantation activities and there are low levels of public awareness about donation. The Western Cape has transplant teams in the public and the private sector and a population of 5.8 million with 1.4 million accessing private health care. Methods A structured data collection sheet was completed by the transplant coordinators (2 state and 3 private) after every family approach for consent to organ donation from April 28th 2017 to 14th November 2017. Family demographics, circumstances of the approach to the family, and various key points in the transplant coordinator discussion were recorded and analysed in all cases whether consent was granted or refused.Results and Discussion A total of 52 families were approached for consent with 48 in the public sector and only 4 in the private sector. The consent rate was low at 17.3%. There was a 100% refusal rate in the private sector. The condition of the donor at the time of referral was poor with only 52.9% still being actively managed by the treating team. Most potential donors (75%) required at least a litre of immediate fluid resuscitation at the time of initial assessment.The majority of referrals (75%) came from trauma or casualty units with only 13 (25%) being referred from an Intensive Care Unit. All private sector referrals were in an Intensive Care Unit.Traumatic brain injury was the most frequent cause of death (75%). Family discussions were often large with 25% involving between 6 - 10 people and 21.2% involving more than 10 people. A group decision about donation was made in 71.2% of cases. Only 51.9% of families had heard about organ donation prior to being approached and only 9.6% had discussed organ donation as a family. No potential donor was a registered organ donor. In most cases (84.6%) the family was receptive to the organ donation discussion.The consent discussion was held in English 86.5% of the time but for 35.3% of families their home language was Afrikaans and for 23.5% it was isiXhosa.An interpreter was used in 1 case. The most commonly cited reasons for not supporting organ donation were against my religion (32.6%) and against my culture (25.6%). A religious leader was involved in 2 cases.Conclusion Consent rates were low. Despite most families not being aware of organ donation most families were receptive to discussions around organ donation. Decision making was often made by a large family group. Many areas for improvement were identified by this study: increased public awareness about deceased donation, improved donor management, better access to ICU, improving the number of referrals and engagement with religious and cultural leaders.

Influences on a Culture that Supports Organ Donation After Circulatory Death

Organ donation remains rare, particularly in Australia where various initiatives attempt to bolster donation rates including a renewed interest in Donation after Circulatory Death (DCD). DCD reintroduction has been accompanied by increased donor numbers and organs transplanted, with associated favourable short- and long-term transplant outcomes. However, reintroduction has been met with variable institutional and individual support. Ethical concerns are often raised, particularly surrounding how a clinician’s decision to palliate and withdraw cardiopulmonary support may be influenced by the desire for DCD. The current study aims for a greater understanding of DCD perceptions among staff involved. Materials and Methods This qualitative study utilised semi-structured interviews with intensive care staff at the Alfred Hospital ICU in Melbourne. Staff participants were recruited through email invitation, and a trained interviewer used a semi-structured interview guide to explore perceptions surrounding DCD. Twelve staff participants were interviewed based on reaching a data saturation point. Several 10-point Likert scales were included. Interviews were digitally recorded and transcribed verbatim for thematic analysis. Results Twelve participants were interviewed; eight intensive care physicians, three donation coordinators and one bedside nurse. Responses to the Likert scale questions were averaged (n=12). Donation after brain death was unanimously accepted (Average=10.0), whereas DCD acceptance was lower but remained supported (Average=8.8). Interview responses generated five themes, each containing subthemes. Themes included: 1) Logistical and circumstantial obstacles surrounding DCD implementation; 2) Cultural and environmental influences on DCD decision making; 3) Influence of personal factors on DCD implementation; and 4) Influence of families of potential donors on DCD. Discussion Respondents had concerns with DCD where perceptions existed that DCD would increase family distress, either from timeframes not being met or logistical delays. A second major source of concern stemmed from personal conflict relating to their role. There was difficulty transitioning from primarily sustaining life or facilitating palliation alone to advocating for DCD, especially where there was perceived potential for deviations from standard palliation in analgesia, sedation and investigations. Overall, concerns were overcome by reliance on a supportive work environment, rationalisation of concerns over time and reliance on protocols. Conclusion A supportive culture within the Alfred Hospital ICU meant DCD occurred with minimal institutional resistance. However, some individual concerns surrounding DCD were identified. These may be present and amplified in other centers. More study is required in centers where institutional resistance to DCD is identified that DCD may be further promoted to expand the donor pool.