The worldwide organ shortage occurs despite people’s positive organ donation attitudes. The discrepancy between attitudes and behaviour is evident in Australia particularly, with widespread public support for organ donation but low donation and communication rates. This problem is compounded further by the paucity of theoretically based research to improve our understanding of people’s organ donation decisions. This program of research contributes to our knowledge of individual decision making processes for three aspects of organ donation: (1) posthumous (upon death) donation, (2) living donation (to a known and unknown recipient), and (3) providing consent for donation by communicating donation wishes on an organ donor consent register (registering) and discussing the donation decision with significant others (discussing). The research program used extended versions of the Theory of Planned Behaviour (TPB) and the Prototype/Willingness Model (PWM), incorporating additional influences (moral norm, self-identity, organ recipient prototypes), to explicate the relationship between people’s positive attitudes and low rates of organ donation behaviours. Adopting the TPB and PWM (and their extensions) as a theoretical basis overcomes several key limitations of the extant organ donation literature including the often atheoretical nature of organ donation research, thefocus on individual difference factors to construct organ donor profiles and the omission of important psychosocial influences (e.g., control perceptions, moral values) that may impact on people’s decision-making in this context. In addition, the use of the TPB and PWM adds further to our understanding of the decision making process for communicating organ donation wishes. Specifically, the extent to which people’s registering and discussing decisions may be explained by a reasoned and/or a reactive decision making pathway is examined (Stage 3) with the novel application of the TPB augmented with the social reaction pathway in the PWM. This program of research was conducted in three discrete stages: a qualitative stage (Stage 1), a quantitative stage with extended models (Stage 2), and a quantitative stage with augmented models (Stage 3). The findings of the research program are reported in nine papers which are presented according to the three aspects of organ donation examined (posthumous donation, living donation, and providing consent for donation by registering or discussing the donation preference). Stage One of the research program comprised qualitative focus groups/interviews with university students and community members (N = 54) (Papers 1 and 2). Drawing broadly on the TPB framework (Paper 1), content analysed responses revealed people’s commonly held beliefs about the advantages and disadvantages (e.g., prolonging/saving life), important people or groups (e.g., family), and barriers and motivators (e.g., a family’s objection to donation), related to living and posthumous organ donation. Guided by a PWM perspective, Paper Two identified people’s commonly held perceptions of organ donors (e.g., altruistic and giving), non-donors (e.g., self-absorbed and unaware), and transplant recipients (e.g., unfortunate, and in some cases responsible/blameworthy for their predicament). Stage Two encompassed quantitative examinations of people’s decision makingfor living (Papers 3 and 4) and posthumous (Paper 5) organ donation, and for registering and discussing donation wishes (Papers 6 to 8) to test extensions to both the TPB and PWM. Comparisons of health students’ (N = 487) motivations and willingness for living related and anonymous donation (Paper 3) revealed that a person’s donor identity, attitude, past blood donation, and knowing a posthumous donor were four common determinants of willingness, with the results highlighting students’ identification as a living donor as an important motive. An extended PWM is presented in Papers Four and Five. University students’ (N = 284) willingness for living related and anonymous donation was tested in Paper Four with attitude, subjective norm, donor prototype similarity, and moral norm (but not donor prototype favourability) predicting students’ willingness to donate organs in both living situations. Students’ and community members’ (N = 471) posthumous organ donation willingness was assessed in Paper Five with attitude, subjective norm, past behaviour, moral norm, self-identity, and prior blood donation all significantly directly predicting posthumous donation willingness, with only an indirect role for organ donor prototype evaluations. The results of two studies examining people’s decisions to register and/or discuss their organ donation wishes are reported in Paper Six. People’s (N = 24) commonly held beliefs about communicating their organ donation wishes were explored initially in a TPB based qualitative elicitation study. The TPB belief determinants of intentions to register and discuss the donation preference were then assessed for people who had not previously communicated their donation wishes (N = 123). Behavioural and normative beliefs were important determinants of registering and discussing intentions; however, control beliefs influenced people’s registering intentions only. Paper Seven represented the first empirical test of the role of organ transplant recipient prototypes (i.e., perceptions of organ transplant recipients) in people’s (N = 465) decisions to register consent for organ donation. Two factors, Substance Use and Responsibility, were identified and Responsibility predicted people’s organ donor registration status. Results demonstrated that unregistered respondents were the most likely to evaluate transplant recipients negatively. Paper Eight established the role of organ donor prototype evaluations, within an extended TPB model, in predicting students’ and community members’ registering (n = 359) and discussing (n = 282) decisions. Results supported the utility of an extended TPB and suggested a role for donor prototype evaluations in predicting people’s discussing intentions only. Strong intentions to discuss donation wishes increased the likelihood that respondents reported discussing their decision 1-month later. Stage Three of the research program comprised an examination of augmented models (Paper 9). A test of the TPB augmented with elements from the social reaction pathway in the PWM, and extensions to these models was conducted to explore whether people’s registering (N = 339) and discussing (N = 315) decisions are explained via a reasoned (intention) and/or social reaction (willingness) pathway. Results suggested that people’s decisions to communicate their organ donation wishes may be better explained via the reasoned pathway, particularly for registering consent; however, discussing also involves reactive elements. Overall, the current research program represents an important step toward clarifying the relationship between people’s positive organ donation attitudes but low rates of organ donation and communication behaviours. Support has been demonstrated for the use of extensions to two complementary theories, the TPB and PWM, which can inform future research aiming to explicate further the organ donation attitude-behaviour relationship. The focus on a range of organ donation behaviours enables the identification of key targets for future interventions encouraging people’s posthumous and living donation decisions, and communication of their organ donation preference.

Thesis (B.A.)--Haverford College, Dept. of Philosophy, 2005. / Includes bibliographical references.

Hundreds of Canadians die each year while awaiting a vital organ transplant. Consistent with several countries in the world, the demand for organs for transplantation outweighs the supply. In Canada, citizens must actively register to enlist themselves as organ donors after death occurs. The aim of this thesis was to examine and evaluate the acceptability of an emergency department-based organ donation registration strategy. Secondarily, we identified the proportion of emergency physicians, nurses and clerks who are personally registered as organ donors. We conducted three self-administered surveys as well as an a priori sub-study to evaluate the effect of a prenotification letter on postal surveys of physicians. We discovered that key stakeholders in emergency departments are engaged in organ donation and feel that the emergency department is an acceptable place to promote organ donation registration. In addition, we identified several barriers to such a potential intervention which largely revolve around time and resource limitations.

Background Organ donation may occur after death determination by neurological criteria or by circulatory criteria (DCC). This thesis evaluates two controversial practices specific to DCC: (1) antemortem heparin administration to DCC donors with the aim of improving organ function, and (2) cardiac donation after DCC, which has not yet been adopted in Canada. Objectives (1) Describe antemortem heparin practices in DCC and explore its effects on transplant outcomes. (2) Describe the opinions, concerns, and insights of Canadian healthcare providers and the public regarding cardiac DCC. Methods Project 1: Systematic review and meta-regression analysis of published studies examining antemortem heparin in DCC donation. Projects 2 and 3: A qualitative interview study to evaluate the perspectives of healthcare providers and a mixed methods study involving focus groups with members of the Canadian public. Results Project 1: We found broad variability in the dosing and timing of heparin administration in DCC. While there were no clinical trials, meta-regression analysis detected no benefit to antemortem heparin in liver transplantation. Projects 2 and 3: Among healthcare providers, we found broad support for cardiac DCC but concerns about potential lack of support by the public. Among members of the public, we found majority support for cardiac DCC with priorities including respect for the wishes of dying individuals and ensuring that they are treated with dignity. Conclusions While preliminary results failed to demonstrate the benefit of antemortem heparin administration to DCC donors, high-quality clinical trials are needed to better evaluate the risks and benefits. Regarding cardiac DCC, despite healthcare providers’ concerns about lack of public support, most public stakeholders engaged in our study were supportive. The multi-modal approach of this thesis may serve as a model for evaluating other controversial practices in deceased organ donation. / Thesis / Candidate in Philosophy / Organs that are donated and transplanted from deceased individuals save thousands of lives every year. Some organs are donated after death by circulatory criteria (i.e., after the heart has stopped beating). We evaluated two controversial practices in organ donation after death is determined by circulatory criteria: (1) giving heparin, a blood thinner, just before death, and (2) heart donation after death is determined by circulatory criteria. In Project 1, our review of existing literature showed broad differences in heparin use around the time of death and heparin had no benefits on liver transplant outcomes. In Project 2, we found that healthcare providers and members of the public supported heart donation after death is determined by circulatory criteria but expressed concerns that are important to consider when establishing heart donation programs. Our approach of using multiple methods to evaluate practices in organ donation can serve as one model for evaluating other controversial practices in organ donation.

1 Summary This thesis deals with the issue of donation and its modalities. Due to the fact that the contract of donation is a very often concluded nominate contract, which is like a contract of purchase or exchange, a legal title of ownership transfer, the topic is contemporary and useful for practice. The aim of this thesis is to analyze the current legal regulation of donation, while using relevant judicial decisions. This thesis consists of eight chapters, which are for the purpose of better clarity logically divided into subchapters. The introductory chapter revolves around the issue of donation in general, especially with respect to the conceptual elements of donation, that is gratuitousness, voluntariness and the object of donation. Separate subchapters are then focused on distinguishing donation from similar legal conduct as well as from the pledge to donate. The second chapter deals with the legal regulation of the contract of donation itself, whereas outlined are firstly the differences between a real and a consensual contract of donation. In this part of the thesis the transfer of ownership of the gift is also briefly tackled. Special subchapter is then dedicated to the issue of parties and subjects of the contract of donation. Also discussed in this chapter is the form of contract of donation as...

In Ontario, the organs of deceased donors are usually allocated to those recipients who are ranked highest on the province’s waiting list for transplant surgery. However, on rare occasion, a donor, or the donor’s family, will request that an organ be given to a designated recipient or designated group of recipients. The ethical acceptability of these so-called “directed donations” of organs from deceased donors is debated in the transplant literature. The purpose of this study was to elicit the views of a group of transplant professionals in Ontario on the question, “Under what circumstances, if any, should a donor or the donor’s family be allowed to choose the recipient of the organ?” Qualitative in-depth interviews were conducted with 14 Ontario transplant professionals from a range of clinical disciplines. An analysis of these interviews revealed several practical and ethical considerations that the transplant professionals believed to be important in assessing the acceptability of directed donations.

In Ontario, the organs of deceased donors are usually allocated to those recipients who are ranked highest on the province’s waiting list for transplant surgery. However, on rare occasion, a donor, or the donor’s family, will request that an organ be given to a designated recipient or designated group of recipients. The ethical acceptability of these so-called “directed donations” of organs from deceased donors is debated in the transplant literature. The purpose of this study was to elicit the views of a group of transplant professionals in Ontario on the question, “Under what circumstances, if any, should a donor or the donor’s family be allowed to choose the recipient of the organ?” Qualitative in-depth interviews were conducted with 14 Ontario transplant professionals from a range of clinical disciplines. An analysis of these interviews revealed several practical and ethical considerations that the transplant professionals believed to be important in assessing the acceptability of directed donations.

Bakgrund: Donation av vävnad och/eller organ behövs för att hålla igång transplantationsverksamheten. Transplantation har funnits länge och har växt avsevärt de senaste åren. Trots detta råder det brist på donatorer och kunskap inom området för allmänheten. Syfte: Syftet var att undersöka kunskap och attityder kring donation och transplantation bland sjuksköterskestudenter, samt undersöka om det finns någon skillnad mellan män och kvinnor gällande kunskap och attityder. Metod: Webbenkät med 439 deltagare på sjuksköterskeprogrammet termin 1-6, där 84 svarade på enkäten. Totalt 22 män och 62 kvinnor. Resultat:De största angivna anledningarna till att inte donera var etiska skäl 17%, (n=14) samt avsaknad av kunskap 17%, (n=14). Resultaten kunde ej påvisa signifikanta skillnader mellan könen i frågor som attityder, benägenhet samt anledningar till att donera respektive inte donera. Attityderna kring transplantation och donation av vävnad från deltagarna var genomgående positiva 100%, (n=84) trots att endast ca hälften av deltagarna 48% (n=40) var registrerade donatorer sedan tidigare. Nittiosex procent (n=81) av studiegruppen kunde tänka sig att ta emot en donation om det skulle höja deras livskvalitet eller rädda deras liv. Blodkomponenter 78%, (n=66) och organ/ annan vävnad 70%, (n=59) var de vanligaste att kunna tänka sig att donera, och altruism verkade vara den största anledningen. Slutsats: Sammanfattningsvis kan det sägas att mer information behövs för att allmänheten ska kunna ta välinformerade beslut om donation samt att vidare forskning behövs inom området. / Background: Donation of organic tissue and/or organs is crucial in the transplantation network. Transplantation has existed for a long time but it has grown substantially during the last few years. Despite of this there is a shortage of donors and knowledge of the subject. Aim: The aim was to examine the nursing student’s knowledge and attitudes towards donation and transplantation and examine if there are any differences between men and women in knowledge and attitudes. Method: Eighty four out of 439 participants responded to an internet survey, 22 men and 62 women from 1st – 6th semester in the nursing program. Results: The major reasons stated not to donate were ethical reasons 17%, (n=14) and lack of information 17%, (n=14). The results could not show any relevant differences between the genders when it came to attitudes, tendencies or reasons to donate or not donate. The attitudes towards transplantation and donation of tissue were entirely positive 100% (n=84) despite the fact that only 48% (n=40) of the participators were registered donors. Ninety-six percent (n=81) of the studied group would consider receiving a transplant if it could save their lives or enhance their quality of life. Blood components 78%, (n=66) and organs/other tissue 70%, (n=59) were the most common choices to donate and the reason seemed to be altruism. Conclusion: To conclude, more knowledge is needed for the general public to make well-grounded decisions concerning donations and also more research and studies are needed to be conducted in the field of transplantation.

<p>Blood products are used for transfusion in many routine procedures as well as emergency medical care. The balance between the supply and demand of blood products in Canada is being threatened by an increasing aging population, a growing immigrant population, and advances in medical technology which places additional strain on the blood supply. The objective of this research is to investigate the effects of demographic determinants and clinic accessibility on the frequency of blood donation in Canada excluding the province of Québec, providing a national assessment of blood donor correlates at the individual level. Exploration of these demographic factors in addition to clinic accessibility may help to explain why a limited number of repeat donors are currently contributing, with many donors giving blood only once a year. Repeat donors are vital to maintain a safe and secure blood supply, therefore it is important to retain existing donors in addition to recruiting new volunteers. In this study, individual donor and clinic information is obtained from the Canadian Blood Services 2008 national dataset, with contextual data from the 2006 Canadian Census. Discrete choice models are used to assess the effects of these variables on the frequency of blood donation across the country, highlighting the importance of clinic accessibility. The analysis is prepared for major Census Metropolitan Areas in Canada. Results may contribute to service optimization and targeted advertising, ultimately aiming to encourage the eligible population to donate.</p> / Master of Arts (MA)

De senaste tio åren har det skett en stor ökning av monetära gåvor till humanitära hjälporganisationer i Sverige. Trots att de monetära gåvorna har ökat, har behovet ökat i större utsträckning. Just nu pågår konflikter eller allvarliga kriser i 27 länder runt om i världen och 89,4 miljoner människor är i behov av hjälp. FNs sökta summa för att möta dessa människors behov är 11 miljarder dollar mer än vad de efterfrågade för fem år sedan. Förutom detta innebär akuta kriser, likt vid tsunamin år 2004 att det sker närmast explosionsartade ökningar av spontana gåvor till hjälporganisationer. Även om dessa gåvor är viktiga för organisationerna innebär regelbundna gåvor en större möjlighet för planering och flexibilitet Detta faktum innebär att det är av stor vikt att öka antalet regelbundna givare. Studier har visat vad det är som gör att en individ väljer att skänka pengar till en hjälporganisation eller inte. Däremot saknas det vidare forskning kring olika typer av givare och deras eventuella skillnader. Enligt modellen Reasoned action approach kan en individs intention att utföra ett beteende härledas till individens attityd, subjektiva norm och upplevda kontroll över det specifika beteendet. Genom att ta reda på måtten på dessa samt intentionen går det sedan att förutspå samt förändra beteendet. Det faktum att spontana givare valt att stödja hjälporganisationer och deras arbete med monetära bidrag men ändå inte valt att teckna ett regelbundet givande gör att det är av intresse att undersöka vad som påverkar en spontan givares intention till att förändra sitt beteende. Således är studiens frågeställning: Vad påverkar en spontan givares intention att förändra sitt beteende och bli regelbunden givare? För att besvara frågeställningen och uppfylla syftet med studien genomfördes en kvantitativ undersökning i form av en enkät som distribuerats via sociala medier. Vid analysen av det empiriska materialet visade det sig att spontana givare inte har intentionen att börja skänka pengar regelbundet till humanitära hjälporganisationer i Sverige. Spontana givares attityd, subjektiva norm och upplevda kontroll över beteendet bidrar alla tre till deras intention. Det som till störst del bidrar till intentionen är deras upplevda kontroll över beteendet i form av känslan av att de kommer ha råd med regelbundna donationer samt att processen att tecknat ett sådant avtal är enkel. Denna information kan användas av hjälporganisationer för att öka antalet regelbundna givare.