京都大学 / 新制・課程博士 / 博士(経営科学) / 甲第24769号 / 経営博第24号 / 新制||経営||5(附属図書館) / 京都大学大学院経営管理教育部経営科学専攻 / (主査)准教授 HAN Hyun Jeong, 教授 原 良憲, 教授 山田 仁一郎, 教授 若林 靖永 (佛教大学) / 学位規則第4条第1項該当 / Doctor of Philosophy in Management Science / Kyoto University / DFAM

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<p><strong>Background:</strong> Organ donation in India is a complex issue due to the country’s large population, diverse religious beliefs and myths surrounding organ donation, varying literacy rates, nation-wide focus on disease control, and the commercialization of organs. India has only made marginal steps to address the significant obstacles in order to ensure adequate supplies of organs are available to meet the demand.</p> <p><strong>Purpose: </strong>The purpose of this study is to analyze the feasibility of implementing an organ donor registry in Mumbai, India. This is achieved by reviewing current organ donation policies and processes in Mumbai, exploring perceptions of key informants about Indian government health priorities, and identifying possible reasons why the Indian government has not made efforts to increase the deceased donor rate.</p> <p><strong>Methods:</strong> This qualitative policy analysis employs semi-structured interviews with physicians, transplant coordinators, and representatives of organ donation advocacy groups in Mumbai to explore key informants’ perceptions about the feasibility of developing and implementing an organ donor registry. The 3-I framework (ideas, interests, and institutions) is used to analyze the results and frame the discussion and their implications.</p> <p><strong>Results:</strong> Key informants cite various barriers to the implementation of an organ donor registry in Mumbai, including public misconceptions about organ donation, competing health priorities on the government agenda, and limited hospital infrastructure.</p> <p><strong>Conclusion: </strong>In the absence of a focusing event or a policy entrepreneur who is able to push the issue of organ donation onto the health policy agenda, both central and state governments may have little incentive to aggressively pursue the implementation of a donor registry in more than a superficial way. Moreover, even if the issue reached the government’s policy agenda, current barriers may be too overwhelming to overcome. This suggests that implementing an organ donor registry in Mumbai as a means of enhancing organ availability is not feasible in the current environment. Instead, efforts to enhance the transplant system should focus on alternate strategies, such as public education, until the policy environment becomes more amenable to change.</p> / Master of Science (MSc)

Yes / The World Health Organization (WHO) recommends 100% blood should be from voluntary non-remunerated donors (VNRD) yet the majority of blood donations (75%) in Barbados are family/replacement donations. Increasing VNRD is paramount to achieving a safe, reliable blood supply and understanding the population is a strategy suggested by the WHO to inform donor recruitment and education. To obtain information to devise strategies for a voluntary donor mobilization campaign in Barbados. Methods: Participants in Barbados (n=429) completed a self-administered questionnaire in 2014. The questionnaire comprised 31 questions including demographics (age, sex, highest educational attainment) and blood donation-related knowledge, attitudes and practices. Analysis of variance, t-test and linear regression were used to analyse data. Results: Fifty-three per cent (n=219) of participants had previously donated blood; only 23.9% of these had donated within the past two years and almost half were family/replacement donors only. Knowledge deficits included blood donation requirements, deferral factors and maximum yearly donations. Most participants (79%) were willing to donate with more information. Participants with higher educational attainment and previous donors had higher total knowledge and attitude scores (p<0.01). Single, female, and younger participants were less likely to donate blood (p<0.05). Conclusion: Barbados can likely increase voluntary blood donation rates by addressing knowledge deficits through education campaigns and increasing awareness of the need for donation.

Yes / Following organ donation, bodies of children are generally cared for in hospital mortuaries or by funeral directors, and their families are offered little routine bereavement support. A partnership between an organ donation nursing team and regional children's hospice trialled an initiative where families were offered bereavement support from the hospice, and their child's body was cared for in a 'cool room' after death. Hospice services are usually restricted to children with life-limiting conditions, and their families. To explore the perceptions and experience of nursing staff who are involved in supporting families of children and young people who have been cared for in children's hospice cool rooms after death, following organ donation. A qualitative exploratory study consisting of a focus group interview with registered nurses from the children's hospice and organ donation teams. A purposeful sample of nurses was recruited. Data were collected in a digitally-recorded focus group interview during March 2018. The interview was transcribed and analysed using a qualitative content approach. Six nurses participated in the focus group. Analysis revealed five themes that characterised the perceptions of nurses: (i) barriers to care, (ii) bereavement care for families, (iii) impact on families and staff, (iv) influencers and enablers of change, and (v) sustainability of new practices. Nurses perceived the long-term, responsive and family-centred approach to bereavement support as a strength of the hospice model, reducing the experience of moral distress in organ donation nurses.

With a global and national shortage in the number of registered organ donors, this study employed a qualitative thematic analysis of thirteen episodes from popular medical dramas that aired between 2016-2020. The aim of this study was to allow for a better understanding of how the media utilizes entertainment television to portray storylines related to organ donation. The analyzed shows included in this study were: Grey's Anatomy, The Good Doctor, New Amsterdam, Chicago Med, and The Resident. From the analysis, six major themes emerged: Urgency of Transplant, Ethical Decision-Making, Emotional Impacts of Organ Donation on Patient and Families, Familial Relationships Impacting Donation, Viewer Education via Vicarious Learning, and Excitement Surrounding Surgery. In addition to these themes, both favorable and unfavorable cues related to organ donation were present throughout the analysis. These findings have implications for audience members via social cognitive theory. This study illuminated the ongoing efforts made by the entertainment television industry to portray organ donation in a factual manner and to provide the viewing public with potential opportunities for organ donation education. / Master of Arts / With a global and national shortage in the number of registered organ donors, this study analyzed thirteen episodes from popular medical dramas that aired between 2016-2020 to determine what themes were present amongst the analyzed shows. The analyzed shows included in this study were: Grey's Anatomy, The Good Doctor, New Amsterdam, Chicago Med, and The Resident. The aim of this study was to allow for a better understanding of how the media utilized entertainment television to portray storylines related to organ donation. From the analysis, six major themes emerged: Urgency of Transplant, Ethical Decision-Making, Emotional Impacts of Organ Donation on Patient and Families, Familial Relationships Impacting Donation, Viewer Education via Vicarious Learning, and Excitement Surrounding Surgery. In addition to the emergence of these themes, the analysis revealed both favorable and unfavorable cues related to organ donation were present in these entertainment storylines. This study illuminated the ongoing efforts made by the entertainment television industry to portray organ donation in a factual manner and to provide the viewing public with opportunities for organ donation education.