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      Does organ donation legislation affect individuals' willingness to donate their own or their relative's organs? Evidence from European Union survey data

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      1 , , 1 , 2 , 1
      BMC Health Services Research
      BioMed Central

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          Abstract

          Background

          Maintaining adequately high organ donation rates proves essential to offering patients all appropriate and available treatment options. However, the act of donation is in itself an individual decision that requires a depth of understanding that interacts with the social setting and the institutional framework into which an individual is embedded. This study contributes to understanding factors driving organ donation rates by examining how country regulation, individuals' awareness of regulatory setting, social interactions and socio-demographic determinants influence individuals' willingness to donate their own organs or those of a relative.

          Methods

          We draw representative data from the Eurobarometer survey 58.2 undertaken in 2002 with respondents throughout the European Union to capture heterogeneity in institutional setting. We use logistic regression techniques to estimate the determinants of willingness to donate one's own organs and those of a deceased relative. We employ interaction terms to examine the relationship between institutional setting and respondent's awareness of organ donation legislation in their country.

          Results

          Our findings indicate that individuals are more likely to donate their organs than to consent to the donation of a relative's organs. Both decisions are affected by regulation (presumed consent), awareness of regulation and social interactions such as the ability to count on others in case of a serious problem (reciprocity). Furthermore, education (more educated), age (younger), expressing some sort of political affiliation determine willingness to donate one's own organs and consent to the donation of those of a relative.

          Conclusion

          This study confirms and develops further previous research findings that presumed consent organ donation policy positively affects the willingness of individuals to donate their own organs and those of relative by highlighting the importance of awareness of this regulation and an individual's level of social interactions in making choices about donation. Results found using interaction terms underline the importance of population awareness of organ donation legislation as well as the legislation type itself. Findings also point to the role of social interactions in influencing individuals' willingness to donate their organs or those of a relative.

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          Most cited references26

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          Medicine. Do defaults save lives?

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            Estimating the number of potential organ donors in the United States.

            As the need for transplantable organs increases, waiting lists of patients become longer. We studied the size and composition of the national pool of brain-dead organ donors during a three-year period and, on the basis of these data, considered ways to increase the rate of donation. We reviewed hospital medical records of deaths occurring in the intensive care unit from 1997 through 1999 in the service areas of 36 organ-procurement organizations to identify brain-dead potential organ donors. We examined data on characteristics of the potential donors, the processes of referral to organ-procurement organizations and of requesting donations, and the hospitals. We identified a total of 18,524 brain-dead potential organ donors during the study period. The predicted annual number of brain-dead potential organ donors is between 10,500 and 13,800. The overall consent rate (the number of families agreeing to donate divided by the number of families asked to donate) for 1997 through 1999 was 54 percent, and the overall conversion rate (the number of actual donors divided by the number of potential donors) was 42 percent. Hospitals with 150 or more beds were more likely than smaller hospitals to have potential donors and actual donors (P<0.001); 19 percent of hospitals accounted for 80 percent of all potential donors. Calculations of the number of donors per million persons in the general population did not correlate well with the performance of organ-procurement organizations as measured by the conversion rate. Lack of consent to a request for donation was the primary cause of the gap between the number of potential donors and the number of actual donors. Since potential and actual donors are highly concentrated in larger hospitals, resources invested to improve the process of obtaining consent in larger hospitals should maximize the rate of organ recovery. The performance of organ-procurement organizations can be assessed objectively through the comparison of the number of actual donors with the number of potential donors in the given service area. Copyright 2003 Massachusetts Medical Society
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              Psychological aspects of organ donation: a critical review and synthesis of individual and next-of-kin donation decisions.

              This article presents a critical review of psychological perspectives on organ donation. The review considers individual decisions to donate organs posthumously and next-of-kin consent decisions. A theoretical analysis of intention to donate is presented for both types of donation decisions, and the literature is reviewed within the context of the proposed framework. Donation decisions are examined as a function of attitude toward donation and the religious, cultural, altruistic, normative, and knowledge-based beliefs that comprise the attitude. Consent decisions are primarily influenced by prior knowledge of the deceased individual's wishes. An alternative conceptual model is offered to explain the basis of consent decisions in the absence of this knowledge. Suggestions are offered to improve measurement strategy and to guide theoretically based organ donation research within selected disciplines of psychology.
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                Author and article information

                Journal
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central
                1472-6963
                2008
                27 February 2008
                : 8
                : 48
                Affiliations
                [1 ]LSE Health, London School of Economics, London, UK
                [2 ]European Institute, London School of Economics, London, UK
                Article
                1472-6963-8-48
                10.1186/1472-6963-8-48
                2292708
                18304341
                14becce7-4fb5-4eb1-ae4e-850a267591d5
                Copyright © 2008 Mossialos et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 11 July 2007
                : 27 February 2008
                Categories
                Research Article

                Health & Social care
                Health & Social care

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