Motivation and emotion/Book/2013/Organ donation

Overview
In Australia the need for organ donors is becoming increasingly more apparent, yet in 2012 only a small percentage of people received a vital organ transplant giving them a new lease on life. So why is this the case? Why do people choose, and more importantly, choose not to donate. Altruistic intentions seem to be the primary motivator for people to donate their organs, however fear regarding the process prevents people from following through on these intentions. This chapter will discuss in more depth the motivations for why people engage in living and non-living organ donation, as well as the factors which prevent others from doing so.



Organ donation
Organ donation is an extremely complex yet beneficial process. It involves transplanting organs and/or tissue from donors into a patient who may be ill or dying. However the recipient, although in most cases, does not need to be sick or dying to receive a transplant; for example a person with damaged corneas may receive a cornea transplant which will significantly improve their vision.

Living donation
The donor does not need to be deceased in order to donate their organs; for example a person may donate bone marrow and other organs such as a kidney whilst they are still alive (Kidney Health Australia, 2013).

Deceased donation
There must be a clear definition of 'death' when discussing organ donation. There are two forms of death after which organs may be harvested for transplantation; cardiac death and brain death.

Cardiac death
Cardiac death is the most common fatality; breathing ceases and the heart stops beating. Eventually all organs shut down due to a lack of oxygen within the body. With this form of death organs are generally not able to be harvested however some tissue and the corneas are able to be used for transplantation (Donate Life, 2013).

Brain death
Brain death occurs when the brain suffers severe trauma which causes it to cease functioning permanently. This may occur after stroke, infection, lack of oxygen or other brain injuries. Although the person may be considered deceased organs are still able to be harvested if the person died whilst in hospital. All remaining organs are able to be artificially sustained through a ventilator thus giving the clinicians and family time to come to a decision regarding organ donation (Donate Life, 2013).

History
The history of organ donation is fairly recent. The first documented case of an organ or tissue donation was in Germany in 1823; a skin graft was taken from one location on the individual's body and placed onto another area of the body (Chapman, 1992). However, the first successful solid organ transplant did not occur until 1954 (Keller, 2002-2003). Australia's contributions have been more recent, with particular attention being paid to the study of liver transplantation.

Table 1.

Australia's History of Organ Donation

Statistics in Australia

 * Around 1600 people are on the organ transplant waiting list
 * In 2012, 1052 Australians benefitted from organ and tissue donation
 * 80% of Australians are willing to become organ donors. 78% are willing to become tissue donors
 * Less than 60% of families give consent for organ and tissue donation to proceed
 * 44% of Australians do not know or are unsure of the donation wishes of their family

The statistic which is probably the most concerning is the fact that less than 60% of families give their consent to proceed with organ donation. Considering 80% of Australian's are willing to be organ donors, perhaps the primary issue which needs to be addressed is the need for families to discuss their intentions and wishes regarding organ donation, so that in the event of death the correct decision is made; respecting the individual's wishes and giving someone a new lease on life.

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Demographic of donors
There is some evidence to suggest that those who intend to donate, based on having a signed donor card, are more likely to be young, white and educated, with a higher socio-economic status and less traditional religious views (Siminoff, Gordon, Hewlett & Arnold, 2001).



Altruism
It is generally considered that altruistic intentions and behaviours are the driving motivator for people to donate their organs. Yet this can be somewhat ambiguous when we consider how different people define an altruistic behaviour. For the sake of this chapter, we will define altruism as the unselfish concern for the welfare of others (Oswalt, 1974). In a behavioural sense, an altruistic person will engage in acts which are costly to the self but will benefit another individual or group as a whole (Fehr & Fischbacher, 2003). When we consider altruism in relation to organ donation, we can see how this psychological concept is a driving motivator for people to become a donor; the ultimate unselfish act would be to donate a part of yourself in order to save the life of another.

Although this may seem like a wishy-washy explanation, altruism has been identified empirically in a number of instances. In 1998 Stevens showed that when interviewing the elderly, majority displayed an altruistic nature in relation to organ donation. The subjects explained that the desire to help others outweighed the fears and concerns they had about the process and death itself. Furthermore the importance of altruism has been extensively documented throughout the works of Horton & Horton (1991) and Kopfman & Smith (1996). We can see from this that altruism then, is a strong motivator for donation. But how can we convert this intrinsic motivator into an external action to organ donation? The notion of empathy comes into play here.

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Empathy
By now it is clear that in order to get more people to become organ donors they have to be altruistically motivated to do so. Easier said than done right? Well perhaps not. There is much evidence to suggest that empathy is the principal underlying motivator behind all altruistic behaviours. Once again we find the definition of empathy somewhat unclear; however we may describe it as feeling a sense of compassion for the perceived welfare of a victim (Skumanich & Kintsfather, 1996). Empathy is related to altruism in that the individual is motivated to engage in a helping behaviour with the intention of reducing the victim’s distress. A study conducted by Cohen and Hoffner (2013) describe that individual's who demonstrate greater empathic concern are more willing to become organ donors. Furthermore, Skumanich & Kintsfather (1996) describe how eliciting an empathic response may significantly promote the behavioural intention to sign an organ donor card.

Therefore we can see that not only is empathy the primary motivator behind altruism, it also positively predicts behavioural intentions to donate. Thus, perhaps inducing empathy is the key to getting more people to donate; creating empathy elicits an altruistic response which drives a person to want to donate rather than triggering an explicit motivation which may not result in long term success for wanting to donate.

The Theory of Planned Behaviour (TPB)
The Theory of Planned Behaviour attempts to explain, understand, predict and ultimately change human social behaviour (Azjen, 2011). Expanded from the Theory of Reasoned Action, Azjen 2013 states that TPB describes how attitudes and beliefs impact intentions, and these intentions ultimately determine behaviour. Furthermore, positive attitudes leading to intentions make the individual more likely to behave based on those intentions. Therefore it may be assumed that individuals with a positive attitude toward organ donation are more likely to become a donor, compared to those with a negative attitude. However, the evidence seems to contradict this theory; although individuals tend to have a favourable attitude towards organ donation, very few actually follow through on this intention and become a donor. Could this come down to how strongly the individual believes in organ donation? Does organ donation comprise a core belief or is it simply something they think they would like to do? Parisi & Katz (1986) believe that this notion has a major impact on whether an individual would be willing to sign a donor consent card. They found that those with strong positive attitudes and those with weak negative attitudes were particularly prepared to sign a donor consent card. This suggests that if attitudes toward organ donation were to become more prominent in an individual’s psyche, and their weak positive beliefs changed to strong ones, the rate of organ donation may be dramatically increased.



So, if altruism is inherently present within humans (Hoffman, 1981) and this is the primary motivator for organ donation, why then does such a disparity exist between the need for donors and people willing to donate? Well, evidence suggests that the primary reason for this is fear.

Fear
A significant amount of research has been conducted to determine the primary reasons why people choose not to donate. The resounding explanation is fear; fear that death will be called prematurely, fear of pain after death and fear of bodily mutilation. Particularly, fear of death being called prematurely tends to be the most common explanation for non-donors. Indeed, Nijkamp, Hollestelle, Zeegers, van den Borne & Reubsaet (2008) conducted meta-analyses of 1280 studies based on organ donation motivation and found that the overall predictor for a non-donor was fear of death and organ-donation related fear.

Studies have also shown that fear also extends to worry about the recipient of the donors' organs. Morgan and Harrison (2008) demonstrated that people may also fear that their organs will be given to people who they believe are undeserving or who are responsible for their illness. Furthermore, that organ transplantation favours the rich and famous.

If we aim to reduce these fears within the population the rate of organ donation may increase dramatically. Clearly, these fears are the result of a lack of knowledge and understanding about the process of organ donation and transplantation. Through education and more effective awareness campaigns which state the facts of organ donation, we may improve the stigma associated with this vital life saving medical therapy.

Religious concerns also effect whether an individual chooses to donate their organs. Particularly, those of the Orthodox Jewish faith may decide not to donate nor to receive organs as it opposes their religious beliefs regarding mutilation of the body and unnecessary extension of life (Radecki & Jaccard, 1997). However, much of the research suggests that this type of fear only effects a small percentage of the population and would not benefit from more awareness or campaigning anyway.

Opt-in vs opt-out
Evidence suggests that the majority of Australian’s (80%) are willing to become organ donors and support the notion of transplantation (Donate Life, 2013). Yet the actual number of donors is significantly less than this percentage. One suggestion has been that individuals are required to opt-in to become an organ donor. The majority of countries, including Australia have adopted the Opt-in policy for organ donation. With this type of donation policy, individuals are required to actively choose and consent to being an organ donor; everyone is considered to be a non-donor unless they explicitly express otherwise. Furthermore, even if an individual does consent to be an organ donor, the next-of-kin is still consulted on whether organ donation may occur in the event of death.

The notion of an opt-out policy for organ donation assumes that everyone is considered an organ donor unless they explicitly state otherwise (Saunders, 2012). This process eliminates the variance that exists between one’s intentions and their actions; individuals who have not registered to be an organ donor, but have the intention to do so would not have to worry about changing their non-donor status. Furthermore, individuals with a non-donor stance still have the opportunity to opt-out of becoming an organ donor. Countries who have adopted the opt-out policy for organ donation generally have a much higher rate of donation compared to countries with an opt-in policy. Although it cannot be determined whether this increase is due solely to the opt-out policy, it is an interesting area of concern when we consider the extremely low rates of organ donation in Australia.

Family consent
As stated previously there is an alarming statistic which describes a significant variance between an individual's intentions to donate and the family refusing to allow such procedures after death. Therefore, it is imperative that families discuss their donation intentions to ensure an individual's wishes are respected. Radecki and Jaccard (1997) illustrate that an influential factor which may effect the decision made by the next-of-kin to donate their loved ones’ organs is previous discussion. If family members are made aware of the deceased individuals wishes they are more likely to act upon these wishes, particularly if they are favourable towards organ donation. Furthermore, Rosel, Frutos, Blanca & Ruiz (1999) describe that the primary factor which effects a family members’ decision to donate their loved ones organs is the expressed wishes of the deceased. Thus it is clear from this and other evidence that this discussion is fundamental in increasing the rates of organ donation. The variance between intentions and action may be reduced if familial consent is increased through discussion. Indeed, recent campaigns have highlighted the importance of expressing one’s wishes to their family.

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So, if you're thinking about donating, be sure to discuss it with your family because in the end, they will have the final say regarding organ donation.

 So now that you know all the motivations behind why people donate their organs, why not become a donor yourself? It's a simple process with the ease of online registration. But if you're having doubts or are experiencing some of the fears mentioned above, knowledge is your greatest weapon. Know the facts.

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Your organ donation has the potential to drastically improve the lives of ten people, so have an open discussion with your family and sign up to be an organ donor today!

 REGISTER NOW 

 Ultimately the primary motivator for people to donate organs is the notion of altruism which is derived from feeling a sense of empathic concern. Often, individual's will state that fear is the main reason why they have not registered to become an organ donor. Yet, this may not be the only reason why organ donation rates are so low; in Australia the opt-in policy may affect numbers. The low rate may also be attributed to families being unaware of the donation wishes of their relatives thus consent is not achieved. Knowledge regarding the process of organ donation in addition to discussing wishes tends to be the most beneficial ways of increasing an individual's likelihood to donate.