Objectives: The introduction of the living donation in organ transplantation introduces important new psychological conflicts and ethical questions in the transplantation process. Operation related risks, as well as dependencies in the family structure, generate considerable pressure on potential donors. The aim of the study was to reconstruct the determinants of willingness to donate before transplantation.Methods: Evaluation of 20 taped and transcribed interviews oriented to current approaches in qualitative interview research. The approach used is based on grounded theory, qualitative (...) content analysis, and the concept of the ideal type.Results: Before surgery, “openly motivated” donors push for an operation, leaving no room for ambivalence in the evaluation process. They idealise the relationship with the recipient, and link their donation with the individual—partly in subconscious expectations and wishes. In contrast, “openly ambivalent” donors formulate their anxieties and express arguments against donation.Conclusions: Statements that claim ambivalence towards donation or utterance of arguments against donation indicate earlier coercion. Before transplantation, potential donors should have the opportunity to discuss their emotional situation to help their decision making process. (shrink)

It is essential to engage the public in conservation measures to conserve insects. We investigate the Protection Motivation Theory, as well as knowledge, attitudes, and sociodemographic variables as predictors of willingness to donate and actual donations to insect conservation for a representative German sample. The PMT subcomponents severity, self-efficacy, and response efficacy, as well as attitudes toward insects, income, and education level, significantly predicted WTD. In contrast, severity, response barriers, age, gender, and the WTD significantly influenced actual donations. (...) Overall, components of the PMT have high predictive power for both dependent variables. Our results suggest that an intention-behavior gap exists between the intention to donate and the actual donation toward insect conservation. Measures to increase WTD and actual donations for insect conservation are discussed. (shrink)

This study aims to assess the level and determinants of the general public's willingness to organ donation. We conducted a population-based cross-sectional study of 4261 participants in China. The primary outcome was the willingness to donate organs. Logistic regression modelling was used to determine the factors that affect willingness to donate organs. Overall, the proportion of participants who showed a willingness to donate organs was 47.45% (95%CI: 0.46, 0.49) in this study. Logistic regression (...) modelling showed participants from Western (OR = 1.33, 95%CI = 1.11-1.59) and Eastern China (OR = 1.40, 95%CI = 1.19-1.65) were more willing to donate organs compared with those from Central China. The odds of being willing to donate organs was higher in females than males (OR = 1.35, 95%CI = 1.17-1.55); and was higher in those participants with experience of organ donation (OR = 1.58, 95%CI = 1.13-2.21), experience of caring for organ transplant patients (OR = 1.45, 95%CI = 1.01-2.07), and those undertaking related voluntary activities (OR = 1.67, 95%CI = 1.45-1.94), than those without. The general public's level of willingness to organ donation was not high in this study. Geographical region, gender, experience of organ donation related activities, taking care of organ transplant patients and volunteering in related activities were independently associated with participants' willingness to donate organs. (shrink)

This study aims to assess the level and determinants of the general public's willingness to organ donation. We conducted a population-based cross-sectional study of 4261 participants in China. The primary outcome was the willingness to donate organs. Logistic regression modelling was used to determine the factors that affect willingness to donate organs. Overall, the proportion of participants who showed a willingness to donate organs was 47.45% (95%CI: 0.46, 0.49) in this study. Logistic regression (...) modelling showed participants from Western (OR = 1.33, 95%CI = 1.11-1.59) and Eastern China (OR = 1.40, 95%CI = 1.19-1.65) were more willing to donate organs compared with those from Central China. The odds of being willing to donate organs was higher in females than males (OR = 1.35, 95%CI = 1.17-1.55); and was higher in those participants with experience of organ donation (OR = 1.58, 95%CI = 1.13-2.21), experience of caring for organ transplant patients (OR = 1.45, 95%CI = 1.01-2.07), and those undertaking related voluntary activities (OR = 1.67, 95%CI = 1.45-1.94), than those without. The general public's level of willingness to organ donation was not high in this study. Geographical region, gender, experience of organ donation related activities, taking care of organ transplant patients and volunteering in related activities were independently associated with participants' willingness to donate organs. (shrink)

This study aims to assess the level and determinants of the general public's willingness to organ donation. We conducted a population-based cross-sectional study of 4261 participants in China. The primary outcome was the willingness to donate organs. Logistic regression modelling was used to determine the factors that affect willingness to donate organs. Overall, the proportion of participants who showed a willingness to donate organs was 47.45% (95%CI: 0.46, 0.49) in this study. Logistic regression (...) modelling showed participants from Western (OR = 1.33, 95%CI = 1.11-1.59) and Eastern China (OR = 1.40, 95%CI = 1.19-1.65) were more willing to donate organs compared with those from Central China. The odds of being willing to donate organs was higher in females than males (OR = 1.35, 95%CI = 1.17-1.55); and was higher in those participants with experience of organ donation (OR = 1.58, 95%CI = 1.13-2.21), experience of caring for organ transplant patients (OR = 1.45, 95%CI = 1.01-2.07), and those undertaking related voluntary activities (OR = 1.67, 95%CI = 1.45-1.94), than those without. The general public's level of willingness to organ donation was not high in this study. Geographical region, gender, experience of organ donation related activities, taking care of organ transplant patients and volunteering in related activities were independently associated with participants' willingness to donate organs. (shrink)

Donors to biobanks are typically asked to give blanket consent, allowing their donation to be used in any research authorized by the biobank. This type of consent ignores the evidence that some donors have moral, religious, or cultural concerns about the future uses of their donations – concerns we call “non-welfare interests”. The nature of non-welfare interests and their effect on willingness to donate to a biobank is not well understood. In order to better undersand the influence of (...) non-welfare interests, we surveyed a national sample of the US population using a probability-based internet panel. Logistic regression models assessed the demographic and attitudinal characteristics associated with participants’ willingness to give consent for unspecified future uses of their donation when presented with 7 research scenarios that raised possible non-welfare interest concerns. Most people had non-welfare interests that significantly affect their willingness to donate to a biobank using blanket consent. Some non-welfare interests are associated with subgroups but others are not. A positive attitude toward biomedical research in general was associated with increased willingness to donate, while concerns about privacy and being African American were associated with decreased willingness. Non-welfare interests matter and can diminish willingness to donate to a biobank. Our data suggest that trust in research promotes willingness to donate. Ignoring non-welfare interests could erode this trust. Donors’ non-welfare interests could be accommodated through greater transparency and easier access to information about the uses of donations. (shrink)

Biobanks and biospecimen collections are becoming a primary means of delivering personalized diagnostics and tailoring individualized therapeutics. This shift towards precision medicine requires interactions among a variety of stakeholders, including the public, patients, healthcare providers, government, and donors. Very few studies have investigated the role of healthcare students in biobanking and biospecimen donations. The main aims of this study were to evaluate the knowledge of senior healthcare students about biobanks and to assess the students’ willingness to donate biospecimens (...) and the factors influencing their attitudes. A cross-sectional study was conducted among senior healthcare students at King Abdulaziz University, Saudi Arabia. The data were obtained using a self-administered questionnaire in English. In addition to the respondents’ biographical data section, the questionnaire assessed the respondents’ general knowledge about biobanking, the factors influencing their willingness to donate biospecimens to biobanks and their general attitudes towards biomedical research. A total of 597 senior healthcare students were included in the study. The general knowledge score was 3.2 out of 7. Only approximately 44% and 27% of students were aware of the terms “Human Genome Project” and “biobank,” respectively. The majority of the students were willing to donate biospecimens to biobanks. Multiple factors were significantly associated with their willingness to donate, including their perceived general health, past experience with both tissue testing and tissue donation, biobanking knowledge score and biomedical research attitude score. The main reasons for students’ willingness to donate were advancement of medical research and societal benefits, whereas misuse of biospecimens and confidentiality breaches were the main reasons for a reluctance to donate. Despite their strong willingness to donate biospecimens, students exhibited a notable lack of knowledge about biobanking and the HGP. To expedite the transition towards PM, it is highly recommended to enhance healthcare curricula by including more educational and awareness programmes to familiarize students with OMICs technologies in addition to the scope of research and clinical applications. (shrink)

In recent years, the concepts of charity and development aid have changed significantly. Present concepts combine direct money transfer with co-production, knowledge sharing and the development of products and services designed for the need of developing and transition economies. The concept of micro-financing is a financial service which has proven to allow for entrepreneurs in the respective countries to start up their businesses. A relatively new financial product for these countries is micro-insurance. This article deals with the question whether consumers (...) in the Netherlands are willing to donate micro-insurances and which factors influence this willingness to contribute to the non-profit micro-insurance approach of an insurance company. The data were collected with questionnaires among a sample of the Dutch population. The data have been processed in a one-way between-groups ANOVA, a paired sample t test and an ordinal regression analysis. The results show that approximately half of the Dutch consumers are willing to pay an additional amount on their insurance premium for the donation of micro-insurances. The amount of the insurance premium did, however, not affect the willingness to donate. If consumers could choose the beneficiary less people are willing to donate, yet those people are willing to donate more money. In conclusion, there is readiness among consumers to contribute to micro-insurance via an insurance company that assists in setting up micro-insurance projects. This indicates a possible role for companies to act as an intermediary between philanthropic acts and consumers. (shrink)

BackgroundFew studies have identified the willingness rate of developing countries population to be enrolled in clinical trials.MethodsAll participants including patients, healthy volunteers and doctors completed a questionnaire to examine factors affecting the consent to participate in medical research.ResultsOverall, 80 % of the included population agree to participate in health research. This rate was lower for trials dealing with life-threatening diseases. Altruism and perceived risk of harm were the main reason to respectively accept or refuse to participate in clinical trials. (...) Factors significantly associated with willingness were: age <40 years 1.6 [95 % Confidence Interval 1.2-2.1]) and prior history of blood donation.ConclusionMost participants expressed their willingness to be included in medical research especially if they are young or if they have history of blood donation. However, consent to participate is low when medical research required acute care. (shrink)

Background Voluntary post-mortem donation to science (PDS) is the most appropriate source for body dissection in medical education and training, and highly useful for biomedical research. In Mexico, unclaimed bodies are no longer a legal source, but PDS is legally possible, although scarcely facilitated, and mostly ignored by the general population. Therefore, we aimed to evaluate the attitude and willingness for PDS and to identify a sociodemographic profile of people with willingness toward PDS. Methods A validated on-line survey (...) was distributed by the convenience method via the social networks of a Catholicism-inspired, private university in northern Mexico. Frequency analyses of all variables and coded free comments were complemented with association studies. Results Although the responder cohort (n = 143) was too small and biased to be representative of the university community (n = 13,500), willingness to post-mortem organ donation was 90.7% and to PDS 70.7%. In this cohort, PDS willingness had the strongest association with mature age (> 40 years old; P, 0.0008). Among young adults, willingness to PDS was the lowest among volunteers from technical and business schools and the highest among those from the social sciences (P, 0.009). Respondents from the social sciences were also the most consistent between attitude and behavior with respect to organ donation. A free comment option revealed respondents were interested in the unusual taboo topic. Conclusions A small, but sufficiently large proportion expressed willingness toward PDS. In our university cohort, which was biased in higher education and altruism, mature age and social interest were associated with PDS willingness. (shrink)

The DAP (Death Associated Protein) kinase family is a novel subfamily of pro-apoptotic serine/threonine kinases. All five DAP kinase family members identified to date are ubiquitously expressed in various tissues and are capable of inducing apoptosis. The sequence homology of the five kinases is largely restricted to the N-terminal kinase domain. In contrast, the adjacent C-terminal regions are very diverse and link individual family members to specific signal transduction pathways. There is increasing evidence that DAP kinase family members are involved (...) in both extrinsic and intrinsic pathways of apoptosis and may play a role in tumor progression. This review will focus on structural composition and subcellular localization of DAP kinase family members and on signal transduction pathways leading to their activation. Potential mechanisms of DAP kinase family-mediated apoptosis will be discussed. BioEssays 23:352–358, 2001. © 2001 John Wiley & Sons, Inc. (shrink)

Population-based genomics studies have proven successful in identifying genetic variants associated with diseases. High-quality biospecimens linked with informative health data from diverse segments of the population have made such research possible. However, the success of biobank research depends on the willingness of the public to participate in this type of research. We aimed to explore the factors associated with the willingness of the public to participate in biobank research from four low- and middle-income countries in the Arab region (...) (Egypt, Jordan, Morocco, and Sudan). We used a previously validated questionnaire to assess several constructs that included the public’s perceptions, attitudes, and willingness to participate in biobank research. We recruited 967 participants. More than half did not have prior awareness of biobanks. Participants’ willingness to donate biospecimens and health data was less than 10%. Our results also showed that participants harbored concerns with trust, privacy, and with data-sharing involving international researchers. Predictors of willingness to participate in biobank research included no previous involvement in research and positive attitudes toward biobanks. Finally, our study showed several differences between the four countries regarding several of the investigated constructs. We conclude there should be additional efforts to raise public awareness and enhance perceptions of the public in biobanking research to enhance trust. We further recommend qualitative research to explore the underlying factors that contribute to the public’s concerns with international data sharing that would enhance global health. (shrink)

This paper is an attempt to examine the traditional Yoruba beliefs about organ donation. Organ donation and transplantation remain a rare occurrence in African, this to a large extent can be as a result of the traditional African orientation on the one hand and the advancement in medical research that come with transplanting organ on the other. In this paper, we x-ray the problem of organ shortage in most African countries. We identified that apart from lack of awareness on organ (...) donation, Africans traditionally would not be willing to donate their organs after death. This paper critically examines beliefs in some African cultures and their relationship with organ donation. We analyze life after death in the Yoruba tradition and the belief in the continuation of the body after death. The paper concludes that the African belief in the continuation of the body in the afterlife contributes to the non-willingness of Africans to donate an organ after death. (shrink)

This paper examines the influence on product innovation of factors based on a company’s transformation and exploitation of knowledge gathered from its intra-organizational relationships. Specifically, this paper analyses the influence of intra-organizational social capital on realized absorptive capacity. Moreover, it analyses the mediating role of RACAP on the relationship between internal SC and product innovation. Based on a sample of companies from the Spanish biotechnological and pharmaceutical industries, two hypotheses were tested using a structural equations model and the partial least (...) squares technique. The results support both hypotheses, suggesting that the development of strong and tightly knit links based on a common understanding and trust among company members lead the firm to develop dynamic capabilities for transforming and exploiting knowledge acquired externally, which fosters innovation based on new product development. Research limitations, implications and future research are also discussed by the authors of the paper. (shrink)

This comprehensive anthology offers over 40 readings that are critical to the understanding of anthropological theory and the development of anthropology as an academic discipline. The fourth edition maintains a strong focus on the "four-field" roots of the discipline in North America but has been reorganized with a new section on twenty-first-century theory, including coverage of postcolonial and public anthropology. New key terms and introductions accompany each reading and a revamped glossary makes the book more student-friendly. Used on its own, (...) or together with the overview text A History of Anthropological Theory, Fourth Edition, this anthology offers a flexible and unrivaled introduction to anthropological theory that reflects not only the history but also the changing nature of the discipline today. For additional resources, visit the "Teaching Theory" page at www.utpteachingculture.com. (shrink)

Background: Shortage of donor organs is one of the major problems for liver transplant programmes. Living liver donation is a possible alternative, which could increase the amount of donor organs available in the short term.Objective: To assess the attitude towards living organ donation in the general population to have an overview of the overall attitude within Germany.Methods: A representative quota of people was evaluated by a mail questionnaire . This questionnaire had 24 questions assessing the willingness to be a (...) living liver donor for different potential recipients. Factors for and against living liver donation were assessed.Results: Donating a part of the liver was almost as accepted as donating a kidney. The readiness to donate was highest when participants were asked to donate for children. In an urgent life-threatening situation the will to donate was especially high, whereas it was lower in the case of recipient substance misuse. More women than men expressed a higher disposition to donate for their children. Sex, religion, state of health and age of the donor, however, did not influence other questions on the readiness to consider living organ donation. The will for postmortem organ donation positively correlated with the will to be a living organ donor.Conclusions: The motivation in different demographic subgroups to participate in living liver transplantation is described. Differences in donation readiness resulting from the situation of every donor and recipient are thoroughly outlined. The acceptance for a living liver donation was found to be high – and comparable to that of living kidney donation. (shrink)

BackgroundUndocumented immigrants can donate their organs, but lack access to organ transplantation. This challenges foundational principles of organ donation: fairness and informed consent. Little is known about undocumented immigrants’ knowledge of barriers to their access to organ transplantation or how this might affect their decision to donate their organs.MethodsThe study was performed in an urban, university-affiliated, safety-net hospital. We interviewed hospitalized patients who selfidentified as undocumented immigrants and were unaware of having any contraindication to organ donation (for example, (...) cancer). We first recorded their demographic characteristics and knowledge and attitudes regarding organ donation. We then assessed the effects of informing participants about limits to their access to organ transplants on their willingness to donate.ResultsThis group of 59 uninsured Hispanic immigrants had adequate knowledge about organ donation. Participants were suspicious about inequality within the medical system, but most were willing to donate their organs (74 percent). Most participants (74 percent) were aware that they would have to pay to receive an organ, but they dramatically underestimated the out-of-pocket expenses. Yet willingness to donate their organs was unaffected by participants being explicitly informed of the low likelihood that they would be able to afford to receive an organ transplant.ConclusionsDespite being well informed about the organ donation system, undocumented Hispanic immigrants underestimate the costs and overestimate their likelihood of receiving an organ. Even when they are given this information, they remain willing to donate their own organs. (shrink)

BackgroundThis article is part of a study to gain insight into the decision-making process by looking at the views of the relatives of potential brain dead donors. Alongside a literature review, focus interviews were held with healthcare professionals about their role in the request and decision-making process when post-mortal donation is at stake. This article describes the perspectives of the relatives.MethodsA content-analysis of 22 semi-structured in-depth interviews with relatives involved in an organ donation decision.ResultsThree themes were identified: ‘conditions’, ‘ethical considerations’ (...) and ‘look back’. Conditions were: ‘sense of urgency’, ‘incompetence to decide’ and ‘agreement between relatives’. Ethical considerations result in a dilemma for non-donor families: aiding people or protecting the deceased’s body, especially when they do not know his/her preference. Donor families respect the deceased’s last will, generally confirmed in the National Donor Register. Looking back, the majority of non-donor families resolved their dilemma by justifying their decision with external arguments. Some non-donor families would like to be supported during decision-making.DiscussionThe discrepancy between general willingness to donate and the actual refusal of a donation request can be explained by multiple factors, with a cumulative effect. Firstly, half of the participants stated that they felt that they were not competent to decide in such a crisis and they seem to struggle with utilitarian considerations against their wish to protect the body. Secondly, non-donor families refused telling that they did not know the deceased’s wishes or contesting posthumous autonomy of the eligible. Thirdly, the findings emphasise the importance of Donor Registration, because it seems to prevent dilemmas in decision-making, at least for donor families.ConclusionDiscrepancies between willingness to consent to donate and refusal at the bedside can be attributed to an unresolved dilemma: aiding people or protect the body of the deceased. Non-donor families felt incompetent to decide. They refused consent for donation, since their deceased had not given any directive. When ethical considerations do not lead to an unambiguous answer, situational factors were pivotal. Relatives of unregistered eligible donors are more prone to unstable decisions. To overcome ambivalence, coaching during decision-making is worth investigation. (shrink)

We are developing the Neurological Disease Ontology (ND) to provide a framework to enable representation of aspects of neurological diseases that are relevant to their treatment and study. ND is a representational tool that addresses the need for unambiguous annotation, storage, and retrieval of data associated with the treatment and study of neurological diseases. ND is being developed in compliance with the Open Biomedical Ontology Foundry principles and builds upon the paradigm established by the Ontology for General Medical Science (OGMS) (...) for the representation of entities in the domain of disease and medical practice. Initial applications of ND will include the annotation and analysis of large data sets and patient records for Alzheimer’s disease, multiple sclerosis, and stroke. (shrink)

Public surveys conducted in many countries report widespread willingness of individuals to donate a kidney while alive to a family member or close friend, yet thousands suffer and many die each year while waiting for a kidney transplant. Advocates of financial incentive programs or “regulated markets” in kidneys present the problem of the kidney shortage as one of insufficient public motivation to donate, arguing that incentives will increase the number of donors. Others believe the solutions lie—at least (...) in part—in facilitating so-called “altruistic donation;” harnessing the willingness of relatives and friends to donate by addressing the many barriers which serve as disincentives to living donation. Strategies designed to minimize financial barriers to donation and the use of paired kidney exchange programs are increasingly enabling donation, and now, an innovative program designed to address what has been termed “chronologically incompatible donation” is being piloted at the University of California, Los Angeles, and elsewhere in the United States. In this program, a person whose kidney is not currently required for transplantation in a specific recipient may instead donate to the paired exchange program; in return, a commitment is made to the specified recipient that priority access for a living-donor transplant in a paired exchange program will be offered when or if the need arises in the future. We address here potential ethical concerns related to this form of organ “banking” from living donors, and argue that it offers significant benefits without undermining the well-established ethical principles and values currently underpinning living donation programs. (shrink)

BackgroundOrgan donation has become one of the most effective ways to save lives and improve the quality of life for patients with end-stage organ failure. No previous studies have investigated the preferences for the different consenting options for organ donation in Egypt. This study aims to assess Egyptians’ preferences regarding consenting options for posthumous organ donation, and measure their awareness and acceptance of the Egyptian law articles regulating organ donation.MethodsA cross sectional study was conducted among 2743 participants over two years. (...) Each participant was required to rank eleven consenting options from 1 to 11, and to report his awareness and acceptance of the seven articles of the Egyptian law of organ donation.Results47% of the participants expressed willingness to donate their organs after death. This percentage increased to 78% when consenting options were explained to participants. “Informed consent by donor only” was the most preferred type of consent for one third of respondents. Awareness of the law articles regulating organ donation was relatively low ranging from 56% to 23%.ConclusionCurrently, around half of the Egyptian population agree to posthumous organ donation. This percentage could be increased significantly by raising the awareness about how the process of donation could be regulated and how the patient’s right of decision could be protected. (shrink)

We consider a real-valued function f defined on the set of infinite branches X of a countably branching pruned tree T. The function f is said to be a limsup function if there is a function $u \colon T \to \mathbb {R}$ such that $f(x) = \limsup _{t \to \infty } u(x_{0},\dots,x_{t})$ for each $x \in X$. We study a game characterization of limsup functions, as well as a novel game characterization of functions of Baire class 1.

End-of-life organ donation is controversial in Islam. The controversy stems from: scientifically flawed medical criteria of death determination; invasive perimortem procedures for preserving transplantable organs; and incomplete disclosure of information to consenting donors and families. Data from a survey of Muslims residing in Western countries have shown that the interpretation of religious scriptures and advice of faith leaders were major barriers to willingness for organ donation. Transplant advocates have proposed corrective interventions: reinterpreting religious scriptures, reeducating faith leaders, and utilizing (...) media campaigns to overcome religious barriers in Muslim communities. This proposal disregards the intensifying scientific, legal, and ethical controversies in Western societies about the medical criteria of death determination in donors. It would also violate the dignity and inviolability of human life which are pertinent values incorporated in the Islamic moral code. Reinterpreting religious scriptures to serve the utilitarian objectives of a controversial end-of-life practice, perceived to be socially desirable, transgresses the Islamic moral code. It may also have deleterious practical consequences, as donors can suffer harm before death. The negative normative consequences of utilitarian secular moral reasoning reset the Islamic moral code upholding the sanctity and dignity of human life. (shrink)

Background The perception of organ donation and brain death among Syrian population has not been previously explored. The goal of this study is to evaluate the attitude and knowledge of organ donation among Syrians and the willingness of this population to donate their organs. Methods We conducted a survey-based cross-sectional study in four hospitals in Aleppo, Syria in November 2019. Patient demographic, awareness of brain death; and attitude toward organ donation were collected and analyzed. Results A total of (...) 350 individuals were invited to participate in the survey among whom 303 agreed to participate in the study. The majority of our participants heard about organ donation with television, social media, and the internet being the most common sources of information. When assessing knowledge about brain death, only 40% answered 3 or more questions correctly. Fifty-eight percent of respondents agreed with the idea of organ donation and 183 would like to donate their organs one day. The leading motivation to organ donation was the desire to help, while the most common reason to refuse donation was the refusal to disfigure a dead body by removing an organ. Religious reasons were cited as motivation for organ donation by 43% of participants, and a reason for refusing to donate organs by 24%. Most respondents were unaware of the laws and legislations related to organ donation in Syria. When asked if religion and law were encouraging organ donation, 76% of respondents would donate their organs. Although more positive attitude was found in those with better brain death knowledge, this did not translate into more willingness to donate organs in this group of participants. Conclusions The promotion of organ donations from deceased donors is a necessity given the rising shortage of organs. The information provided by this study could help policy makers build future strategies to promote deceased organ donation programs and overcome current obstacles preventing such initiatives from achieving their goals. (shrink)

To determine the knowledge and ethical perception regarding organ donation amongst medical students in Karachi- Pakistan.

This article explores how the type of consent given for organ donation should affect the judgement of a patient's overall benefit with regards to donation of their organs and the pre-mortem interventions required to facilitate this. The findings of a qualitative study of the views of 10 healthcare professionals, combined with a philosophical analysis inform the conclusion that how consent to organ donation is given is a reliable indicator only of the strength of evidence about views on donation and subsequent (...) willingness to undergo pre-mortem interventions. It is not an indicator of the strength of actual desire to donate. Clinical management of living patients prior to donation after circulatory death must therefore respect the values, wishes and beliefs of the potential donation after circulatory death donor. Our participants, however, suggested that the information currently provided is sufficient to authorise donation and that this consent, however provided, was sufficient to proceed with pre-mortem interventions. Respect for autonomy underpinned this ‘all or nothing’ approach. Although the legal requirements for donation authorisation and the protection of patients without capacity are clear, practice and policy regarding consent in donation after circulatory death may be based on donation following brainstem death where the patient is already dead when the family is approached. Custom and practice in donation after circulatory death may need to be revised to protect the interests of the dying potential donor. (shrink)

Although transplantation surgeries are relatively successful and save the lives of many, only few are willing to donate organs. In order to better understand the reasons for donation or refusing donation and their implications on and influence by public policy, we conducted a survey examining public views on this issue in Israel. Between January and June 2010, an anonymous questionnaire based on published literature was distributed among random and selected parts of Israeli society and included organ recipients, organ donors, (...) soldiers, university and high school students, and the general population. The analysis of 799 questionnaires revealed that, although 74.7 percent have not signed a donor card, 60.8 percent of participants consider doing so. Additionally, 54.3 percent of respondents objected to giving or receiving compensation for donation, and, if at all, priority in transplantation care is the most desired form of such compensation. The health status of the donor and knowing that donation saves lives or that there exists a shortage of organs for transplantation are the two factors most affecting motivation to donate. Lack of information, relatives’ views on donation, and type of organ involved in donation are factors most inhibiting donation. Willingness to donate is significantly affected by the proximity of the recipient to the donor. With regard to most organs, their contribution to one’s sense of “self” and its symbolic role strongly affects motivation to donate, except for donation to relatives. Compensation for organ donation has little effect on motivation to donate during life and after death. Our findings suggest new ways to construct a more effective public policy on this issue. (shrink)

With aims to both increase organ supply and better reflect individual donation preferences, many nations worldwide have shifted from ‘opt‐in’ to ‘opt‐out’ systems for post‐mortem organ donation (PMOD). In such countries, while a prospective donor's willingness to donate their organs/tissues for PMOD was previously ascertained—at least partially—by their having recorded positive donation preferences on an official register prior to death, this willingness is now presumed or inferred—at least partially—from their not having recorded an objection to PMOD—on an (...) official organ donation register. Using evidence regarding the presence and prevalence of selective donation preferences, and via exploration of how appeals to donation preferences are used to both motivate and legitimate shifts to opt‐out frameworks, this paper draws attention to a set of previously unexplored problems for opt‐out organ donation arising in contexts where: (a) individuals demonstrate selective post‐mortem organ/tissue donation preferences, (b) legislation provides prospective donors with the opportunity to selectively permit/refuse the donation of certain organs/tissues in line with these preferences. While selective preferences pose few problems for opt‐in systems where a selective occasion is built into the process of signing the donor register, this is not the case for opt‐out systems. The loss of this selective occasion can cause significant problems where appeals to preferences motivate/legitimate shifts to opt‐out but evidence regarding variable preferences does not feed into determinations regarding organ/tissue exclusions. The nature of these problems depends on how the authorization aspect of ‘opt‐out’ systems is framed (e.g. as presumed consent, deemed consent or, given the role of familial consent in many jurisdictions as consent in name only). (shrink)

Organ donation is a life-saving process for patients suffering from an advanced organ failure. A disparity between donated organs and required organs for transplantation is one of the major problems in Iran. Since personal attitudes about organ donation is a main factor influencing willingness to donate organ, the present study sought to provide a deeper understanding of the attitudes of university students in Iran regarding organ donation. This qualitative study was conducted in 2016. Semi-structured interviews were held for (...) collecting data from eighty five students from various universities in Hamadan city, Iran. Using a purposive sampling method, the students were selected based on the maximum variation. The content analysis method was used for data analysis by the research team and criteria for the study’s rigor was considered. Overall, the students had positive attitudes toward organ donation by brain-dead patients. Nevertheless, not of them stated that they would become an organ donor. During the data analysis, 376 primary codes, 13 categories, and 6 themes were developed. Themes were “cognitive readiness”, “mediators of decision making”, “beliefs and motivations”, “interactions with the health system”, “dependency”, and “integrity of the body”. Also, thirteen sub-themes were developed. Many factors influence the students’ attitudes toward organ donation. Identification and explanation of these factors can help healthcare managers and policymakers for planning and improving the organ donation culture in the society. (shrink)

With the gap between the number of transplantable organs and the number of people needing transplants widening, many have argued for moving from an opt-in to an opt-out system of deceased organ donation. In the first system, individuals must register their willingness to become donors after they die. In the second system, it is assumed that individuals wish to become donors unless they have registered an objection to donation. Opting out has also been described as presumed consent. Spain has (...) had the most successful presumed consent policy, resulting in a substantial increase in the donation rate. 1 Despite support for an opt-out system from the British Medical Association and other groups since 1999, the report of a task force delivered in November 2008 recommended that the current opt-in system in the UK be retained. 2 The USA has also retained an opt-in system.3 Two prominent American bioethicists, Tom Beauchamp and James Childress, claim that an opt-out policy “would not likely be adopted in the United States, and if it were adopted, it probably would not increase the number of organs for transplantation because so many citizens would opt out.”4Offering financial incentives such as paying funeral expenses for a deceased donor’s family is one way of increasing the number of organs. A regulated market in organs is another.5 In the UK at least, there is broader support for presumed consent. Among the alternatives to opting in, this system has the best prospect of eventually being adopted. Presumed consent would not obviate but retain the basic idea of consent, because individuals would still have the right to opt out and choose not to donate. 6One argument for presumed consent is that it would reduce the incidence of free riding. For a free rider, it is not rational …. (shrink)

This research performed four experiments to investigate the influence of infant schema cues on charitable donation intention and examine the moderating effect of gender. The results indicate that: individuals stimulated by infant schema cues had a higher willingness to donate when facing charity promotion; the main effect was not due to the perceived cuteness of character in posters; empathy played an entirely mediating role in the relationship between infant schema cues and donation intention; gender moderated the influence of (...) infant schema on donation intention: infant schema cues are effective for improving females’ donation intention, but ineffective for males. These findings contributed to the literature on infant schema and provide practical significance for introducing infant schema in charity promotion. (shrink)

With the rapid development of information and communication technology, social media-based donation platforms emerged.1 These platforms innovatively demonstrate peer information on the donation page, which inevitably brings the peer influence into donors’ donation decision process. However, how the peer influence will affect the psychological process of donation decisions are remained unknown. This study used the number of donated peers to examine the effects of peer influence on donors’ donation decisions and extracted event-related potential from electroencephalographic data to explore the underlying (...) psychological process. The behavioral results indicated that the number of donated peers positively influenced donors’ willingness to donate. The ERP results suggested that a larger number of donated peers might indicate a higher level of conformity and greater perceived emotional rewards, as a larger P2 amplitude was observed. Following the early processing of emotional stimuli, cognitive detection of decisional risk took place, and the donors reckoned a smaller number of donated peers as a high potential risk, which was reflected by a larger N2 amplitude. In the later stage, the larger number of donated peers, which represented a higher magnitude of prospective emotional rewards, led to a higher incentive to donate, and reflected in a larger amplitude of P3. Additionally, implications and future directions were discussed. (shrink)

We examined how presentations of organ donation cases in the media may affect people’s decisions about organ donation issues. Specifically, we focused on the combined effect of the information about the number of recipients saved by the organs of one deceased person and the identifiability of the donor and the recipient in organ donation descriptions, on people’s willingness to donate the organs of a deceased relative. Results suggest that reading about more people who were saved by the organs (...) of a deceased donor does not increase willingness to donate. Replicating earlier research, we found that reading about a case of organ donation involving an identified deceased donor, deceased willingness to donate. However, this effect was attenuated when participants read about more recipients who were saved by the donation. Importantly, the presentation that prompted the greatest willingness to donate a deceased relative’s organs was the one that featured an unidentified donor and only one identified recipient. Finally, an explorative investigation into participants’ subconscious thoughts of death following the organ donation story revealed that identifying a deceased organ donor prompts more thoughts of death in the perceiver. (shrink)

The organ donation and transplantation (ODT) system heavily relies on the willingness of individuals to donate their organs. While it is widely believed that public trust plays a crucial role in shaping donation rates, the empirical support for this assumption remains limited. In order to bridge this knowledge gap, this article takes a foundational approach by elucidating the concept of trust within the context of ODT. By examining the stakeholders involved, identifying influential factors, and mapping the intricate trust (...) relationships among trustors, trustees, and objects of trust, we aim to provide a comprehensive understanding of trust dynamics in ODT. We employ maps and graphs to illustrate the functioning of these trust relationships, enabling a visual representation of the complex interactions within the ODT system. Through this conceptual groundwork, we pave the way for future empirical research to investigate the link between trust and organ donation rates, informed by a clarified understanding of trust in ODT. This study can also provide valuable insights to inform interventions and policies aimed at enhancing organ donation rates. (shrink)

BackgroundThe success of biobanking is directly linked to the willingness of people to donate their biological materials for research and storage. Ethical issues related to patient consent are an essential component of the current biobanking agenda. The majority of data available are focused on population-based biobanks in USA, Canada and Western Europe. The donation decision process and its ethical applications in clinical populations and populations in countries with other cultural contexts are very limited. This study aimed to evaluate (...) the decision-making experience of the clinical biobank donors, as well as psychological and social motivators and deterrents of this decision and associated ethical risks.MethodsSemi-structured interviews were conducted in two medical institutions, in St Petersburg (Russia), in 2016–2017, among 13 donors of a clinical biobank (pregnant women, cardiac patients, and patients with multiple sclerosis) and three donation organisers—medical specialists involved in recruiting donors for a clinical biobank. Analysis of interview data was based on qualitative content analysis.ResultsDonors of a clinical biobank express beliefs in the absence of risks associated with the donation. The primary motivators for donating to the biobank were: prosocial, indirect reciprocity (response to or anticipation of an act in kind by a third party), intrinsic motivation (to enhance their self-esteem and satisfying their curiosity about the donation process), and comparability with personal values. A high level of trust in biomedical research and the particular physician can contribute to a favourable decision. The overall decision-making process regarding the biobank donation could be described as quick and not based on a careful reading of informed consent documents. The integration of biobank donation decision-making in the process of medical care might prompt patient to donate to biobank without proper consideration. The specific type of therapeutic misconception—the presence of unrealistic hope that donation could provide a direct benefit for a third person in need was discovered.ConclusionsPatients recruited to a clinical biobank in Russia have virtually no concerns as to the storage of their biomaterials. The donation decision is mainly motivated by prosocial attitudes and other factors that are similar to the motivating factors of blood donation. The fact of going through inpatient treatment and poor differentiation between donation for other people's benefit and for research purposes can make the process of obtaining consent more ethically problematic. (shrink)

This paper focuses on voluntary consent in the context of living organ donation. Arguing against three dominant views, I claim that voluntariness must not be equated with willingness, that voluntariness does not require the exercise of relational moral agency, and that, in cases of third-party pressure, voluntariness critically depends on the role of the surgeon and the medical team, and not just on the pressure from other people. I therefore argue that an adequate account of voluntary consent cannot understand (...) voluntariness as a purely psychological concept, that it has to be consistent with people pursuing various different conceptions of the good and that it needs to make the interaction between the person giving consent and the person receiving consent central to its approach. (shrink)

Mass media campaigns are widely and successfully used to change health decisions and behaviors for better or for worse in society. In the United States, media campaigns have been launched at local offices of the states’ department of motor vehicles to promote citizens’ willingness to organ donation and donor registration. We analyze interventional studies of multimedia communication campaigns to encourage organ-donor registration at local offices of states’ department of motor vehicles. The media campaigns include the use of multifaceted communication (...) tools and provide training to desk clerks in the use of scripted messages for the purpose of optimizing enrollment in organ-donor registries. Scripted messages are communicated to customers through mass audiovisual entertainment media, print materials and interpersonal interaction at the offices of departments of motor vehicles. These campaigns give rise to three serious concerns: (1) bias in communicating information with scripted messages without verification of the scientific accuracy of information, (2) the provision of misinformation to future donors that may result in them suffering unintended consequences from consenting to medical procedures before death (e.g, organ preservation and suitability for transplantation), and (3) the unmanaged conflict of interests for organizations charged with implementing these campaigns, (i.e, dual advocacy for transplant recipients and donors). We conclude the following: (1) media campaigns about healthcare should communicate accurate information to the general public and disclose factual materials with the least amount of bias; (2) conflicting interests in media campaigns should be managed with full public transparency; (3) media campaigns should disclose the practical implications of procurement as well as acknowledge the medical, legal, and religious controversies of determining death in organ donation; (4) organ-donor registration must satisfy the criteria of informed consent; (5) media campaigns should serve as a means of public education about organ donation and should not be a form of propaganda. (shrink)

BackgroundSocio-cultural perceptions surrounding death have profoundly changed since the 1950s with development of modern intensive care and progress in solid organ transplantation. Despite broad support for organ transplantation, many fundamental concepts and practices including brain death, organ donation after circulatory death, and some antemortem interventions to prepare for transplantation continue to be challenged. Attitudes toward the ethical issues surrounding death and organ donation may influence support for and participation in organ donation but differences between and among diverse populations have not (...) been studied.ObjectivesIn order to clarify attitudes toward brain death, organ donation after circulatory death and antemortem interventions in the context of organ donation, we conducted a scoping review of international English-language quantitative surveys in various populations.Study appraisalA search of literature up to October 2020 was performed, using multiple databases. After screening, 45 studies were found to meet pre-specified inclusion criteria.Results32 studies examined attitudes to brain death, predominantly in healthcare professionals. In most, around 75% of respondents accepted brain death as equivalent to death of the person. Less common perspectives included equating death with irreversible coma and willingness to undertake organ donation even if it caused death. 14 studies examined attitudes to organ donation following circulatory death. Around half of respondents in most studies accepted that death could be confidently diagnosed after only 5 min of cardiorespiratory arrest. The predominant reason was lack of confidence in doctors or diagnostic procedures. Only 6 studies examined attitudes towards antemortem interventions in prospective organ donors. Most respondents supported minimally invasive procedures and only where specific consent was obtained.ConclusionsOur review suggests a considerable proportion of people, including healthcare professionals, have doubts about the medical and ethical validity of modern determinations of death. The prognosis of brain injury was a more common concern in the context of organ donation decision-making than certainty of death. (shrink)

BackgroundThe SARS-CoV-2 pandemic has highlighted once more the great need for comprehensive access to, and uncomplicated use of, pre-existing patient data for medical research. Enabling secondary research-use of patient-data is a prerequisite for the efficient and sustainable promotion of translation and personalisation in medicine, and for the advancement of public-health. However, balancing the legitimate interests of scientists in broad and unrestricted data-access and the demand for individual autonomy, privacy and social justice is a great challenge for patient-based medical research.MethodsWe therefore (...) conducted two questionnaire-based surveys among North-German outpatients (n = 650) to determine their attitude towards data-donation for medical research, implemented as an opt-out-process.ResultsWe observed a high level of acceptance (75.0%), the most powerful predictor of a positive attitude towards data-donation was the conviction that every citizen has a duty to contribute to the improvement of medical research (> 80% of participants approving data-donation). Interestingly, patients distinguished sharply between research inside and outside the EU, despite a general awareness that universities and public research institutions cooperate with commercial companies, willingness to allow use of donated data by the latter was very low (7.1% to 29.1%, depending upon location of company). The most popular measures among interviewees to counteract reservations against commercial data-use were regulation by law (61.4%), stipulating in the process that data are not sold or resold (84.6%). A majority requested control of both the use (46.8%) and the protection (41.5%) of the data by independent bodies.ConclusionsIn conclusion, data-donation for medical research, implemented as a combination of legal entitlement and easy-to-exercise-right to opt-out, was found to be widely supported by German patients and therefore warrants further consideration for a transposition into national law. (shrink)

A frequent justification in the literature for using stated preference methods (SP) is that they are the only methods that can capture the so-called total economic value (TEV) of environmental changes to society. Based on follow-up interviews with SP survey respondents, this paper addresses the implications of that argument by shedding light on the construction of TEV, through respondents’ perspective. It illuminates the deficiencies of willingness to pay (WTP) as a measure of value presented as three aggregated themes considering (...) respondents’ unintentionality, their retraction once they understood that their WTP could be decisive in cost-benefit analysis and the inherent incompleteness of WTP. We discuss why the TEV discourse persists, how it conceals rather than reveals broader notions of value and in what ways our results support the development of alternative approaches that truly endorse plurality in environmental valuation and decision-making. (shrink)

This study analyzed consumers' willingness to pay for non-pirated computer software and examined how attitudes toward intellectual property rights and perceived risk affect WTPs. Two commonly used software products, Microsoft Windows and Microsoft Office, were used in the study as objects to reveal consumer assessed values. A consumer survey was administered in Taiwan and the total valid samples were 799. Respondents in this study included students from senior high schools, colleges, and graduate schools, and general consumers who were no (...) longer full-time students. The estimated average WTP for Windows was USD 58.55 and for Office was USD 53.49, much lower than the respective suggested retail prices in the market. Social norms had strong positive influences on willingness-to-pay for software products. The prosecution risk did not significantly increase WTPs for software products due to the reason that individuals who used pirated software were not at a high risk of being prosecuted. Performance risk was positively correlated to WTPs for software products. The respondents segmented into the low-WTP cluster were more likely to use pirated software than those in the high-WTP segment. Source reliability, legitimacy, technical support, and customer service were emphasized in decisions of respondents in the high-WTP segment and could be used in marketing strategies. (shrink)

An effective method to increase the number of potential cadaveric organ donors is to make people donors by default with the option to opt out. This non-coercive public policy tool to influence people’s choices is often justified on the basis of the as-judged-by-themselves principle: people are nudged into choosing what they themselves truly want. We review three often hypothesized reasons for why defaults work and argue that the as-judged-by-themselves principle may hold only in two of these cases. We specify further (...) conditions for when the principle can hold in these cases and show that whether those conditions are met is often unclear. We recommend ways to expand nationwide surveys to identify the actual reasons for why defaults work and discuss mandated choice policy as a viable solution to many arising conundrums. (shrink)

Critical thinking skills have associated critical thinking virtues, and the internal motivation to carefully examine an issue in an effort to reach a reasoned judgment, what I call the “willingness to inquire”, is the critical thinking virtue that stands behind all skilled and virtuous thinking that contributes to critical thinking. In this paper, I argue that the willingness to inquire is therefore a more primary critical thinking virtue than charity, open-mindedness, or valuing fallacious-free reasoning.

By means of minimal assumptions on the individual preferences, I show that the Willingness To Pay (WTP) for both a FSD and SSD reduction of risk is the sum of a mean effect, a pure risk effect and a wealth effect. As a result, the WTP of a risk-averse decision maker may be lower than the WTP of a risk-neutral one, for a large class of individual preferences’ representation and a large class of risks.

In this paper I argue that underlying phronêsis is the more foundational virtue of a willingness to be rationally persuaded. A WTBRP is a virtue in the sense that it fulfills the doctrine of the mean by falling between two vices – never sticking to your position and never giving it up. Articulating a WTBRP in this way also helps address problems phronêsis faces in light of implicit bias research.

We have investigated attitudes towards the use of health data among the Swedish population by analyzing data from a survey answered by 1645 persons. Health data are potentially useful for a variety of purposes. Yet information about health remains sensitive. A balance therefore has to be struck between these opposing considerations in a number of contexts. The attitudes among those whose data is concerned will influence the perceived legitimacy of policies regulating health data use. We aimed to investigate what views (...) are held by the general public, and what aspects matter for the willingness to let one’s data be used not only for one’s own care but also for other purposes. We found that while there is a broad willingness to let one’s data be used, the possibility to influence that use is considered important. The study also indicated that when respondents are required to balance different interests, priority is typically given to compulsory schemes ensuring that data are available where needed, rather than voluntary participation and data protection. The policy implications to be drawn from this are not self-evident, however, since the fact that a majority has a certain attitude does not by itself determine the most adequate policy. (shrink)

The concept of community integrated pest management (IPM), which is well developed in Indonesia and Vietnam, was recently introduced in Nepal. However, it has not been widely practiced, due mainly to lack of financial and technical support. This study determined an individual’s willingness to pay (WTP) for community IPM training. Determinants of WTP were identified; and sample average estimates, opportunity costs of training, and probability values were used to estimate WTP for a group of households. Estimated WTP revealed that (...) individuals were in favor of community IPM, hence it could be implemented with the support of local villagers. Community IPM demand functions showed that individuals’ knowledge and awareness of pesticide pollution are crucial for implementation. The annual welfare gained by providing five days community IPM training was calculated to be US $25.23 per household. (shrink)

Despite the majority opinion of Muslim jurists that organ donation is permitted in Sharia, surveys indicate continuing resistance by lay Muslims, especially to donating organs following death. Pakistan, a country with 165 million Muslims, currently reliant on live donors, is considering steps to establish deceased donor programs which will require public acceptance and support. This article analyzes the results of in-depth interviews with 105 members of the public focusing on opinions and knowledge about juristic rulings regarding kidney donations, donor-family dynamics (...) in deceased donation decisions, and attitudes towards buying kidneys. The objective was to determine the influence if any of cultural and religious values, and norms of traditional family structures and kinships, on decisions to donate. Study participants view donation of kidneys, particularly from the deceased, through a different lens from that used by jurists and physicians, one that also does not conform to familiar paradigms defining ethical organ donation. A socially modulated understanding of Islam passed down the generations, and longstanding family-centric norms, shape the moral worldview of many rather than academic juristic rulings or non-contextual concepts of autonomy and rights. The results of this study also highlight that medical science may be universal but its application occurs within particularities of cultural and religious values, social constructs of the self and its relationship with others, and different ways in which humans comprehend illness, suffering, and death. These findings are of relevance both to transplant related professionals and bioethicists involved with this field. (shrink)