Public attitudes toward incentives for organ donation: a national study of different racial/ethnic and income groups (original) (raw)
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Do Incentives Matter? Providing Benefits to Families of Organ Donors
American Journal of Transplantation, 2005
Whether the number of organs available for transplant would be positively or negatively affected by providing benefits to families of organ donors has been debated by policymakers, ethicists and the transplant community at large. We designed a telephone survey to measure public opinion regarding the use of benefits in general and of five types in particular: funeral benefits, charitable contributions, travel/lodging expenses, direct payments and medical expenses. Of the 971 adults who completed the survey (response rate = 69%), all were from Pennsylvania households, 45.6% were registered organ donors, and 51.7% were nonwhite. Although 59% of respondents favored the general idea of incentives, support for specific incentives ranged from 53% (direct payment) to 84% (medical expenses). Among those registered as donors, more nonwhites than whites supported funeral benefits (88% vs. 81%; p = 0.038), direct payment (63% vs. 41%; p < 0.001) and medical expenses (92% vs. 84%; p = 0.013). Among those not registered as donors, more nonwhites supported direct payment (64% vs. 46%; p = 0.001). Most respondents believed that benefits would not influence their own behavior concerning donation but would influence the behavior of others. While benefits appear to be favored, their true impact can only be assessed through pilot programs.
Clinical Journal of the American Society of Nephrology, 2012
Background and objective The acceptability of financial incentives for organ donation is contentious. This study sought to determine (1) the acceptability of expense reimbursement or financial incentives by the general public, health professionals involved with organ donation and transplantation, and those with or affected by kidney disease and (2) for the public, whether financial incentives would alter their willingness to consider donation. Design, setting, participants, & measurements Web-based survey administered to members of the Canadian public, health professionals, and people with or affected by kidney disease asking questions regarding acceptability of strategies to increase living and deceased kidney donation and willingness to donate a kidney under various financial incentives. Results Responses were collected from 2004 members of the Canadian public October 11-18, 2011; responses from health professionals (n=339) and people with or affected by kidney disease (n=268) were collected during a 4week period commencing October 11, 2011. Acceptability of one or more financial incentives to increase deceased and living donation was noted in .70% and 40% of all groups, respectively. Support for monetary payment for living donors was 45%, 14%, and 27% for the public, health professionals, and people with or affected by kidney disease, respectively. Overall, reimbursement of funeral expenses for deceased donors and a tax break for living donors were the most acceptable. Conclusion The general public views regulated financial incentives for living and deceased donation to be acceptable. Future research needs to examine the impact of financial incentives on rates of deceased and living donors.
Racial Disparities in Preferences and Perceptions Regarding Organ Donation
Journal of General Internal Medicine, 2006
OBJECTIVES: To identify reasons for lower organ donation rates by African Americans, we examined knowledge and attitudes about brain death, donation, and transplantation and trust in the health care system.METHODS: Data were collected from 1,283 subjects in Ohio using a random digit dial telephone survey. Items were developed based on focus group results. Willingness-to-donate indicators included a signed donor card and willingness to donate one's own and a loved one's organs.RESULTS: Compared with whites, African-Americans had lower rates of signing a donor card (39.1% vs 64.9%, P<.001), and willingness to donate their own organs (72.6% vs 88.3%, P<.001) or a loved one's organs (53.0% vs 66.2%, P<.001). African Americans had lower scores on the Trust in the Health Care System scale (mean scores±SD, 9.43±3.05 vs 9.93±2.88, P<.01) and were more likely to agree that “if doctors know I am an organ donor, they won't try to save my life” (38.6% vs 25.9%, P<.001), the rich or famous are more likely to get a transplant (81.9% vs 75.7%, P<.05), and less likely to agree that doctors can be trusted to pronounce death (68.2% vs 82.9, P<.001). African Americans were also more likely to agree that families should receive money for donating organs (45.6% vs 28.0%, P<.001) and funeral expenses (63.1% vs 46.6%, P<.001).CONCLUSIONS: African Americans reported greater mistrust in the equity of the donation system and were more favorable about providing tangible benefits to donor families than white respondents.
The Milbank Quarterly, 1995
R ight n o w , more t h a n 37,000 A m ericans are waiting for an organ transplant to restore their good health (United Network for Organ Sharing 1994). Sadly, with their hopes for a medical miracle left unfulfilled, nine of these people will die today, and another nine every day this year. A shortage of organs exists despite the fact that there are more than enough potential organ donors to meet current needs. State and federal laws that require hospital personnel to make requests for organ and tissue donations have not closed the gap (Caplan et al. 1991). Ultimately, the scarcity of organs leads to public skepticism about the integrity and fairness of the nation's organ distribution system. Most recently, the public's concerns were underscored by allegations of pref erential treatment for Governor Robert P. Casey of Pennsylvania, who received a heart-liver transplant at Pittsburgh's Presbyterian University Hospital (Colburn 1993). The fear is that these concerns will decrease the public's willingness to donate (Caplan 1992). The continuing shortage of organs for transplant, coupled with a growing pessimism among medical professionals about the failure of ed ucation efforts to "sell" the public on organ donation, is inspiring in-*Coauthors are listed at the end o f the article.
Financial incentives for cadaver organ donation: an ethical reappraisal1
Transplantation, 2002
A panel of ethicists, organ procurement organization executives, physicians, and surgeons was convened by the sponsorship of the American Society of Transplant Surgeons to determine whether an ethically acceptable pilot trial could be proposed to provide a financial incentive for a family to consent to the donation of organs from a deceased relative. An ethical methodology was developed that could be applied to any proposal for monetary compensation to elucidate its ethical acceptability. An inverse relationship between financial incentives for increasing the families' consent for cadaver donation that clearly would be ethically acceptable (e.g., a contribution to a charity chosen by the family or a reimbursement for funeral expenses) and those approaches that would more likely increase the rate of donation (e.g., direct payment or tax incentive) was evident. The panel was unanimously opposed to the exchange of money for cadaver donor organs because either a direct payment or tax incentive would violate the ideal standard of altruism in organ donation and unacceptably commercialize the value of human life by commodifying donated organs. However, a majority of the panel members supported reimbursement for funeral expenses or a charitable contribution as an ethically permissible approach. The panel concluded that the concept of the organ as a gift could be sustained by a funeral reimbursement or charitable contribution that conveyed the appreciation of society to the family for their donation. Depending on the amount of reimbursement provided for funeral expenses, this approach could be ethically distinguished from a direct payment, by their intrusion into the realm of altruism and voluntariness. We suggest that a pilot project be conducted to determine whether this kind of a financial incentive would be acceptable to the public and successful in increasing organ donation. An increasing number of patients awaiting solid organ transplantation are dying waiting on the list. This increase
Correlates of support for organ donation among three ethnic groups
Clinical Transplantation, 1999
Telephone interviews about organ donation were conducted with 4880 white respondents, 634 African-American respondents and 566 Hispanic respondents. Forty-three percent (42.9%) of whites, 31.2% of Hispanics and 22.6% of African-Americans reported that they were willing to donate their organs after their death (p B 0.001). Logistic regression analysis revealed three significant correlates of willingness to donate across all ethnic groups: having had a family discussion about end-of-life issues; the belief that a doctor does all he or she can to save a life before pursuing donation; and concerns about surgical 'disfigurement' of a relative's body after donation. Concerns in relation to body disfigurement were more prevalent among African-American and Hispanic respondents (p B 0.001) than among white respondents. Public education should: a) stress the need for family communication about end-of-life issues including organ donation; b) underline the fact that donation is considered only after all efforts to save the life of the patient are exhausted; and c) reassure minorities that the body of the donor is treated respectfully and not disfigured.