A global pandemic is not a good time to introduce ‘opt-out’ for organ donation

Following several international examples, England introduced a system of deemed consent for organ donation in May 2020. This had been planned for over a year. However, the unprecedented circumstances of the COVID-19 pandemic raise issues that make the timing of this change unfortunate. The planned public awareness campaign has thus far been overshadowed by media coverage of the pandemic, and will likely continue to be, creating a situation in which a significant portion of the population may be unaware of having become potential organ donors. Further, the immediate impact of the new policy is likely to be significantly weakened by the suspension of the majority of organ donation and transplant activity. In this article, we first outline the details of the new model introduced in England, before considering the impact of the pandemic on transplantation services. We put forward three ethical reasons why, given the unprecedented circumstances, the change should have been postponed. We argue that (1) COVID-19 dominating headlines will prevent widespread awareness of the change, thereby undermining the autonomy of those who do not wish to be donors; (2) a lack of transplant activity during the pandemic will make the impact of the change difficult to measure; and (3) trust in the new system may be damaged given controversial decisions regarding Do Not Attempt Cardiopulmonary Resuscitation orders and the allocation of scarce intensive care resources. These reasons combined make for a shaky start at best and present a risk of the new system failing to achieve its desired and essential effect of increasing the number of voluntary organ donors.

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Introducing an Organ Donor Registry is Saskatchewan

Health Reform Observer - Observatoire des Réformes de Santé ◽

10.13162/hro-ors.v9i2.4598 ◽

2021 ◽

Vol 9 (2) ◽

Author(s):

Amy Zarzeczny ◽

◽

Luiza Radu ◽

Keyword(s):

Organ Donation ◽

Public Interest ◽

Public Awareness ◽

National Level ◽

Organ Donor ◽

Organ Donors ◽

Media Campaign ◽

Organ Donations ◽

Paper Form ◽

Evaluation Metric

On 3 September 2020, Saskatchewan launched an organ donor registry that allows participants 16 years and older to register their intent to be an organ donor either online or using a paper form. Saskatchewan has historically performed poorly at a national level with low rates of organ donations. Saskatchewan's new registry is intended to increase the numbers of organ donors in the province, while also helping to modernize its organ donation system and ease donation conversations with families. Saskatchewan's introduction of this registry brought the province in line with other provinces and territories across Canada that use similar systems, and provided a response to the surge in public interest around organ donation that followed the Humboldt Bronco bus crash tragedy and related ``Logan Boulet Effect.'' The 2019-2020 and 2020-2021 provincial budgets included dedicated funding for the development and launch of the registry, which was accompanied by a media campaign to increase public awareness. Though it is too early to evaluate the success of the registry, early indications suggest donation rates will be a key evaluation metric. Registries are commonly thought to help increase public awareness of, and support for, organ donation, but improving Saskatchewan's organ donation rates will likely also require companion measures to strengthen the culture and practice of donation in the province.

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The ‘opt-out’ approach to deceased organ donation in England: A misconceived policy which may precipitate moral harm

Clinical Ethics ◽

10.1177/1477750919851052 ◽

2019 ◽

Vol 14 (2) ◽

pp. 63-69

Author(s):

Tobias K Cantrell

Keyword(s):

Organ Donation ◽

Public Awareness ◽

Recent Attempt ◽

Individual Autonomy ◽

Presumed Consent ◽

Opt Out ◽

The Family ◽

Deceased Organ Donation ◽

Tissue Act ◽

Human Tissue Act

In an effort to solve the shortage of transplantable organs, there have been several proposals to introduce an opt-out approach to deceased organ donation in England (also termed ‘deemed’, or ‘presumed’ consent). In seeking to enact the so-called ‘opt-out proposal’ via an amendment to the Human Tissue Act 2004, The Organ Donation (Deemed Consent) Bill 2017–19 represents the most recent attempt at such legal reform. Despite popular calls to the contrary, I argue in this paper that it would be premature for England, or, indeed, any country, to adopt an opt-out approach at this time. Not only is the available evidence inconclusive on whether introduction of the opt-out proposal would increase the supply of transplantable organs (a common misconception), but there is also a chance that doing so might bring about an otherwise avoidable moral harm through an unjustified interference with individual autonomy. I maintain that the resources required to change the law to such effect would be better expended on alternative, provenly efficacious and less contentious mechanisms for increasing the supply of transplantable organs, such as: improving communication with the family of the deceased, developing infrastructure, raising public awareness and enhancing staff training, attitudes and understanding towards organ donation.

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Establishment of a multidisciplinary concussion program: impact of standardization on patient care and resource utilization

Journal of Neurosurgery Pediatrics ◽

10.3171/2013.10.peds13241 ◽

2014 ◽

Vol 13 (1) ◽

pp. 82-89 ◽

Cited By ~ 19

Author(s):

Sara Anne Wilkins ◽

Chevis N. Shannon ◽

Steven T. Brown ◽

E. Haley Vance ◽

Drew Ferguson ◽

...

Keyword(s):

Emergency Department ◽

Retrospective Study ◽

Resource Utilization ◽

Media Coverage ◽

Public Awareness ◽

Return To Play ◽

Management Protocol ◽

Before And After ◽

Multiple Variables ◽

The Impact

Object Recent legislation and media coverage have heightened awareness of concussion in youth sports. Previous work by the authors' group defined significant variation of care in management of children with concussion. To address this variation, a multidisciplinary concussion program was established based on a uniform management protocol, with emphasis on community outreach via traditional media sources and the Internet. This retrospective study evaluates the impact of standardization of concussion care and resource utilization before and after standardization in a large regional pediatric hospital center. Methods This retrospective study included all patients younger than 18 years of age evaluated for sports-related concussion between January 1, 2007, and December 31, 2011. Emergency department, sports medicine, and neurosurgery records were reviewed. Data collected included demographics, injury details, clinical course, Sports Concussion Assessment Tool-2 (SCAT2) scores, imaging, discharge instructions, and referral for specialty care. The cohort was analyzed comparing patients evaluated before and after standardization of care. Results Five hundred eighty-nine patients were identified, including 270 before standardization (2007–2011) and 319 after standardization (2011–2012). Statistically significant differences (p < 0.0001) were observed between the 2 groups for multiple variables: there were more girls, more first-time concussions, fewer initial presentations to the emergency department, more consistent administration of the SCAT2, and more consistent supervision of return to play and return to think after adoption of the protocol. Conclusions A combination of increased public awareness and legislation has led to a 5-fold increase in the number of youth athletes presenting for concussion evaluation at the authors' center. Establishment of a multidisciplinary clinic with a standardized protocol resulted in significantly decreased institutional resource utilization and more consistent concussion care for this growing patient population.

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Promoting organ donation through Basic Life Support Training –outcomes from the #conversations study.

10.21203/rs.3.rs-118191/v1 ◽

2020 ◽

Author(s):

Caroline Wroe ◽

Natasha Newell ◽

Yitka Graham ◽

Marcus Diamond ◽

Michael O'Malley ◽

...

Keyword(s):

Organ Donation ◽

Basic Life Support ◽

Life Support ◽

Cultural Influences ◽

Organ Donor ◽

Educational Interventions ◽

Recent Change ◽

Baseline Survey ◽

Opt Out ◽

The Impact

Abstract Background: More than 6000 people are waiting for an organ transplant in the UK. Although a recent change in organ donor legislation to an opt out system is hoped to address this disparity expert review highlights that ‘opt out’ is only one of several factors that impact organ donation rates. Studies show that ethnicity, religion and cultural influences impact opinions towards organ donation. The importance of education is well established and interpersonal educational interventions have been shown to be more effective than mass media approaches to changing behaviour around organ donation. This study evaluates the impact of an educational intervention delivered with Basic Life Support training prior to the change in legislation to positively influence views on organ donation.Methods: An educational film promoting organ donation was developed from patient’s stories, evaluated, reviewed and embedded into BLS training. All staff attending BLS training were invited to participate in the study, complete a baseline survey, watch the film and complete another survey 3-5 working days after the training.Results: During the study period 338 attended BLS training, 8 out of 10 agreed to participate in the study, 6 out of 10 stayed behaving for the intervention and 3 out of 10 completed all stages of the study. Support for organ donation was almost universal in the baseline survey and of those who completed the study, >9 out of 10 felt the intervention had helped them understand the need for organ donation and 1 in 2 had subsequently discussed organ donation with their family and friends. 1 in 4 did not support the forthcoming change in organ donation legislation.Conclusions: A brief targeted intervention delivered through BLS training is effective in promoting discussion and improves support for organ donation. The mandatory nature of BLS training reduces bias in engagement and offers huge potential for delivery of a limited intervention around organ donation at pace and scale. Further understanding of NHS staff awareness of and opinions to the change in organ donation legislation is warranted. Trial Registration#conversations was prospectively registered with the ISRCTN on 23/01/2019.ISRCTN 36338010IRAS project ID 233611

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The impact of news exposure on collective attention in the United States during the 2016 Zika epidemic

10.1101/346411 ◽

2018 ◽

Author(s):

Michele Tizzoni ◽

André Panisson ◽

Daniela Paolotti ◽

Ciro Cattuto

Keyword(s):

United States ◽

Disease Transmission ◽

Information Seeking ◽

Media Coverage ◽

Public Awareness ◽

News Coverage ◽

The United States ◽

Human Behaviour ◽

Disease Dynamics ◽

The Impact

AbstractIn recent years, many studies have drawn attention to the important role of collective awareness and human behaviour during epidemic outbreaks. A number of modelling efforts have investigated the interaction between the disease transmission dynamics and human behaviour change mediated by news coverage and by information spreading in the population. Yet, given the scarcity of data on public awareness during an epidemic, few studies have relied on empirical data. Here, we use fine-grained, geo-referenced data from three online sources – Wikipedia, the GDELT Project and the Internet Archive – to quantify population-scale information seeking about the 2016 Zika virus epidemic in the U.S., explicitly linking such behavioural signal to epidemiological data. Geolocalized Wikipedia pageview data reveal that visiting patterns of Zika-related pages in Wikipedia were highly synchronized across the United States and largely explained by exposure to national television broadcast. Contrary to the assumption of some theoretical models, news volume and Wikipedia visiting patterns were not significantly correlated with the magnitude or the extent of the epidemic. Attention to Zika, in terms of Zika-related Wikipedia pageviews, was high at the beginning of the outbreak, when public health agencies raised an international alert and triggered media coverage, but subsequently exhibited an activity profile that suggests nonlinear dependencies and memory effects in the relation between information seeking, media pressure, and disease dynamics. This calls for a new and more general modelling framework to describe the interaction between media exposure, public awareness and disease dynamics during epidemic outbreaks.

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The Impact of Religion and Provision of Information on Increasing Knowledge and Changing Attitudes to Organ Donation: An Intervention Study

Journal of Religion and Health ◽

10.1007/s10943-019-00961-0 ◽

2019 ◽

Vol 59 (4) ◽

pp. 2082-2095 ◽

Cited By ~ 3

Author(s):

Ferid Krupic

Keyword(s):

Organ Donation ◽

Qualitative Content Analysis ◽

Theory And Practice ◽

Organ Donors ◽

Focus Group Interviews ◽

Attitudes And Practices ◽

Group Interviews ◽

Changing Attitudes ◽

Religious Aspects ◽

The Impact

AbstractOne of the most significant developments in recent history has probably been organ donation and organ transplantation. They are frequently the only treatment available in certain cases. However, there is an ever-increasing discrepancy between the number of people needing transplantation and the organs available, because the decision to donate an organ is up to each individual. The study aims to assess the impact of the intervention on knowledge, attitudes and practices on organ donation among religious immigrants in Sweden. Data were collected through three group interviews using open-ended questions and qualitative content analysis. Thirty-six participants, 18 males and 18 females from six countries, participated in the focus group interviews. The analysis of the collected data resulted in two main categories: “Religion in theory and practice” and “More information—more knowledge about organ donation” including seven subcategories. Understanding of religion and religiosity, happiness by taking the class, the practice of religion in everyday life, the overcoming the prejudices in religion, having more information about organ donation and the donations process, as well as that the increased information changes people’s minds, were some of things the informants emphasised as predictors of the decision of organ donation. A class dealing with religion, the religious aspects of organ donation and the way the Swedish healthcare system is organised increased people’s knowledge and changed their attitudes so they became potential organ donors. More intervention studies are needed in every field of medicine to build confidence and give time to educate and discuss issues with potential organ donors in Sweden.

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It Is All About Control: Understanding Reluctance to Register for Organ Donation

Nonprofit and Voluntary Sector Quarterly ◽

10.1177/0899764018807755 ◽

2018 ◽

Vol 48 (3) ◽

pp. 665-680 ◽

Cited By ~ 1

Author(s):

Hagai Katz ◽

Maria Blekher ◽

David A. Bosch

Keyword(s):

Organ Donation ◽

Death And Dying ◽

Gain Control ◽

Organ Donors ◽

Actual Behavior ◽

Loss Of Control ◽

Lack Of Control ◽

Perceived Importance ◽

The Impact ◽

Death Causes

This article tests the theory that anxiety about death causes feelings of lack of control, which, with other factors, results in reluctance to donate organs, despite endorsement of the act. Using a survey of U.S. and U.K. registered organ donors and unregistered adults ( N = 777), we tested the impact of trust in medical professionals, perceived importance of information on the transplant processes, anxiety regarding loss of control at one’s end-of-life, and a prosocial view of organ donation on willingness to register as donor. Structural analyses show that control mediated the associations of trust and information with willingness, while prosocial did not predict willingness. The findings explain the gap between stated attitudes and actual behavior, and suggest that framing donor card registration and organ donation as a way to gain control over the loss of agency in death and dying may encourage organ donation.

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Can financial rewards complement altruism to raise deceased organ donation rates?

Nursing Ethics ◽

10.1177/0969733020918927 ◽

2020 ◽

Vol 27 (6) ◽

pp. 1436-1449

Author(s):

Rajah Rasiah ◽

Navaz Naghavi ◽

Muhammad Shujaat Mubarik ◽

Hamid Sharif Nia

Keyword(s):

Socioeconomic Status ◽

Organ Donation ◽

Financial Incentives ◽

Structural Equation ◽

Public Awareness ◽

Equation Modeling ◽

Willingness To Donate ◽

Deceased Organ Donation ◽

The University ◽

The Impact

Background: Organ supply–demand in developing countries worldwide has continued to widen. Hence, using a large survey (n ¼ 10,412), this study seeks to investigate whether human psychology could be used to inculcate philanthropy to raise deceased organ donation rates. Methods: Three models were constructed to examine multidimensional relationships among the variables. Structural equation modeling was applied to estimate the direct and indirect influence of altruism, financial incentives, donation perception, and socioeconomic status simultaneously on willingness to donate deceased organs. Ethical considerations: The study was approved by the University of Malaya ethics committee. Results: The results show that altruism amplifies the impact of socioeconomic status and donation perception on willingness to donate. Also, the results show that financial incentives cannot complement altruism to raise organ donation rates. Hence, investing in education and public awareness enhances altruism in people, which then increases the propensity to donate. Conclusion: Evidence suggests that governments should allocate resources to increase public awareness about organ donation. Awareness programs about the importance of philanthropic donations and the participation of medical consultants at hospitals in the processes form the foundation of such a presumptive approach.

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Organ Donation and the Ars Moriendi

The Linacre Quarterly ◽

10.1177/0024363919874591 ◽

2019 ◽

Vol 86 (4) ◽

pp. 327-334

Author(s):

Stephen Doran

Keyword(s):

Organ Donation ◽

Human Person ◽

Organ Donor ◽

Third Party ◽

Organ Donors ◽

Potential Organ Donor ◽

Ars Moriendi ◽

Dying Patients ◽

Donation Process ◽

The Impact

Organ donation is rightly understood as a gift that is a genuine act of love. Organ donation as an act of love requires it to be an act of freedom that honors the integrity of the human person who is in the process of dying. However, the process of organ donation, by necessity, inserts a third party of interest whose primary aim is to assist someone other than the dying person. Caregivers can become “organ focused” instead of “patient focused.” The procurement of organs potentially results in the commodification of the potential organ donor. Furthermore, death is not a momentary event but rather an ontological change in the person where the union of body and soul becomes divided. This Catholic understanding of death is important to assess the impact of organ donation on the process of dying. Family members of organ donors often have traumatic memories associated with the organ donation process, potentially overshadowing the ars moriendi—the art of dying. Summary: While organ donation is an act of love, the donation process can be distraction from the care of the dying patient, who may be treated differently than other dying patients who are not organ donors. A Catholic understanding of death is helpful in assessing the impact of the organ donation process.

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