Comparing organ donation decisions for next-of-kin versus the self: results of a national survey.

OBJECTIVES: Intensive care audits point to family refusal as a major barrier to organ donation. In this study, we sought to understand refusal by accounting for the decision-maker's mindset. This focused on: (1) how decisions compare when made on behalf of a relative (vs the self); and (2) confidence in decisions made for family members. DESIGN: Cross-sectional survey in Singapore. SETTING: Participants were recruited from community settings via door-to-door sampling and community eateries. PARTICIPANTS: 973 adults who qualified as organ donors in Singapore. RESULTS: Although 68.1% of participants were willing to donate their own organs, only 51.8% were willing to donate a relative's organs. Using machine learning, we found that consistency was predicted by: (1) religion, and (2) fears about organ donation. Conversely, participants who were willing to donate their own organs but not their relative's were less driven by these factors, and may instead have resorted to heuristics in decision-making. Finally, we observed how individuals were overconfident in their decision-making abilities: although 78% had never discussed organ donation with their relatives, the large majority expressed high confidence that they would respect their relatives' wishes on death. CONCLUSIONS: These findings underscore the distinct psychological processes involved when donation decisions are made for family members. Amidst a global shortage of organ donors, addressing the decision-maker's mindset (eg, overconfidence, the use of heuristics) may be key to actualizing potential donors identified in intensive care units.

Brain Death in Asia: Do Public Views Still Influence Organ Donation in the 21st Century?

BACKGROUND: Historically, brain death legislation was adopted in Asia at a much later stage than it was in the West, with heated public debates surrounding these laws. In this study, we investigated whether the poor acceptance of brain death continues to the present day, focusing on the following: (1) what the Asian public understands brain death to be; (2) how views toward brain death are compared with those of cardiac death; and (3) the extent to which brain death perception contributes to the low rate of deceased organ donation that has been observed amongst Asians. METHODS: Using a door-to-door sampling strategy, we recruited 622 residents in Singapore between September 2016 and July 2017. RESULTS: Our results suggest that resistance toward brain death persists, with the majority of respondents equating this as a bleak outcome but not as death. Correspondingly, they considered cardiac death a better indicator of death and were more fearful of being alive during organ donation. In turn, these views predicted a decreased willingness to donate either their own or their family members' organs. CONCLUSIONS: Taken together, our results suggest that views of brain death continue to hamper organ donation, and are seemingly resistant to both time and legislation.