Public awareness of organ donation.

Abstract

A telephone survey of public attitudes toward organ donation and transplantation was conducted in a community in southwestern Ontario. The subjects were selected at random; the response rate was 57%. Of the 50 respondents 62% stated that they had signed the organ donor card accompanying their driver's licence. These respondents were more likely than those who did not sign it to have discussed organ donation with their families. At least 80% of the respondents said they would agree to donate their organs and those of their next-of-kin, and 80% said that the organ donor card should be considered a legal document. Organ transplantation was regarded by all but one respondent as an acceptable medical procedure. Also discussed were concerns about organ donation and possible strategies to improve the availability of organs for transplantation.

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I Clinical and CommunityStudies
Public awareness of organ donation
Susan Evers, PhD
Vernon T. Farewell, PhD
Philip F. Halloran, MD, PhD
A telephone survey of public attitudes toward
organ donation and transplantation was con-
ducted in a community in southwestern Ontario.
The subjects were selected at random; the re-
sponse rate was 57%. Of the 50 respondents 62%
stated that they had signed the organ donor card
accompanying their drivers licence. These re-
spondents were more likely than those who did
not sign it to have discussed organ donation
with their families. At least 80% of the respon-
dents said they would agree to donate their
organs and those of their next-of-kin, and 80%
said that the organ donor card should be consid-
ered a legal document. Organ transplantation
was regarded by all but one respondent as an
acceptable medical procedure. Also discussed
were concerns about organ donation and possi-
ble strategies to improve the availability of
organs for transplantation.
Enquete telephonique dans une ville du sud-
ouest de l'Ontario sur les opinions de la popula-
tion quant au don et a la greffe d'organes. Parmi
les sujets choisis au hasard 57% repondent. Des
50 repondants 62% disent avoir signe la carte de
consentement qui accompagne le permis de con-
duire. Ceux qui ont signe, plus souvent que ceux
qui n'ont pas signe, avaient parle du don d'orga-
nes avec leur famille. Plus de 80% des repon-
From the Department ofHealth Studies, University of Waterloo,
Waterloo, Ont., and the Division ofNephrology and Immunolo-
gy, University ofAlberta Hospital, Edmonton
Reprint requests to: Dr. Susan Evers, Department of Health
Studies, University of Waterloo, Waterloo, Ont. N2L 3G1
dants consentiraient a donner leurs organes et
ceux de leur plus proche parent. Pour 80% des
repondants la carte de consentement devrait
avoir force de loi. Tous, a l'exception d'un seul,
considerent que
la greffe d'organes
bonne chose du point de vue medical. On
discute aussi de certaines inquietudes au sujet
du don d'organes et des moyens d'augmenter la
disponibilite des organes pour fins de greffe.
est une
he public's negative attitude toward organ
donation is consistently cited as the major
factor in the current shortage of organs for
transplantation.'-3
50% of possible donor situations actually resulted
in donations such a shortage would not exist.4
In general, public opinion surveys have found
that while most people have a positive attitude
toward organ donation and transplantation this
seldom results in concrete action.23 A 1983 survey
by the Kidney Foundation of Canada found that
while 90% of the respondents agreed with the
concept of organ donation, only 20% had signed a
donor card.4 A 1984 study in Ontario had similar
findings: 89.1% of the respondents had heard of
organ donor cards, but only 25.5% stated that they
had signed one.' A comparison of the results from
Gallup polls in 19831 and 1987 (Toronto Star, Mar.
16, 1987: page A2) showed an increase, from 21%
to 25%, in the proportion of people who had
signed an organ donor card. The results of a survey
on public attitudes, commissioned by the Ontario
Ministry of Health's task force on kidney donation,
indicated a resistance to expressing support for
organ donation and transplantation by signing
organ donor cards.5 In that survey 60 individuals
It has been estimated that if
CMAJ, VOL. 138, FEBRUARY 1,1988
237

Page 2

people who had signed an organ donor card,
people who had not signed a card and parents of
children who had their driver's licence - under-
went a 2-hour interview. To our knowledge, no
population-based studies have been done in Cana-
da.
We conducted a small survey to ascertain
public attitudes toward organ donation and the
bases for these attitudes and thus to identify
predictors of attitude and behaviour.
Methods
We developed a questionnaire based on the
literature to date and conducted a telephone sur-
vey in a city of 80 000 people in southern Ontario.
While most of the questions had multiple-choice
answers, several were open-ended so as to identify
issues that were not suggested by the literature.
The subjects were selected from listed tele-
phone numbers by the use of a table of random
numbers. Only one person, aged 18 years or older,
per household was selected because of the expect-
ed correlation in responses among people in the
same household. If there was no answer when the
call was placed, the interviewer was instructed to
try the number two more times over the next 2
weeks before removing
contacted were asked if, for purposes of research
on kidney transplantation, they would be willing
to answer questions on medical procedures.
it from the list. Those
Results
Of the 88 people contacted by telephone 50
(57%) were willing to be questioned. Their demo-
graphic characteristics are shown in Table I. There
were no significant differences between the re-
spondents who stated that they had signed the
organ donor card accompanying their driver's li-
cence and those who had not. However, more of
the respondents who had signed the organ donor
card (20 of 31) than of those who had not signed it
(4 of 14) had discussed organ donation with their
families (p = 0.027).
Organ transplantation was viewed as accepted
medical treatment by all but one of the respon-
dents (Table II). At least 80% of the respondents
said they would agree to organ donation for
themselves and their next-of-kin. Also, 80% felt
that the organ donor card should be a legal
document whose provisions should not be usurped
by the next-of-kin.
Newspapers or magazines and television were
cited by 90% of the respondents as being the
primary sources of information about organ trans-
plantation. The driver's licence itself was cited by
32%. The two most frequently cited determinants
of whether the respondents would agree to organ
donation were altruism (cited by 40%) and the
knowledge that a friend or relative needed an
organ (cited by 32%).
There were several specific concerns about
organ donation and transplantation, the two most
common being that financial status might deter-
mine who would receive an organ transplant (cited
by 16%) and that the donated organ might be of
inferior quality or from a carrier of human im-
munodeficiency virus (cited by 10%). We did not
find a differential reaction to the type of organ
donation; that is, the respondents were as support-
Table I-- Demographic characteristics of respondents
and number who had signed an organ donor card
I ~arai,;teristiC'*
Mat
;qe.
4/
40
ReligioLs pireference
ProtestanT
Cathol'ic
None
Level of edUcation
Less than high school
High school, some
college or university
C%ollege or university
graduate
Marital status
Married
Never married
Widowed
No. who had
signed an
N o. of
respondents organ donor cardt
19
30
24
23
31
10
9
1 3
21
1 5
35
13
2
14
16 (25i
17 (23)
14 (19)
18 (28)
4
9
(8)
6 (10)
15 (19)
10
19 (31)
1 1
1
(1)
*Four of the respondents did not state their sex, age or level
of education.
+Numbers in parenthesis indicate number of people answer-
ing the question about organ donor cards if different fromn
the total number of respondents.
Table
organ donation and transplantation
11
--- Respondents' answers to questions on
No. (and %) of
respondents
Resprnse
Organ transplantation is an acceptable form
of medicai treatment
Want next-of-kin to give consent for
donation of organs
Willing to give consent for donation of
organs from next-of-kin
Has discussed organ donation with family
A signed donor card should be a legal
document whose provisions should not
be usurped by next-of-kin
Familiar with the term brain death
Acceptable that a person should be
maintained on a life support system for
organ donation
A central registry should be established as
organrs become available
49 (98)
42 (84)
40 (80)
27 (54)
40 (80)
41 (82)
38 (76)
49 (98)
238
CMAJ, VOL. 138, FEBRUARY 1, 1988

Page 3

ive of kidney transplantation as they were of heart
or other organ transplantation. The respondents
who stated that it was acceptable to maintain a
person on a life support system for purposes of
organ donation (38 of 50) were also queried on
what would be an acceptable length of time.
Surprisingly, most (27 of 38) said that 48 hours or
more was acceptable. Finally, 12 of the 14 respon-
dents who said that they had not signed the organ
donor card said that they were willing to do so.
Discussion
We have demonstrated the feasibility of a
random population-based survey of public atti-
tudes toward organ donation. The results give
some insight into factors affecting behaviour. Since
62% of the respondents had signed a donor card,
and since the response rate was 57%, we estimated
that at least 35% of the population has signed a
donor card. Our findings on the factors that
influence behaviour
are
however, to the people who responded to the
survey.
Further research into the issues and concerns
about organ donation and transplantation is essen-
tial for the development of public education strate-
gies. The disparity between the numbers of re-
spondents who were willing to donate organs and
of those who had already signed a donor card
suggests that the solution to the current shortage of
organs for transplantation is not solely an increase
in public acceptance of the procedure. The goal
may be to ensure that people who are willing to
sign an organ donor card do so and make their
intentions known to their families. Approximately
one-third of the respondents cited the driver's
licence as a source of information on organ dona-
tion. Thus, the donor card should receive more
attention in public education campaigns. Because
there is support for making the organ-donor card a
legal document, a central registry of names of
people who have given consent might also be
considered.
necessarily
restricted,
References
1. Robinette MA, Marshall WJS, Arbus GS et al: The donation
process. Transplant Proc 1985; 17 (suppl 3): 45-65
2. Manninen DK, Evans RW: Public attitudes and behavior
regarding organ donation. JAMA 1985; 253: 3111-3115
3. Richardson KE: Attitudes toward organ donation and trans-
plantation at an urban university. Dialysis Transplant 1982;
11: 1058-1062
4. Gilmore A: Procuring donor organs: firm but friendly en-
couragement required. Can Med Assocj 1986; 134: 932-937
5. Corlett S: Public attitudes towards human organ donation.
TransplantProc 1985; 17 (suppl 3): 103-110
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CMAJ, VOL. 138, FEBRUARY 1, 1988
239