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Semrau L. The Altruism Requirement as Moral Fiction. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2024; 49:257-270. [PMID: 38530655 DOI: 10.1093/jmp/jhae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
It is widely agreed that living kidney donation is permitted but living kidney sales are not. Call this the Received View. One way to support the Received View is to appeal to a particular understanding of the conditions under which living kidney transplantation is permissible. It is often claimed that donors must act altruistically, without the expectation of payment and for the sake of another. Call this the Altruism Requirement. On the conventional interpretation, the Altruism Requirement is a moral fact. It states a legitimate constraint on permissible transplantation and is accepted on the basis of cogent argument. The present paper offers an alternative interpretation. I suggest the Altruism Requirement is a moral fiction-a kind of motivated falsehood. It is false that transplantation requires altruism. But the Requirement serves a purpose. Accepting it allows kidney donation but not kidney sale. It, in short, rationalizes the Received View.
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Affiliation(s)
- Luke Semrau
- Bloomsburg University, Bloomsburg, Pennsylvania, USA
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2
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Shrivastav V, Murugan Y, Gandhi R, Nagda J. Knowledge, Attitudes, and Practices Regarding Organ Donation Among Medical Students in India: A Mixed Methods Study. Cureus 2024; 16:e56136. [PMID: 38618406 PMCID: PMC11015158 DOI: 10.7759/cureus.56136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Deceased organ donation rates are extremely low in India. As future physicians, medical students can advocate organ donation in society. However, their knowledge, attitudes, and practices regarding organ donation remain understudied in India. Therefore, the present study aimed to assess the knowledge, attitudes, and practices related to deceased organ donation among undergraduate medical students in India using a mixed methods approach. MATERIALS AND METHODS This is a mixed-method study with a cross-sectional survey conducted among 400 randomly selected medical students at a medical college in India using a pretested questionnaire. Additionally, 20 in-depth interviews were conducted to gain qualitative insights. RESULTS Knowledge was high regarding organ donation (90%) but lower for brain death (27.5%). Most had positive attitudes, but only 11% were registered donors, and 10% had discussed organ donation with family. Multivariate regression revealed that having third- and fourth-year-old students, urban upbringing, good knowledge, and positive attitudes were associated with increased willingness to donate. Qualitative findings revealed gaps in brain death understanding, religious myths, lack of conviction, and family disapproval as barriers. CONCLUSION Despite good awareness, gaps in the comprehension of brain death persist among students. However, the registration and family discussion rates are very low. Targeted strategies such as integrating ethical issues into medical curricula, public awareness campaigns busting myths, simplifying donor registration, and promoting family conversations are strongly recommended. This can empower students to become physician advocates driving organ donation uptake in India.
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Affiliation(s)
| | - Yogesh Murugan
- Family Medicine, Guru Gobindsingh Government Hospital, Jamnagar, IND
| | - Rohankumar Gandhi
- Community Medicine, Shri M P Shah Government Medical College, Jamnagar, IND
| | - Jay Nagda
- Internal Medicine, Narendra Modi Medical College, Ahmedabad, IND
- Community Medicine, Shri M P Shah Government Medical College, Jamnagar, IND
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Rodger D, Venter B. A fair exchange: why living kidney donors in England should be financially compensated. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2023; 26:625-634. [PMID: 37620641 PMCID: PMC10725849 DOI: 10.1007/s11019-023-10171-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 08/26/2023]
Abstract
Every year, hundreds of patients in England die whilst waiting for a kidney transplant, and this is evidence that the current system of altruistic-based donation is not sufficient to address the shortage of kidneys available for transplant. To address this problem, we propose a monopsony system whereby kidney donors can opt-in to receive financial compensation, whilst still preserving the right of individuals to donate without receiving any compensation. A monopsony system describes a market structure where there is only one 'buyer'-in this case the National Health Service. By doing so, several hundred lives could be saved each year in England, wait times for a kidney transplant could be significantly reduced, and it would lessen the burden on dialysis services. Furthermore, compensation would help alleviate the common disincentives to living kidney donation, such as its potential associated health and psychological costs, and it would also help to increase awareness of living kidney donation. The proposed system would also result in significant cost savings that could then be redirected towards preventing kidney disease and reducing health disparities. While concerns about exploitation, coercion, and the 'crowding out' of altruistic donors exist, we believe that careful implementation can mitigate these issues. Therefore, we recommend piloting financial compensation for living kidney donors at a transplant centre in England.
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Affiliation(s)
- Daniel Rodger
- Institute of Health and Social Care, School of Allied and Community Health, London South Bank University, London, UK.
- Department of Psychological Sciences, University of London, Birkbeck, UK.
| | - Bonnie Venter
- Centre for Health, Law, and Society, Bristol Law School, University of Bristol, Bristol, UK
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4
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Armitage RC. Non-directed (altruistic) kidney donation: Altruism or insurance policy? J Eval Clin Pract 2023. [PMID: 37771089 DOI: 10.1111/jep.13929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/08/2023] [Accepted: 09/14/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION Since non-directed (altruistic) kidney donors do not stand to benefit from the lengthening and strengthening of a relationship that they intrinsically value, their donations are considered to constitute the most altruistic variety of living kidney donation. METHODOLOGY This paper uses publicly-available data to assess the expected value that accrues to the donor of altruistic kidney donation. FINDINGS Compared to healthy non-donors, living kidney donors experience only marginally increased absolute risks of poor physical health outcomes, and no difference in important psychosocial health outcomes. Crucially, the chance of requiring a kidney donation is only marginally increased by becoming a living kidney donor. In the United Kingdom, previous living kidney donors that subsequently become in need of any organ donation (not only kidneys) themselves are considered priority patients for these donations. They consequently experience shorter waiting times for these organs and reduced exposure to the inherently harmful effects of dialysis therapy (if a kidney donation is required) compared to non-donors in need of organ donation. As such, while key data points required to compute an accurate and complete expected value calculation are unavailable, it is likely that the additional risk incurred by becoming a living kidney donor is outweighed by the benefit of being considered a priority patient for the donation of any type of organ in the event that this is needed. CONCLUSION Accordingly, the expected value of becoming a living kidney donor is likely to be positive, meaning the act of doing so may be considered akin to the taking out of an insurance policy. In the context of non-directed (altruistic) kidney donation, this may diminish the extent to which such a donation is considered altruistic.
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Affiliation(s)
- Richard C Armitage
- Academic Unit of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK
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5
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Clark NL, Copping L, Swainston K, McGeechan GJ. Attitudes to Organ Donor Registration in England Under Opt-Out Legislation. Prog Transplant 2023; 33:208-215. [PMID: 37475461 DOI: 10.1177/15269248231189869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Introduction: In England, everyone is considered an organ donor unless they have registered for opt-out donation. Research Question: This study evaluated positive statements and negative affective attitudes against anticipated organ donor status and whether the order in the attitudes and statements presented impacted organ donor intention under an opt-out system. Design: A quasi-experimental mixed between-within design was employed with participants assigned to 1 of 2 conditions. Participants in the first condition received negative affective attitude statements followed by positive statements. This was reversed in the second condition to combat ordering effects. Participants (N = 679) were asked about their donor status under an opt-out system. There were three groups: opt-in (actively), opt-out/not sure, and deemed consent (no objection). Organ donor intentions were measured at three intervals: baseline, post-positive statements, and post-negative attitudes. Results: Approximately 10% of participants would opt-out or were unsure of their intentions to be an organ donor under an opt-out system. Significant effects were found in both positive statements and negative affective attitudes. All groups expressed greater medical mistrust and were most influenced by cognitive attitudes. Conclusions: Under the opt-out system in England, it is anticipated that the majority would actively opt-in or have no objection to being automatically registered as an organ donor. Public health campaigns would benefit from promoting the most influential positive statements and refuting the most detrimental negative attitudes to increase intentions of those who plan to opt-out or are unsure.
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Affiliation(s)
- Natalie L Clark
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Lee Copping
- Centre for Applied Psychological Science, Teesside University, Middlesbrough, UK
| | - Katherine Swainston
- School of Psychology, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Grant J McGeechan
- Centre for Applied Psychological Science, Teesside University, Middlesbrough, UK
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Zuchowski M, Mamode N, Draper H, Gogalniceanu P, Norton S, Chilcot J, Auburn T, Clarke A, Williams L, Burnapp L, McCrone P, Maple H. Exploring Staff Attitudes Towards Unspecified Kidney Donors in the United Kingdom: Results From the BOUnD Study. Transpl Int 2023; 36:11258. [PMID: 37359823 PMCID: PMC10285071 DOI: 10.3389/ti.2023.11258] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023]
Abstract
Unspecified kidney donation (UKD) has made substantial contributions to the UK living donor programme. Nevertheless, some transplant professionals are uncomfortable with these individuals undergoing surgery. This study aimed to qualitatively explore the attitudes of UK healthcare professionals towards UKD. An opportunistic sample was recruited through the Barriers and Outcomes in Unspecified Donation (BOUnD) study covering six UK transplant centres: three high volume and three low volume centres. Interview transcripts were analysed using inductive thematic analysis. The study provided comprehensive coverage of the UK transplant community, involving 59 transplant professionals. We identified five themes: staff's conception of the ethics of UKD; presence of the known recipient in the donor-recipient dyad; need for better management of patient expectations; managing visceral reactions about the "typical" unspecified kidney donor; complex attitudes toward a promising new practice. This is the first in-depth qualitative study of attitudes of transplant professionals towards UKD. The data uncovered findings with strong clinical implications for the UKD programme, including the need for a uniform approach towards younger candidates that is adhered to by all transplant centres, the need to equally extend the rigorous assessment to both specified and unspecified donors, and a new approach to managing donor expectations.
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Affiliation(s)
- Mira Zuchowski
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, King’s College London, London, United Kingdom
| | - Nizam Mamode
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Heather Draper
- Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Peter Gogalniceanu
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Sam Norton
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, King’s College London, London, United Kingdom
| | - Joseph Chilcot
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, King’s College London, London, United Kingdom
| | - Timothy Auburn
- School of Psychology, University of Plymouth, Plymouth, United Kingdom
| | - Alexis Clarke
- School of Psychology, University of Plymouth, Plymouth, United Kingdom
| | - Lynsey Williams
- School of Psychology, University of Plymouth, Plymouth, United Kingdom
| | - Lisa Burnapp
- Directorate of Organ and Tissue Donation and Transplantation, NHS Blood and Transplant, Watford, United Kingdom
| | - Paul McCrone
- Institute for Lifecourse Development, University of Greenwich, London, United Kingdom
| | - Hannah Maple
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
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Hierro LÁ, Patiño D, Atienza P, Garzón AJ, Cantarero D. The effect of altruism on COVID-19 vaccination rates. HEALTH ECONOMICS REVIEW 2023; 13:2. [PMID: 36595138 PMCID: PMC9807973 DOI: 10.1186/s13561-022-00415-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND After the emergence of the first vaccines against the COVID-19, public health authorities have promoted mass vaccination in order to achieve herd immunity and reduce the effects of the disease. Vaccination rates have differed between countries, depending on supply (availability of resources) and demand (altruism and resistance to vaccination) factors. METHODS This work considers the hypothesis that individuals' health altruism has been an important factor to explain the different levels of vaccination between countries, using the number of transplants as a proxy for altruism. Taking European Union's countries to remove, as far as possible, supply factors that might affect vaccination, we carry out cross-sectional regressions for the most favorable date of the vaccination process (maximum vaccination speed) and for each month during the vaccination campaign. RESULTS Our findings confirm that altruism has affected vaccination rates against the COVID-19. We find a direct relationship between transplants rates (proxy variable) and vaccination rates during periods in which the decision to be vaccinated depended on the individual's choice, without supply restrictions. The results show that other demand factors have worked against vaccination: political polarization and belonging to the group of countries of the former Eastern bloc. CONCLUSIONS Altruism is a useful tool to define future vaccination strategies, since it favors the individuals' awareness for vaccination.
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Affiliation(s)
- Luis Á Hierro
- Department of Economics and Economic History, University of Sevilla, Avda. Ramón y Cajal, S/N, 41018, Seville, Spain
| | - David Patiño
- Department of Economics and Economic History, University of Sevilla, Avda. Ramón y Cajal, S/N, 41018, Seville, Spain
| | - Pedro Atienza
- Department of Economics and Economic History, University of Sevilla, Avda. Ramón y Cajal, S/N, 41018, Seville, Spain.
| | - Antonio J Garzón
- Department of Economics and Economic History, University of Sevilla, Avda. Ramón y Cajal, S/N, 41018, Seville, Spain
| | - David Cantarero
- Department of Economics, Universidad de Cantabria, Research Group on Health Economics and Health Services Management-Marqués de Valdecilla Research Institute (IDIVAL), Avda. de los Castros S/N, 39005, Santander, Spain
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8
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Rochelle TL, Ng JS. Examining behavioural intention towards organ donation in Hong Kong. J Health Psychol 2023; 28:17-29. [PMID: 35443819 DOI: 10.1177/13591053221092857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although many people report favourable attitudes towards organ donation, Hong Kong has one of the lowest rates of organ donation globally. The present study examined behavioural intention towards organ donation. A convenience sample of 225 Hong Kong Chinese adults (118 = female) aged 18-82 years were recruited to an online survey. Behavioural intention, attitudes, subjective norms, self-efficacy, knowledge and altruism were examined. ANOVA was conducted to examine key differences based on behavioural intention, regression then examined predictors of behavioural intention to donate before exploratory analysis examined the mediating role of subjective norms on the relationship between self-efficacy and behavioural intention. Findings revealed over one third (38%) of respondents were actively registered as organ donors. Women were significantly more likely to be registered as organ donors. Subjective norms and self-efficacy were strong predictors of behavioural intention to donate, and subjective norms significantly mediated the relationship between self-efficacy and behavioural intention to donate.
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9
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Katvan E, Cohen J, Rahamimov R, Ashkenazi T. A Comparison of Recalled Pain Memory Following Living Kidney Donation Between Directed and non-Directed, Altruistic Donors. Prog Transplant 2022; 32:285-291. [PMID: 36039525 DOI: 10.1177/15269248221122897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction: Pain following donor nephrectomy for living kidney donation is common. In Israel, non-directed, altruistic donations account for 45% of all kidney transplants. Design: This cross-sectional, retrospective survey included 2 groups of donors derived from the data of Israel Transplant, namely directed and non-directed, altruistic donors, who donated between 2015 to 2018. The degree of recalled pain memory post-surgery was assessed using the Visual Analog Scale at 5 time points: immediately post-surgery, after 1 week, 1 month and 3 months post-surgery and in the month preceding completion of the questionnaire. In addition, continued requirement for analgesics for more than one-month post-surgery, the degree of interference with daily activities in the month preceding the questionnaire and the recalled time to return to full-time employment were also noted. Results: In total, 246 (131 directed and 115 non-directed, altruistic) donors were included in the study. Non-directed, altruistic donors reported statistically significantly lower degrees of recalled pain memory at all time points, a lower requirement for prolonged analgesic use and less recalled interference with daily activities due to pain. In addition, these donors recalled returning significantly earlier to full-time employment. Finally, no significant differences in the degree of recalled pain memory were noted for directed donors according to their relation to the recipient, apart from donation to a spouse. Conclusion: These unique findings, if validated in a prospective study, could provide important information to potential non-directed, altruistic donors regarding the expected level of post-surgical pain and their return to full-time employment.
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Affiliation(s)
- Eyal Katvan
- Bar Ilan University, Ramat-Gan, Israel, and Peres Academic Center, Rehovot, Israel.,Israel Transplant, Tel Aviv, Israel
| | | | - Ruth Rahamimov
- Department of Nephrology and Hypertension, Rabin Medical Center, Petach Tikva, Israel.,Department of Organ Transplantation, Rabin Medical Center, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Two significant concepts in organ donation: Empathic tendency and altruism. Transpl Immunol 2022; 75:101731. [DOI: 10.1016/j.trim.2022.101731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 11/05/2022]
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Kong S. Examining the Effect of Self-Determined Appeal Organ Donation Messages and Respective Underlying Mechanism. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10619. [PMID: 36078336 PMCID: PMC9518106 DOI: 10.3390/ijerph191710619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
This study examined how intrinsic motivation and its respective underlying mechanism influence people's attitude and intentions of organ donation. The findings revealed the importance of meeting people's customized psychological needs. For the general population, especially non-organ donors, autonomous appeal message will be more effective in promoting their intention of becoming an organ donor. For registered organ donors, competence-based organ donation messages are more effective in increasing their promotion and seeking behavior of organ donation. This study also discovered underlying mechanisms of intrinsic motivation, such as self-integrity, pride, and sympathy. Pairing underlying mechanism with competence-based messages can maximize the message impact.
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Affiliation(s)
- Sining Kong
- Department of Communication and Media, College of Liberal Arts, Texas A&M University at Corpus Christi, Corpus Christi, TX 78412, USA
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12
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Mitchell SL, Clark MK. Rethinking nonprofit service disintermediation through service communication interactions. JOURNAL OF SERVICE MANAGEMENT 2022. [DOI: 10.1108/josm-10-2021-0401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeA significant management issue for nonprofit organisations (NPOs) is the disconnect between services beneficiaries and the funders of those services. Individual donors and fundraisers provide the resources to enable other people (or animals) to be supported. The purpose of this paper is to address this service management challenge through new types of customer service interactions that bring together service donors and service recipients through innovative digital communication.Design/methodology/approachBased on a review, and illustrated by recent examples of innovative best practice, the authors develop a new conceptual framework for understanding the relationship between customer participation and service brand communication.FindingsThe paper starts by identifying the problem of “nonprofit service disintermediation”. The paper also outlines the inadequacies of popular frameworks of communication, widely taught in business schools, to understand the new reality of customer-service organisation engagement in the digital age. Through adopting a customer engagement lens, the paper develops a new conceptual framework for understanding the relationship between customer participation and service brand communication.Research limitations/implicationsGiven the authors’ focus on the intersection between new communication opportunities and customer service interactions, this paper adds novel insight to theory and raises important implications for management.Originality/valueThe paper explores how, through these new communication interactions, engagement with, and loyalty to, the brand is built over time in a fluid and dynamic way. It identifies a disintermediated relationship, distinct to other service contexts, but significant in terms of value and social impact.
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Mental Health and Well-Being of Solid Organ Transplant Donors. The Forgotten Sacrifices. TRANSPLANTOLOGY 2021. [DOI: 10.3390/transplantology2030026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In light of a global organ shortage, living donor transplantation has become increasingly relevant as an alternative to deceased donor transplantation. While current research has revolved around the medical aspects of transplantation, there remains a paucity of literature regarding the quality of life (QOL) of living donors. Hence, this review aims to provide a comprehensive outline of the current landscape of living liver and kidney transplantation, with a focus on the mental health and wellbeing of donors. As highlighted in previous studies, organ donation has a significant impact on both physical and mental aspects of donor wellbeing, with marked deteriorations occurring in the short term. Furthermore, other qualitative aspects such as financial burden contribute greatly to donor distress, reflecting a need for improved donor care. To address these pertinent issues, recommendations for a successful transplant program are detailed in this review, which encompasses psychological and social aspects of donor care throughout the donation process. Further research can be done on the impact of recipient deaths on donor QOL and appropriate interventions. Overall, given the selfless sacrifices of living donors, the care of their mental wellbeing is essential. Therefore, greater emphasis should be placed on the provision of adequate psychosocial support for them.
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14
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Anonymous Living Liver Donation: Literature Review and Case Series Report. Transplant Direct 2021; 7:e726. [PMID: 34291148 DOI: 10.1097/txd.0000000000001181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/24/2021] [Accepted: 04/27/2021] [Indexed: 12/24/2022] Open
Abstract
Background Anonymous living liver donations (ALLDs) raise ethical concerns regarding the donors' motivations. Thus, ALLDs are not as widely accepted as directed donations from friends and family. Literature on ALLDs is limited. Understanding this particular group of individuals is crucial, as they could further help mitigate the shortage of liver grafts worldwide. Methods A literature review was performed to identify current definitions, ethical considerations, different approaches, and barriers to ALLD worldwide. Furthermore, we present our current experience after the establishment of a protocol to enable an ALLD program in our center and surveyed potential donors to better understand their motives throughout the process. Results Literature regarding ALLD is scarce. Canada leads the experience with the majority of case reports published to date. Survey-based evaluation of this unique group of individuals reflects the selflessness nature of anonymous living donors and shows that most of them experience the donation as a positive and life-changing event. In our experience, 41 individuals initiated the process of ALLD during the study period. Most were lost to follow-up or deemed ineligible. Five candidates fully completed the donation process and successfully underwent living liver donation. Given that 2 candidates have a follow-up period <3 mo from donation, we have only included data on the first 3 donors in this analysis. Eight individuals (19.5%) responded to the survey with respondents sharing similar reasons for initiating ALLD but varied and multifactorial reasons for terminating. Conclusions Different institutional protocols can be used to accomplish ALLD, including the one utilized by our institution. Adopting policies to allow for ALLDs and reducing modifiable factors that contribute to ending donation has the potential to increase grafts and decrease wait times.Supplemental Visual Abstract: http://links.lww.com/TP/C251.
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15
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Nguyen NT, Maxwell AP, Donnelly M, O'Neill C. The role of motivational and legal contexts in understanding support for tissue donation across 27 European countries. Eur J Public Health 2021; 31:259-264. [PMID: 33024999 DOI: 10.1093/eurpub/ckaa148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There is a mismatch between attitudinal support for tissue donation and its translation into behavioural action (i.e. become registered donor). The legal and motivational context around tissue donation may contribute to better understanding of this mismatch. METHODS Data were extracted from the Eurobarometer 82.2 survey (2014). Data included socio-demographic characteristics, motivations underlying attitudes to tissue donation and the legal context within which donation was considered (opt-in and opt-out consent). The sample was partitioned based on contextual information and seemingly unrelated bivariate probit regressions were used to explore the relationship between passive and active support for tissue donation. RESULTS Approximately 56% of 25 879 respondents stated a willingness to donate tissue after death (passive support) and 9.1% reported that they were a registered donor (active support). We found evidence of unobserved heterogeneity between active and passive support across contexts. Our findings suggest that contexts in which altruistic motives can be supported by self-interest may increase the probability of converting passive to active support. Factors associated with increased support for tissue donation included: higher levels of education; good knowledge of the healthcare system; confidence in the safety of tissue donation; readiness to be a tissue recipient and knowing a recipient of donated tissue. CONCLUSIONS Our findings demonstrate the value of examining active and passive support for tissue donation together within specific contexts. This more nuanced approach affords clearer insights that may help to guide policy makers confronted with apparently conflicting evidence around strategies intended to promote organ and tissue donation.
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Affiliation(s)
- Nga Tq Nguyen
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Alexander P Maxwell
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,Regional Nephrology Unit, Belfast City Hospital, Belfast, UK
| | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Ciaran O'Neill
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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16
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Thomas R, Consolo H, Oniscu GC. Have we reached the limits in altruistic kidney donation? Transpl Int 2021; 34:1187-1197. [PMID: 34008872 DOI: 10.1111/tri.13921] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 01/05/2023]
Abstract
Altruistic donation (unspecified donation) is an important aspect of living donor kidney transplantation. Although donation to a stranger is lawful and supported in many countries, it remains uncommon and not actively promoted. Herein, we ask the question if we have reached the limit in altruistic donation. In doing so, we examine important ethical questions that define the limits of unspecified donation, such as the appropriate balance between autonomous decision-making and paternalistic protection of the donor, the extent of outcome uncertainty and risk-benefit analyses that donors should be allowed to accept. We also consider the scrutiny and acceptance of donor motives, the potential for commercialization, donation to particular categories of recipients (including those encountered through social media) and the ethical boundaries of active promotion of unspecified kidney donation. We conclude that there is scope to increase the number of living donation kidney transplants further by optimizing existing practices to support and promote unspecified donation. A number of strategies including optimization of the assessment process, innovative approaches to reach potential donors together with reimbursement of expenses and a more specific recognition of unspecified donation are likely to lead to a meaningful increase in this type of donation.
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Affiliation(s)
- Rachel Thomas
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK
| | | | - Gabriel C Oniscu
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK.,Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK
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van Daal M, Muntinga ME, Steffens S, Halsema A, Verdonk P. Sex and Gender Bias in Kidney Transplantation: 3D Bioprinting as a Challenge to Personalized Medicine. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2020; 1:218-223. [PMID: 33786482 PMCID: PMC7784814 DOI: 10.1089/whr.2020.0047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 05/26/2020] [Indexed: 12/17/2022]
Abstract
In this article, we explore to what extent sex and gender differences may be reproduced in the 3D bioprinting of kidneys. Sex and gender differences have been observed in kidney function, anatomy, and physiology, and play a role in kidney donation and transplantation through differences in kidney size (sex aspect) and altruism (gender aspect). As a form of personalized medicine, 3D bioprinting might be expected to eliminate sex and gender bias. On the basis of an analysis of recent literature, we conclude that personalized techniques such as 3D bioprinting of kidneys alone do not mean that sex and gender bias does not happen. Therefore, sex and gender considerations should be included into every step of developing and using 3D-bioprinted kidneys: in the choice of design, cells, biomaterials, and X-chromosome-activated cells.
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Affiliation(s)
- Manon van Daal
- Department Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC-VUmc, Amsterdam, The Netherlands
| | - Maaike E. Muntinga
- Department Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC-VUmc, Amsterdam, The Netherlands
| | - Sandra Steffens
- Department of Curriculum Development, Hannover Medical School, Hannover, Germany
| | - Annemie Halsema
- Faculty of Humanities/Philosophy, Amsterdam VU, Amsterdam, The Netherlands
| | - Petra Verdonk
- Department Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC-VUmc, Amsterdam, The Netherlands
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18
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El-Menyar A, Al-Thani H, Mehta T, Varughese B, Al-Maslamani Y, Mekkodathil AA, Singh R. Beliefs and Intention to Organ Donation: A Household Survey. Int J Appl Basic Med Res 2020; 10:122-127. [PMID: 32566529 PMCID: PMC7289197 DOI: 10.4103/ijabmr.ijabmr_108_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/01/2019] [Accepted: 01/17/2020] [Indexed: 11/04/2022] Open
Abstract
Background Organ transplantation is considered as the last therapeutic option for the treatment for end-stage organ failure. However, the gap between the demand and supply of transplantable organs is still wide. Extensive researches have been conducted to understand this gap, and many countries have introduced Opt-out laws and have started targeted awareness programs. We aimed to assess, among the household residents, the normative behavior and beliefs and its correlation to intentions toward becoming organ donors. Subjects and Methods A household survey with the resident population of Qatar was conducted from October 2016 to November 2016. A sample of 1044 individuals aged 18 and above, residing in eight municipalities within the country, was selected using a two-stage systematic random sampling method to understand the relationship between organ donation intentions and behavioral, normative, and control beliefs. Independent female enumerators collected data on electronic tablets and exported to SPSS for data analysis. Results Data from 930/1044 (89%) individuals responded to the intention-related questions were taken for final analysis. Multivariate analysis brought out that behavioral beliefs (standardized beta coefficient = 0.25, t = 6.5, P = 0.001) and normative beliefs (standardized beta coefficient = 0.32, t = 8.4, P = 0.001) were significant contributors to intention to donate organs whereas control beliefs (standardized beta coefficient = -0.07, t = -2.3, P = 0.02) were negatively associated to organ donation intention. Conclusions Findings indicate that behavioral and normative beliefs play a very important role in contributing to the intention of the individual toward organ donation.
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Affiliation(s)
- Ayman El-Menyar
- Department of Surgery, Trauma and Vascular Surgery, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma and Vascular Surgery, Doha, Qatar
| | - Tulika Mehta
- Department of Surgery, Trauma Surgery, Psychology, Hamad Medical Corporation, Doha, Qatar
| | - Betsy Varughese
- Department of Medicine, Research Section, Hamad Medical Corporation, Doha, Qatar
| | - Yousuf Al-Maslamani
- Department of Surgery, Transplant Section, Hamad General Hospital, Doha, Qatar
| | | | - Rajvir Singh
- Cardiology Research Center, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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Monday OI. Is altruism always sufficient for organ donation? vroom's expectancy theory, for expanding the organ donor pool. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2020; 31:503-507. [PMID: 32394924 DOI: 10.4103/1319-2442.284026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Organ transplantation is perhaps one area in which scientists have accomplished stunning outcomes in the 21st century. Nonetheless, the shortage of organs remains a major challenge of medical science, and worldwide, thousands of human organs are buried every day, especially from cerebrum-dead-injury victims. Using a method of philosophical analysis, this viewpoint study contends that the root cause of organ shortage is the dependence solely on altruistic organ donations. The unselfish organ donation is good, yet it is not enough. To close the gap between the demand and supply of organs, steps need to be taken to improve the organ donation pool. The Victor Vroom's expectancy theory, if applied, could expand the organ donor pool for transplantation.
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20
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Kool E, van der Graaf R, Bos A, Fauser B, Bredenoord A. What constitutes a reasonable compensation for non-commercial oocyte donors: an analogy with living organ donation and medical research participation. JOURNAL OF MEDICAL ETHICS 2019; 45:736-741. [PMID: 31375547 PMCID: PMC6860404 DOI: 10.1136/medethics-2019-105474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/02/2019] [Accepted: 07/16/2019] [Indexed: 05/08/2023]
Abstract
There is a growing consensus that the offer of a reasonable compensation for oocyte donation for reproductive treatment is acceptable if it does not compromise voluntary and altruistically motivated donation. However, how to translate this 'reasonable compensation' in practice remains unclear as compensation rates offered to oocyte donors between different European Union countries vary significantly. Clinics involved in oocyte donation, as well as those in other medical contexts, might be encouraged in calculating a more consistent and transparent compensation for donors if the elements that constitute a reasonable compensation are explicated. In doing so, lessons can be learnt from living organ donation and medical research participation. Practices in which the elements of a reasonable compensation for the individuals involved have already been more defined in the literature. By means of analogical reasoning, we will outline the different components of a reasonable compensation and subsequently apply these to the context of oocyte donation. We will argue that oocyte donors should first of all be reasonably reimbursed direct expenses related to the donation, without standard remuneration of lost wages. Second, donating oocytes requests a serious time investment, therefore donors are entitled to suitable compensation for their time spent and efforts made. Finally, we will explain that a reasonable compensation consisting of these two components allows for altruism to remain the key value of oocyte donation for reproductive treatment. However, if we acknowledge that donors' motives are more complex and often include reasons from self-interest, the reasonable compensation may be complemented with modest (non)monetary benefits.
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Affiliation(s)
- Emy Kool
- Medical Humanities, Julius Center for Health Sciences and Primary Care Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rieke van der Graaf
- Medical Humanities, Julius Center for Health Sciences and Primary Care Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annelies Bos
- Reproductive Medicine and Gynecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Bartholomeus Fauser
- Reproductive Medicine and Gynecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Annelien Bredenoord
- Medical Humanities, Julius Center for Health Sciences and Primary Care Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
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21
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Ferguson E, Murray C, O’Carroll RE. Blood and organ donation: health impact, prevalence, correlates, and interventions. Psychol Health 2019; 34:1073-1104. [DOI: 10.1080/08870446.2019.1603385] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Eamonn Ferguson
- School of Psychology, University of Nottingham, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Catherine Murray
- Division of Psychology, University of Stirling, Stirling, Scotland
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22
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Gonzalo J, Perul M, Corral M, Caballero M, Conti C, García D, Vassena R, Rodríguez A. A follow-up study of the long-term satisfaction, reproductive experiences, and self-reported health status of oocyte donors in Spain. EUR J CONTRACEP REPR 2019; 24:227-232. [DOI: 10.1080/13625187.2019.1588960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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23
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Boylan AR, Locock L, Machin L. From waste product to blood, brains and narratives: developing a pluralist sociology of contributions to health research. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:585-600. [PMID: 29493796 PMCID: PMC6446731 DOI: 10.1111/1467-9566.12715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The aim of this paper is to examine the meaning of the concept of donation in health research. Drawing on a set of narrative interviews with people invited to donate biosamples for research and a range of other studies, we identify several conceptual themes that speak to the complexity of the current landscape of critical thinking about donation. These conceptual themes are: the language of 'donation'; a hierarchy of biosamples; alternative informational value; narratives as donation; coincidental donation, convenience and degree of invasiveness; and rights, consent and benefits of research participation. We call for a reconceptualisation of research donation to encompass not only the numerous types of sample readily classed as donations, but also other types of data and contributions, including narrative interviews, psychometric data, patient-reported outcome measures, record-linkage, and time and effort. We argue for the development of a pluralist sociology of research donations, and suggest that a 'sociology of research contributions' might better capture this complexity.
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Affiliation(s)
- Anne‐Marie R. Boylan
- Health Experiences Research Group (HERG), Nuffield Department of Primary Care, Health SciencesUniversity of OxfordUK
| | - Louise Locock
- Health Services Research UnitUniversity of AberdeenUK
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24
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Heru A. Should narrative coherence be considered in the assessment of motivation in the non-directed kidney donation? Gen Hosp Psychiatry 2018; 55:1-3. [PMID: 30153558 DOI: 10.1016/j.genhosppsych.2018.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 11/17/2022]
Abstract
Donating a kidney to a stranger is known as a Good Samaritan, altruistic, or non-directed donation. Living donation is the only instance in medicine where the "do-no-harm" dictum is intentionally violated. Healthcare professionals 'doing the harm' are ethically responsible to ensure the lowest risk for both the physical and psychological health of the potential donor. To this end, experts in the transplant community published Guidelines for the Psychosocial Evaluation of Living Unrelated Kidney Donors in the United States [1]. These Guidelines focus on the identification of risk and protective factors, and basic principles underlying informed consent and outlined a recommended process for donor evaluation. The components of the evaluation include a comprehensive history and current status, capacity to consent, psychological status, relationship to recipient, motivation, donor knowledge and understanding, social support, and financial suitability. The case of a donor, Ms. Angelo, is presented because her responses during evaluation raised questions about how best to understand her motivation. My proposal is that altruism and motivation are best understood by considering the narrative coherence in the donor's story.
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Affiliation(s)
- Alison Heru
- Department of Psychiatry, University of Colorado Hospital, University of Colorado School of Medicine, 13001 East 17th Place Room 2317, Aurora, Colorado 80045, United States..
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25
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Saunders B. How altruistic organ donation may be (intrinsically) bad. JOURNAL OF MEDICAL ETHICS 2018; 44:681-684. [PMID: 29921619 DOI: 10.1136/medethics-2018-104817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/13/2018] [Accepted: 05/22/2018] [Indexed: 06/08/2023]
Abstract
It has traditionally been assumed that organ donation must be altruistic, though the necessity of altruistic motivations has recently been questioned. Few, however, have questioned whether altruism is always a good motive. This paper considers the possibility that excessive altruism, or self-abnegation, may be intrinsically bad. How this may be so is illustrated with reference to Tom Hurka's account of the value of attitudes, which suggests that disproportionate love of one's own good-either excessive or deficient-is intrinsically bad. Whether or not we accept the details of this account, recognising that altruistic motivations may be intrinsically bad has important implications for organ procurement. One possible response is to say that we should take further measures to ensure that donors have good motives-that they are altruistic is no longer enough. An alternative is to say that, since altruistic donation need not be intrinsically good, we have less reason to object to other motivations.
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26
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Ferguson E, Zhao K, O'Carroll RE, Smillie LD. Costless and Costly Prosociality: Correspondence Among Personality Traits, Economic Preferences, and Real-World Prosociality. SOCIAL PSYCHOLOGICAL AND PERSONALITY SCIENCE 2018. [DOI: 10.1177/1948550618765071] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Prosociality can either be costly (e.g., donating to charity) or costless (e.g., posthumous organ donation). Whereas links between personality and costly prosociality have been explored, links with costless prosociality and personality are at present unknown. We address this in two studies: Study 1 ( N = 200) confirms the distinction between costless and costly prosociality based on willingness to engage with health and nonhealth prosociality. Study 2, using data from four samples (student and community; N = 733) shows, across incentivized and hypothetical economic games to assess costless (generosity game [GG]) and costly (dictator game [DG]) prosociality, that organ donor behavior was linked to greater allocations in the GG and that charity/volunteering behavior was linked to greater allocations in the DG. Costless and costly prosocialities are associated with different personality traits (e.g., costly with politeness and compassion and costless with intellect). Implications for cooperative phenotypes and recruiting organ donors are discussed.
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Affiliation(s)
- Eamonn Ferguson
- School of Psychological Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Kun Zhao
- The University of Melbourne, Melbourne, Australia
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27
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Wongboonsin K, Jindahra P, Teerakapibal S. The Influence of Neighbor Effect and Urbanization Toward Organ Donation in Thailand. Prog Transplant 2017; 28:49-55. [PMID: 29243539 DOI: 10.1177/1526924817746684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Toward population wellness, an extreme scarcity of organ supply is proven to be an enormous hindrance. Preferences toward organ donation are vital to raise the organ donation rate. Notably, the area people live in can address the social influence on individual preference toward organ donation. RESEARCH QUESTIONS This article studies the impact of the neighbor effect on organ donation decisions, addressing the social influence of urbanization on preferences. How neighborhood-specific variables, population density, and socioeconomic status drive the neighbor effect is investigated. The pursuit of organ donor traits is to be answered. DESIGN The study uses organ donation interview survey data and neighborhood-specific data from Thailand to estimate a series of logistic regression models. RESULTS Individuals residing in urban areas exhibit a greater likelihood to sign the donor card than those in rural areas. The neighborhood socioeconomic status is the key driver. An individual is more willing to be an organ donor when having neighbors with higher socioeconomic statuses. Results also reveal positive influences of males and education on the organ donation rate. DISCUSSION This article documents the "neighbor effect" on the organ donation decision via living area type, offering an alternative exposition in raising the organ donation rate. In shifting the society norm toward organ donation consent, policy-makers should acknowledge the benefit of urbanization on organ donation decision derived from resourceful urban areas. Moreover, raising education levels does improve not only citizens' well-being but also their tendency to exhibit an altruistic act toward others.
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Affiliation(s)
- Kua Wongboonsin
- 1 Sasin Graduate Institute of Business Administration, Chulalongkorn University, Bangkok, Thailand
| | - Pavitra Jindahra
- 2 Sasin Graduate Institute of Business Administration, Chulalongkorn University, Bangkok, Thailand
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28
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Pauli J, Basso K, Ruffatto J. The influence of beliefs on organ donation intention. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2017. [DOI: 10.1108/ijphm-08-2016-0040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Recent technological developments in healthcare have enabled an increased number of organ transplantation surgeries. At the same time, there is an increase in the number of people awaiting organ transplant, coupled with the difficulty in donation. To bridge this gap, this study aims to propose to evaluate the effect of three types of beliefs (clinical beliefs, financial incentive beliefs and beliefs on the social benefits of altruism and solidarity) on the intention to donate organs. Moreover, this paper uses the attitudes in relation to donation to explain the effect of these beliefs on the intention to donate organs.
Design/methodology/approach
The research was conducted using a survey of 422 Brazilian participants and a mediation analysis to test the mediation hypotheses.
Findings
The results suggest that the effect of three types of beliefs (clinical, economic order and social solidarity) influence the intention to donate organs indirectly through the formation of attitudes concerning organ donation.
Research limitations/implications
This article contributes to the understanding of the formation of organ donation intentions and the role of different types of beliefs in the formation of such intentions.
Originality/value
The findings extend the discussions regarding the role of beliefs in the formation of attitudes and intentions of organ donation and have significant value in creating public policies that further promote organ donation.
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29
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Thornton V. Lives and choices, give and take: Altruism and organ procurement. Nurs Ethics 2017; 26:587-597. [PMID: 28745573 DOI: 10.1177/0969733017710985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In 2015, Wales introduced a deemed consent: soft opt-out system for organ procurement in order to address the chronic shortage of organs for transplant. Early statistical evidence suggests that this has had a positive impact on cadaveric organ donation. Such a system for procurement has previously been dismissed by the Organ Donation Taskforce, who suggested that opting out could potentially undermine the concept of donated organs as gifts and this could then negatively impact the number of organs offered for transplant. Considerable weight was placed upon the need to retain the altruistic gift element associated with an opt-in system. This article will consider the role of altruism in an organ procurement policy. A broad utilitarian approach will be taken when putting forward the arguments in favour of adopting a weak altruism position in a soft opt-out system for procurement with a combined registry.
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30
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Ashall V, Hobson‐West P. 'Doing good by proxy': human-animal kinship and the 'donation' of canine blood. SOCIOLOGY OF HEALTH & ILLNESS 2017; 39:908-922. [PMID: 28164318 PMCID: PMC5516241 DOI: 10.1111/1467-9566.12534] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This article demonstrates the relevance of animals to medical sociology by arguing that pet owners' accounts of veterinary decision-making can highlight key sociological themes which are important to both human and animal health. Based on semi-structured interviews, the article argues that interspecies 'kinship' allows for the extension of sociological claims regarding altruism, self-interest and mutuality from human blood donation to companion animal blood 'donation'. Furthermore, this study extends sociological understanding of the human-animal bond by showing how the dog's status as kin meant they were expected to donate blood, and that the act of donation itself represents an important opportunity for family 'display'. However, owners who do not or cannot donate blood themselves describe pet blood donation as an opportunity to lessen associated feelings of guilt or obligation through 'doing good by proxy'. These findings raise critical sociological and ethical questions concerning the risks and benefits of donation, and for how we understand third-party decision making. Finally, the article argues for the close entanglement of human and animal health, and concludes that sociologists of health and medicine should explore the radical possibility that decision-making in healthcare more generally might be influenced by experiences at the veterinary clinic, and vice versa. (A Virtual Abstract of this paper can be viewed at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA).
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Affiliation(s)
- Vanessa Ashall
- Centre for Applied BioethicsSchool of Veterinary Medicine and ScienceUniversity of Nottingham
| | - Pru Hobson‐West
- Centre for Applied BioethicsSchool of Veterinary Medicine and ScienceUniversity of Nottingham
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31
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Zhao K, Ferguson E, Smillie LD. Prosocial Personality Traits Differentially Predict Egalitarianism, Generosity, and Reciprocity in Economic Games. Front Psychol 2016; 7:1137. [PMID: 27555824 PMCID: PMC4977318 DOI: 10.3389/fpsyg.2016.01137] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 07/18/2016] [Indexed: 11/13/2022] Open
Abstract
Recent research has highlighted the role of prosocial personality traits-agreeableness and honesty-humility-in egalitarian distributions of wealth in the dictator game. Expanding on these findings, we ran two studies to examine individual differences in two other forms of prosociality-generosity and reciprocity-with respect to two major models of personality, the Big Five and the HEXACO. Participants (combined N = 560) completed a series of economic games in which allocations in the dictator game were compared with those in the generosity game, a non-constant-sum wealth distribution task where proposers with fixed payoffs selected the size of their partner's payoff ("generosity"). We further examined positive and negative reciprocity by manipulating a partner's previous move ("reciprocity"). Results showed clear evidence of both generosity and positive reciprocity in social preferences, with allocations to a partner greater in the generosity game than in the dictator game, and greater still when a player had been previously assisted by their partner. There was also a consistent interaction with gender, whereby men were more generous when this was costless and women were more egalitarian overall. Furthermore, these distinct forms of prosociality were differentially predicted by personality traits, in line with the core features of these traits and the theoretical distinctions between them. HEXACO honesty-humility predicted dictator, but not generosity allocations, while traits capturing tendencies toward irritability and anger predicted lower generosity, but not dictator allocations. In contrast, the politeness-but not compassion-aspect of Big Five agreeableness was uniquely and broadly associated with prosociality across all games. These findings support the discriminant validity between related prosocial constructs, and have important implications for understanding the motives and mechanisms taking place within economic games.
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Affiliation(s)
- Kun Zhao
- Melbourne School of Psychological Sciences, The University of Melbourne, MelbourneVIC, Australia
| | - Eamonn Ferguson
- School of Psychology, University of NottinghamNottingham, UK
| | - Luke D. Smillie
- Melbourne School of Psychological Sciences, The University of Melbourne, MelbourneVIC, Australia
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32
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Ummel D, Achille M. Transplant Trajectory and Relational Experience Within Living Kidney Dyads. QUALITATIVE HEALTH RESEARCH 2016; 26:194-203. [PMID: 25700284 DOI: 10.1177/1049732315570128] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Living kidney donation is considered common practice across most Westernized countries. While extensive research has documented the experience of living donors, few studies have addressed the perspective of recipients, and even fewer have examined the experience of donor and recipient as an interactive dyad. In this study, our aim was to examine the reciprocal influence between donors and recipients across the transplantation process. We recruited a homogeneous sample of 10 donors and recipients, who were interviewed individually. Data were analyzed using interpretative phenomenological analysis. The presentation of results follows the stages of the transplantation process: the disease experience, the experience of offering and accepting a kidney, the screening period, the surgery, and the post-transplantation period. Results are discussed within the framework of Mauss's gift exchange theory, social roles, and altruism. This comprehensive description of the dyadic experience provides a way to frame and understand psychosocial aspects and relational implications of living renal transplantation.
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Affiliation(s)
- Deborah Ummel
- Department of psychology, Université de Montréal, Montréal, Québec, Canada
| | - Marie Achille
- Department of psychology, Université de Montréal, Montréal, Québec, Canada
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33
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Moorlock G. Directed altruistic living donation: what is wrong with the beauty contest? JOURNAL OF MEDICAL ETHICS 2015; 41:875-879. [PMID: 26126975 PMCID: PMC4680184 DOI: 10.1136/medethics-2014-102230] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 03/03/2015] [Accepted: 06/08/2015] [Indexed: 06/04/2023]
Abstract
This paper explores the specific criticism of directed altruistic living organ donation that it creates a 'beauty contest' between potential recipients of organs. The notion of the beauty contest in transplantation was recently used by Neidich et al who stated that '[a]ltruism should be the guiding motivation for all donations, and when it [is], there is no place for a beauty contest'. I examine this beauty contest objection from two perspectives. First, I argue that, when considered against the behaviour of donors, this objection cannot be consistently raised without also objecting to other common aspects of organ donation. I then explore the beauty contest objection from the perspective of recipients, and argue that if the beauty contest is objectionable, it is because of a tension between recipient behaviour and the altruism that supposedly underpins the donation system. I conclude by briefly questioning the importance of this tension in light of the organ shortage.
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Abstract
In 2008 the Australian Government introduced a national reform agenda to increase organ and tissue donation. Australia continues to perform poorly by international standards on measures of organ procurement, however. This paper outlines three proposals to improve donation rates and considers the empirical evidence available for each. A number of ethical objections frequently given to resist such proposals are also addressed. Firstly, it is recommended that Australia implement an 'opt-out' system of organ donation. Secondly, the existing veto rules should be changed to better protect the wishes of those who wish to donate. Finally, a numer of incentives should be offered to increase donation rates; these could include incentives of financial value, but also non-financial incentives such as prioritisation for the receipt of organs for previous donors.
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Affiliation(s)
- William Isdale
- University of Queensland, St Lucia, Australia. .,Uehiro Centre for Practical Ethics, Oxford University, Oxford, UK.
| | - Julian Savulescu
- Uehiro Centre for Practical Ethics, Oxford University, Oxford, UK.,Monash University, Clayton, Australia
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35
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Abstract
This paper explores problems associated with using altruism as the central value in gamete donation, and in doing so draws on empirical data that sheds light on why gamete donors choose to donate. Donation of bodily material is, arguably, supposed to be motivated by altruism, and this is the view taken by many European governments. Other values are often ignored or rejected as morally inappropriate. This paper analyses some conceptual and practical problems with the use of altruism as the motivation to determine moral acceptability-drawing on empirical data that suggests gamete donors are not motivated purely by altruism, and that motivations are in fact quite complex. Two problems are first analysed: (1) how do we distinguish altruistic from non-altruistic donations and (2) how do we distinguish between removing barriers and providing incentives. A final question, triggered by the Nuffield Council on Bioethics' report, is whether the meaning of the payment should be decided on the basis of an a priori definition or on the basis of the donors' subjective experience. It is concluded that there are different legitimate core values in donation, which should be balanced. In order to value the good generated by donation, donors with mixed motives should be accepted, as long as helping others is an important motive and also features in their motivation.
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Affiliation(s)
- Guido Pennings
- Department of Philosophy and Moral Science, Bioethics Institute Ghent (BIG), Ghent University, Blandijnberg 2, 9000, Ghent, Belgium,
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Fortin MC. Is the Canadian Legal Framework Too Restrictive and Based on False Premises? Can J Kidney Health Dis 2014; 1:8. [PMID: 25780603 PMCID: PMC4349664 DOI: 10.1186/2054-3581-1-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 05/16/2014] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marie-Chantal Fortin
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
- Bioethics Program, Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montreal, Canada
- Nephrology and Transplantation Division, Centre hospitalier de l'Université de Montréal (CHUM), 1560 Sherbrooke Street East, Montreal, Quebec H2L 4M1, Canada
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