Consenting options for posthumous organ donation: presumed consent and incentives are not favored

BMC Medical Ethics

Eman Al-Gaai²  Abdelraheem Ahmed²  Hala Amer²  Sumaya Hammami²  Abdullah Eissa²  Kristine A Concepcion²  Hunaida M Abdulhameed²  Muhammad M Hammami¹ 

[1] Alfaisal University college of Medicine, Riyadh, Saudi Arabia;Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh, 11211, Saudi Arabia

关键词: Gender difference;    Financial incentive;    Medical incentives;    Informed consent;    Presumed consent;    Mandated choice;    Norm perception;    Preference;    Islamic ethics;    Organ donation;   

Others  :  800009
DOI  :  10.1186/1472-6939-13-32

 received in 2012-06-13, accepted in 2012-11-15,  发布年份 2012

【 摘 要 】

Background

Posthumous organ procurement is hindered by the consenting process. Several consenting systems have been proposed. There is limited information on public relative attitudes towards various consenting systems, especially in Middle Eastern/Islamic countries.

Methods

We surveyed 698 Saudi Adults attending outpatient clinics at a tertiary care hospital. Preference and perception of norm regarding consenting options for posthumous organ donation were explored. Participants ranked (1, most agreeable) the following, randomly-presented, options from 1 to 11: no-organ-donation, presumed consent, informed consent by donor-only, informed consent by donor-or-surrogate, and mandatory choice; the last three options ± medical or financial incentive.

Results

Mean(SD) age was 32(9) year, 27% were males, 50% were patients’ companions, 60% had ≥ college education, and 20% and 32%, respectively, knew an organ donor or recipient. Mandated choice was among the top three choices for preference of 54% of respondents, with an overall median[25%,75%] ranking score of 3[2,6], and was preferred over donor-or-surrogate informed consent (4[2,7], p < 0.001), donor-only informed consent (5[3,7], p < 0.001), and presumed consent (7[3,10], p < 0.001). The addition of a financial or medical incentive, respectively, reduced ranking of mandated choice to 7[4,9], p < 0.001, and 5[3,8], p < 0.001; for donor-or-surrogate informed consent to 7[5,9], p < 0.001, and 5[3,7], p = 0.004; and for donor-only informed consent to 8[6,10], p < 0.001, and 5[3,7], p = 0.56. Distribution of ranking score of perception of norm and preference were similar except for no-organ donation (11[7,11] vs. 11[6,11], respectively, p = 0.002). Compared to females, males more perceived donor-or-surrogate informed consent as the norm (3[1,6] vs. 5[3,7], p < 0.001), more preferred mandated choice with financial incentive option (6[3,8] vs. 8[4,9], p < 0.001), and less preferred mandated choice with medical incentive option (7[4,9] vs. 5[2,7], p < 0.001). There was no association between consenting options ranking scores and age, health status, education level, or knowing an organ donor or recipient.

Conclusions

We conclude that: 1) most respondents were in favor of posthumous organ donation, 2) mandated choice system was the most preferred and presumed consent system was the least preferred, 3) there was no difference between preference and perception of norm in consenting systems ranking, and 4) financial (especially in females) and medical (especially in males) incentives reduced preference.

【 授权许可】

   
2012 Hammami et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Clark PAC: Financial Incentives for Cadaveric Organ Donation: An Ethical Analysis. The Internet Journal of Law, Healthcare and Ethics; 2006:4(1).
• [2]Sheehy E, Conrad SL, Brigham LE, Luskin R, Weber P, Eakin M, Schkade L, Hunsicker L: Estimating the number of potential organ donors in the United States. N Engl J Med 2003, 349(7):667-74.
• [3]Kingdom of Saudi Arabia. Ministry of Health: Center for Organ Transplantation. Annual Report 2008. Available at Saudi Center for Organ Transplantation. [http://www.scot.org.sa/en/ webcite], accessed 10 June 2012
• [4]Abadie A, Gay S: The impact of presumed consent legislation on cadaveric organ donation: a cross-country study. J Health Econ 2006, 25(4):599-620.
• [5]English V, Sommerville A: Presumed consent for transplantation: a dead issue after Alder Hey? J Med Ethics 2003, 29:147-152.
• [6]Mossialos E, Costa-Font J, Rudisill C: Does organ donation legislation affect individuals’ willingness to donate their own or their relative’s organs? Evidence from European Union Survey data. BMC Health Serv Res 2008, 8:48. BioMed Central Full Text
• [7]Chouhan P, Draper H: Modified mandated choice for organ procurement. J Med Ethics 2003, 29:157-162.
• [8]Payment Subcommittee of the United Network for Organ Sharing Ethics Committee, 2–3http://www.unos.org/resources/bioethicsasp?index = 3 webcite
• [9]Larijani B, Sadeghi S, Jessri M, Zahedi F: Financial incentives in organ transplantation: ethical views. Iran J Allergy Asthma Immunol 2007, 6(Suppl. 5):39-45.
• [10]Wright L: Is presumed consent the answer to organ shortage? No. BMJ 2007, 334:1089.
• [11]Pierscionek BK: What is presumed when we presume consent? BMC Med Ethics 2008, 9:8. BioMed Central Full Text
• [12]Lawson A: Presumed consent for organ donation in the United Kingdom. JICS 2008, 9(2):116-117.
• [13]Akrami SM, Osati Z, Zahedi F, Raza M: Brain death: recent ethical and religious considerations in Iran. Transplant Proc 2004, 36:2883-2887.
• [14]Golmakani MM, Niknam MH, Hedayat KM: Transplantation ethics from the Islamic point of view. Med Sci Mont 2005, 11(4):RA105-109.
• [15]Dworkin R: Life’s dominion. Vintage Books, New York; 1993:199-213.
• [16]Glannon W: Do the sick have a right to cadaveric organs? J Med Ethics 2003, 29:153-156.
• [17]Fabre C: Whose body is it anyway? Justice and the Integrity of the Person. Oxford University Press, Oxford; 2006:72-96.
• [18]Kass LR: Organs for sale? Propriety, property and the price of progress. In Bioethics. 4th edition. Edited by Shannon TA. Paulist Press, NJ, USA; 1993:468-488.
• [19]Björkman B, Hansson SO: Bodily rights and property rights. J Med Ethics 2006, 32:209-214.
• [20]Charlesworth M: Bioethics in a liberal society. Cambridge. University Press, Cambridge; 1993:14.
• [21]Young L, Saxe R: It’s not just what you do, but what’s on your mind: a review of Kwame Anthony Appiah’s “Experiments in Ethics”. Neuroethics 2010, 3:201-207.
• [22]Randhawa G, Brocklehurst A, Pateman R, Kinsella S, Parry V: Faith leaders united in their support for organ donation: findings from the UK organ donation taskforce study. Transpl Int 2010, 23(2):140-6.
• [23]Altraif IH, Al Sebayel MI, Nondo H: knowledge and attitude towards organ donation among males in Riyadh, Saudi Arabia. Saudi J Kidney Dis Transpl 1996, 7(2):135-8.
• [24]Alam AA: Public opinion on organ donation in Saudi Arabia. Saudi J Kidney Dis Transplant 2007, 18(1):54-59.
• [25]Naçar M, Cetinkaya F, Baykan Z, Poyrazoğlu S: Attitudes and behaviors of students from the faculty of theology regarding organ donation: a study from Turkey. Transplant Proc 2009, 41(10):4057-61.
• [26]Saleem T, Ishaque S, Habib N, Hussain SS, Jawed A, Khan AA, Ahmad MI, Iftikhar MO, Mughal HP, Jehan I: Knowledge, attitudes and practices survey on organ donation among a selected adult population of Pakistan. BMC Med Ethics 2009, 10:5. BioMed Central Full Text
• [27]Berlinger N, Wu AW: Subtracting insult from injury: addressing cultural expectations in the disclosure of medical error. J Med Ethics 2005, 31(2):106-8.
• [28]Daar SA, Khitamy A: Bioethics for clinicians: 21. Islamic bioethics CMAJ 2001, 164(1):60-63.
• [29]The Meanings of The Holy Qur'an by Abdullah Yusufali [http://www.islam101.com/quran/yusufAli/index.htm webcite]. Accessed June 2012
• [30]Al-Faqih SR: The influence of Islamic views on public attitudes towards kidney transplant donation in a Saudi Arabian community. Public Health 1991, 105(2):161-5.
• [31]Al-Ghanim SA: The willingness toward deceased organ donation among university students. Implications for health education in Saudi Arabia. Saudi Med J 2009, 30(10):1340-5.
• [32]El-Shoubaki H, Bener A: Public knowledge and attitudes toward organ donation and transplantation: a cross-cultural study. Transplant Proc 2005, 37(5):1993-1997.
• [33]Odusanya OO, Ladipo CO: Organ donation: knowledge, attitudes, and practice in Lagos. Nigeria. Artif Organs 2006, 30:626-9.
• [34]Wong LP: Knowledge, attitudes, practices and behaviors regarding deceased organ donation and transplantation in Malaysia’s multi-ethnic society: a baseline study. Clin Transplant 2011.
• [35]Bilgel H, Sadikoglu G, Goktas O, Bilgel N: A survey of the public attitudes towards organ donation in a Turkish community and of the changes that have taken place in the last 12 years. Transpl Int 2004, 17(3):126-30.
• [36]Spital A: Mandated choice: the preferred solution to the organ shortage? Arch Intern Med 1992, 152:2421-4.
• [37]Griffith R, Tengnah C: Consent to organ donation part 1: the current arrangements. BrJ Community Nurs 2009, 14(12):544-7.
• [38]Saunders B: Normative consent and opt-out organ donation. J Med Ethics 2010, 36(2):84-87.
• [39]Emson HE: It is immoral to require consent for cadaver organ donation. J Med Ethics 2003, 29:125-127.
• [40]Harris J: Organ procurement: dead interests, living needs. J Med Ethics 2003, 29:130-134.
• [41]Spital A: Obtaining consent for organ donation: what are our options? Best practice & research clinical anaesthesiology 1999, 13(2):179-193.
• [42]Siminoff LA, Mercer MB: Public policy, public opinion, and consent for organ donation. Camb Q Healthc Ethic 2001, 10(40):377-386.
• [43]Rithalia A, McDaid C, Suekarran S, Norman G, Myers L, Sowden A: A systematic review of presumed consent systems for deceased organ donation. Health Technol Assess 2009., 13(26)
• [44]Randhawa G, Brocklehurst A, Pateman R, Kinsella S, Parry V: 'Opting-in or opting-out?'–the views of the UK's faith leaders in relation to organ donation. Health Policy 2010, 96(1):36-44.
• [45]Rithalia A, McDaid C, Suekarran S, Myers L, Sowden A: Impact of presumed consent for organ donation on donation rates: a systematic review. BMJ 2009, 338:a3162.
• [46]Horvat LD, Cuerden MS, Kim SJ, Koval JJ, Young A, Garg AX: Informing the debate: rates of kidney transplantation in nations with presumed consent. Ann Intern Med 2010, 153:641-9.
• [47]Truog RD: Consent for organ donation–balancing conflicting ethical obligations. N Engl J Med 2008, 358(12):1209-11.
• [48]Zink S, Werlieb SL: Forced altruism is not altruism. Am J Bioethics 2004, 4:29-31.
• [49]Translation of Sahih Bukhari. Translator: M. Muhsin Khan[http://www.shariahprogram.ca/Hadith/Sahih-Bukhari/001-1.sbt.html webcite]. Accessed 11 June 2012
• [50]McKneally M: Letter reply. J Thorac cardiovasc Surg 2003, 126:2108.
• [51]Arnold R, Barlett S, Bernat J: Financial incentives for cadaver organ donation: an ethical reappraisal. Transplantation 2002, 73(8):1361-7.
• [52]American Medical Association Council on Ethical and Judicial Affairs: Council on Ethical and Judicial Affairs report 124, cadaveric organ donation: encouraging the study of motivation (1-A-02). The Association, Chicago; 2002.
• [53]Bruzzone P: Financial incentives for organ donation: a slippery slope toward organ commercialism? Transplant P 2010, 42(4):1048-49.
• [54]Fan VY, Lin SC, Salhi C: Reply to the editor. Lancet 2010, 376:231.
• [55]Byrne MM, Thompson P: A positive analysis of financial incentives for cadaveric organ donation. J Health Economics 2001, 20:69-83.
• [56]Haddow G: "Because you're worth it?" The taking and selling of transplantable organs. J Med Ethics 2006, 32:324-328.
• [57]Alghanim SA: Knowledge and attitudes toward organ donation: a community-based study comparing rural and urban populations. Saudi J Kidney Transpl 2010, 21(1):23-30.
• [58]Satel S: “Death’s waiting list,”. New York Times, New York Times; 2006. May 15, 2006. http://www.nytimes.com/2006/05/15/opinion/15satel.html?r=1&th=&oref=slogin&emc=t webcite
• [59]Delmonico FL, Arnold R, Scheper-Hughes N, Siminoff LA, Kahn J, Youngner SJ: Ethical incentives – not payment – for organ donation. N Engl J Med 2002, 346:2002-2005.
• [60]Gill MB: Presumed consent, autonomy, and organ donation. J Med Philos 2004, 29:37-59.
• [61]Wilkinson R: Organ donation: the debate. Nurs Stand 2000, 14:41-2.
• [62]Hammami MM, Attalah S, Al Qadire M: Which Medical Error to Disclose to Patients and by Whom? Public Preference and Perceptions of Norm and Current Practice. BMC Med Ethics 2010, 11:17. BioMed Central Full Text
• [63]Al-Qadire MM, Hammami MM, Abdulhameed HM, Al Gaai EA: Saudi views on consenting for research on medical records and leftover tissue samples. BMC Med Ethics 2010, 11:18. BioMed Central Full Text
• [64]Morgan M, Adams OP, Seed PT, Jones R: Ethnicity and attitudes to deceased kidney donation: a survey in Barbados and comparison with black Caribbean people in United Kingdom. BMC Public Health 2010, 10:266. BioMed Central Full Text