Lee Shepherd

An international comparison of deceased and living organ donation/transplant rates in opt-in and opt-out systems: a panel study

BackgroundPolicy decisions about opt-in and opt-out consent for organ donation are based on limited evidence. To fill this gap we investigated the difference between deceased and living organ donation rates in opt-in and opt-out consent systems across a 13 year period. We controlled for extensive covariates and estimated the causal effect of consent with instrumental variables analysis.MethodThis panel study used secondary data analysis to compare organ donor and transplant rates in 48 countries that had either opt-in or opt-out consent. Organ donation data were obtained over a 13-year period between 2000 and 2012. The main outcome measures were the number of donors, number of transplants per organ and total number (deceased plus living) of kidneys and livers transplanted. The role of consent on donor and transplant rates was assessed using multilevel modeling and the causal effect estimated with instrumental variables analysis.ResultsDeceased donor rates (per-million population) were higher in opt-out (M = 14.24) than opt-in consent countries (M = 9.98; χ = -4.27, 95% confidence interval (CI) = -8.08, -0.45, P = .029). However, the number of living donors was higher in opt-in (M = 9.36) than opt-out countries (M = 5.49; B = 3.86, 95% CI = 1.16, 6.56, P = .006). Importantly, the total number of kidneys transplanted (deceased plus living) was higher in opt-out (M = 28.32) than opt-in countries (M = 22.43; B = -5.89, 95% CI = -11.60, -0.17, P = .044). Similarly, the total number of livers transplanted was higher in opt-out (M = 11.26) than opt-in countries (M = 7.53; B = -3.73, 95% CI = -7.47, 0.01, P = .051). Instrumental variables analysis suggested that the effect of opt-in versus opt-out consent on the difference between deceased and living donor rates is causal.ConclusionsWhile the number of deceased donors is higher than the number of living donors, opt-out consent leads to a relative increase in the total number of livers and kidneys transplanted.

Do affective attitudes predict organ donor registration? A prospective study

This study assessed whether people’s affective attitudes predicted organ donor registration at a later time. People who were not registered as an organ donor prior to completing the study (N = 150) first rated their affective attitudes towards organ donation. We then measured whether they clicked on a hyperlink to register as an organ donor. Believing that the body should be kept whole for burial (bodily integrity) was the only affective attitude to predict this organ donation behaviour. Future campaigns should target this concern in order to increase organ donor registration and the availability of donor organs.

Awareness of legislation moderates the effect of opt-out consent on organ donation intentions.

Background With the worldwide shortage of organs to meet the demand for transplants, many countries are considering whether introducing opt-out consent would increase the availability of donor organs. This research assessed whether people’s willingness to donate their organs for transplant purposes was greater in opt-out than opt-in countries and whether such effects were moderated by people’s awareness of their nation’s legislative system. Methods Using secondary data from the 2010 Eurobarometer (n=29,288), this study compared people’s willingness to donate their organs in a representative sample from 19 opt-out and 10 opt-in consent countries from across Europe. Results The majority of participants (66.04%) stated that they were willing to donate their organs for transplant purposes. The proportion of people who were willing to donate their organs did not differ between opt-in (65.97%) and opt-out (66.37%) countries. However, the effect of consent on willingness to donate was moderated by people’s awareness of their nation’s organ donation legislation. When people were aware of their nation’s legislation, the proportion of people who were willing to donate their organs was greater in opt-out (85.26%) than opt-in (80.72%) countries. By contrast, when people were not aware of their nation’s legislation, there was no difference in people’s willingness to donate their organs in opt-in (58.63%) and opt-out (59.23%) countries. Conclusions Opt-out consent countries should increase people’s awareness of their legislation to improve donor rates. Further research is needed to understand the factors that moderate the effect of opt-out consent legislation on organ donation.

Increasing organ donation via anticipated regret (INORDAR): protocol for a randomised controlled trial

BackgroundThroughout the world there is an insufficient supply of donor organs to meet the demand for organ transplantations. This paper presents a protocol for a randomised controlled trial, testing whether a simple, theory-based anticipated regret manipulation leads to a significant increase in posthumous organ donor registrations.MethodsWe will use a between-groups, prospective randomised controlled design. A random sample of 14,520 members of the adult Scottish general public will be contacted via post. These participants will be randomly allocated into 1 of the 4 conditions. The no questionnaire control (NQC) group will simply receive a letter and donor registration form. The questionnaire control (QC) arm will receive a questionnaire measuring their emotions and non-cognitive affective attitudes towards organ donation. The theory of planned behavior (TPB) group will complete the emotions and affective attitudes questionnaire plus additional items assessing their cognitive attitudes towards organ donation, perceived control over registration and how they think significant others view this action. Finally, the anticipated regret (AR) group will complete the same indices as the TPB group, plus two additional anticipated regret items. These items will assess the extent to which the participant anticipates regret for not registering as an organ donor in the near future. The outcome variable will be NHS Blood and Transplant verified registrations as an organ donor within 6 months of receiving our postal intervention.DiscussionThis study will assess whether simply asking people to reflect on the extent to which they may anticipate regret for not registering as an organ donor increases organ donor registration 6 months later. If successful, this simple and easy to administer theory-based intervention has the potential to save lives and money for the NHS by reducing the number of people receiving treatments such as dialysis. This intervention may also be incorporated into future organ donor campaigns.Trial registration numberISRCTN: ISRCTN92204897

When do next-of-kin opt-in? Anticipated regret, affective attitudes and donating deceased family member's organs.

This research assessed whether affective factors promote and prevent family members from donating their loved one’s organs. Participants (N = 191) imagined that a family member had died and that they had to decide whether or not to donate their organs and body parts for transplantation purposes. The least organs and body parts were donated when the deceased opposed donation. Moreover, participants who were not registered organ donors donated fewer organs than registered donors. This effect was mediated by anticipated regret, disgust and the perceived benefits of donation. Organ donation campaigns should target such factors to increase donor rates.

The role of STI-related attitudes on screening attendance in young adults.

Abstract This study assessed whether attitudes towards STI screening, visiting a clinic and having an STI (STI stigma) predict STI screening attendance in young adults. Participants (N = 217) rated each of these attitudes and completed measures assessing their STI knowledge, past sexual behaviour and sexual health. STI stigma and having favourable attitudes towards STI screening positively predicted screening attendance. People were less likely to attend if they had a negative attitude towards visiting sexual health clinics. Researchers should assess attitudes towards the attitude object (screening), condition (STI stigma) and process (visiting a clinic) to understand the different ways that attitudes predict behaviour.

The role of social–cognitive and emotional factors on testicular self‐examination

This study determined the role of social–cognitive and affective factors in promoting testicular self‐examination.

The role of fear in predicting sexually transmitted infection screening

Objective: This study assessed the extent to which social-cognitive factors (attitude, subjective norm and perceived control) and the fear of a positive test result predict sexually transmitted infection (STI) screening intentions and subsequent behaviour. Design: Study 1 (N = 85) used a longitudinal design to assess the factors that predict STI screening intention and future screening behaviour measured one month later at Time 2. Study 2 (N = 102) used an experimental design to determine whether the relationship between fear and screening varied depending on whether STI or HIV screening was being assessed both before and after controlling for social-cognitive factors. Main Outcome Measures: Across the studies the outcome measures were sexual health screening. Results: In both studies, the fear of having an STI positively predicted STI screening intention. In Study 1, fear, but not the social-cognitive factors, also predicted subsequent STI screening behaviour. In Study 2, the fear of having HIV did not predict HIV screening intention, but attitude negatively and response efficacy positively predicted screening intention. Conclusion: This study highlights the importance of considering the nature of the health condition when assessing the role of fear on health promotion.

The role of social-cognitive and emotional factors on exclusive breastfeeding duration

Background: Previous research has suggested that exclusive breastfeeding is likely to be predicted by social-cognitive variables and fear. However, there is little research assessing the role of regret and self-conscious emotions (e.g., pride and guilt) in promoting exclusive breastfeeding. Research aim: The primary aim of this research was to determine whether social-cognitive variables, fear, regret, and self-conscious emotions predict exclusive breastfeeding duration. The secondary aim of this research was to assess whether these factors predict infant-feeding choice (i.e., exclusively breastfed, combination fed, or generally formula fed). Methods: In this nonexperimental one-group self-report survey, 375 mothers rated social-cognitive variables toward breastfeeding (attitude, subjective norm, perceived control, and self-efficacy), their fear toward inadequate nutrition from breastfeeding and breastfeeding damaging their physical appearance, and the extent to which mothers may feel pride toward breastfeeding and negative self-conscious emotions (guilt and shame) and regret for not breastfeeding their infant. Results: Exclusive breastfeeding duration was positively predicted by self-efficacy, pride, and regret but negatively predicted by the fear toward inadequate nutrition. We also found that in contrast with exclusive breastfeeding, generally formula feeding an infant was associated with lower self-efficacy, pride, and regret but higher subjective norm and fear toward inadequate nutrition through breastfeeding. Conclusion: The authors argue that it is important to consider the role of self-conscious emotions and regret on exclusive breastfeeding.

Responding to Sexual Objectification: The Role of Emotions in Influencing Willingness to Undertake Different Types of Action

Women may respond to being sexual objectified in different ways, such as confronting the perpetrator, ignoring the action, blaming oneself or considering the action as flattering. However, there has been little research looking at what predicts each of these different responses. The present research assessed the role of emotions in promoting and deterring different anticipated responses to sexual objectification. In both Studies 1 (n = 189) and 2 (n = 187), female participants were asked to imagine themselves in a situation where they received an inappropriate sexual comment. Participants then rated the emotions they believed they would feel and how they thought they would act in the situation. I found that expecting feelings of anger resulted in women thinking they would confront the perpetrator (i.e., undertake an active response) and that expecting disgust negatively predicted the belief that they would view the action as flattering (i.e., anticipate a benign response). By contrast, expecting shame resulted in women believing they would blame themselves (i.e., undertake a self-blame response). Study 2 also found that expecting pride was positively associated with anticipating a benign response. These findings suggest that the emotions that women expect to feel influence their anticipated responses to sexual objectification. It is, therefore, important to consider the emotional reactions that women have to instances of sexual objectification.