Body-Part Donation

The following is an excerpt from “More about Generosity: An Addendum to the Generosity, Social Psychology and Philanthropy Literature Reviews,” (University of Notre Dame, July 7, 2009).

Achille, Marie, John Soos, Marie-Chantal Fortin, Michel Pâquet, Marie-Josée Hébert. 2007. “Differences in psychosocial profiles between men and women living kidney donors.” Clinical Transplantation 21(3):314-320.

Background: The expansion of kidney transplantation by living donation has led to a disproportional increase in the women to men ratio among donors and this difference cannot be explained on the basis of medical exclusion. The present study was designed to test whether women donors are more likely to (i) display altruistic and gender-typed nurturing behaviour and (ii) be subtly influenced by family pressure to donate and less able to resist this pressure.

Methods: All 71 (61% women) individuals who had donated a kidney at our centre between 1995 and 2005 were sent a survey. Thirty-nine individuals (71% response rate; 64% female participation) filled out and returned the survey, which included standardized measures of altruism, self-esteem, family dynamics and endorsement of gender-stereotyped roles, as well as sociodemographic questions and questions about donation.

Results: Findings show no difference between women and en in terms of the psychological attributes measured. One woman and two men reported having felt pressure to donate, and 92% of women compared with 54% of men reported having felt free to change their mind. Men took longer than women to make the decision to donate.

Conclusions: Results suggest that among individuals who have already donated, there is no evidence that women may be more inclined to donate than man because of differences in their psychosocial profiles or because they may be more vulnerable to family pressure. Future research may gain from focusing on men and women donors and non-donors in families where transplantation is being considered.

Ahmed, S.G., U.A. Ibrahim, A.W. Hassan. “Adequacy and pattern of blood donations in north-eastern Nigeria: the implications for blood safety.” Annals of Tropical Medicine and Parasitology, 101(8):725-731.

In a retrospective analysis, the quantities, patterns and adequacy of blood donations made, between 1984 and 2006, at the University of Maiduguri Teaching Hospital in north-eastern Nigeria were explored and related to blood safety in the study area. The types of blood donor were reviewed and the annual increments in the number of donations made were estimated and compared with the annual increments in the numbers of in-patients managed at the study hospital. The mean annual increment in the number of blood donations (4%) fell well below the mean annual increment in in-patient numbers (11%). The blood donations received at the hospital fell into four types: voluntary, family-replacement, commercial and pre-deposit autologous donations. Over the study period, the percentage of donations falling into the voluntary and family-replacement categories fell from 31% to 5% and from 49% to 23%, respectively. These falls were matched by increases in the percentages of donations categorised as commercial and autologous, which rose from 20% to 63%, and from 1% to 9%, respectively. By the end of the study period, the quantity of blood being donated at the hospital was grossly inadequate and predominantly derived from family and commercial donors, who were found to be generally inferior, in terms of blood safety, to voluntary donors. There is an urgent need to rectify this situation by setting up a functional and national blood-transfusion service in Nigeria.

Alessandrini, Megan. 2007. “Community volunteerism and blood donation: Altruism as a lifestyle choice.” Transfusion Medicine Reviews 21(4):307-316.

Volunteering behavior is culturally based and occurs at different rates in different geographical locations. Although it might be assumed that the links between volunteering and the practice of blood donation would be strong, the reasons for this are less obvious. Blood collection in Australia is conducted exclusively by the Australian Red Cross Blood Service, a non-governmental human service organization with links to the Australian Red Cross. This article is based on research conducted in Australia in 2004, which makes comparisons with the motivations disclosed by blood donors in Canada and the European Union. Whereas some respondents derive benefit from volunteering by experiencing a sense of social connection, others make no such claim. More blood donors feel a responsibility to help others, regardless of personal connection to those receiving the assistance. Furthermore, more blood donors than former blood donors and non-donors have parents who are or were volunteers. Blood donors are represented in greater numbers as having volunteered during their school years too.

Bekkers, Rene. 2008. “Straight from the heart.” Advances in Medical Sociology 10:197-221.

This study seeks to answer the question of whether donations to the Dutch Heart Association are a form of solidarity of the healthy with the sick. In doing so, I test hypotheses on the origins of charitable donations in awareness of need in conjunction with dispositional empathic concern, social networks & own health. Methodology — I report probit, tobit & multinomial regression analyses on data from the Giving in the Netherlands Panel Survey (20022004; n=1,246) on donations to the Dutch Heart Association & other health charities. Findings — I find that experience with cardiovascular diseases is associated with a higher likelihood of donating to the Dutch Heart Association, especially among those with higher levels of empathic concern & social responsibility, & among those who are not in excellent health themselves. Support for the Dutch Heart Association comes from those who are aware of the need for contributions & more easily imagine themselves in a situation similar to those of heart patients. Research limitations/implications — The results confirm the role of empathic concern, explore the role of own health & seem to reject the role of ties to family members. The study is limited to the Dutch Heart Association. Future research should test whether these results can be generalized to donations to other charitable causes. Originality/value of chapter — This study contributes to our knowledge on charitable donations, revealing new insights on the influence of awareness of need. Adapted from the source document.

Bekkers, Rene, and Ingrid Veldhuizen. 2008. “Geographical differences in blood donation and philanthropy in the Netherlands: What role for social capital?” Tijdschrift voor Economische en Sociale Geografie 99(4):483-496.

The key question addressed in this paper is whether geographical differences in blood donation and philanthropy reflect differences in social capital. We do find considerable spatial variation in blood donation and philanthropy between municipalities in the Netherlands. But we do not find that blood donation and philanthropy have strong or even moderately positive relations with each other or with indicators of prosocial norms and engagement in voluntary associations. However, voter turnout is strongly related to both blood donation and philanthropy. We conclude that the spatial variation in blood donation and philanthropy is not due to differences in social capital. Adapted from the source document.

Boulware, L.E., M. U. Troll, N.-Y. Wang, N. R. Powe. 2007. “Perceived transparency and fairness of the organ allocation system and willingness to donate organs: A national study.” American Journal of Transplantation 7(7):1778-1787.

The influence of perceptions of organ allocation on willingness to donate organs is unclear. We performed a national study assessing the relation of public perceptions of organ allocation to willingness to donate organs, and we assessed the contribution of beliefs regarding discrimination in health care to observed associations. Among 845 participants, a majority (65%) reported that they less than “mostly” understand allocation, and most (71%) reported that they believe allocation is “unfair” or are “unsure” of its fairness. Participants reporting less understanding were less willing to donate (56%) than persons reporting greater understanding (67%) (p < 0.01). Participants believing allocation is “unfair” or who are “unsure” about fairness were less willing to donate (54%) than persons believing allocation is “fair” (68%) (p < 0.01). Associations were stronger among certain demographic subgroups. Participants with the least favorable perceptions of allocation were more likely than their counterparts to believe that race and income discrimination occur in transplantation and to believe that they personally experienced income discrimination in health care. Adjustment for these beliefs partially attenuated associations between perceptions regarding allocation and willingness to donate. Interventions enhancing transparency and perceived fairness of organ allocation may improve willingness to donate, particularly if they address concerns regarding discrimination in transplantation and health care.

Burditt, Caitlin, Mark L. Robbins, Andrewa Paiva, Wayne F. Velicer, Beryl Koblin and Debra Kessler. 2009. “Motivation for blood donation among African Americans: developing measures for stage of change, decisional balance, and self-efficacy constructs.” Journal of Behavioral Medicine. SpringerLink.×41lm1670628806.

Despite a specific need for transfused blood among African Americans due to higher rates of sickle cell disease, African Americans donate blood significantly less frequently than their White counterparts. This study describes the development and validation of culturally adapted measures of the transtheoretical model (TTM) constructs of Stage of Change, Decisional Balance, and Self-efficacy applied to blood donation in an African American sample. Exploratory and confirmatory analyses produced one pros and two cons scales for the Decisional Balance Inventory, and one scale for the Situational Self-efficacy Measure. Expected patterns for the Decisional Balance and Self-efficacy Scales by Stage of Change were found, but only the pros and one cons scale varied significantly. Results provide support for use of the TTM applied to blood donation and have important implications for development of effective assessment and intervention tools to increase blood donation among the African American population.

Cantarovich, Félix, Ricardo Heguilén, Mario Abbud Filho, Valter Duro-Garcia, Robert Fitzgerald, David Mayrhofer-Reinhartshuber, Maria-Luisa Lavitrano, Vincent L. M. Esnault. 2007. “An international opinion poll of well-educated people regarding awareness and feelings about organ donation for transplantation.” Transplant International 20(10):512-518.

Despite repeated campaigns promoting transplantation, the high donation refusal rate remains unchanged. We targeted a well-educated population to assess the impact of our current transplantation promoting programs and personal feelings toward new approaches to organ donation. A questionnaire was proposed in five universities to students and university staffs that would have been likely to benefit from previous information campaigns in two South American and three European countries. All of the 2321 people interviewed replied to at least one question. Organ shortage was considered as a serious public health issue. However, there was a widespread ignorance of religious precepts concerning transplantation that contributed to the low acceptance rate of organ sharing after death. Financial rewards for donors or their families remain controversial. There was a general agreement for early educational programs in schools. Most people still consider organ donation as a gift, but many would now agree to readily share body parts after death. This biased population of well-educated people has still little knowledge of organ donation. The negative impact of ignorance surrounding religious precepts and the high acceptance rate of educational programs in schools, justify supporting an intensive international effort in education that should also include Church leaders.

Cavazzini, Martina, and Chiari di Clemente. 2007. “Talking with Senegalese immigrants in Pisa about gift-giving and blood donation.” Religioni e Societa 22:56-68.

This article is the first report of a research concerning blood donation among Senegalese immigrants in Pisa. The first part discusses the concept of gift & the practices of mutual solidarity in traditional Senegalese culture. The authors focus in particular on the institution of teranga, a set of rules concerning mutual, socially horizontal & anonymous aid. In the second part, the authors discuss Senegalese attitudes toward blood donation in their homeland & in Italy. They show a great generosity in front of emergence situations, but a little disposition to participate in regular & rationalized blood donations. Adapted from the source document.

_Dalsgaard, Steffen. 2007. “’I Do It For The Chocolate’: An Anthropological Study of Blood Donation in Denmark.” Distinktion: Scandinavian Journal of Social Theory 14:101-117._

In this article, blood donation in Denmark is analysed with the theoretical perspective on exchange developed by Pierre Bourdieu. In most western countries blood donation is based on free donations given by voluntary donors to an unknown recipient. However, this supposedly non-economic donation cannot be seen isolated from the wider web of bioeconomical relations in which it is embedded. In the blood bank donors are met with hospitality and small counter-prestations also highlighting it as part of a symbolic economy. Ethnographic data mainly consisting of interviews and observations collected at a blood bank can thus with Bourdieu be said to show the relationship between donor and bank as one that is maintained and characterized by strategies of reciprocity employed by blood bank personnel to ensure that donors keep coming back. These strategies are essential in the social construction of the ideas of altruism and the ‘pure gift’. Finally the article elaborates on Bourdieu’s contribution to the debate on the gift by discussing the importance of the acceptance and reception of the gift itself.

Ferguson, Eamonn, Kathleen Farrell, and Claire Lawrence. 2008. “Blood donation is an act of benevolence rather than altruism.” Health Psychology 27(3):327-336.

Objectives: Blood donation is described as an archetypal altruistic behavior, and recruitment/retention campaigns emphasize altruism. Here, a benevolence hypothesis for blood donation (both the donor and recipient benefit) rather than the altruism hypothesis (only the recipient gains) is proposed. Design: Three United Kingdom-based studies contrasted benevolence and altruism: (a) a 6-month prospective study of blood donor behavior (Study 1: N = 957), (b) a cross-sectional study of blood donors’ intentions (Study 2: N = 333), and © an experimental study examining the effect of benevolent and altruistic messages on willingness to help across high- and low-cost helping behaviors for committed and noncommitted blood donors (Study 3: N = 200). Main Outcome: Donor behavior and intentions-willingness. Measures: Beliefs in personal and societal benefit (Time 1) and actual donations (Time 2) were assessed in Study 1; beliefs in benevolence, altruism, hedonism, and kinship along with donation intentions were assessed in Study 2; and empathy, donor commitment, and willingness to donate blood, money, fund-raise, and staff a telephone helpline were assessed in Study 3. Results: Beliefs in personal rather than societal benefit predicted actual future donation. A path model showed that only beliefs in benevolence were associated with intentions to donate. Committed blood donors were more willing to donate blood when exposed to a benevolent message rather than an altruistic one. This effect was not observed for other forms of helping. Conclusions: The benevolence hypothesis is supported, suggesting that blood donor motivation is partly selfish. Blood donation campaigns should focus on benevolent rather than purely altruistic messages.

Gillum, F., A. F. Eder, T. L. McLaurin-Jones. 2008. “Hispanic ethnicity, race and blood donation in the United States.” Transfusion Medicine 18(6):366-370.

The aim of this study was to assess the hypothesis that blood donation rates vary with Hispanic ethnicity (family origin in Spanish-speaking countries) in addition to race in the United States. Lower blood donation rates have been reported among African Americans (AAs) compared with non-Hispanic European Americans (EAs). Adequate published reports on donation rates are not available for Hispanic Americans (HAs). Using data from a 2002 national survey, which included 4923 men and 7600 women aged 15–44 years with complete data, we tested the hypothesis using weighted bivariate and multivariate statistics. Among men aged 25–44 years, the percentage [95% confidence limits (95% CL)] with a history of blood donation since 1985 was similar at ages 25–34 years (46%, 42–49) and 35–44 years (41%, 37–45). It was highest in non-Hispanic EA (49%, 45–52%), intermediate in AA (35%, 30–40%) and lowest in HA (30%, 25–36%) (P < 0·001). Other variables significantly (P < 0·01) associated with history of blood donation in bivariate analyses were nativity (United States/other), education (<12/≥12 years), poverty (<200%/≥200% poverty limit) and married (yes/no). Variables that are not significantly associated were age, metropolitan residence (yes/no), receipt of public assistance (yes/no), current labour-force participation (yes/no) and religion raised. Compared with non-Hispanic EA, the adjusted odds ratios were essentially the same for Hispanics 0·66 (95% CL 0·47–0·92) and AAs 0·64 (95% CL 0·49–0·84). Only 34% of women had donated blood, but the association with race/ethnicity was similar. Similar patterns were also seen at ages 15–24 years. HAs and AAs have similar low blood donation rates compared with non-Hispanic EAs. The difference is not explained by sociodemographic variables.

Glaw, Xanthe Meryn, Therese M. Garrick, Peter J. Terwee, Jo R. Patching, Helen Blake, and Clive Harper. 2009. “Brain donation: who and why?” Cell and Tissue Banking. SpringerLink.

Understanding what influences people to donate, or not donate, body organs and tissues is very important for the future of transplant surgery and medical research (Garrick in J Clin Neurosci 13:524–528, 2006). A previous web-based motivation survey coordinated by the New South Wales Tissue Resource Centre found that most people who participated in brain donation were young, female, educated Australians, not affiliated with any particular religion, and with a higher prevalence of medical illness than the general Australian population. It discussed the main motivating factors for brain donation to be “the benefits of the research to medicine and science”. This study has been replicated in a paper-based version to capture a broader cross-section of the general population, to find out who they are and what motivates them to donate. All consented and registered brain donors (n = 1,323) were sent a questionnaire via the post and recipients were given 3 months to complete the questionnaire and return it in a reply paid envelope. Results were entered into the original web-based survey and analyzed using SPSS version 10. Six hundred and fifty-eight questionnaires were returned completed, a response rate of 53%. The results show that people from all age groups are interested in brain donation. The over 65’s are the largest of the groups (30.7%). The majority of the participants were female (60.6%), married (49.2%) with children (65.8%), employed (52.9%) and have a tertiary education (73.3%). They were either non-religious (48.2%) or Christian (41.6%) and were mostly Australian (65.4%). Most (81%) had pledged to donate other organs and tissues for transplantation. The most commonly cited reasons for the donation were to benefit science (27.6%), to benefit medicine (23.9%), a family illness (17.5%) and to benefit the community (16.6%). This study demonstrates that people across all age groups are interested in brain donation. Recruitment of new brain donors could target the over 65 female Australians, who are not religious or Christian and who have also donated other organs and tissues for transplant purposes. It also indicates the need to make donation for research part of the national transplant donation program.

Godin, Gaston, Paschal Sheeran, Mark Conner, and Marc Germain. 2008. “Asking questions changes behavior: Mere measurement effects on frequency of blood donation.” Health Psychology 27(2):179-194.

Objective: This research examined the impact of completing a questionnaire about blood donation on subsequent donation behavior among a large sample of experienced blood donors. DESIGN: Participants (N=4672) were randomly assigned to an experimental condition that received a postal questionnaire measuring cognitions about donation or a control condition that did not receive a questionnaire. MAIN OUTCOME MEASURES: Number of registrations at blood drives and number of successful blood donations were assessed using objective records both 6 months and 12 months later. RESULTS: Findings indicated that, compared to control participants, the mean frequency of number of registrations at blood drives among participants in the experimental group was 8.6% greater at 6 months (p<.0.007), and was 6.4% greater at 12 months (p<.035). Significant effects were also observed for successful blood donations at 6 months (p<.001) and 12 months (p<.004). CONCLUSION: These findings provide the first evidence that the mere measurement is relevant to promoting consequential health behaviors. Implications of the research for intervention evaluation are discussed.

Goette, Lorenz, and Alois Stutzer. 2008. “Blood donations and incentives: Evidence from a field experiment.” Working Paper No. 08-3, Federal Reserve Bank of Boston, Boston, MA.

There is a longstanding concern that material incentives might undermine prosocial motivation, leading to a decrease in blood donations rather than an increase. This paper provides an empirical test of how material incentives affect blood donations in a large-scale field experiment spanning three months and involving more than 10,000 previous donors. We examine two types of incentive: a lottery ticket and a free cholesterol test. Lottery tickets significantly increase donations, in particular among less motivated donors. The cholesterol test leads to no discernable impact on usable blood donations. If anything, it creates a small negative selection effect in terms of donations that must be discarded.

Goncalez, Thelma T., Ester C. Sabino, Sanny Chen, Nanci Alves Salles, Dalton Chamone, Willie McFarland, and Edward L. Murphy. 2008. “Knowledge, Attitudes and Motivations Among Blood Donors in São Paulo, Brazil.” AIDS and Behavior 12(4Suppl):S39-47.

Recruiting safe, volunteer blood donors requires understanding motivations for donating and knowledge and attitudes about HIV. We surveyed 1,600 persons presenting for blood donation at a large blood bank in São Paulo, Brazil using a self-administered, structured questionnaire, and classified motivations into three domains as well as categorizing persons by HIV test-seeking behavior. Motivations, in descending order, and their significant associations were: “altruism”: female gender, volunteer donor and repeat donor status; “direct appeal”: female gender, repeat donor status and age 21–50 years; “self-interest”: male gender, age under 20 years, first-time donor status and lower education. HIV test-seekers were more likely to give incorrect answers regarding HIV risk behavior and blood donation and the ability of antibody testing to detect recent HIV infections. Altruism is the main motivator for blood donation in Brazil; other motivators were associated with specific demographic subgroups. HIV test-seeking might be reduced by educational interventions.

Gunderman, Richard B. 2008. “Giving ourselves: the ethics of anatomical donation.” Anatomical Sciences Education 1(5):217-219.

In some European countries, such as Italy, medical education is threatened by a dearth of anatomical specimens. Such a shortage could spread to other nations, including the United States. This article addresses two ethical questions in body donation. Why might people choose to donate their bodies to education and science? What sorts of ethical appeals might anatomists, physicians, and other health professionals make to patients and family members for anatomical donation? Two models of giving, egoistic and liberal, merit close examination.

Gyllström Krekula, Linda, Silvia Malenicka, Margareta Linder, Annika Tibel. 2009. “From words to action – influence of two organ donation campaigns on knowledge and formal decision making.” Clinical Transplantation 23(3):343-350.

Introduction: In Sweden, two donation campaigns have been carried out; one short term (STC) during October 2001, and one long term (LTC) between the years 2003–2005. The goal was not only to inform the public but also to create a positive attitude, make people talk about donation and formally declare their decision.

Methods: The effects of the two campaigns were evaluated through three opinion polls.

Results: The willingness to donate was widespread (86%) before and after the campaigns. The LTC increased the knowledge of the Donor Card (24–35%, p < 0.001) and the National Donor Registry (19–40%, p < 0.001). The LTC focused on making people register, still though, only a small increase of registrants was found (11–14%, p = 0.043). The proportion expecting the question of organ donation if their relative was to die under circumstances that made organ donation possible increased (73–79%, p = 0.002). No corresponding increase was found regarding the number having informed a relative about their decision (20–23%, ns).

Conclusion: The LTC was successful in increasing the expectation for the donation request. It also improved the knowledge of the Card and the Registry and slightly increased the number having registered. However, neither of the campaigns succeeded in making people inform their relatives.

Hinrichs, A., S. M. Picker, A. Schneider, R. Lefering, E. A. M. Neugebauer, B. S. Gathof. 2008. “Effect of blood donation on well-being of blood donors.” Transfusion Medicine 18(1):40-48.

The demand for blood products steadily increases. Concurrently, blood donor recruitment becomes more and more difficult. This study aimed to investigate effects of blood donation on blood donors, which could be helpful for blood donor recruitment and retention. In addition to cortisol measurements in saliva, three questionnaires quantifying mood (good/bad), vigilance (awake/tired), agitation (calm/nervous), actual strain and asking for donation-related effects perceived were distributed to 110 whole blood donors (DON). Results obtained were compared with 109 control subjects (CON) lacking the blood donation experience. Overall, 216 subjects completed the questionnaires. Sixty-eight percent of DON reported at least one effect perceived with blood donation. Exclusively, positive, negative or mixed effects were described by 26·5%, 23·5% and 17·6%, respectively. Among positive effects (i.e. physical/psychological well-being, feeling satisfied, happy, proud), no significant differences were observed between males and females (P = 0·07), whereas mixed or negative effects (i.e. vertigo, dizziness, tiredness, pain) were significantly (P = 0·03; P = 0·049) more associated with females. DON showed higher levels of well-being than CON as indicated by better mood (P = 0·004), higher vigilance (P = 0·015) and relaxation (P = 0·003). The latter even increased after donation with maximum values after 15 and 30 min. Despite significantly higher initial strain scores (P = 0·008), first-time donors maintained a better mood (P = 0·025) than repeat donors. DON showed a statistically better psychological well-being than CON, although the donation experience was perceived as stressful, especially for first-time donors. The results may facilitate donor recruitment and retention as blood donation may become less frightening and perhaps even attractive.

Hyde, Melissa K., and Katherine M. White. 2009 “Student and community perceptions about organ donors, non-donors and transplant recipients.” Journal of Community & Applied Social Psychology 19(2):125-141.

Despite efforts to encourage organ donation, low organ donation rates in Australia and other Western nations do not meet the demand for transplantable organs. One influence on organ donation decision-making yet to be fully explored is that of prototype perceptions about organ donors, non-donors and transplant recipients. We conducted focus groups and interviews with 54 student and community participants to explore these perceptions of donors and non-donors in a living and posthumous context, as well as transplant recipients. Using content and thematic analysis, transcripts were analysed for consistently emerging themes. Donors were generally perceived positively as altruistic and giving and as ordinary people; however, some participants questioned the motives of living anonymous donors. Non-donors were commonly viewed negatively as self-absorbed and unaware, with living-related non-donors particularly perceived as cold-hearted and weak. Transplant recipients were generally viewed sympathetically (unfortunate and unwell); however, many participants also expressed negative views about transplant recipients as responsible for their predicament, depending upon the type of organ transplant needed. To encourage people’s willingness to donate their organs, it is crucial to understand the extent to which these perceptions influence organ donation decisions.

Lemmens, K.P.H., C. Abraham., R.A.C. Ruiter, I.J.T. Veldhuizen, C.J.G. Dehing, A.E.R. Bos, and H.P. Schaalma. 2009. “Modelling antecedents of blood donation motivation among non-donors of varying age and education.” British Journal of Psychology 11)Pt. 1):71-90.

Understanding blood donation motivation among non-donors is prerequisite to effective recruitment. Two studies explored the psychological antecedents of blood donation motivation and the generalisability of a model of donation motivation across groups differing in age and educational level. An older well-educated population and a younger less well-educated population were sampled. The studies assessed the role of altruism, fear of blood/needles and donation-specific cognitions including attitudes and normative beliefs derived from an extended theory of planned behaviour (TPB). Across both samples, results showed that affective attitude, subjective norm, descriptive norm, and moral norm were the most important correlates of blood donation intentions. Self-efficacy was more important among the younger less well-educated group. Altruism was related to donation motivation but only indirectly through moral norm. Similarly, fear of blood/needles only had an indirect effect on motivation through affective attitude and self-efficacy. Additional analyses with the combined data set found no age or education moderation effects, suggesting that this core model of donation-specific cognitions can be used to inform future practical interventions recruiting new blood donors in the general population.

Kurz, Richard S., Darcell P. Scharff, tanchica Terry, Shanica Alexander, and Amy Waterman. 2007. “Factors influencing organ donation decisions by African Americans: A review of the literature.” Medical Care Research and Review 64(5):475-517.

The purpose of this article is to review the literature from 1980 to 2005 regarding organ donation decision making by African Americans for themselves and their loved ones and recommend improvements in subsequent studies. Using the behavioral model of health services utilization as an organizing framework, the review procedure consists of a (1) search of health and medical literature using several key words and eight indexes, (2) selection of articles based on specific criteria, and (3) review of each article with regard to the population and sample used, study design, dependent variables addressed, and its findings. The review indicates that predisposing, enabling, and need factors each influence African Americans’ organ donation decision making. Retrospective chart reviews provide a good design for future multivariate analyses of the many factors influencing African American decision making. Interventions to influence decision making should emphasize both community education and the process of organ procurement.

Masser, Barbara M., Katherine M. White, Melissa K. Hyde, Deborah J. Robinson, and Natalie G. 2009. “Predicting blood donation intentions and behavior among Australian blood donors: Testing an extended theory of planned behavior model.” Transfusion 49(2):320-329.

Background: Donor retention poses a significant problem to blood collection agencies around the world. Previous research using an augmented theory of planned behavior (TPB) approach has demonstrated that attitude, subjective norm, self-efficacy, moral norm, anticipated regret, donation anxiety from prior blood donations, and self-identity as a blood donor predicts experienced donors’ intentions and that intentions, self efficacy, moral norm, and anticipated regret may impact upon people’s actual blood donation behavior. STUDY DESIGN AND METHODS: Established blood donors (n = 263) completed questionnaires assessing standard TPB constructs, anticipated regret, moral norm, donation anxiety, and self-identity as a blood donor. Three months later, a second questionnaire assessing blood donation behavior in the intervening 3 months was mailed and returned by 182 donors. RESULTS: With structural equation modeling, the final augmented TPB model provided an excellent fit to the data and included a direct path from intention to behavior and indirect paths to behavior through intention for attitude, self-efficacy, and anticipated regret. Moral norm, donation anxiety, and donor identity indirectly predicted intention through attitude. In total, 51 percent of the variance in donors’ attitudes, 86 percent of variance in donors’ intentions, and 70 percent of the variance in donors’ behavior were accounted for in the final model. CONCLUSION: An augmented TPB framework proved efficacious in determining the predictors of the intentions and behavior of established blood donors. Further, this framework highlighted the importance of considering in the future how donors’ motivations for donating blood may evolve as a function of the number of prior donations.

Merchant, Altaf, and John Ford. 2008. “Nostalgia and giving to charity: A conceptual framework for discussion and research.” International Journal of Nonprofit & Voluntary Sector Marketing 13(1):13-30.

Academic work involving nostalgia has shown it to evoke a basket of emotions. This paper proposes a conceptual model that links nostalgia to charitable giving. We argue that the nostalgia evoked by certain NPOs (not-for-profit organizations) is likely to have a bearing on both emotional and familial utility derived by the donor. This in turn is likely to drive the donor commitment to the NPO. Thus by evoking nostalgia, certain NPOs are likely to emotionally engage their current and potential donors, which could facilitate the creation of long-term intimate relationships between them and their donors. However, the extent to which the NPO can evoke nostalgia is likely to depend upon the nostalgia proneness of the donor, the emotional importance of the past experiences evoked by the NPO, and the characteristics of the NPO such as the extent to which the NPO can alleviate the feelings of alienation, discontinuity, and the need for authenticity experienced by the donor. The paper provides a series of research propositions and proposes a research agenda.

Meslin, Eric M., Patrick M. Rooney, and James G. Wolf. 2008. “Health-related philanthropy: Toward understanding the relationship between the donation of the body (and its parts) and traditional forms of philanthropic giving.” Nonprofit and Voluntary Sector Quarterly 37(1Suppl):44S-62S.

The academic study of philanthropy has focused on the public good from private action and includes the study of the public good of improving health and studies of the various determinants of giving. Yet one very obvious act of giving in the health field has been largely neglected in philanthropic studies: the donation of the body, such as blood and tissue donation, organ donation, and the donation of one’s body for medical research or education. In August 2003, a research team at the Indiana University Center for Bioethics conducted a study of these two aspects of philanthropy as part of a project titled Health Related Philanthropy: The Donation of the Body (and Parts Thereof). This article describes the project and summarizes the results of a national survey conducted as part of that project.

Park, Hee Sun, Yoon Sook Shin, and Doshik Yun. 2009. “Differences between White Americans and Asian Americans for social responsibility, individual right and intentions regarding organ donation.” Journal of Health Psychology 14(5):707-712.

This study examined factors affecting intention to enroll in an organ donor registry and intention to talk to family about organ donation. Participants indicated their views about maintaining body integrity as an individual right and donating organs as a social responsibility. Results showed that the influence of social responsibility on intention to enroll was stronger for white Americans than for Asian Americans. Individual right was negatively associated with intention to enroll among Asian Americans, but not among white Americans. Social responsibility was significant for intention to talk among both white Americans and Asian Americans, but individual right was not significant.

Pimenteira Thomaz, Ana Claire; Luiz Victor Maia Loureiro; Thatiane da Silva Oliveira; Norma Caroline de Mendonça Furtado Montenegro; Egliailson Dantas Almeida, Júnior; Claudio Fernando Rodrigues Soriano; and Jairo Calado Cavalcante. 2008. “The human milk donation experience: motives, influencing factors, and regular donation.” Journal of Human Lactation 24(1):69-76.

The aim of this investigation was to identify factors that influenced or motivated women (N = 737) to donate human milk to human milk banks in Alagoas, Brazil. The most common characteristics of a regular donor were having 4 to 7 pregnancies (relative risk [RR] = 1.9285; 95% confidence interval [CI] = 1.0388-3.5800) and having obtained a higher education level (RR = 2,0625; 95% CI = 1.0097-4.2130). The most commonly reported reasons for donating were “encouragement of a health professional” (61.3%), followed by “the needs of the babies the banks serve” (25.3%). Most of the donors (49.9%) were introduced during their stay in the hospital to the human milk bank to which they donated, and 25.8% chose the bank recommended by a health professional. Health professionals play an indispensable role in motivating mothers to become human milk donors.

Reddy, Deepa S. 2007. “Good gifts for the common good: Blood and bioethics in the market of genetic research.”_Cultural Anthropology_ 22(3):429-472.

This article is based on ethnographic fieldwork conducted with the Indian community in Houston, as part of a NIH–NHGRI-sponsored ethics study and sample collection initiative entitled “Indian and Hindu Perspectives on Genetic Variation Research.” At the heart of this research is one central exchange—blood samples donated for genetic research—that draws both the Indian community and a community of researchers into an encounter with bioethics. I consider the meanings that come to be associated with blood donation as it passes through various hands, agendas, and associated ethical filters on its way to the lab bench: how and why blood is solicited, how the giving and taking of blood is rationalized, how blood as material substance is alienated, processed, documented, and made available for the promised ends of basic science research. Examining corporeal substances and asking what sorts of gifts and problems these represent, I argue, sheds some light on two imbricated tensions expressed by a community of Indians, on the one hand, and of geneticists and basic science researchers, on the other hand: that gifts ought to be free (but are not), and that science ought to be pure (but is not). In this article, I explore how experiences of bioethics are variously shaped by the histories and habits of Indic giving, prior sample collection controversies, commitments to “good science” and the common “good of humanity,” and negotiations of the sites where research findings circulate.

Ríos, Antonio, Laura Martínez-Alarcón , José Sánchez, Nicholas Jarvis , Dolores Guzmán , Pascual Parrilla and Pablo Ramírez. 2009. “Factors that influence the attitude of East European residents in Spain towards living kidney donation.” Transplant International 22(7):707-716.

Emigration from East European (EE) countries into the South East of Spain (SES) is becoming more common. The objective of this study was to analyse the attitude towards living kidney donation in this group. A sample of residents (n = 320) in the SES who come from EE was obtained randomly and stratified by a respondent’s nationality (November-05 to April-06). Attitude was evaluated using a validated questionnaire that was completed anonymously and was self-administered. Control group: native Spanish citizens. The questionnaire completion rate was 83% (n = 265). A total of 83% (n = 220) were in favor of related living donation. Attitude is similar to that of the urban control group (P = 0.0534) and more positive than that prevalent in the rural setting (P < 0.001). The variables that were related to attitude included: a respondent’s marital status (P < 0.001); the country of origin (P = 0.014); attitude towards deceased donation (P < 0.001); having discussed the subject within the family (P < 0.001); a respondent’s belief that he might need a transplant organ (P = 0.002) and concern about possible ‘mutilation’ after donation (P < 0.001). There is a favorable attitude towards related living kidney donation among EE who are resident in the SES and this attitude is closely related to attitude towards deceased donation, the attitude of one’s family and feelings of reciprocity.

Sampath, S., V. Ramsaran, S. Parasram, S. Mohammed, S. Latchman, R. Khunja, D. Budhoo, C. Poon King, K. S. Charles. 2007. “Attitudes towards blood donation in Trinidad and Tobago.” Transfusion Medicine 17(2):83-87.

The aims of this study were to determine the factors that influence blood donation in different demographic groups in a multi-ethnic, multicultural community, and to devise a strategy for a national campaign to increase voluntary non-remunerated blood donations.
—The majority (87%) of blood donations in Trinidad and Tobago are replacement donations. Seventy per cent of the country’s transfusion needs are not met. In 1998, the World Health Assembly recommended that reliance on replacement donations should be phased out due to their association with an increased risk of transfusion-transmitted infections.
—An observer-administered questionnaire was completed by 1423 respondents in a multi-ethnic borough in central Trinidad. Respondents were classified as donors or non-donors and grouped by age, race, religion, employment status and highest level of education. The prevalence of a history of blood donation and the factors that encouraged donation or conversely discouraged donation in each demographic group were recorded.
—A total of 1146 (81·2%) respondents had never donated blood. Of the 277 (18·8%) who had previously donated, replacement for a family member or friend was the most common reason (86·9%). The prevalence of donation was low in all racial, religious, gender, educational and age groups. However, there were significant demographic variations. The majority (71·3%) of non-donors cited a lack of information as a major reason for non-donation and expressed a willingness to donate if access to information and donation facilities were improved.
—Voluntary blood donation in Trinidad and Tobago could be greatly increased by a national education campaign and increased accessibility to donation centres. This would ensure a safer and more reliable blood supply.

Shaw, Rhonda. 2008. “Rethinking reproductive gifts as body projects.” Sociology 42:11-28.

In New Zealand, ovarian egg donation and surrogate pregnancy arrangements are often viewed through the interpretative lens of altruism and reproductive gift-giving. However, gift terminology does not represent the narrative accounts of all women who have participated in donor-assisted conception strategies. Drawing on interview data with New Zealand women, this article deals with accounts from donors who see their donative acts not so much as gifts, but as projects of the self, or as events that serve to mark out new beginnings in their lives.

-. 2007. “The gift-exchange and reciprocity of women in donor-assisted conception.” Sociological Review 55(2):293-310.

This paper explores the rhetoric of gift-exchange as it pertains to the donation of ovarian eggs (oocytes) and participation in surrogate pregnancy arrangements. It does so by drawing on the analysis of interviews with New Zealand women engaged in these practices. Contrary to the view that women’s reproductive gift-giving is intrinsically coercive and exploitative, the narrative accounts of donors involved in this research tend to suggest that women’s moral identities as ethical subjects are created in the donative process. Despite this, many anxieties and contradictions involving the exchanges of women involved in donor-assisted reproduction remain. This paper discusses some of these complexities in light of perceptions and theorisations of the gift relationship. Adapted from the source document.

Segev, D.L., and R. A. Montgomery. 2008. “Regional and racial disparities in the use of live non-directed kidney donors.” American Journal of Transplantation 8(5):1051-1055.

Use of live non-directed donors (LNDDs), or altruistic donors, has increased significantly over the past decade and has fueled debate regarding the ethics and allocation of this new source of live donor kidneys. Three allocation philosophies are currently in use, including donor-centric, recipient-centric and socio-centric models, and our group has also advocated the use of LNDDs in paired donation. However, no universally accepted allocation policy exists, nor does national oversight. To determine allocation patterns resulting from current practice models, we analyzed the 372 LNDD kidney transplants performed in the United States since 1998. Most LNDD transplants occurred at a minority of centers, with only five centers performing over 10, and over 28% of LNDDs traveled out-of-state to donate. Furthermore, a center’s use of LNDD kidneys did not correlate with that center’s organ shortage. Finally, African Americans were significantly under-represented among recipients who were allocated LNDD kidneys, even after accounting for differences in the racial makeup of the waiting list representing centers using LNDD kidneys. These disparities suggest the need for continued monitoring and discussion of LNDD at a national level. If non-directed donation continues to rise at its current rate, a national allocation policy may be reasonable.

Steele, et al. 2008. The role of altruistic behavior, empathetic concern, and social responsibility motivation in blood donation behavior. Transfusion 48(1):43-54.

Background: Blood donation can be described as a prosocial behavior, and donors often cite prosocial reasons such as altruism, empathy, or social responsibility for their willingness to donate. Previous studies have not quantitatively evaluated these characteristics in donors or examined how they relate to donation frequency.

Study design and methods: As part of a donor motivation study, 12,064 current and lapsed donors answered questions used to create an altruistic behavior, empathetic concern, and social responsibility motivation score for each donor. Analysis of variance was used to compare mean scores by demographics and donor status and to determine the influence of each variable on the mean number of donations in the past 5 years.

Results: The mean score for each prosocial characteristic appeared high, with lower scores in male and younger donors. Higher altruistic behavior and social responsibility motivation scores were associated with increased past donation frequency, but the effects were minor. Empathetic concern was not associated with prior donation. The largest differences in prior donations were by age and donor status, with older and current donors having given more frequently.

Conclusion: Most blood donors appear to have high levels of the primary prosocial characteristics (altruism, empathy, and social responsibility) commonly thought to be the main motivators for donation, but these factors do not appear to be the ones most strongly related to donation frequency. Traditional donor appeals based on these characteristics may need to be supplemented by approaches that address practical concerns like convenience, community safety, or personal benefit.

Sung, R.S., J. Galloway, J. E. Tuttle-Newhall, T. Mone, R. Laeng , C. E. Freise and P. S. Rao. “Organ Donation and Utilization in the United States, 1997–2006.” American Journal of Transplantation 8(4 Pt. 2):922-934.

Deceased organ donation has increased rapidly since 2002, coinciding with implementation of the Organ Donation Breakthrough Collaborative. The increase in donors has resulted in a corresponding increase in the numbers of kidney, liver, lung and intestinal transplants. While transplants for most organs have increased, discard and nonrecovery rates have not improved or have increased, resulting in a decrease in organs recovered per donor (ORPD) and organs transplanted per donor (OTPD). Thus, the expansion of the consent and recovery of incremental donors has frequently outpaced utilization. Meaningful increases in multicultural donation have been achieved, but donations continue to be lower than actual rates of transplantation and waiting list registrations for these groups. To counteract the decline in living donation, mechanisms such as paired donation and enhanced incentives to organ donation are being developed. Current efforts of the collaborative have focused on differentiating ORPD and OTPD targets by donor type (standard and expanded criteria donors and donors after cardiac death), utilization of the OPTN regional structure and enlisting centers to increase transplants to match increasing organ availability.

Tison, Geoffrey H., Changli Lu, Furong Ren, Kenrad Nelson, and Hua Shan. 2007. “Influences of general and traditional Chinese beliefs on the decision to donate blood among employer-organized and volunteer donors in Beijing, China.” Transfusion 47(10):1871-1879.

Background: For the past several decades, Chinese blood centers have relied on blood donations from employer-organized donors (blood donors who donate blood in groups with coworkers as prearranged by the employer and the local blood center). Recently the government has decided to phase out employer-organized donors and transition to the use of only volunteer donors (blood donors who donate individually independent of employers). Evaluating the beliefs and attitudes of employer-organized and volunteer donors is critical to maintain an adequate blood supply after this transition.

Study design and methods: The study population consisted of 431 volunteer donors and 527 employer-organized donors who completed a structured questionnaire in July 2005.

Results: Employer-organized donors tended to be older, male, and married, with higher education and higher income compared to volunteer donors. Volunteer donors were more often motivated by altruism (p < 0.001) and more likely to donate larger volumes (400 mL vs. 200 mL) of blood (volunteer 70.5% vs. employer-organized 7%; p < 0.001). Employer-organized donors were more inhibited by factors related to traditional Chinese beliefs, such as the belief that blood donation affects life energy “Qi” (volunteer 3.1% vs. employer-organized 12.7%; p < 0.001), and requested more time off from work after donating. Employer-organized donors also express a greater concern about contracting disease from donating blood.

Conclusion: To recruit voluntary donors effectively in China and other countries with traditional cultures, efforts need to counteract traditional beliefs and perceptions of risk that discourage donation by emphasizing the benefits, safety mechanisms, physiology, and epidemiology of blood donation. In China, there is a rich opportunity to convert prior employer-organized donors into volunteer donors, and the institution of a confidential predonation screening system may help to facilitate truthful risk factor disclosure.

Weinberg, I., S. Zarka, Y. Levy and E. Shinar. 2009. “Why would young people donate blood? A survey-based questionnaire study.” Vox Sanguinis 96(2):128-132.

Background and Objectives: Different issues associated with blood donation among young donors were studied, towards building a large and consistent blood donor base.

Methods: Data were collected from 221/285 donors in drives conducted among military personnel (response rate of 78%), through a self-administered questionnaire tailored to review knowledge, beliefs, attitudes and habits regarding blood and general donations. Data were then further analysed using a multivariate model. Results: The most significant factors related to blood donation were the donors’ perception of approval from a superior (the commander’s request to donate blood) and the participant’s military rank or position (P < 0·0001 and P = 0·0019, respectively). Experienced blood donors comprised 71·9% of all donors and more donations were noted among men (P = 0·0013).

Conclusions: The important role of a significant superior, and his or her personal involvement in the blood drive organization was elucidated. Various other factors, previously found to be related to readiness or reluctance to donate blood, were insignificant among the studied population. Our finding may assist blood centres in optimizing their efforts in recruiting and retention of young donors.

Wildman, John, and Bruce Hollingsworth. 2008. “Blood donation and the nature of altruism.” Journal of Health Economics 28: 92-503.

Approximately 10% of people have O-negative blood. Because it can be transfused into almost anyone, hospitals particularly value such blood. We use this fact, together with the assumption that blood types are exogenously assigned by nature, to design an empirical inquiry into altruism. We also investigate the timing of donations, especially focusing on the behaviour of new and established donors. We show that O-negative blood donors donate no more often than other people. Thus individuals apparently do not exhibit pure altruism. We speculate that instead blood donors may be driven by a broad notion of duty rather than by a far-sighted, rational unselfishness.

Wolfe, R.A., R. M. Merion, E. C. Roys, F. K. Port. 2009. “Trends in organ donation and transplantation in the United States, 1998-2007. American Journal of Transplantation 9(4 Pt 2):869-878.

Yee, Samantha, Jason A. Hitkari, and Ellen M. Greenblatt. 2007. “A follow-up study of women who donated oocytes to known recipient couples for altruistic reasons. Human Reproduction 22(7):2040-2050.

Background: Current legislation in Canada allows for only altruistic gamete donation. Limited clinical data are available on the emotional and psychological impact of altruistic oocyte donation on known donors.

Methods: Seventeen women who had donated oocytes to known parties without financial compensation agreed to receive the oocyte donation questionnaire (ODQ) to explore the psychological domains of altruistic oocyte donation.

Results: Thirteen ODQ were returned, giving a response rate of 76%. All subjects indicated that they were primarily motivated by a ‘desire to give and help’ the recipient couple. Most subjects did not find the donation decision difficult but some found the post-donation psychological adjustments challenging. Subjects also indicated that mandatory counselling on the psychological implications of oocyte donation was an important component of cycle preparation. The majority of subjects had disclosed the donation to others and felt that disclosure to the presumptive child was essential.

Conclusions: The findings provide clinical materials for conceptualizing the dynamics entailed by known altruistic oocyte donation, with regards to motivation, relationship implications, donor satisfaction and plans for disclosure. The data support the provision of psycho-social support services.

Yee, Samantha. 2009. “Gift without a price tag: Altruism in anonymous semen donation.” Human Reproduction 24(1):3-13.

Commercialization of human gametes is now legally prohibited in Canada under the Assisted Human Reproduction Act 2004, making semen donation in Canada altruistic and anonymous by law. Donors must be altruistically motivated to donate gametes without receiving monetary rewards. Globally speaking, Canada is neither the first nor the only country in the world that has legislation to support altruistic gamete donation. Other countries have advocated similar systems either through legislative changes or implementation of best practice models. This paper is a review of literature assessing the differences in donation behaviours under paid and altruistic donation models. It provides contextual information of the current semen donation situation in Canada, while drawing upon relevant literature and research data from other countries as references. The author also attempts to re-conceptualize the meanings of altruism through exploring the complex interplay between psycho-social and institutional factors in influencing donors’ behaviours. Although there is a substantial amount of research studying the impacts on donor recruitment when payment is withdrawn, very few research studies are found that focus on exploring altruistic donor recruitment strategies. It is unrealistic to expect the altruistic donation culture to emerge spontaneously in Canada without any multi-level efforts to coordinate the recruitment strategies. Research programmes are greatly needed to generate empirical knowledge that can guide the development of altruistic donor recruitment models geared to the current socio-cultural environment and legislative framework in Canada. The findings will be invaluable when the legislation comes up for parliamentary review in the near future.

Zeiler, Kristen. “Just love in live organ donation.” 2009. Medicine, Health Care and Philosophy 12(3): 323-331.

Emotionally-related live organ donation is different from almost all other medical treatments in that a family member or, in some countries, a friend contributes with an organ or parts of an organ to the recipient. Furthermore, there is a long-acknowledged but not well-understood gender-imbalance in emotionally-related live kidney donation. This article argues for the benefit of the concept of just love as an analytic tool in the analysis of emotionally-related live organ donation where the potential donor(s) and the recipient are engaged in a love relation. The concept of just love is helpful in the analysis of these live organ donations even if no statistical gender-imbalance prevails. It is particularly helpful, however, in the analysis of the gender-imbalance in live kidney donations if these donations are seen as a specific kind of care-work, if care-work is experienced as a labour one should perform out of love and if women still experience stronger pressures to engage in care-work than do men. The aim of the article is to present arguments for the need of just love as an analytic tool in the analysis of emotionally-related live organ donation where the potential donor(s) and the recipient are engaged in a love relation. The aim is also to elaborate two criteria that need to be met in order for love to qualify as just and to highlight certain clinical implications.