title: The reasons families donate organs for transplantation: implications for policy and practice.
abstract: BACKGROUND
  The objective of this study is to examine the reasoning behind donation decisions of donor-eligible patients' next-of-kin. Cases were identified through chart review at hospitals in Ohio and Pennsylvania. Family decision makers of donor-eligible patients (N = 420) were interviewed to understand decisions regarding organ donation.
  
  
  METHODS
  Responses to inquiries regarding donation decisions were recorded verbatim and then categorized into major themes. Patterns of reasons to donate or not were examined to identify trends. Logistic regression was employed to explore the associations between decision-maker characteristics and donation decision.
  
  
  RESULTS
  Most families gave more than one reason for their decision. Respondents who chose to donate most frequently mentioned altruistic reasons for their decision (78%). However, this response was almost never provided as a single reason. Seventy-five percent of families attributed the decision to the patient's explicit communication of a desire to donate. The belief that the patient did not want to donate was cited by 51% of families who did not donate; 36% of these families cited this as the sole reason for not donating. Concerns about disfigurement and feelings of emotional exhaustion also played a significant role.
  
  
  CONCLUSIONS
  Reasons to donate or not are complex. Altruism, although important, does not seem to be sufficient to motivate organ donation. Knowing patient's preferences was a stronger influence overall. Moreover, certain reasons were highly correlated with each other. Supportive emotional care for the family and reassurance and information about the donation process are indicated as important issues to address to encourage donation.
authors.affiliation: Department of Bioethics, School of Medicine, Case Western Reserve University, Ohio 44106-4976, USA. las5@po.cwru.edu
authors.forename: Laura
authors.initials: L
authors.lastname: Siminoff
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Mercer
authors.forename: Gregory
authors.initials: G
authors.lastname: Graham
authors.forename: Christopher
authors.initials: C
authors.lastname: Burant
mesh_terms: D000328:Adult; D000533:Altruism; D001290:Attitude; D003657:Decision Making; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D045808:Refusal to Participate / Q000523:psychology; D012923:Social Class; D014019:Tissue Donors / Q000523:psychology*; D009927:Tissue and Organ Procurement / Q000331:legislation & jurisprudence*