title: Factors that influence the decision to be an organ donor: a systematic review of the qualitative literature.
abstract: BACKGROUND
  Transplantation is the treatment of choice for organ failure, but a worldwide shortage of suitable organs exists. We conducted a systematic review of qualitative studies that explored community attitudes towards living and deceased solid organ donation to inform strategies to improve organ donation rates.
  
  
  METHODS
  Medline, Embase, PsycINFO and EconLIT were searched. Qualitative studies that explored community attitudes towards living and deceased solid organ donation were included. A thematic synthesis of the results and conclusions reported by primary authors was performed.
  
  
  RESULTS
  Eighteen studies involving 1019 participants were identified. Eight themes emerged. The decision to be an organ donor was influenced by (i) relational ties; (ii) religious beliefs; (iii) cultural influences; (iv) family influences; (v) body integrity; (vi) previous interactions with the health care system-medical mistrust, validity of brain death and fear of early organ retrieval; (vii) the individual's knowledge about the organ donation process and (viii) major reservations about the process of donation, even in those who support organ donation.
  
  
  CONCLUSIONS
  This review of qualitative studies highlights that seemingly intractable factors, such as religion and culture, are often tied in with more complex issues such as a distrust of the medical system, misunderstandings about religious stances and ignorance about the donation process. Intervention that could be considered includes culturally appropriate strategies to engage minority groups, especially through religious or cultural leaders, and more comprehensively available information about the donation process and its positive outcomes.
authors.affiliation: School of Public Health, The University of Sydney, Sydney, Australia. michelle.irving@sydney.edu.au
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Irving
authors.forename: Allison
authors.initials: A
authors.lastname: Tong
authors.forename: Stephen
authors.initials: S
authors.lastname: Jan
authors.forename: Alan
authors.initials: A
authors.lastname: Cass
authors.forename: John
authors.initials: J
authors.lastname: Rose
authors.forename: Steven
authors.initials: S
authors.lastname: Chadban
authors.forename: Richard D
authors.initials: RD
authors.lastname: Allen
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
authors.forename: Kirsten
authors.initials: K
authors.lastname: Howard
mesh_terms: D003657:Decision Making; D006801:Humans; D036301:Qualitative Research; D012196:Review Literature as Topic; D014019:Tissue Donors / Q000523:psychology*; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*