title: Consenting options for posthumous organ donation: presumed consent and incentives  are not favored.
abstract: 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.
authors.affiliation: Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh, 11211, Saudi Arabia. muhammad@kfshrc.edu.sa
authors.forename: Muhammad M
authors.initials: MM
authors.lastname: Hammami
authors.forename: Hunaida M
authors.initials: HM
authors.lastname: Abdulhameed
authors.forename: Kristine A
authors.initials: KA
authors.lastname: Concepcion
authors.forename: Abdullah
authors.initials: A
authors.lastname: Eissa
authors.forename: Sumaya
authors.initials: S
authors.lastname: Hammami
authors.forename: Hala
authors.initials: H
authors.lastname: Amer
authors.forename: Abdelraheem
authors.initials: A
authors.lastname: Ahmed
authors.forename: Eman
authors.initials: E
authors.lastname: Al-Gaai
mesh_terms: D000328:Adult; D002755:Choice Behavior / Q000941:ethics; D003657:Decision Making / Q000941:ethics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D019724:Presumed Consent / Q000941:ethics*; D011639:Public Opinion; D012529:Saudi Arabia; D012737:Sex Factors; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers; D009927:Tissue and Organ Procurement / Q000941:ethics*