title: Public awareness and attitudes to living organ donation: systematic review and integrative synthesis.
abstract: BACKGROUND
  The deceased-donor organ shortage has driven widespread adoption of living-donor transplantation. Yet, public views on living donation are not well understood. This study aims to synthesize studies on public awareness and attitudes toward living organ donation.
  
  
  METHODS
  Electronic databases and reference lists were searched to September 2012. Summary estimates from survey data were obtained by random effects meta-analysis. Qualitative descriptive synthesis of each study was performed.
  
  
  RESULTS
  Forty-seven studies involving 34,610 respondents were included. The proportion of respondents aware of living organ donation was 76.7% (4 studies, n=3248; 95% confidence interval, 46.2%-97.0%; I=99.7%). The majority were in favor of living directed donation (85.5% (11 studies, n=15,836; 95% confidence interval, 81.6%-89.6%; I=98%), with recipient and community benefit as the rationale provided. However, barriers included fear of surgical and health risks, lack of knowledge, respect for cultural norms, financial loss, distrust in hospitals, and avoiding recipient indebtedness. The public voiced concern about possible risks or an obligatory pressure exerted on the donor. Many supported reimbursement for out-of-pocket expenses, paid leave, wait-listing priority, health insurance, and donor acknowledgment. There was strong opposition to financial incentives, which they believed risked exploitation and inequity and diminished voluntary altruistic donation.
  
  
  CONCLUSIONS
  The public is generally supportive of living donation and articulated important equity and ethical considerations for protecting the health and safety of living donors. This supports increased public engagement and strengthening of a shared view among professionals and the public in living donation practice and policy.
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia. allison.tong@sydney.edu.au
authors.forename: Allison
authors.initials: A
authors.lastname: Tong
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Chapman
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Josephson
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
mesh_terms: D001364:Awareness; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D019520:Living Donors / Q000523:psychology; D026684:Personal Autonomy; D009927:Tissue and Organ Procurement / Q000191:economics