title: Hindering factors and suggestions related to organ donation decisions: perspective of the Taiwan Ali-Shan Tsou aboriginal tribe.
abstract: OBJECTIVE
  Ali-San Tsou (AST) is one of leading aboriginal tribes in Taiwan with traditional godly beliefs related to life and death. Lacking related knowledge, health professionals (HPs) often failed to help them reach good dying or organ donation (OD). This study aimed to explore hindering factors and suggestions related to OD for good dying from Taiwan AST's own perspective.
  
  
  METHODS
  An explorative qualitative design was employed using a purposive sample of the AST tribes from Taiwan. Data were collected with AST residents by face-to-face interviews and analyzed by content analysis.
  
  
  RESULTS
  Thirty AST residents (16 females and 14 males) with ages ranging from 28 to 78 (mean, 54.5) years completed interviews. Of them, 85% reported various diseases. In this study 73% were Catholics and Christians, 17% held traditional godly believes, and 10% had no religious affiliation. Eight hindering factors were reported: (1) limited information about organs and OD; (2) no qualified organs for donation; (3) worry about lack of forgiveness by ancestors; (4) tribe elders who might not accept concept of OD; (5) intact bodies were required at home during spirit-companion rituals; (6) earth burial with intact bodies was preferred; (7) bodies due to accidental and bad death were impermissible for OD; and (8) worry about possession by the donor's spirit. Seven suggestions were also reported for HPs to enhance AST's OD decisions: (1) starting with friendship and a caring relationship; (2) providing spiritual support from reverent religions; (3) stressing good deeds and honoring tribe folks by OD; (4) avoiding accidental/bad death; (5) providing relevant modern medical knowledge of human organs and OD; (6) introducing OD as part of a good-dying care plan; and (7) demonstrating a respectful discussion mindset about OD.
  
  
  CONCLUSIONS
  Eight hindering factors and 7 types of suggestions for enhancing AST aboriginal people's OD decisions were first explored in this project. In the future, HPs are encouraged to invite AST to share the concepts of OT and try to clarify the related concerns with respect for their cultural contexts. With mutual respect, the efforts of sharing and integrating OD into good-dying care would be more possible.
authors.affiliation: Institute of Clinical & Community Health Nursing, National Yang-Ming University, Chayi, Taiwan; National Taiwan University Hospital, Chayi, Taiwan.
authors.forename: A N
authors.initials: AN
authors.lastname: Chen
authors.affiliation: Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chayi, Taiwan.
authors.forename: K F
authors.initials: KF
authors.lastname: Chen
authors.affiliation: Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chayi, Taiwan.
authors.forename: P C
authors.initials: PC
authors.lastname: Chang
authors.affiliation: Department of Gerontological Care and Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
authors.forename: F Jong
authors.initials: FJ
authors.lastname: Shih
authors.affiliation: Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chayi, Taiwan.
authors.forename: C R
authors.initials: CR
authors.lastname: Chen
authors.affiliation: Institute of Clinical & Community Health Nursing, National Yang-Ming University, Chayi, Taiwan; Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chayi, Taiwan. Electronic address: ppaul456tw@yahoo.com.tw.
authors.forename: F-Jin
authors.initials: FJ
authors.lastname: Shih
authors.affiliation: Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chayi, Taiwan. Electronic address: cych03497@gmail.com.
authors.forename: C-Y
authors.initials: CY
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D000533:Altruism; D044466:Asian People / Q000523:psychology*; D001293:Attitude to Death / Q000208:ethnology*; D002562:Ceremonial Behavior; D003142:Communication; D032882:Comprehension; D003466:Cultural Characteristics; D005260:Female; D037921:Gift Giving; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D057220:Health Literacy; D006801:Humans; D007398:Interpersonal Relations; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology; D010353:Patient Education as Topic; D011369:Professional-Patient Relations; D011639:Public Opinion; D036301:Qualitative Research; D012068:Religion and Medicine; D013624:Taiwan / Q000453:epidemiology; D014019:Tissue Donors / Q000523:psychology* / Q000600:supply & distribution; D009927:Tissue and Organ Procurement; D066027:Transplant Recipients / Q000523:psychology*