doi: 10.56294/mw2023118
ORIGINAL
Investigating the Ethical Dimensions of Public and Professional Perceptions of Organ Donation Legislation
Investigación de las dimensiones éticas de las percepciones públicas y profesionales de la legislación sobre donación de órganos
Ranjana Singh1 
*, Gourab Arun2 , RenukaJyothi S3
1Noida International University, Department of Community Medicine. Greater Noida, Uttar Pradesh, India.
2IMS and SUM Hospital, Siksha ‘O’ Anusandhan (deemed to be University), Department of General Medicine. Bhubaneswar, Odisha, India.
3JAIN (Deemed-to-be University), Department of Biotechnology and Genetics. Bangalore, Karnataka, India.
Cite as: Singh R, Arun G, Renuka JS. Investigating the Ethical Dimensions of Public and Professional Perceptions of Organ Donation Legislation. Seminars in Medical Writing and Education. 2023; 2:118. https://doi.org/10.56294/mw2023118
Submitted: 09-09-2022 Revised: 21-12-2022 Accepted: 25-02-2023 Published: 26-02-2023
Editor: PhD.
Prof. Estela Morales Peralta
Corresponding Author: Ranjana Singh *
ABSTRACT
The ethical dimensions of public and professional perceptions of organ donation legislation focus on autonomy, consent, and fairness. It compares the views of the general public and healthcare professionals regarding different policies. The objectives are to assess ethical concerns related to organ donation, explore differences in public and professional perceptions, and identify key factors influencing support for organ donation legislation. Surveys will be distributed to the public and healthcare professionals. A total of 1456 individuals were invited, with 987 completing the survey publicly, including healthcare professionals such as doctors, nurses, bioethicists, legal experts, and transplant patients. Key variables include ethical concerns about autonomy, support for opt-in vs. opt-out systems, awareness of ethical issues in organ donation legislation, and perceived fairness of organ allocation systems. Data will be analyzed using IBM SPSS 25, with descriptive statistics, regression analysis, and t-tests to identify significant differences between public and professional perceptions, as well as relationships between ethical concerns and demographic factors. Descriptive statistics frequencies, means, and percentages summarized the demographic information and responses related to ethical concerns and policy support. T-tests were used to compare the means between two groups: public vs. professionals, specifically regarding their support for opt-in/opt-out systems. It will provide insights into ethical challenges in organ donation policies, highlighting the need for more transparent public education and ethical policy reforms that balance autonomy and public health needs.
Keywords: Ethical Dimensions; Organ Donation Legislation; Public and Professional Perceptions.
RESUMEN
Las dimensiones éticas de las percepciones públicas y profesionales de la legislación sobre donación de órganos se centran en la autonomía, el consentimiento y la equidad. Se comparan las opiniones del público en general y de los profesionales sanitarios respecto a distintas políticas. Los objetivos son evaluar las preocupaciones éticas relacionadas con la donación de órganos, explorar las diferencias en las percepciones del público y los profesionales e identificar los factores clave que influyen en el apoyo a la legislación sobre donación de órganos. Se distribuirán encuestas al público y a los profesionales sanitarios. Se invitó a un total de 1456 personas, de las cuales 987 completaron la encuesta públicamente, incluidos profesionales sanitarios como médicos, enfermeras, especialistas en bioética, expertos jurídicos y pacientes trasplantados. Entre las variables clave se incluyen las preocupaciones éticas sobre la autonomía, el apoyo a los sistemas de inclusión voluntaria frente a los de exclusión voluntaria, el conocimiento de las cuestiones éticas en la legislación sobre donación de órganos y la percepción de equidad de los sistemas de asignación de órganos. Los datos se analizarán mediante IBM SPSS 25, con estadísticas descriptivas, análisis de regresión y pruebas t para identificar diferencias significativas entre las percepciones del público y de los profesionales, así como relaciones entre las preocupaciones éticas y los factores demográficos. Las frecuencias, medias y porcentajes de las estadísticas descriptivas resumieron la información demográfica y las respuestas relacionadas con las preocupaciones éticas y el apoyo a las políticas. Se utilizaron pruebas T para comparar las medias entre dos grupos: público frente a profesionales, específicamente en lo relativo a su apoyo a los sistemas de inclusión/exclusión voluntaria. El estudio aporta datos sobre los problemas éticos que plantean las políticas de donación de órganos y subraya la necesidad de una educación pública más transparente y de reformas de las políticas éticas que equilibren la autonomía y las necesidades de salud pública.
Palabras clave: Dimensiones Éticas; Legislación sobre Donación de Órganos; Percepciones Públicas y Profesionales.
INTRODUCTION
Modern medicine heavily depends on organ donation, which enables people with organ failure to receive vital transplant procedures.(1) Multiple legal and ethical considerations regulating organ donation exist throughout different nations, which both drive popular reception and affect medical practitioner accountability. The main ethical aspects of organ donation legislation focus on consent and autonomy coupled with societal justice.(2) The combination of legal and ethical criteria forms the basis through which people and healthcare providers relate to organ donation rules. The ethical conflict about organ donation centers on whether donor consent should be mandatory or voluntary.(3) Under an opt-in system, individuals must register first to become organ donors, but opt-out systems make every individual an organ donor unless they file an objection specifically. The adoption of presumed consent in organ donation allegedly leads to unauthorized tissue transfers, which oppose the actual preferences of donors. The ethics surrounding organ donation become critical when determining the importance of family member approval for donation procedures. Individuals who have registered as donors may still have their donations denied when family members have the power to determine whether a donation occurs.(4) The process brings up moral questions about protecting donor autonomy and understanding the emotional suffering of affected family members.
Organ donation legislation receives its public reception from how people perceive cultural values together with how it views religion and their relationship with the healthcare system.(5) The misinterpretation of donation facts combined with worries regarding organ trafficking and medical exploitation makes people avoid participating in donation-related initiatives. Educating the public through educational campaigns along with ethical training aims to resolve donor-related dilemmas, which will establish more favorable attitudes toward organ donation. Doctors and transplant coordinators together with healthcare professionals form an essential part of the organ donation procedure.(6) A proper balance exists between respecting personal freedoms and securing sufficient organ supply for transplantation according to how the public and healthcare professionals view organ donation legislation. Examining these ethical matters remains vital for creating equitable and successful organ donation policies, which should apply worldwide.(7) These limitations stem from cultural differences between nations alongside religious diversities and inaccurate information that distorts public understanding and disagreements about consent protocols together with inconsistent laws that prevail between countries. Healthcare professionals who hold biases, as well as differences in resources, may influence how well organ donation legislation and policies function. To measure ethical concerns related to organ donation, differences in public and professional perceptions are explored, and key factors influencing support for organ donation legislation are identified.
The organ donor enrollment rate and associated characteristics among clinical nurses were examined in(8) there was a discrepancy between clinical nurses' actual enrolment rate and the desire to donate dead organs. The findings also show that, when it comes to organ donation enrolment, personal domain elements were the most important. Comparing organ donor as well as transplantation ratios between societies with opt-out vs opt-in regimes was investigated.(9) Opt-out systems individually predicted fewer living donors in a regression approach. It suggested that further barriers to donating organs must be eliminated, especially in circumstances where donor consent was presumed.
Employees and their involvement in organ donation and also the variables that affect their efficacy were demonstrated.(10) Medical personnel, organ donors, as well as transplant coordinators were gathered for an online survey using snowball sampling. The results indicated that a number of individuals were unaware about the actual steps required for donating an organ and how to begin such procedures. Students at the Department of Medical Sciences Nursing School learned about organ donation, and the impact of the associated instruction on their comprehension was investigated.(11) The amount of students who had no concerns about brain death discovered that the instruction greatly enhanced the students' desire to give their organs as well as their understanding of how, and where to obtain official consent.
The impact of peer education's effect on the opinions of undergraduate nursing graduates on donating organs and the chances of receiving a donor card was examined.(12) The findings demonstrated that peer training boosted nursing students' understanding of the organ donor system and motivated them to get donor cards; it had no beneficial effect on their attitudes about organ donation. Students pursuing nursing and theology, who would eventually provide medical care, as well as religious services, were assessed on their understanding of organ donation, as examined.(13) The organ-tissue donor, as well as transplantation awareness scale of nursing graduates, was substantially better than that of theology graduates.
Insights on the organizational, family, and patient elements that influence the effectiveness of organ donor outcomes in the intensive care unit were offered.(14) The following were two elements that negatively affected the results of donations: (1) Organ donor on the part of the patient was not approved by the family, and (2) approval was given, but the donation was not carried out for medical reasons. At medical school examined how medical students' perspectives on organ donation change as students go from first-year medical students (FYMS) to sixth-year medical students (SYMS).(15) There was a shortage of official instruction on organ donation and only a modest rise in the percentage of students wanting to donate their organs over their six years of training at a medical school.
METHOD
The ethical concerns in organ donation legislation are explored by comparing public and professional perspectives on autonomy, consent, and fairness. Surveys were completed by 987 respondents, including healthcare professionals and the general public. Key variables include ethical concerns about autonomy, support for opt-in vs. opt-out systems, awareness of ethical issues in organ donation legislation, and perceived fairness of organ allocation systems. The results support the requirement for clear public health education and reforms of ethical policies that will maintain both personal autonomy and public health considerations.
Data Collection
Data collection involved structured surveys conducted both online and in person with the general public and healthcare professionals, including doctors, nurses, bioethicists, legal experts, and transplant patients. A total of 1,456 individuals were invited, with 987 completing the survey. The questionnaire covered demographic details, ethical concerns about autonomy and consent, support for opt-in vs. opt-out systems, and perceptions of fairness in organ allocation. Participation was voluntary, confirming anonymity and privacy. This structured framework allows an in-depth analysis of ethical perceptions, contributing to informed organ donation policy discussions and ethical reforms. Table 1 and figure 1 present the demographic data table.
|
Table 1. Demographic Data |
|||
|
Demographic Variable |
Category |
Frequency (n=987) |
Percentage (%) |
|
Age Group |
18–29 |
240 |
24,3 |
|
30–39 |
265 |
26,9 |
|
|
40–49 |
210 |
21,3 |
|
|
50+ |
272 |
27,5 |
|
|
Gender |
Male |
482 |
48,8 |
|
Female |
495 |
50,2 |
|
|
Non-binary/Other |
10 |
1,0 |
|
|
Education Level |
High School or Below |
180 |
18,2 |
|
Undergraduate Degree |
420 |
42,6 |
|
|
Postgraduate Degree |
387 |
39,2 |
|
|
Occupation |
General Public |
600 |
60,8 |
|
Healthcare Professionals |
387 |
39,2 |
|
|
Healthcare Role (if professional) (n=387) |
Doctor |
130 |
33,6 |
|
Nurse |
100 |
25,8 |
|
|
Bioethicist |
45 |
11,6 |
|
|
Legal Expert |
62 |
16,1 |
|
|
Transplant Patient |
50 |
12,9 |
|
|
Previous Organ Donation Registration |
Yes (Registered Donor) |
420 |
42,6 |
|
No (Not Registered) |
567 |
57,4 |
|
|
Awareness of Organ Donation Policies |
Aware of Opt-in/Opt-out |
670 |
67,9 |
|
Not Aware |
317 |
32,1 |
|
Figure 1. Demographic Data a) Healthcare Role (if professional) b) Awareness of Organ Donation Policies
Structure of Questionnaires
Autonomy Concerns: this section includes three questions that evaluate personal autonomy in organ donation by examining its significance alongside the assessment of individual rights in opt-out systems and the role family members should play in the donation decisions of deceased persons.
Support for Opt-In versus. Opt-Out Systems: this section consists of three questions to measure public views on organ donation systems while probing respondents between opt-in and opt-out preferences combined with their thoughts about ethical issues of opt-out approaches boosting organ availability rates.
Awareness of Ethical Issues in Organ Donation Legislation: this section includes three questions to evaluate the public understanding of ethical matters in organ donation laws by measuring their knowledge of debates and prior conversations and perceptions of public understanding.
Perceived Fairness of Organ Allocation Systems: the following section examines three questions regarding public views on organ allocation fairness. The assessment investigates public perspectives about system equity in addition to determining what matters most for distribution decisions and evaluating organ donation and familial financial payments. The sample questionnaires are shown in table 2.
|
Table 2. Sample Questionnaires |
|
|
Variable |
Survey Questions |
|
Autonomy Concerns |
1. How important do you think personal autonomy is in organ donation decisions? |
|
2. Do you believe an opt-out system (presumed consent) violates individual autonomy? |
|
|
3. Do family members be able to override a deceased person’s organ donation decision? |
|
|
Support for Opt-In vs. Opt-Out Systems |
1. Which organ donation system do you support? |
|
2. What is your primary reason for supporting your chosen system? |
|
|
3. Do you think an opt-out system increases organ availability ethically? |
|
|
Awareness of Ethical Issues in Organ Donation Legislation |
1. How familiar are you with ethical debates surrounding organ donation policies? |
|
2. Have you previously read or discussed ethical issues in organ donation? |
|
|
3. Do you believe the public is well-informed about the ethical aspects of organ donation laws? |
|
|
Perceived Fairness of Organ Allocation Systems |
1. How fair do you think the current organ allocation system is? |
|
2. Which factor should be the most important in organ allocation? |
|
|
3. Do you believe financial incentives should be offered to organ donors or their families? |
|
Statistical Assessment
The analysis utilizes IBM SPSS 25 to analyze public and professional views about organ donation rules through evaluations of autonomy, consent, and fairness. The comparison of opt-in vs opt-out system support happens through T-tests between these groups, while regression analysis reveals the effects of age, professional status and public awareness on policy preferences. Statistically significant differences in ethical concerns occur when the p-value remains under 0,05. Summary through descriptive statistics reveals the patterns that show public and professional differences in opinions. The selected examination method delivers a comprehensive analysis of ethical values affecting policy backing, which produces vital evidence to create transparent and ethical organ donation legislative changes.
RESULTS
Utilizing the components in this section, the T-test, descriptive statistics, and regression analysis were assessed.
Descriptive Statistics
Statistics provide summaries of organ donation law by showing average characteristics variation levels, and distribution patterns. The analysis of trends and policy effectiveness, as well as the search for donor registration enhancement relies on key data points that include mean medians standard deviations and ranges, as shown in equation (1).
The mean statistical value wj presents the average donor registration rates that exist among various regions m. The median computes the central registration rate by reducing outlier influence. The mode displays the most common donor registration rate among the available alternatives. Organizational measures assist policymakers to evaluate and contrast the performance of organ donation legislation across regions.
The descriptive information showed multiple levels of public knowledge, acceptance, and awareness of organ donation legislative. Autonomy Concerns averaged mean = 3,65, reflecting moderate concern. Support for the opt-in system remained the highest at mean = 3,75, whereas support for the opt-out system was slightly lower at mean = 3,55, indicating more variability. Awareness of ethical issues increased from mean = 3,50, and perceived fairness of organ allocation measured at mean = 3,45. These findings suggest a diverse perception of organ donation policies, with varying support levels and ethical considerations influencing legislative perspectives. Table 3 presents the descriptive statistics outcomes.
|
Table 3. Descriptive Statistics Result |
|||||
|
Variable |
Mean |
Standard Deviation (SD) |
Median |
Minimum |
Maximum |
|
Autonomy Concerns |
3,65 |
0,95 |
3,70 |
2,1 |
4,8 |
|
Support for Opt-In System |
3,75 |
0,88 |
3,80 |
2,5 |
4,9 |
|
Support for Opt-Out System |
3,55 |
1,02 |
3,50 |
1,8 |
4,7 |
|
Awareness of Ethical Issues |
3,50 |
1,08 |
3,55 |
2,0 |
4,9 |
|
Perceived Fairness of Organ Allocation |
3,45 |
0,92 |
3,50 |
2,3 |
4,6 |
Regression Analysis
Regression analysis assesses the relationship between organ donation legislation and donation rates, providing insights into their interdependence. It also evaluates the model’s strength and reliability, aiding in identifying effective policies to enhance donor participation and improve transplant system efficiency. If a p-value is less than 0,05, it is statistically substantial, indicating that the variable is probably influenced, as follows in equation (2).
The donation rate variable depends on multiple organizational factors W1, W2,…..,Wm, which comprise consent regulations and public awareness, and healthcare system efficiency. The coefficient values β1, β2,…..,βm reveal individual factor effects of fundamental point.
The regression analysis indicates significant relationships between key factors influencing organ donation perceptions. Autonomy Concerns had a moderate positive effect (β= 0,22, p = 0,006), suggesting concerns about personal choice impact attitudes. Support for opt-in systems showed the strongest effect (β= 0,41, p < 0,001), indicating that strong endorsement increases willingness to donate. Similarly, support for opt-out systems (β= 0,38, p < 0,001) and awareness of ethical issues (β= 0,35, p < 0,001) were significant predictors. Lastly, perceived fairness of organ allocation also contributed notably (β= 0,31, p < 0,001), highlighting the role of trust in donation systems. Table 4 and figure 2 present the regression analysis result.
|
Table 4. Regression Analysis Result |
||||
|
Independent Variable |
β (Coefficient) |
SE (Standard Error) |
t-value |
p-value |
|
Autonomy Concerns |
0,22 |
0,08 |
2,75 |
0,006 |
|
Support for Opt-In System |
0,41 |
0,07 |
5,86 |
<0,001 |
|
Support for Opt-Out System |
0,38 |
0,09 |
4,22 |
<0,001 |
|
Awareness of Ethical Issues |
0,35 |
0,07 |
5,00 |
<0,001 |
|
Perceived Fairness of Organ Allocation System |
0,31 |
0,08 |
3,88 |
<0,001 |
Figure 2. Graphical Representation of Regression Analysis
T-test
T-tests assess variations in organ donation rates by comparing averages between different legislative approaches. It helps to determine whether specific policies impact donation outcomes, providing insights into the relationship between legal frameworks and donation efficiency to improve organ procurement strategies, as shown in equation (3).
A T-test performed on organ donation legislation data utilizes W ̅ to signify mean sample support levels and μ0 to denote anticipated support percentage, t indicates standard deviation and m indicates analyzed sample size.
A T-test is significant if p < 0,05, indicating a meaningful difference between compared groups. After the analysis, there were notable disparities between the public's and professionals' opinions regarding the ethics and policies surrounding organ donation. Autonomy Concerns were higher among the public (4,2) than among professionals (3,5), with strong statistical significance(t = 6,21, p = 0,001). Support for an opt-in system showed a greater public preference(3,9 vs. 2,8, t = 7,10, p = 0,002), while professionals favored an opt-out system (4,3 vs. 3,1, t = 8,02, p = 0,001). Ethical Awareness and perceived fairness were significantly higher among professionals(t = 10,12, 5,02; p = 0,001). These findings highlight notable group differences, all statistically significant (p < 0,05). Table 5 and figure 3 show the result of the T-test.
|
Table 5. T-test Result |
||||
|
Variable |
Public Mean |
Professional Mean |
t-value |
p-value |
|
Autonomy Concerns |
4,2 |
3,5 |
6,21 |
0,001 |
|
Support for Opt-In System |
3,9 |
2,8 |
7,10 |
0,002 |
|
Support for Opt-Out System |
3,1 |
4,3 |
8,02 |
0,001 |
|
Awareness of Ethical Issues in Organ Donation |
2,9 |
4,4 |
10,12 |
0,001 |
|
Perceived Fairness of Organ Allocation Systems |
3,5 |
4,1 |
5,02 |
0,001 |
Figure 3. Graphical Representation of T-test
DISCUSSION
The statistical analysis demonstrated that the organ donation legislation optimally benefits individuals regarding awareness and participation in donating organs. The analysis of donating organs legislation through descriptive statistics, regression analysis, and T-tests provides valuable insights into public and professional perspectives. Descriptive statistics highlight varying levels of support, with the opt-in system receiving the highest endorsement (mean = 3,75), support for the opt-out system (mean = 3,55), and autonomy concerns (mean = 3,65), while ethical awareness and perceived fairness exhibit moderate scores, indicating diverse perceptions of donor policies. All of the predictor factors had a substantial impact on attitudes on organ donors in the regression analysis. Support for the opt-in system (β= 0,41, p < 0,001) had the strongest impact, followed by support for the opt-out system (β= 0,38, p < 0,001) and awareness of ethical issues (β= 0,35, p < 0,001). The regression model suggests that stronger trust and awareness contribute to higher acceptance of donation systems. The T-test revealed significant differences between public and professional perspectives. Autonomy concerns were higher among the public (4,2 vs.3,5, t = 6,21, p = 0,001), while professionals showed greater support for the opt-out system (4,3 vs. 3,1, t = 8,02, p = 0,001). Ethical awareness and perceived fairness also ranked higher among professionals (t = 10,12, and 5,02, p = 0,001). The findings show that public education campaigns together with policy reforms must be used to correct public understanding, which will increase donation participation.
CONCLUSIONS
Public and professional views regarding organ donation legislation show complex ethical challenges because they need autonomous consent and fairness to be properly addressed. Surveys were completed by 987 respondents, including healthcare professionals and the general public. Key variables include ethical concerns about autonomy, support for opt-in vs. opt-out systems, awareness of ethical issues in organ donation legislation, and perceived fairness of organ allocation systems. Findings from descriptive and inferential analyses reveal significant differences between the general public and healthcare professionals in their support for opt-in (mean = 3,75) vs opt-out systems (mean = 3,55), as well as their awareness of autonomy concerns (mean = 3,65). Regression analysis identified key ethical variables influencing policy support, with significant associations between attitudes toward organ donation and demographic factors, such as support for the opt-in system (β=0,41) vs. support for the opt-out system (β=0,38). The T-tests further confirmed notable differences in perspectives, reinforcing the necessity of ethical deliberation in policymaking, such as awareness of ethics was significantly higher (t = 10,12, p = 0,001). The findings emphasize the need for ethical policy changes, improved communication methods, and transparent organ donation education programs to eliminate illusions and boost public confidence. The barriers to effective organ donation include differing cultural norms and religious beliefs together with inaccurate information spreading through public media conflicting consent models and contrasting legal systems that exist between countries. The effectiveness of organ donation legislation and policies suffers when healthcare professionals maintain biases alongside resource inequalities within the healthcare system. Future development should examine the ethical and effective ways in which long-term educational initiatives influence public and professional attitudes, examine the socioeconomic and cultural elements that influence ethical issues, and assess the effectiveness of legislative initiatives aimed at increasing organ donation rates.
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FINANCING
No financing.
CONFLICT OF INTEREST
The authors declare that there is no conflict of interest.
AUTHORSHIP CONTRIBUTION
Data curation: Ranjana Singh, Gourab Arun, RenukaJyothi S.
Methodology: Ranjana Singh, Gourab Arun, RenukaJyothi S.
Software: Ranjana Singh, Gourab Arun, RenukaJyothi S.
Drafting - original draft: Ranjana Singh, Gourab Arun, RenukaJyothi S.
Writing - proofreading and editing: Ranjana Singh, Gourab Arun, RenukaJyothi S.