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Organ donation: The influence of personal attitude on professional behavior
ELSEVIER
Organ Donation: The Influence of Personal Attitude on Professional Behavior G.R. Schiitt and D. Henne-Bruns
NUMBER of organ donors in Germany has been standards: 14 pmp (per miLlion population) during the last 3 years. Various factors were discussed that might account for this. Objection to organ donation is one reason that was identified as a cause for the low donation rate. Presently, Germany has no transplantation law. Practice is that next of kin is approached after the death of a person, and the will of the deceased (when stated on a donor card) or the will of the next of kin is followed by the medical doctors. When families were approached for organ donation, the objection rate increased from 20% in 1993 to 35% in 1996. Only 5% of the deceased carried donor cards. Our transplant unit planned a comprehensive education program because 29 donor referrals during 1996 resulted in only 13 organ donations, mainly due to an astonishing rate of 40% refusals of next of km. At the beginning, we distributed a standardized questionnaire to find out who the best source of information on organ donation would be. We asked 500 individuals from various professions (students, office workers, nurses, and medical doctors in intensive care units who they believed should provide information on organ donation. Seventy-five percent of all those questioned stated that the medical doctor should be the primary source of information on transplantation-related matters. Fifty percent indicated that medical insurance companies and 45% that television and print media would be an appropriate source. With this knowledge at hand, we approached the largest medical insurance company in our area. The company initiated a mailing campaign during which 700,000 clients received information on organ donation in combination with a donor card. We added a series of public lectures that were held in our hospital. Simultaneously, we wrote a personal letter to 980 practitioners in our area in which they were asked to display information material on organ donation in their offices. We were hoping to distribute material on organ donation via the physicians, as requested by the majority of public respondents to our questionnaire. Disappointingly, only 9.5% of the medical doctors were willing to do so. Nearly 90% refused! The professional attitude of doctors, who are thought to be the group that, based on their educational background, would provide the most objective information on this medical subject, was in sharp disagreement to the expectations expressed by the public. We placed telephone follow-up calls to a subset
T” comparatively low by international
0041-1345/97/$17.00 PII so041 -1345(97)00893-2
3246
of the doctors who had refused to display the material in their offices. The most frequently named reason for refusal was personal unwillingness to donate organs and a lack of time, associated with concerns that patients might ask further questions on the information material. These results are in agreement with the finding that 90% of nonprofessional adults in our area were willing to be approached for organ donation in case of the death of a relative (even though this was rated an emotionally disturbing question). However, 44% of the doctors in our affiliated donor hospitals stated that no approach of the family would be made by them, out of fear that the approach of a family for organ donation in a situation of mourning would be inappropriate. The results show that the personal attitude of professionals toward organ donation differs greatly from the attitude of the general public in Germany. We recently changed our information strategy and emphazised the information of doctors in our affiliated hospitals. After giving lectures at each hospital, we developed a new information strategy for this year’s national day of organ donation. We approached the hospitals and provided them with a list of patients at their own clinic on the waiting list for organ transplantation, The director of the hospital was informed about the long waiting times of the patients and the number of donor referrals from his hospital in the last 3 years. We then asked for support concerning the public information by distributing information material during a 2-week period around the day of organ donation and by having the doctors answer public questions. Ten of 14 hospitals agreed to participate. These actions combined the information of all doctors at the hospitals (they were tutored by staff of the transplant office) with a high local news profile (patients and doctors of the neighborhood were suddenly involved in making organ donation an important issue for the community). The preliminary results of this new campaign are encouraging: the rate of organ donation in our area increased by 30% during the first 6 months of 1997 compared with the same time period of the previous year. From the Department of General Surgery, Transplantationszentrum Kiel, Kiel, Germany. Address reprint requests to G.R. SchiXt, Department of General Surgery, Transplantationszentrum Kiel, Arnold-Heller-Str 7, 24105 Kiel, Germany.
0 1997 by Elsevier Science Inc. 6.55 Avenue of the Americas, New York, NY 10010
Transplantation
Proceedings,
29, 3246 (1997)
Organ Donation: The Influence of Personal Attitude on Professional Behavior G.R. Schiitt and D. Henne-Bruns
NUMBER of organ donors in Germany has been standards: 14 pmp (per miLlion population) during the last 3 years. Various factors were discussed that might account for this. Objection to organ donation is one reason that was identified as a cause for the low donation rate. Presently, Germany has no transplantation law. Practice is that next of kin is approached after the death of a person, and the will of the deceased (when stated on a donor card) or the will of the next of kin is followed by the medical doctors. When families were approached for organ donation, the objection rate increased from 20% in 1993 to 35% in 1996. Only 5% of the deceased carried donor cards. Our transplant unit planned a comprehensive education program because 29 donor referrals during 1996 resulted in only 13 organ donations, mainly due to an astonishing rate of 40% refusals of next of km. At the beginning, we distributed a standardized questionnaire to find out who the best source of information on organ donation would be. We asked 500 individuals from various professions (students, office workers, nurses, and medical doctors in intensive care units who they believed should provide information on organ donation. Seventy-five percent of all those questioned stated that the medical doctor should be the primary source of information on transplantation-related matters. Fifty percent indicated that medical insurance companies and 45% that television and print media would be an appropriate source. With this knowledge at hand, we approached the largest medical insurance company in our area. The company initiated a mailing campaign during which 700,000 clients received information on organ donation in combination with a donor card. We added a series of public lectures that were held in our hospital. Simultaneously, we wrote a personal letter to 980 practitioners in our area in which they were asked to display information material on organ donation in their offices. We were hoping to distribute material on organ donation via the physicians, as requested by the majority of public respondents to our questionnaire. Disappointingly, only 9.5% of the medical doctors were willing to do so. Nearly 90% refused! The professional attitude of doctors, who are thought to be the group that, based on their educational background, would provide the most objective information on this medical subject, was in sharp disagreement to the expectations expressed by the public. We placed telephone follow-up calls to a subset
T” comparatively low by international
0041-1345/97/$17.00 PII so041 -1345(97)00893-2
3246
of the doctors who had refused to display the material in their offices. The most frequently named reason for refusal was personal unwillingness to donate organs and a lack of time, associated with concerns that patients might ask further questions on the information material. These results are in agreement with the finding that 90% of nonprofessional adults in our area were willing to be approached for organ donation in case of the death of a relative (even though this was rated an emotionally disturbing question). However, 44% of the doctors in our affiliated donor hospitals stated that no approach of the family would be made by them, out of fear that the approach of a family for organ donation in a situation of mourning would be inappropriate. The results show that the personal attitude of professionals toward organ donation differs greatly from the attitude of the general public in Germany. We recently changed our information strategy and emphazised the information of doctors in our affiliated hospitals. After giving lectures at each hospital, we developed a new information strategy for this year’s national day of organ donation. We approached the hospitals and provided them with a list of patients at their own clinic on the waiting list for organ transplantation, The director of the hospital was informed about the long waiting times of the patients and the number of donor referrals from his hospital in the last 3 years. We then asked for support concerning the public information by distributing information material during a 2-week period around the day of organ donation and by having the doctors answer public questions. Ten of 14 hospitals agreed to participate. These actions combined the information of all doctors at the hospitals (they were tutored by staff of the transplant office) with a high local news profile (patients and doctors of the neighborhood were suddenly involved in making organ donation an important issue for the community). The preliminary results of this new campaign are encouraging: the rate of organ donation in our area increased by 30% during the first 6 months of 1997 compared with the same time period of the previous year. From the Department of General Surgery, Transplantationszentrum Kiel, Kiel, Germany. Address reprint requests to G.R. SchiXt, Department of General Surgery, Transplantationszentrum Kiel, Arnold-Heller-Str 7, 24105 Kiel, Germany.
0 1997 by Elsevier Science Inc. 6.55 Avenue of the Americas, New York, NY 10010
Transplantation
Proceedings,
29, 3246 (1997)