Determinants of organ donation registration among university students in Hong Kong

Abstract

Past research has revealed that the majority of people in Hong Kong possess a positive attitude towards posthumous organ donation. Despite this, only around 2% of citizens have registered for organ donation. Given the huge need worldwide for organs for transplants, it has become increasingly important to understand such attitude-behavior inconsistency. The present research attempted to bridge the current knowledge gap by identifying the determinants for organ donation registration through employing the Theory of Reasoned Action (TRA). The work focused on Hong Kong Chinese university students, and it comprised three studies. In Study 1, a qualitative approach using semi-structured focus groups was adopted to explore the core beliefs held by the university students. A total of 19 students from three universities in Hong Kong participated. Findings suggested that their attitudes towards organ donation involved both the cognitive and affective nature; subjective norm of family, friends, and respected people were identified as influential to students’ views on organ donation. Items for direct and indirect measures of both attitude and subjective norm were generated, which has been lacking in past research. In addition, measures of filial piety, fears of organ donation, anxiety of body damage after death, and distance to death, and an organ donation perception inventory were proposed for scale development. In Study 2, a total of 211 university students participated in a survey that used the measures proposed in Study 1. Exploratory and confirmatory factor analyses were conducted to identify the factor structures. The measures were evaluated and various scales were established with adequate psychometric properties and satisfactory internal consistency and construct validity. In particular, the study established standard measures of attitude and subjective norm for TRA research and also the first comprehensive organ donation perception inventory. To build a model, in Study 3 the predictors of organ donation registration were examined. Logistic regression, multiple hierarchical regressions, and path analysis were performed on the same data set as Study 2. Results revealed that affective attitude, subjective norm of family, distance to death, self-rated knowledge of organ donation, and age were the predictors in the organ donation registration model, which correctly predicted 80% of the registration status. Affective attitude was predicted by the perception of the positive factor of helping, as well as negative factors including concerns about keeping the body intact, constitution of family burden, and indifference to organ donation. Body intactness concerns involve both cognitive and emotional aspects that could be predicted by fears of organ donation and anxiety of body damage after death. The present research using a mixed methods approach offers significant contributions to the TRA research theoretically, methodologically, and practically. Theoretically, the research confirmed and expanded the TRA model, and an organ donation registration model was built. Methodologically, a total of seven measures have been established for future research in organ donation. Practically, the findings have nine implications for organ donation policies and promotion strategies. In particular, policy makers need to enhance people’s knowledge of organ donation as well as addressing their negative feelings and perceptions of impact, especially for body intactness issues. In view of the importance of family support, a promotion strategy that is family-based rather than individual-based is recommended. Engaging people in discussion and death education are also crucial in making any promotion a success.