Comparing organ donation decisions for next-of-kin versus the self: Results of a national survey

Abstract Objectives Intensive care audits point to family refusal as a major barrier to organ donation. In this study, we sought to understand refusal by accounting for the decision-maker’s mindset. This focused on: (1) how decisions compare when made on behalf of a relative (versus the self); and (2) confidence in decisions made for family members. Design Cross-sectional survey in Singapore. Setting Participants were recruited from community settings via door-to-door sampling and community eateries. Participants 973 adults who qualified as organ donors in Singapore. Results Although 68.1% of participants were willing to donate their own organs, only 51.8% were willing to donate a relative’s. Using machine learning, we found that consistency was predicted by: (i) religion, and (ii) fears about organ donation. Conversely, participants who were willing to donate their own organs but not their relative’s were less driven by these factors, and may instead have resorted to heuristics in decision-making. Finally, we observed how individuals were overconfident in their decision-making abilities: although 78% had never discussed organ donation with their relatives, the large majority expressed high confidence that they would respect their relatives’ wishes upon death. Conclusions These findings underscore the distinct psychological processes involved when donation decisions are made for family members. Amidst a global shortage of organ donors, addressing the decision-maker’s mindset (e.g., overconfidence, the use of heuristics) may be key to actualizing potential donors identified in intensive care units. Strengths and Limitations of this Study We used a multi-disciplinary approach combining psychology theory and machine learning analyses to understand family refusal in a novel manner. We directly compared organ donation decisions made from the self versus for next-of-kin, and also documented overconfidence in the decision-making process. The study was conducted in an urban setting and may not apply to rural contexts.