“I’d register, but I’ve never been asked…” Key factors influencing decisions about whether to register as an organ donor

Kirsten Howard¹, Stephen Jan², John M. Rose³, Michelle Irving^1,4, Germaine Wong^1,4, Allison Tong^1,4, Jonathan C. Craig^1,4, Steven Chadban^5,6, Richard D. Allen⁶, Alan Cass^2,7

¹School of Public Health, University of Sydney, Sydney, Australia, ²The George Institute for International Health, Sydney, Australia, ³Institute for Transport and Logistics Studies, University of Sydney, Sydney, Australia, ⁴Centre for Kidney Research, The Children's Hospital Westmead, Westmead, Australia, ⁵Central Clinical School, Bosch Institute, University of Sydney, Sydney, Australia, ⁶Department of Renal Medicine, Royal Prince Alfred Hopspital, Sydney, Australia, ⁷Menzies School of Health Research, Casuarina, Australia

Background: Despite broad public support for organ donation, there is a chronic shortage of deceased donor organs. We aimed to identify the key factors that would influence the decision about whether to register as an organ donor

Methods: A best-worst-scaling method was used where policies/services are described by factors presented with varying levels. Community respondents were recruited from an existing internet panel; quota sampling ensured they were broadly representative of the adult Australian age distribution. Participants answered 30 online scenarios presenting 9 factors (Table1), and chose, in each, the factor that made them most likely, and least likely, to register to be a donor. Using MNL regression we calculated: the importance of each factor, and the contribution each factor made to overall utility of a policy

Results: There were 2041 respondents with a mean age of 45.4 (range18-87); 51.8% were female.  The importance ranking of attributes is shown below (Table1), with the type of consent system ranking highest. The largest gains in overall utility of a policy could be achieved from:  reimbursement of funeral expenses, family priority in the future, how death is defined and direct payment mechanisms.  There were some differences in the valuation of attribute levels with respondent age, for example respondents <50yrs valuing financial mechanisms more highly than older people

Conclusions: How donation intent is registered (ie the consent system in place) and the extent of family overrule were valued highly, as was ease of registration.  Interestingly, less important attributes such as possible incentive mechanisms (funeral expense reimbursement, direct payment and family priority) all significantly contributed positively to overall policy utility, suggesting the Australian public is open to donation policies that include incentives, including financial mechanisms