Beyond altruism: trust, fairness and social inclusion in deceased organ donor registration

© 2016 Dr. Emma Elizabeth TinningDespite decades of research and efforts to increase organ donation, the gap between the supply of and demand for transplantable organs continues to grow. Much of this research relies on models of individual prosocial behaviour, borne out of an almost ubiquitous framing of deceased donation as an altruistic “gift of life”. However this framing has its limitations, in particular the assumption that individual personality traits and preferences drive donation. This thesis takes an alternative approach to explaining donor registration behaviour. A collective, rather than an individual, conceptualization of deceased donation is argued for, in which the parameters of inclusion and fairness (as antecedents to trust and commitment) are key factors in donor registration behaviour. This conceptualisation was empirically tested. First, a series of focus groups of five different migrant populations was conducted in the Gulf State of Qatar. This was followed by a pilot survey, and later a wider study involving Australian participants that tested a collective model of intentions to register. Registration behaviour was subsequently compared with an individual (theory of planned behaviour) model typically used in organ donation studies. The results of the studies highlight the need for investment in donor registration to move beyond communication campaigns that focus on improving attitudes or self-efficacy towards organ donation. Policies focused on strengthening society members' relationships with social institutions and fostering inclusiveness offer scope to increase the uptake of registration in the community