Respondents
Total
Total in %
Total
755
100
Medicine
466
61.7
Economics
289
38.3
Female
386
52.3
Male
352
47.7
Age: 0–19 years
101
13.5
Age: 20–24 years
473
63.3
Age: 25–29 years
149
19.9
Age: 30 years and above
24
3.2
Breakdown by years in each respective program
Medicine total and (%)
Economics total and (%)
1st–2nd year
228 (48.8)
250 (51.2)
3rd–6th year
238 (86.7)
35 (13.3)
In total, the questionnaire consisted of 55 sets of closed questions addressing the following topics: prior knowledge about organ transplantation and allocation, attitudes towards LOD and DOD under different conditions, models of commercialization and incentives, concepts of death and bodily identity, consent models, pro-social behavior, and socio-demographic data. We used a 6-Likert-scale for attitude questions, and yes/no/don’t know for knowledge and for simple questions on decisions or willingness. The questionnaire was pre-tested for comprehensibility and factor analysis was used to explore validity. The evaluation of the survey results took place from 2010 to 2012.
Data processing software SPSS was used to analyze the survey.10 The analysis is based on frequency analysis and the calculation of means for Likert-scales. Differences between groups (academic subject, gender) were analyzed by using a Chi-square test. P-values below 0.05 were defined as significant (*) and p-levels below 0.01 as highly significant (**). For questions where participants could choose between the options yes/no/don’t know, the answers no and don’t know were combined and Chi-square tests were conducted for 4-field matrixes. The main focus of analysis was placed on which groups agreed to certain positions. Subjects who would not or hesitated to agree were regarded as one group.
4.3 Results
4.3.1 Willingness for Organ Donation and Transplantation
Passive willingness means that a person is theoretically willing to donate an organ when asked during a survey. The passive willingness for DOD was 58.4 % among all participating students, while 33.2 % were undecided. If a person holds a donor card, indicating the holder’s willingness to donate, we defined this as active willingness to donate. Significantly, more women (28.6 %) than men (19.4 %) were in possession of a donor card.
The willingness to agree to LOD was much higher among all students than DOD. In the case of a sick partner, 80.3 % of men (men → women) and 85.6 % of women (women → men) were willing to help their partner with a LOD. The willingness to donate a living organ to one’s own child was equally high in both groups (to daughter: women: 85.9 %, men: 85.1 %; to son: women 82.5 %, men: 78.4 %). The question on possible motivations for LOD showed a clear ranking of reasons (ranking each motivation from 1 = total approval—6 = total disapproval). The primary motivation was love (mean 1.32). The second most important motivation was responsibility towards the family (mean 2.24). Moral duty as a motivating factor was seen ambivalently (mean 3.24). Other motivations, such as to meet expectation of the family, gaining social approval, or financial compensation, gained low or no consent (mean ≥ 4.80). The most frequently cited reason against LOD was fear of medical complications (women: 74.9 %; men: 67.9 %) (sig. p = 0.029), followed by the statement that this constitutes an invasion of bodily integrity (women: 47.9 %; men: 42.9 %). 11.7 % of women and 15.6 % of men were of the opinion that this also invades one’s psychological integrity . The majority of respondents believed that LOD would improve the relationship between donor and recipient (66.2 %).
Although anonymous LOD is prohibited in Germany, 44.3 % of all respondents were in favor of it (economics: 47.1 %; medical: 42.7 %) (sig. p = 0.036). Students agreed that LOD should also be allowed between individuals who are not relatives or friends, but are on bowing terms. (75.3 % economics; 63.9 % medical) (p < 0.001).
4.3.2 Images of the Body
To test if different images of the body have an influence on attitudes towards organ donation, attitudes towards different body concepts were the first to be assessed. A large majority of students (84.1 %) favored a holistic concept of the body in which the human body signifies more than just the sum of its parts (see Fig. 4.1).
Fig. 4.1
Attitudes towards different body concepts showing differences between gender differences and differences between academic subjects
Despite this rather clear result, there were significant gender differences: More women (87.6 %) than men (80.6 %) have a holistic conception of the body (sig. p = 0.023). When asked about their position towards a more technical concept of the body, only about 10.9 % of the respondents agreed to the idea that parts of the body can easily be exchanged like in a machine, with a much higher percentage amongst men rather than women. While only 6.3 % of women agreed with this statement, 15.9 % of men agreed (sig. p < 0.001, see Fig. 4.1). Medical students were also more in favor of this body concept (8.3 % economics, 12.5 % medical, sig. p < 0.001), while economics students showed a tendency of being unsure about their answers (15.1 %). Economics students also showed this uncertainty with regard to the idea that the heart is the location of the soul and should not be transplanted, 26.0 % were unsure about this. Uncertainty was also relatively high regarding the question of whether certain body parts are believed to be significant for identity. Thus, 25.3 % of respondents were uncertain whether specific organs determine a person’s individuality. 41.1 % of respondents disagreed with this statement and 33.7 % agreed (see Fig. 4.1).
4.3.2.1 Preferences to Accept an Organ
Moreover, we asked what type of organ the respondents would accept in case of severe organ failure. There was a higher preference for human origin (postmortem or living, see Fig. 4.2) than for animal or artificial organs. Women opted for a living organ significantly more often (76.8 %) than men (71.9 %) (p = 0.014). Respondents were more skeptical about other alternatives, e.g., animal organs, organs from stem cells, or a machine. Yet, more than half of the respondents stated that they would accept an organ grown from stem cells, but while 76.1 % of men would accept such an organ, only 58.9 % of women would agree to this option. Here, women were significantly more uncertain about it (32.3 %) than men (16.6 %) (p < 0.001). The same level of uncertainty emerged on the question of whether an artificial machine would constitute an adequate surrogate organ (31.1 %) or about the option of an animal organ (36.1 %).
Fig. 4.2
Acceptance of an organ in case of illness. Positive answers in %, differences between gender differences and differences between academic subjects
Apart from the origin of an organ, acceptance levels may also vary with respect to the type of the human organ. The answer options ranged from fully acceptable (1) to do not accept at all (6). The kidney showed the highest level of acceptance, scoring 1.3 (whole data set), as well as the liver with 1.4, followed by lung transplant and the heart (1.6). Transplantation of the cornea was also accepted, averaging 2.2. Transplanting single limbs was seen as still acceptable (3.2), as well as receiving a whole eye (3.2). Respondents were uncertain about the option of accepting face transplantation (3.8) and the transplantation of genitals, which showed a mean of 4.3.
Strikingly, the mean values of all options (except for the pancreas) showed that men were more willing to accept any kind of organ than women. While answers with regard to the kidney, liver, and lung only showed a slight tendency towards differing opinions, this difference became more pronounced in the option of accepting a heart transplant (1.5 for men, 1.8 women, sig. p = 0.003). When it comes to externally visible organs, differences between men and women were even more significant. Values on the acceptance of a cornea transplant ranged from 2.0 among men to 2.3 among women (sig. p = 0.003). These differences increased even more in responses to the option on the acceptance of receiving a whole eye transplant (2.8 men; 3.6 women, sig. p < 0.001), acceptance of single limbs (2.8 men; 3.5 women, sig. p < 0.001), a full face (3.4 men, 4.1 women, sig. p < 0.001), or a transplantation of genitals (3.9 men, 4.6 women, sig. p = 0.001).
Overall, the acceptance of an organ was highest for human organs and those organs that are invisible within the body, with men showing greater acceptance of transplantation than women. Students were also asked how important background information about the donor would be for them (see Fig. 4.3).
Fig. 4.3
Importance of information about donors’ characteristics, total (n = 755) (1 = very important—6 not important, means)
Answers (options ranging from 1-very important to 6-not important) showed that mainly information that is closely related to health, like health itself (mean 2.17), or smoking and drinking habits (mean 2.45) were regarded as being important. Other characteristics of a person were of little importance (e.g. skin color 5.4 or occupation 4.82, see Fig. 4.3).
4.3.2.2 Preferences to Donate Certain Organs
Respondents were also asked about their attitude towards donating certain organs (DOD), especially organs that, so far, have not been routinely transplanted. On the one hand, when asked about their personal willingness to donate an organ postmortem, answers showed a high willingness among respondents to donate internal organs such as the liver (73.1 %), heart (57.6 %), or kidney (75.7 %, see Fig. 4.4).
Fig. 4.4
Consent to DOD, organ specific, positive answers in %, total (n = 755)
On the other hand, the willingness to donate visible body parts was generally much lower (cornea/eye 36.6 %, hand/foot 28.9 %, skin 31.7 % see Fig. 4.4). There was an overall difference between men and women. While the overall high willingness to donate internal organs was even higher among women (e.g. liver: 68.9 % men, 78.2 % women, sig. p = 0.004; kidney: 71.8 % men, 80.8 % women, sig. p = 0.004), the picture changed with more visible, external body parts. Here, men showed a slightly (but not significantly) higher willingness to donate than women (cornea/eye: 39.3 % men, 35.0 % women; hand/foot: 32.5 % men, 26.4 % women). The willingness to donate was strongly linked to personal views on particular body concepts. Overall, the willingness to donate organs postmortem was higher among those who had a fragmented, machine-like, or a holistic body concept than those who connected ideas of identity to certain organs (see Fig. 4.5).
Fig. 4.5
Organ-specific willingness to DOD in relation to body concepts, positive answers in %, total (n = 755)
Among respondents who were in favor of the idea that the heart is the location of the soul, only 8.3 % were willing to donate their heart postmortem. When asked about extending recent regulations on transplantation of organs which currently are rarely transplanted rarely or not transplanted at all, body parts such as genitals, the brain, or the face elicited strong rejection or uncertainty. Only 20 % of respondents agreed to a brain transplant, one third remained undecided (27.7 %). Generally, there was a high uncertainty about extending possible options for donation. Thus, in every response option, one third of respondents stated that they could not answer the question. Responses here showed significant gender differences. Women tended to disagree more strongly than men concerning options to extend the scope of organs for transplantation (see Fig. 4.6).
Fig. 4.6
Acceptance of transplantation of different body parts (in genereal), positive answers in %, total (n = 755), gender differences
On the other hand, they were less decisive in their responses to the questions. Thus, 23.9 % of men and 16.9 % of women answered positively about transplanting a brain, 21.9 % of men and 32.7 % of women were unsure (sig. p = 0.002). 40.6 % of men and 29.6 % of women agreed with the transplantation of genital organs, while 32.2 % of men and 36.4 % of women were unsure (sig. p = 0.006). In contrast, 71.4 % of men, but only 57.3 % of women answered positively to eye transplantation, 13 % of men and 14.5 % of women rejected this, and 15.6 % of men and 28.2 % of women were undecided (sig. p < 0.001). 80.4 % of men and 68.6 % of women accepted the transplantation of single limbs, while 13.5 % of men and 21.8 % of women were undecided.
4.3.2.3 Comparing Willingness to Donate with the Acceptance of an Organ Donation
When we compared the question on the general willingness to donate organs postmortem (passive willingness DOD) with the attitude towards generally extending the scope of organ transplantation to certain parts of the body, like the brain or a whole eye, which are currently not transplanted, results showed that those who themselves expressed a positive willingness to donate were generally also positive about expanding the spectrum of organ donation. For example, among those who would be willing to donate their cornea, 75.9 % approved of cornea donation in general, while among those who disapproved of cornea donation, only 56.1 % stated that they were principally positive about the possibility of eye transplantation (sig. p < 0.001). Among the respondents willing to donate a hand or foot, 86.0 % principally approved of the possibility to transplant single limbs. In contrast, among those who rejected to donate a limb, 68.9 % still, in principle, consented to allowing limb transplants. Among those who were willing to donate larger areas of skin, 51.7 % approved of general full-face transplantation. In contrast, only 31.5 % of those who would not donate larger areas of skin themselves voted for the general possibility of a full-face transplant (sig. p < 0.001).
4.3.3 Acceptance of the Brain Death Criterion
The willingness to donate organs postmortem seems to presuppose that people accept the definition of brain death in its current version. Thus, students were asked about their attitude towards different concepts of death (see Fig. 4.7; Table 4.2).
Fig. 4.7
Acceptance of different death concepts, positive answers in %, total (n = 755)
43.9 % of the respondents believed that a patient is dead when his or her brain is completely destroyed. Further, 20.9 % believed that a person is dead when those regions of the brain connected with personality stop functioning (brain stem death) . 47.7 % of the medical students and only 37.6 % of the economics students agreed with the whole brain death criterion (sig. p < 0.001). However, the survey also showed that 29.1 % of the medical students thought that brain death was not a safe criterion for death and agreed that a person is not dead as long as organs are still functioning. Questions concerning the criterion of brain death elicited significant gender and differences between academic subjects. 39.9 % of the female respondents and 30.1 % of the male respondents doubted both brain death criteria (p = 0.012). At this point, it is important to note that 6.9 % of those who did not hold an organ donor card justified this with their doubts about the brain death criteria. Here, too, significant gender differences and differences between academic subjects can be observed. 9.1 % of the female respondents held this opinion in contrast to only 4.5 % of the male respondents (p = 0.016). There also was a connection between body concepts and concepts of death . Those who think the body is similar to a machine accepted the idea of brain death more frequently (brain stem death plus entire brain death: 76.2 %) than those who do not agree with this body concept (63.4 %, p = 0.025).
Table 4.2
Acceptance of different death concepts, differences with regard to gender and academic subject
