Portal de Periódicos da CAPES

Does publicity affect organ donation?

2020; Springer Science+Business Media; Volume: 33; Issue: 9 Linguagem: Inglês

10.1111/tri.13655

1432-2277

Susanna Madden, Michael R. Lucey, James Neuberger,

Organ Transplantation Techniques and Outcomes

Key to sustaining and expanding transplant programmes is public confidence in the integrity of the organ donation, allocation and transplantation process. A public perception that the process is flawed, or worse still corrupt, may be associated with public loss of confidence and withdrawal from donation. In 1998, George Best, a famous former international soccer player with a reputation as a socialite, had a liver transplant for treatment of his end-stage liver disease in July 2002. He made a good recovery but in was subsequently recorded as having returned to alcohol use in August 2003. The adverse publicity led to public comments that this led to a reduction in transplant activity [1, 2]. We also examined the impact of positive stories where another international sporting figure, Jonah Lomu, a famous rugby player from New Zealand, underwent a kidney transplant in July 2004 [3]. Both had significant exposure in the British press so we wanted to examine whether these stories had a demonstrable impact on organ donation. The impact on organ donation and transplantation was assessed by examining the UK Potential Donor Audit (PDA) and the UK Transplant Registry (UKTR). These registries are maintained by NHS Blood and Transplant. The PDA is an audit of all deaths in critical or emergency care in all hospitals in the UK and records whether the deceased met criteria for organ donation, whether consent for donation was requested and whether given. The UKTR records whether organ donation proceeded, whether organs were retrieved and whether transplanted. To assess press coverage, an independent company (Romeike) scanned 1596 publications for the keywords ‘transplant’ and ‘UK Transplant’. The publications scanned covered national daily, regional morning, regional evening, Sunday papers with associated magazines and supplements (which are counted as separate titles), weekly papers and numerous general interest magazines. Television, radio and Internet coverage were not included. Articles were reviewed and data cleaned to ensure that only relevant articles were included. Circulation figures for each article, a surrogate measure of readership, were included in the data from Romeike. In absence of information, figures were extrapolated from prior records. If there was no prior record, figures were taken to be similar to current figures reported on the Audit Bureau of Circulations website 2005 (www.auditbureau.org). These approximate figures were considered adequate for analysis. As can be seen in Fig. 1, there was no demonstrable impact of either of the two events, associated with George Best, on monthly deceased donor numbers in the UK. For the time period the press coverage data were available (August 2003 – December 2004), the total circulation figures (measured as total copy length*total circulation per week) in Fig. 2 show that both George Best's return to alcohol and Jonah Lomu's transplant received a similar amount of press coverage. Other peaks of publication coincided with an advertising campaign by the Driver and Vehicle Licensing Agency (DVLA), the second with a publicity about ovary donation. The weekly number of potential doors, consented rates and transplants during this period is shown in Fig. 3. A dynamic regression time series model was developed to measure the influence of press coverage variables on weekly donor numbers and produced a simple flat rate model equal to a constant number of donors per week (13.8). The analysis determined that none of the press coverage variables or their lagged variables were significant explanatory variables in predicting the weekly donor numbers. Furthermore, no press coverage influence could be established indirectly via the association of potential donor numbers and consent rate when the same modelling techniques were applied. Matasanz [4], who has led the highly successful organ donation programme in Spain, has identified some of the factors that are essential for a successful organ donation programme: these include a proactive donation programme with well-trained transplant coordinators, introduction of systematic death audits in hospitals, and the combination of a positive social atmosphere, an adequate management of mass media relations, and adequate economic reimbursement for the hospitals. A recent review of donation programmes [5] suggested that, at least in the Netherlands, donation rates increased following various information campaigns. This contrasts with our own findings that there was no demonstrable association between various organ donation campaigns and the UK donation rate. Several studies have looked at the impact of publicity on the willingness of the public to support organ donation. Aykas and colleagues [6] conducted a systematic review of reports from national campaigns and a literature search. They concluded that hoaxes about brain death and organ transplantation adversely affect organ donation rates in both Western and Eastern societies. On the other hand, the overall effect of public education campaigns in promoting organ donation was a modest temporary gain of 5%. Following the German organ scandal, an analysis of newspaper articles showed not only were about two thirds negative but extended into doubt about the concept of brain death [7]. Slovic and colleagues [8], following a series of studies to examine how presentations of organ donation cases in the media may affect people's willingness to sign organ donor cards, donate the organs of a deceased relative or become a living kidney donor found that provision of information about the recipients increased the willingness to support organ donation, whereas information about the donor is less effective in increasing support for organ donation. We believe that these data suggest that isolated reports, whether positive or negative, have little direct impact on consent or donation rates. However, the press and other media do play a major role in encouraging organ donation and maintaining public confidence in the fairness of the system and, over time, a string of adverse stories, will erode such confidence. The work was supported by NHS Blood and Transplant. We thank Dr Richard Lawton, Lecturer in Statistical Forecasting (retired) from the Faculty of Computing, Engineering and Mathematical Sciences of the University of the West of England, UK, for his expertise, guidance and support in performing all the statistical analyses presented here and interpretation of the results for the purposes of the original dissertation in candidacy for the degree of MSc Statistics and Management Science.