Boulware L E, Troll M U, Wang N-Y, Powe N R
Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Am J Transplant. 2007 Jul;7(7):1778-87. doi: 10.1111/j.1600-6143.2007.01848.x. Epub 2007 May 25.
The influence of perceptions of organ allocation on willingness to donate organs is unclear. We performed a national study assessing the relation of public perceptions of organ allocation to willingness to donate organs, and we assessed the contribution of beliefs regarding discrimination in health care to observed associations. Among 845 participants, a majority (65%) reported that they less than "mostly" understand allocation, and most (71%) reported that they believe allocation is "unfair" or are "unsure" of its fairness. Participants reporting less understanding were less willing to donate (56%) than persons reporting greater understanding (67%) (p < 0.01). Participants believing allocation is "unfair" or who are "unsure" about fairness were less willing to donate (54%) than persons believing allocation is "fair" (68%) (p < 0.01). Associations were stronger among certain demographic subgroups. Participants with the least favorable perceptions of allocation were more likely than their counterparts to believe that race and income discrimination occur in transplantation and to believe that they personally experienced income discrimination in health care. Adjustment for these beliefs partially attenuated associations between perceptions regarding allocation and willingness to donate. Interventions enhancing transparency and perceived fairness of organ allocation may improve willingness to donate, particularly if they address concerns regarding discrimination in transplantation and health care.
器官分配观念对器官捐赠意愿的影响尚不清楚。我们开展了一项全国性研究，评估公众对器官分配的看法与器官捐赠意愿之间的关系，并评估有关医疗保健中存在歧视的信念对观察到的关联的影响。在845名参与者中，大多数（65%）报告称他们对分配的理解程度低于“大部分”，并且大多数（71%）报告称他们认为分配“不公平”或对其公平性“不确定”。报告理解程度较低的参与者比报告理解程度较高的参与者更不愿意捐赠（56%对67%）（p<0.01）。认为分配“不公平”或对公平性“不确定”的参与者比认为分配“公平”的参与者更不愿意捐赠（54%对68%）（p<0.01）。在某些人口亚组中，这种关联更强。对分配看法最不利的参与者比其他参与者更有可能认为移植中存在种族和收入歧视，并认为他们个人在医疗保健中经历过收入歧视。对这些信念进行调整后，分配观念与捐赠意愿之间的关联部分减弱。提高器官分配透明度和感知公平性的干预措施可能会提高捐赠意愿，特别是如果这些措施能够解决对移植和医疗保健中歧视的担忧。
