Cheung T K, Cheng T C, Wong L Y
The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
Hong Kong Med J. 2018 Apr;24(2):119-127. doi: 10.12809/hkmj176831. Epub 2018 Apr 10.
Under the current opt-in system, the deceased organ donation rate remains low in Hong Kong. An opt-out system and an opt-in system combined with organ allocation priority (ie, priority to donors as transplant recipients) have been proposed to encourage willingness among the general population towards deceased organ donation. This study aimed to compare willingness, and its determinants, across these three legislative systems.
A random telephone survey of Hong Kong permanent residents aged ≥18 years was conducted between August and October 2016 using an anonymous questionnaire. Willingness towards deceased organ donation was compared between the legislative systems with McNemar's test. Determinants of willingness were tested by logistic regression.
The proportion of those willing to consider deceased organ donation under the current opt-in system would significantly increase after combining it with allocation priority (64.5% vs 73.4%; P=0.018). "Fairness or reciprocity" was the major reported reason underlying the increase. In contrast, willingness would decrease after introducing the opt-out system (60.1%), although not significantly (P=0.336). The reduction might be attributable to a "belief of being forced to donate". Under the allocation priority system, reduced willingness to donate was associated with advanced age, lower educational attainment, and lower monthly household income. Under the opt-out system, reduced willingness was associated with being married, having a lower household income, and distrust of local government.
An opt-in system with allocation priority could induce willingness to donate, whereas an opt-out system may reduce willingness. The findings have implications for policy-making and promotion of organ donation.
在当前的选择加入系统下，香港的 deceased 器官捐赠率仍然很低。有人提议采用选择退出系统以及将选择加入系统与器官分配优先权（即捐赠者作为移植受者的优先权）相结合，以鼓励普通民众对 deceased 器官捐赠的意愿。本研究旨在比较这三种立法系统下的意愿及其决定因素。
2016 年 8 月至 10 月期间，使用匿名问卷对年龄≥18 岁的香港永久居民进行了随机电话调查。采用 McNemar 检验比较了各立法系统下对 deceased 器官捐赠的意愿。通过逻辑回归检验意愿的决定因素。
在将当前的选择加入系统与分配优先权相结合后，愿意考虑 deceased 器官捐赠的比例将显著增加（64.5%对 73.4%；P = 0.018）。“公平或互惠”是报告的增加背后的主要原因。相比之下，引入选择退出系统后意愿会下降（60.1%），尽管不显著（P = 0.336）。这种下降可能归因于“被迫捐赠的信念”。在分配优先权系统下，捐赠意愿降低与高龄、较低的教育程度和较低的家庭月收入有关。在选择退出系统下，意愿降低与已婚、家庭收入较低以及对当地政府的不信任有关。
带有分配优先权的选择加入系统可以诱导捐赠意愿，而选择退出系统可能会降低意愿。这些发现对器官捐赠的政策制定和推广具有启示意义。
