Attitudes of Visitors at Adult Intensive Care Unit Toward Organ Donation and Organ Support

Organ transplantation remains the only viable treatment for patients with end-stage organ failure, yet the shortage of deceased donors persists as a critical challenge, particularly in Chinese populations. In Hong Kong, the deceased organ donation rate stood at 6 donors per million population (pmp) in 2017, while mainland China reported 3 donors pmp in 2016. These figures starkly contrast with the growing demand, as over 2000 patients in Hong Kong and approximately 300,000 individuals across mainland China await life-saving transplants. This supply-demand imbalance underscores the urgency to investigate societal attitudes and systemic barriers influencing organ donation. A cross-sectional study involving 520 visitors at Hong Kong intensive care units (ICUs) from 2014 to 2016 provides critical insights into these challenges.

Cultural Beliefs and Death Anxiety

Cultural traditions deeply rooted in Taoist and Buddhist philosophies emphasize bodily integrity after death, historically discouraging organ donation. However, the study revealed a shift among younger, more educated generations: 61% of participants accepted the concept of body disfigurement associated with organ retrieval. Despite 94% expressing support for organ donation in principle, only 66% were willing to donate their own organs posthumously. This discrepancy highlights unresolved psychological and cultural barriers.

Death anxiety exacerbates this gap. In Chinese culture, discussions about death are often avoided due to superstitions about attracting misfortune. The study found only 26% of participants had ever discussed organ donation with family members. Even among those willing to donate, 64.7% had never communicated this preference to relatives. This silence creates practical hurdles during donation decisions, as families frequently override unexpressed donor wishes.

Policy Frameworks and Familial Consent

Hong Kong’s “opt-in” system, requiring explicit donor registration, contrasts with “opt-out” models where consent is presumed unless individuals actively refuse. Public opinion remains divided: a 2017 government survey showed 33.8% supporting opt-out legislation, while 35.9% opposed it. Familial consent requirements further complicate procurement. The study identified that 82% of participants would refuse posthumous donation for a brain-dead relative without prior knowledge of the deceased’s wishes, with 91.3% citing lack of explicit consent as their primary objection.

Current mechanisms like Hong Kong’s Centralized Organ Donation Register (CODR) remain underutilized, with only 3.8% of the population (282,572 individuals) registered by 2018. Proposals to display donor status on identity cards aim to simplify familial consent processes. Additionally, integrating priority allocation systems—where registered donors receive transplantation priority—could incentivize participation, as suggested by local studies showing increased willingness under such models.

Healthcare System Challenges

Under-identification of potential donors outside ICUs represents a systemic barrier. In Hong Kong, most potential donors originate from non-ICU wards, where 34% are lost due to hemodynamic instability or incomplete brain death diagnoses. Frontline healthcare workers often lack training to recognize donors or navigate end-of-life care in acute settings. A local audit revealed only half of potential donors were properly identified and referred. Enhancing staff education and standardizing donor identification protocols could significantly increase procurement rates.

ICU resource allocation for donor care remains contentious. The study explored public acceptance of admitting critically ill patients to ICUs solely for organ preservation. Participants supported ICU admission for brain death diagnosis (58.8%), organ procurement (63.1%), and obtaining familial consent (55.2%). Higher education levels correlated with greater acceptance (72.7% post-secondary vs. 61.7% secondary education). Notably, donor care admissions often require shorter ICU stays than acute care, suggesting efficient resource use.

Public Education and Government Initiatives

Over 90% of respondents perceived government promotion of organ donation as insufficient. Recent efforts include the “Garden of Life” memorial honoring donors and the Committee on Promotion of Organ Donation to facilitate public discourse. Effective health communication strategies, such as message framing emphasizing altruism and societal benefit, could reshape attitudes. For example, campaigns linking donation to life continuation and hope have shown promise in other contexts.

Educational interventions targeting healthcare professionals are equally vital. Training programs improving death notification skills, familial communication, and ethical considerations in donor care could bridge knowledge gaps. A local study demonstrated that educational workshops increased medical students’ donation-related knowledge by 40%, underscoring the potential for systemic change through targeted training.

Conclusion

Hong Kong’s organ donation rates reflect complex interactions between cultural norms, policy frameworks, and healthcare practices. Key interventions include simplifying consent processes through identity card designations, implementing dual-incentive systems combining opt-out legislation with priority allocation, and enhancing medical staff training. Public campaigns must address death anxiety through culturally sensitive messaging, normalizing discussions about end-of-life choices. Simultaneously, ICU protocols should integrate palliative care and donor management, leveraging their cost-effectiveness compared to acute care admissions. Multidisciplinary collaboration among policymakers, healthcare providers, and community leaders remains essential to transform societal attitudes and systemic practices, ultimately bridging the chasm between organ supply and demand.

doi.org/10.1097/CM9.0000000000000059

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