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Title: A Multiethnic Asian Perspective of Presumed Consent for Organ Donation: A Population-Based Perception Study
Authors: Muthiah, Mark D 
Chua, Melissa Sin Hui
Griva, Konstadina 
Low, Ivan 
Lim, Wen Hui
Ng, Cheng Han
Hwang, Jeff YF 
Yap, Jason CH 
Iyer, Shridhar G 
Bonney, Glenn K
Anantharaman, Vathsala 
Huang, Daniel Q 
Tan, Eunice Xiang-Xuan
Lee, Guan-Huei
Kow, Alfred WC
Tai, Bee Choo 
Keywords: presumed consent
organ transplantation
Issue Date: 5-Oct-2021
Citation: Muthiah, Mark D, Chua, Melissa Sin Hui, Griva, Konstadina, Low, Ivan, Lim, Wen Hui, Ng, Cheng Han, Hwang, Jeff YF, Yap, Jason CH, Iyer, Shridhar G, Bonney, Glenn K, Anantharaman, Vathsala, Huang, Daniel Q, Tan, Eunice Xiang-Xuan, Lee, Guan-Huei, Kow, Alfred WC, Tai, Bee Choo (2021-10-05). A Multiethnic Asian Perspective of Presumed Consent for Organ Donation: A Population-Based Perception Study. FRONTIERS IN PUBLIC HEALTH 9. ScholarBank@NUS Repository.
Abstract: Background: Organ shortage is still a world-wide problem, resulting in long waiting lists for kidney, liver, and heart transplant candidates across many transplant centers globally. This has resulted in the move toward presumed consent to increase deceased organ donation rates. However, there remains a paucity of literature on public attitude and barriers regarding the opt-out system, with existing studies limited to Western nations. Therefore, this study aimed to understand public sentiment and different barriers toward organ donation from the perspective of Singapore, a highly diverse and multiethnic Asian society. Methods: A cross-sectional community semi-structured interview was conducted in a public housing estate in Singapore. Pilot test was undertaken before participants were interviewed face-to-face by trained personnel. All statistical evaluations were conducted using Stata. The χ2-test compared subgroups based on patient characteristics while multivariable logistic regression identified predictors of willingness to donate/ assent. Effect estimates were quantified using odds ratio (OR). Findings: Out of 799 individuals, 85% were agreeable to organ donation after death and 81% were willing to assent to donations of family members' organs, which declined by 16% (p < 0.001) after a clinical scenario was presented. Demographic factors including ethnicity, education, marital, and employment status affected willingness to donate and assent. Knowledge correlated significantly with willingness to donate and assent. In particular, knowledge regarding brain death irreversibility had the strongest correlation (AOR 2.15; 95% CI 1.60–2.89). Conclusions: Organ donation rates remain low albeit presumed consent legislation, due to patient-level barriers, including but not limited to knowledge gaps, cultural values, religious backgrounds, and emotional impact at relatives' death. To effectively boost donor rates, it is crucial for policy makers to invest in public education and improve transplant provisions and family protocols.
ISSN: 2296-2565
DOI: 10.3389/fpubh.2021.712584
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