Willing to Donate but Refuse to Sign the Card: Analyzing the Organ Donation Attitude-Behavior Gap

Abstract

Posthumous organ donation plays a crucial role in the American healthcare system, and saves numerous lives at zero cost to the deceased donor. Despite the public holding positive attitudes towards the act, donor registration rates are far lower than they should be. What is it about organ donation that prevents individuals from signing up, despite being supportive of the decision? Past research has found a number of potential factors that may contribute to this attitude-behavior gap, including feelings of disgust, religious concerns, familial concerns, norms, and willingness strength. We designed and ran a study to compare participants’ organ donation attitudes and perceptions of norms, with their donor status, willingness to donate, and likelihood of registration. This unique method gave participants the opportunity to become organ donors, in order to identify those who hold positive attitudes but refuse to sign their cards. These individuals completed a follow-up survey assessing which concerns were influential in their decision not to register. The results revealed that a large majority of participants held strong, positive attitudes towards donation, along with weaker, but still positive perceptions of norms. Critically, it appears that norms, not attitudes, are the best predictors of registration. While positive attitudes are necessary for individuals to consider becoming donors, once they are willing, it is their perception of norms which enables or prevents them from signing their donor cards. Equipped with this newfound knowledge, we propose a number of implications and interventions, such as how perceptions of norms can be improved, and how religious concerns and medical myths can be combatted to decrease hesitancy towards posthumous organ donation. Keywords: organ donation, attitude-behavior gap, perceptions of norms, ick factor