in a random-digit-dialing telephone survey, the researchers found that those who indicated that they would be an organ donor were more likely to be female, to know someone else willing to be an organ donor, and to be less likely to agree that discussions of organ donation remind them of their own mortality.

Cheung and colleagues (1998) examined the cultural attitudes of Asian Americans regarding organ donation in a mail survey with 421 responses and compared them with those of their Caucasian counterparts. The Asian Americans in that study emphasized the importance of maintaining body integrity after death and displayed a lower level of trust of doctors in matters concerning organ donation. In another survey of 683 undergraduates, Asian-American students had higher rates of communication with family members about organ donation and were more likely to have communicated with their parents about funeral arrangements (Rubens, 1996).

Family Decision Making

Studies of familial decision making in hospitals have found that the process for requesting organ donation has not been consistent across different ethnicities. Several studies in the 1980s and 1990s found that white patients were more often identified as potential donors than African-American patients (Hartwig et al., 1993; Guadagnoli et al., 1999b); similar results have been noted for Hispanic patients (Pietz et al., 2004). However, these studies do not likely reflect the changes that occurred as a result of “required request” regulations (see Chapter 4).

Siminoff and colleagues (2003) conducted in-person interviews with 415 families of eligible donors and found that the reasons for consenting to donation were similar between white and African-American families. These reasons included altruism, knowledge that the patient had a donor card or would have wanted to donate, and gaining of meaning for the family from the death of a loved one. The reasons for decisions not to donate included the fact that the family was too exhausted, knowledge that the patient did not want to donate, religion, the family’s desire to avoid disfiguring the patient, poor communication, and poor timing of the request. Another reason, as mentioned above and discussed below, is a lack of trust in the healthcare system.

Spirituality

The role of religion, religiosity, and spirituality in decisions about organ donation is complex and is not yet fully understood. Most major religions actively support organ donation (Box 2-1); however individuals may have their own particular sets of values and beliefs. For example, some



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