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Complexity of Decision-Making!: Case Studies of Cadaveric Organ Donations in Ahmedabad, India
Deepak Saxena1,2, Sandul Yasobant1,2, Poonam Trivedi1
1Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, Gujarat, 382042, India.
Insights
Understanding familial consent for deceased organ donation in India is crucial. This study reveals that family decision-making involves multiple people and extensive communication before consent is given.
Area of Science:
- Medical Sociology
- Public Health
- Transplantation Science
Background:
- Organ donation in India faces demand-supply disequilibrium, necessitating a deeper understanding of the donation process.
- Limited research exists on factors influencing familial consent, decision-making, and psychosocial predictors of successful organ donation in India.
- Evidence-based interventions and policy dialogues are needed to enhance organ donation decisions among relatives.
Purpose of the Study:
- To systematically document the complexity of decision-making in successful cadaveric organ donation cases.
- To explore the experiences of families navigating the deceased organ donation process.
- To identify factors influencing familial consent and decision-making dynamics.
Main Methods:
- A qualitative exploratory study with network assessment was conducted in Gujarat, India (October 2021 - February 2022).
- Semi-structured interviews with open-ended questions focused on the decision-making network.
- Interviews were conducted with the closest relatives of 10 deceased organ donors.
Main Results:
- The decision-making process involved multiple actors, with a minimum of 2 to 7 network nodes and up to 22 ties.
- In most cases, extensive communication occurred among family members before the final decision.
- Social network analysis indicated a high density of communication, highlighting the collective nature of the decision.
Conclusions:
- Deceased organ donation decision-making is complex, involving multiple family members and significant pre-decision interaction.
- Exploring families' experiences provides insights into the cadaveric organ donation process.
- Further research is recommended to generate evidence on factors, family dynamics, and the complexity of successful organ donation.
Background:
The disequilibrium in the demand-supply nexus of organ donation prevails an urgent need for understanding the process and cascade of the donation. There is a lack of evidence in organ donation literature within India that focuses on factors influencing familial consent, the decision-making process, and psychosocial factors that can predict successful organ donation. Such evidence can assist in designing interventions and policy dialogue focusing on the discussion on enhancing donation decisions with relatives. Thus, the present study is an effort to document the decision-making complexity systematically among successful cadaveric organ donation cases.
Methods:
A qualitative exploratory, including the network assessment was implemented between October 2021 and February 2022 in one of the western states of India, Gujarat. A semi-structured interview guide that was comprised of thematic, open-ended questions focused on understanding the network for the decision-making process was prepared, and trained interviewers conducted the interview at the suitable place of the donor's relative.
Results:
The 10 interviews among the closest relatives of the deceased were conducted and the decision-making process indicated the involvement of multiple actors. The social network analysis reveals a minimum node of 2 to 7, with the highest ties of 22. The maximal degree was 3.6, and the density of 1 of these networks. Out of 10, in most cases, the ties were more than 2, with a maximum of 22 ties, which shows that more people communicated to each other before the final decision-making.
Conclusion:
The analysis indicates that the decision-making for deceased organ donation is a complex process as in most cases, multiple family members were involved and interaction happened before the final decision-making. The study explains the decision-making during the cadaveric organ donation process by exploring families' experiences. Further research is recommended to generate evidence on the factors and the family dynamics, including the complexity of successful organ donation.
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