Donor Family Consent and the Behavioural Perspective Model

Abstract

Organ transplantation is one of the greatest medical innovations of the 20th century, providing individuals facing death a hope of survival. In the context of the UK this life saving procedure is totally dependent on the altruism of the potential donor’s family. Currently demand for transplantable organs outstrips supply, resulting in 1000 individuals dying each year. Donor family refusal has been consistently identified as the greatest obstacle preventing an improvement in donation rates. The need for new theory and theory driven methods in understanding donation consent has been highlighted in the existent literature. To date there is a notable absence of a theoretical framework that allows for both individual and external level factors to be analysed together, thus providing a truly holistic depiction of this complex human behaviour.

This thesis seeks to fill this notable gap by exploring donor family consent from a radical behaviourist perspective via the application of the Behavioural Perspective Model (BPM). Specifically this thesis documents a dual-phase sequential research strategy that seeks to answer three overarching research questions: (1) Can the decision to consent be understood as an operant process? (2) What patterns of reinforcement increase the likelihood of consent? (3) Can donor family consent be stimulated via behavioural intervention?

The first empirical phase utilises a case study approach in the exploration of donor family consent, drawing upon multiple sources of evidence (n = 55). The second empirical phase builds upon the findings of the first by utilising a novel simulated laboratory experiment methodology to examine how organ donation consent can be stimulated in different hypothetical scenarios based upon the eight contingency categories of the BPM framework (n= 50).

The results of the employed empirical strategy demonstrate the usefulness of the BPM as an interpretative device in this important health context and thus extend its applicability beyond the traditional consumer behaviour domain. Four key findings have resulted from the two empirical phases of this thesis: (1) the role and importance of positive learning history in influencing consent (2) the open behaviour setting preference of donation decision makers (3) the success of informational reinforcement in stimulating consent and (4) the role of pleasure in the consent process. This thesis complements existing organ donation knowledge by adopting a radical behavioural perspective. In addition to making a unique contribution to existing knowledge by offering a new theoretical perspective to this context, the findings of this thesis offer implications for social marketers on the ways in which consent may be stimulated.