**2. The underlying reasons for organ shortage**

Ignorance and prejudice continue to be the general causes of society's lack of response to the social need of organ donation; particularly with respect to the deceased donor [3]. Several possible explanations for this behavior have been suggested:


**4.** Medical teams are largely untrained in organ donation because of insufficient education on this matter [4–7].

health should be considered an educational challenge in the search to modify socio-psychological behaviors deeply structured in people's mind. Educational procedures searching the best way to spread this notion should be deeply analyzed by experts in social, psychological

The Society, the Barriers to Organ Donation and Alternatives for a Change

http://dx.doi.org/10.5772/intechopen.73756

51

Public education, mainly through the media, non-governmental organizations and lectures by experts, has been the main strategy to change social attitudes toward organ donation. It is important to highlight that the results of these educational endeavors have not been completely satisfactory, as the crisis remains almost unchanged. Although the public is more

The increasing number of patients on waiting lists and their daily mortality is a clear expression of the insufficient impact of social education programs to date. The consequence of this inadequate social response is that at least 22 unreasonable deaths occur everyday on organ

Highlighting the serious situation, Matas and Hays considered that the United States educational policy has had little effect on organ donation [25]. For that reason, the author suggested that making organ donation financially neutral for donors should be supported as one solution to this serious problem. However, it should be considered that this strategy might generate a new type of social injustice and inequality. In addition, it should be noted that there has been several criticisms of the educational social programs on organ donation. Many authors believe that the current methodology is useless and is a needless economic investment [26, 27]. Paradoxically, none of these authors suggested thoughtful modifications to the educational

methodologies in order to achieve a more positive social response to organ donation.

From the earliest times of the transplantation era, the philosophy used for educational purposes has relied on the concept that organ donation is an expression of altruism and solidarity, a "gift" that will save or improve someone's life. In fact, several surveys have shown that, in general, people are open to donate their organs (or those of a family member) after death. However, when facing the moment of grief, a high percentage of people fail to remember this commitment and consequently the "gift of life" is questioned and does not

The inadequate societal response to the persistent lack of donated organs encourages the fol-

**3.** Sharing our bodies after death should be acknowledged as a tacit social agreement for a

lowing conceptual changes in the philosophy of the organ donation message:

**2.** Our body after death is a unique source of health for everyone.

aware about transplantation issues, there remains a shortage of donated organs.

and religious questions.

donation waiting lists [24].

come to fruition.

common welfare.

**2.1. Potential reasons for the present crisis**

**1.** Organ shortage is a health emergency.

*2.1.1. The message to the public has been inadequate*

	- **a.** The instinct of self-preservation [9].
	- **b.** The Freudian notion that nobody thinks about his or her own death until a loved one dies [10].
	- **c.** The ancient idea that the integrity of the body is mandatory for the pathway to eternity [11].
	- **d.** The fears concerning a diagnosis of brain death [12, 13].
	- **e.** Beliefs that the organs will first go to the rich and only then to the poor [14–16].

People are not informed about the beneficial impact of transplantation on health budgets, that is, transplantation can reduce the cost of diseases, which would otherwise have to be treated by expensive long-term therapy [17, 18].

The media has featured stories about criminal "organ commerce" [19].

These myths, misinformation and prejudices are barriers that weaken the instincts of solidarity and altruism, arousing selfishness and uncertainties.

Regarding the aforementioned negative factors on donation, it is important to emphasize the importance of two of them: fear of death and respect for the integrity of the body that are not essentially linked to ignorance and/or bad information. Surveys on the behavior of university students regarding the implication of fear of death as an inhibition factor in the acceptance of organ donation and transplants were investigated in different studies. These surveys showed that negative attitudes toward organ donation were associated with higher fears of death and dying of the self and less strongly with higher fears of the death and dying of others. A study showed that students without donor card and with reservations about donation scored significantly higher fear of physical destruction. Possible implications of these findings for medical education and future research are suggested. It was mentioned that given the urgency, attitude toward organ donation should be considered a civic responsibility transforming an unfortunate yet inevitable event into something that positively affects someone else [20–22].

Body integrity, it also remains a central issue for negative behavior toward organ donation. Fear of mutilation is the fear of losing any part of our body structure, the idea of having limits in the mobility of our body or of losing the integrity of any organ, part of the body or natural function. These ideas can generate ethical and moral inhibitory behaviors regarding the treatment that our bodies or those of loved ones receive at the time of death. These reflections regarding the conservation of the body's image play a significant role in the decision of families toward donation [23].

Understanding that those factors can limit the potential supply of available organs for transplantation, the suggestion that our body after death as a unique and irreplaceable source of health should be considered an educational challenge in the search to modify socio-psychological behaviors deeply structured in people's mind. Educational procedures searching the best way to spread this notion should be deeply analyzed by experts in social, psychological and religious questions.

Public education, mainly through the media, non-governmental organizations and lectures by experts, has been the main strategy to change social attitudes toward organ donation. It is important to highlight that the results of these educational endeavors have not been completely satisfactory, as the crisis remains almost unchanged. Although the public is more aware about transplantation issues, there remains a shortage of donated organs.

The increasing number of patients on waiting lists and their daily mortality is a clear expression of the insufficient impact of social education programs to date. The consequence of this inadequate social response is that at least 22 unreasonable deaths occur everyday on organ donation waiting lists [24].

Highlighting the serious situation, Matas and Hays considered that the United States educational policy has had little effect on organ donation [25]. For that reason, the author suggested that making organ donation financially neutral for donors should be supported as one solution to this serious problem. However, it should be considered that this strategy might generate a new type of social injustice and inequality. In addition, it should be noted that there has been several criticisms of the educational social programs on organ donation. Many authors believe that the current methodology is useless and is a needless economic investment [26, 27].

Paradoxically, none of these authors suggested thoughtful modifications to the educational methodologies in order to achieve a more positive social response to organ donation.
