**4.1 Positive and negative factors affecting volunteering**

The "gift" that the recipient receives from the donor free of charge, which has no physical or symbolic equivalent by nature, is so extraordinary that as a result, the donor, recipient, and their families may find themselves in a mutual creditor-debtor spiral. Such a situation also describes the importance of volunteering in organ donation. It is essential for the organ donor to donate in full volunteering and to be completely free from negative factors. Also, informed consent for organ transplantation requires sufficient information sharing for both the patient and the organ and tissue donor and communication that is free from coercion and threat, does not involve persuasion, and does not aim to manipulate the decision.

It is clear that there is a non-altruistic motivation if the person requests a reward for a donation. However, the fact that such a demand has accompanying elements does not mean that the donation is motivated by altruism and that it involves an altruistic approach. One of the three pillars of autonomy is that the individual is far from influences that control them. In other words, for the action to be autonomous, the person should not be in a situation that prevents their self-management either by internal or external forces. However, not all effects on the person by others are controlling. In this section, controlling concepts will be discussed.

Evaluating the determinants of attitudes towards organ removal from the dead, willingness to donate, and donor behavior in a systematic review of 33 published studies, Wakefield et al. emphasizes that individuals' attitudes towards donation are complex due to differences in social norms, existing laws, and interactions between beliefs and individual factors in each country [29].

However, apart from these regional and personal differences, there are factors that affect donation positively and negatively. A study shows that the team, which will talk to the family of the deceased during the donation process, should reassure the family with their linguistic and cognitive abilities and show their emotions, which has a significant effect on whether the family is a donor [30].

Although organ donation is apparently supported by society, the level of organ donation is very low. Psychological factors that affect the person's decisions to become a donor also play a role in this complexity. They have also led to the need to understand how people predict or inhibit the desire to become organ donors. In a study conducted by Morgan et al., it has been shown that the perceived benefits of organ donation play an effective role in the decision-making process [31]. The volunteer choices of potential donors (e.g., women in strong patriarchal cultures) who do not understand that they are an autonomous moral person, act as expected, and never dare to reject are undermined by persuasion, encouragement, and pressure.

In determining whether an action is autonomous, the two most important conditions require that the person fully understands the issue and is not under control. There is a gradual transition from total freedom to total control for the status of both understanding and being free of controlling influences. This transition involves the scales that reveal the "autonomous actions" and "non-autonomous actions" domains. By considering these domains and thresholds for specific purposes, the boundary between "autonomous enough" and "not autonomous enough" can be carefully determined [7]. There are some factors, such as requests, family, or legal obligations, in making personal decisions. But there are also some factors other than these factors that will directly affect the person's ability to act autonomously. All of these factors are detrimental to the autonomy of the person and aim at taking the person under control.

Informed consent is the most important issue in ensuring the autonomy of the person. Instead of reading standard forms, each individual's unique needs for information should be taken into account with a "customized" approach. It would not be wrong to state that the dignity and value of the human being, the principle of autonomy, and legal aspects of organ transplantation should be addressed for each person in the informed consent form [32].

Concepts such as sacrifice, compassion, interest, renunciation, loyalty, reliability, concern, respect and justice, empathy, and emotional ties are among the positive factors that affect volunteering. Besides, the altruistic nature of the person is an important issue that requires research on its own among positive factors.

Volunteering is essential for autonomous action. External control over an individual's actions weakens the voluntary nature of the actions. Such effects can be grouped under three main categories, namely, persuasion, coercion, and manipulation. If we detail these concepts, we can better evaluate the negative factors affecting volunteering.
