Organ donation, transplantation, and mass media.

CADAVERIC organ shortage is the most important obstacle to more widespread provision of transplants to more patients. This shortage is not primarily the result of a lack of suitable donors but rather the result of failure to identify donors, obtain consent, and procure the organs. Approaching the family represents a key point in the process and at the same time is its most sensitive element because it deals with the human drama of death. The family’s refusal of organ donation remains, together with the failure to identify potential donors, the most important impediment to achieve real improvement in the rates of organ donation. Data from a Spanish multicenter national survey document a significant relationship between the degree to which the public is prepared to accept organ donation on the one hand and the conviction that transplantation is a good and positive element of health care on the other. Consequently, it is easy to understand that any negative broadcast concerning such delicate matters as brain death, organ trafficking, or fairness in the access to transplantation may adversely influence public attitude toward organ donation. Many transplantation specialists denounce such negative broadcasts in the mass media and their effects on public opinion as one of the main causes for the deteriorating image of transplantation and the increase rates of refusals it generates among citizens and even among those health care workers not specifically involved in transplantation medicine. The mass media can be useful in promoting, but also potentially dangerous in adversely affecting organ donation. There are no reasons to believe that polemic discussions concerning transplantation created by journals exclusively to promote scandal or sensationalism: they ask pertinent questions but often report wrong or imprecise answers. The same can be said with respect to the attitude of the major part of the general population, at least in Western countries. They are not “neither for nor against donation.” Consequently success depends on provision of adequate information to the public in an effort to obtain the maximum possible number of organs. The final goal should be an effective system to identify potential organ donors in the places where they are actually found—in the hospitals; such procedures should be accompanied by a system of adequate information and transparency of the system’s operation. In this light, what are the most effective strategies to heighten the level of information concerning organ donation? It is unwise to have much confidence in direct publicity campaigns aimed at the general population unless great amounts of money can be invested to make a significant impact. Such efforts would have to be on a level with those of powerful companies that spend a considerable budget on publicity. Apart from some anecdotal observations, there is no evidence on medical literature documenting that this kind of action is really able to positively influence the attitude of the public toward organ donation. On the contrary, there is a growing feeling that its practical effects are close to nil and that the costeffectiveness ratio is very high indeed. For example, in 1987 a national survey was carried out in Australia by the Australian Kidney Foundation (AKF) addressing the general public and assessing its knowledge about organ donation and transplantation. Two years later this institution produced TV advertisements highlighting the need for organ donation that were screened over a period of 6 –12 months. A national follow-up survey, undertaken in 1990, disappointingly showed unchanged opinions in the community. The scientific community, however, tends to underestimate the power and influence of the lay media, both in a positive or a negative sense. The negative impact is illustrated by some classic examples: In 1980, after only one prime-time TV current affairs program in the United Kingdom had questioned the validity of brain-death criteria (PANORAMA, BBC); it took 15 months for donor referral rates to recover. France and Belgium, both countries with traditionally high organ donation rates, have experienced during the 1990s a significant decrease, which was at least in part attributed to negative publicity. In the French case, publicity was given to the failure to fully inform the bereaved of procurement procedures, and in Belgium a high percentage of nonresidents on national waiting lists was publicized. Rumors concerning organ trafficking irrespective of whether true or false have achieved widespread credibility mainly because they embody some of the most