Introduction: In an on-line survey of the Australian general public, support for organ donation (OD) was high (overall >70%). Opinions about death determination appeared to be more aligned with impressions of quality-of-life outcomes than with biologic definitions of death [1, 2]. Nonetheless, consent rates to OD in Australia are around 50%, despite interventions [3]. We analysed our survey to determine demographic factors associated with differences in opinion.

Method: On-line survey of a representative sample of 1017 members of the general Australian public, comprising 3 ICU case scenarios & multiple-choice questions on death definition & OD decisions. Participants’ age, sex, religious affiliation, & educational level were collected.

Results: Respondents matched Australian population demographics; 51% male, median age 52 years (male) & 42 years (female). 76% lived in metropolitan centres & 57% at least tertiary educated. 23% claimed cultural identity other than Australian & 22% spoke other than English at home. 36% claimed no religious affiliation & 58% identified as Christian. Being religious (p<0.001), tertiary educated (p<0.03) & older (p<0.01) were associated with claimed greater knowledge of OD, whereas non-Australian cultural identity was negatively associated (p<0.01). 70% agreed that a patient determined brain dead was ‘dead’, with older respondents more likely to agree (p<0.001) and non-Australian identity less likely (p<0.01). Female respondents were less confident (p<0.001). Support for OD was higher with increasing age (p<0.001) & lower for those with non-Australian identity (p<0.001) & religious affiliation (p<0.01). In a circulatory death scenario, >70% agreed with life-support withdrawal given prognostic factors, with older (p<0.001) respondents more likely & religious respondents less likely (p<0.001) to agree. Religious respondents were less likely to agree that the patient could be declared dead 2 minutes following circulatory standstill (p<0.03). Older respondents were more likely (p<0.001), and religious less likely (p<0.05) to agree to organ procurement even if this were the proximal cause of death. In a ‘first-person consent’ scenario, 61% of respondents agreed that the patient’s wishes to be taken to the operating room for organ procurement prior to death should be honoured. Female (p<0.01) and religious (p<0.001) respondents were less likely to agree.

Conclusions: We found a consistent relationship between age, religion & female sex and opinions about death & decisions regarding OD. These findings could be useful in advancing strategies to promote OD in the community and to close the gap between reported support for OD and the actual level of support as evidenced by family consents at the bedside of the potential cadaveric donor.

References: 
[1] Skowronski JA et al., Int Med J 2020;50:1192-1201.
[2] O’Leary MJ et al, Int Med J 2022;52:238-248.
[3] https://www.donatelife.gov.au/sites/default/files/2022-02/OTA_2021ActivityReport_Feb2022-Final.pdf