|Other Abstract||Shortage of transplant organs is one of the serious challenges to human health in the world. Due to the shortage of transplant organs, a large number of patients die every year while waiting for organ transplant. As one of the countries with the largest population in the world, organ shortage is especially serious in China. Between 2015 to 2018, a total of 18,294 organs were donated after the deaths of Chinese citizens, yet more than 300,000 transplants are needed each year in China.
The main reason for this problem may be the low participating rates in organ donation registration in Chinese citizens. With the currently existing organ donation system of “opt-in” in China, introducing appropriate incentives to organ donation may be a breakthrough to attract more Chinese citizens to registe as organ donors. However, proper guidance and empirical data on the role of incentives in organ donation registration are still lacked in literatures. The existing studies have the following shortcomings. First, the consensus was still lack on the role of incentives in organ donation registration. The possible main reason might be that due to no comprehensive summary and scientific classification of incentive content, comparing the results from diverse research seemed impossible. Second, the mechanism of the influence of incentives on organ donation registration needs to be further studied. Most studies have compared the effects of motivation either by promoting or inhibiting outcomes, but the mechanism underlining the two outcomes is still lack of exploration. Third, the previous research are lack of integration to the psychological factors affecting organ donation registration. Empirical studies usually only explored a single or several variables, including two only existed reviews. The relative evidences of the influencing factors in China are even more rare, building a gap between the theoretical framework and practice.
To explore the role and psychological mechanism of incentives to organ donation registration in China, this thesis conducted three studies in Chinese adult samples by online questionnaires.
In study 1, we compared the effects of three kinds of incentives on participants with different tendency to organ donation registration. Two sub-studies were designed to compare the effects of health incentive, financial incentive and spiritual incentives on the willingness to donate. The results showed that health incentive and monetary incentive increased the registration intention of the participants with low motivation (uncertain and low propensity), but spiritual incentive reduced the registration intention of the whole sample.
Study 2 (N = 1502) compared the effects of health incentive, monetary incentive and priority incentive on the willingness to register, as well as tested the mediating effect of communal norms and autonomy. We also examined whether the psychological factors of organ donation, composed by cognitive factors and emotional factors, are applicable in China. The results showed that all three incentives could improve the willingness to register, and the level of improvement ranged from high to low was: health incentive, priority incentive and monetary incentive. Results of mediating analysis showed that health incentive improved the registration intention through high autonomy, and the monetary incentive reduced the registration intention through low communal norms, however, the priority incentive showed no significant mediating effects. We also found that cognitive factors and emotional factors are significant predictors of the willingness to register.
Based on study 2, study 3 explored how to optimize the incentive effect through the path of mediating variables. Specifically, study 3 manipulated the description of the communal norms in health incentive and monetary incentive, and explored whether the intention and behavior of organ donation registration could be improved by enhancing the communal norms. Results the mediating effect of communal norms was confirmed repeatedly, however, the manipulation of communal norms had decreased the communal norms in health incentive.
Taking together, the current thesis suggested that: 1) compared with money incentive and priority incentive, health incentive can increase the registration intention by improving autonomy and keeping the high communal norms; 2) spiritual incentive reduced the registration intention; 3) monetary incentive can attract people to know more about organ donation registration; 4) the cognitive and emotional factors can predict the registration intention.
The results of this study can provide theoretical evidence for the popularization and development of organ donation and transplantation and provide empirical suggestions for establishing the incentive mechanism of organ donation system in China. It might be a beneficial attempt for psychology to nudge the public policy.|