Knowledge and Image of Body Organs: Impact on Willingness to Donate

ABSTRACT - Seventy-eight undergraduates were tested about their knowledge and psychological image of body organs. Results indicated that subjects could accurately describe the location and function for many, but not all, organs. The psychological image of the organs, as measured by semantic differential scales, showed that most organs were rated as moderately sacred, adaptable, dependent, personal, and durable. The heart, blood, and brain were consistently ranked as being most important for normal functioning. A significant sex difference was noted in the willingness to donate, even though there was no difference in knowledge. Finally, those subjects unwilling to donate organs held different psychological images of organs than those subjects willing to donate. Implications of the results are discussed.

Citation:

Grant Wilms, Stephen W. Kiefer, James Shanteau, and Patricia McIntyre (1987) ,"Knowledge and Image of Body Organs: Impact on Willingness to Donate", in NA - Advances in Consumer Research Volume 14, eds. Melanie Wallendorf and Paul Anderson, Provo, UT : Association for Consumer Research, Pages: 338-341.

Advances in Consumer Research Volume 14, 1987      Pages 338-341

KNOWLEDGE AND IMAGE OF BODY ORGANS: IMPACT ON WILLINGNESS TO DONATE

Grant Wilms, Kansas State University

Stephen W. Kiefer, Kansas State University

James Shanteau, Kansas State University

Patricia McIntyre, Kansas State University

ABSTRACT -

Seventy-eight undergraduates were tested about their knowledge and psychological image of body organs. Results indicated that subjects could accurately describe the location and function for many, but not all, organs. The psychological image of the organs, as measured by semantic differential scales, showed that most organs were rated as moderately sacred, adaptable, dependent, personal, and durable. The heart, blood, and brain were consistently ranked as being most important for normal functioning. A significant sex difference was noted in the willingness to donate, even though there was no difference in knowledge. Finally, those subjects unwilling to donate organs held different psychological images of organs than those subjects willing to donate. Implications of the results are discussed.

INTRODUCTION

Today there exists an extreme urgency for donated organs due to an increase in incurable diseases. Evans, Manninen, Gersh, Hart, and Rodin (1984) report that diseases of the heart and blood vessels have been the major cause of death in the United States. In 1980, approximately 14,000 people died of conditions for which heart transplants were indicated. The demand for donation of other organs is also high: livers ("Transplants put squeeze on insurers", 1985), kidneys, pancreas (Stuart 1984), corneas, lungs, bone marrow (Caplan 1983), and skin (Chapman 1983) all represent organs for which a great need for donation exists. Thus, the need for organs far exceeds their supply (Brams 1977; Koop 1983; Prottas 1983; Thukral & Cummins 1986).

Previous studies of organ donation decision have focused primarily on how would-be donors perceive the non-therapeutic removal of an organ (Gallop 1983; Manninen & Evans 1985; McIntyre, Barnett, Harris, Shanteau, Skowronski, & Klassen 1987; Pessemier, Bemmaor, & Hanssens 1977; Stark, Reiley, Osieki, & Cook 1984). These reports have not dealt specifically with why people have a tendency to donate certain organs over others. For example, there appears to be a higher likelihood for people to donate their kidneys and blood, while they remain hesitant about donating their heart and corneas (Fulton, Fulton, & Simmons 1977). This hesitancy may stem, in part, from the image they have of various organs and the importance or meaning they attach to these organs.

The purpose of the present study was to determine the knowledge and psychological image of various organs and to evaluate the influence of knowledge and image on willingness to donate.

METHOD

A six section questionnaire was given to 78 undergraduates (42 females and 36 males) at Kansas State University. The subjects were instructed to complete the pages in order and not to turn back to any previously completed page. Subjects typically completed the questionnaire in 30 to 40 minutes.

The first section contained 13 questions about demographic variables, e.g., gender, age, parents' occupation. The second section was a test of the subjects' knowledge of organ location. Each subject was given a list of 13 organs and instructed to match the location of these to a schematic drawing of the human body which contained ten of the organs (see Figure 1). Included in the list of organs were three "catch" organs which could not be assigned to proper locations on the drawing. In the third section of the questionnaire, subjects were given the same 13 organs and asked to match these organs to a brief description of their proper function. Unlike the previous section, all of the organs could be properly assignee.

FIGURE 1

SCHEMATIC DIAGRAM OF HUMAN BODY

After completing the location and function sections, subjects were asked about the meaning or image of various organs. Sixteen semantic differential scales consisting of ratings between bipolar adjectives were used. Subjects judged each organ against the descriptive scales by placing a check mark on one of seven blanks. The 16 scales used were: adaptable/unadaptable, active/inactive, mysterious/not mysterious, sacred/not sacred, warm/cold, strong/weak, durable/not durable, complex/simple, hard/ soft, understandable/not understandable. controllable/ uncontrollable, large/small, independent/dependent, vital/ not vital, emotional/unemotional, and personal/impersonal. In this section, 10 organs (cornea, kidney, bone, skin, brain, pancreas, liver, blood, heart, and lung) were evaluated. The order of organ presentation was randomized across subjects.

The last section consisted of three subsections asking subjects to 1) rank the importance of the 10 organs for the body's normal functioning, 2) check those organs that the subject would be willing to donate, and 3) rank the organs according to how willing they would be to donate them.

RESULTS

As can be seen in Table 1, 90% to 99% of the subjects could accurately describe the location and the function of the cornea, heart, brain, and lung. For the pancreas, liver, and kidney, however, only 30% to 70% could accurately describe the location and only 50% to 75% could describe the function. The percentage of correct responses was not significantly different between the location and function. There was a relatively large discrepancy for the thyroid; over 90% of the subjects could identify location, but only half could identify the correct function.

TABLE 1

PERCENT CORRECT RESPONDING (N=78)

The mean scores for the semantic differential section showed that most of-the organs were rated as being very active, strong, vital, and soft. The organs as a group were rated only moderately adaptable, dependent, personal, and durable. Bone was rated 85 being less active, adaptable, dependent, and mysterious than the other organs; also, bone was rated as being more understandable, controllable, hard, and simple. The brain was rated as very sacred, mysterious, complex, emotional, and personal.

Based on the accuracy of identifying location and function (see Table 1), three categories of organs were defined. The first category consisted of "well-known" organs (cornea, heart, lungs, and brain) which were all quite accurately identified. The second category consisted of "mystery" organs (pancreas, spleen, liver, kidney, and thyroid) which were not accurately identified. The third category consisted of "tissue" organs (bone, skin, and blood) which could not be checked for accuracy of location.

These three categories were then used to combine the organ image ratings into three groups. Using these three groups, the results from nine of the semantic-differential dichotomies are shown in Figure 2. As can be seen, the most accurately identified (i.e., well-known) organs had the highest ratings on all but the mysteriousness and understandability scales. Conversely, the least accurately identified (mystery) organs had the lowest ratings on all but the mysteriousness and activity scales. The tissue organs were generally intermediate. except for the mysteriousness, activity, and understandability scales. These results suggest that more accurately identified organs were generally perceived as having stronger, more extreme images. (Some of the dichotomies omitted from Figure 2 dealt with uninteresting or unrevealing scales, e.g., size, warmth, and hardness. Other dichotomies produced small differences between organs, e.g., adaptability, sacredness, and durability.)

The results from the last section of the questionnaire are shown in Table 2 where the mean rating for importance (1 - not important, 10 - important), percent of subjects willing to donate that organ, and the mean ranking for willingness to donate each organ (1 - not willing to donate, 10 " willing to donate) are shown. The heart, brain, and blood were ranked as being important whereas the cornea and pancreas ranked low in importance. At least in the case of the pancreas, the low ranking of importance may have been related to the low percentage of subjects that could correctly identify the location and function of this organ.

As might be expected, a large percentage of subjects indicated a willingness to donate blood. A relatively large percentage of subjects also were willing to donate a kidney. Willingness to donate the remaining organs was expressed by approximately half the subjects, with the donation of brain tissue having the lowest percentage.

FIGURE 2

SEMANTIC DIFFERENTIAL RATINGS FOR THE THREE ORGAN GROUPS

TABLE 2

IMPORTANCE AND WILLINGNESS TO DONATE ORGANS

Not surprisingly, there was a significant correlation, r = .94, p < .001, between willingness to donate particular organs (column 3 in Table 2) and rankings of organs for donation (column 4 in Table 2). There was no correlation between the importance ranking (column 2) and the percent of subjects willing to donate, r - -.05, n.s. This result suggests that the decision to donate an organ is unrelated to the individual's perception of that organ's importance for normal functioning.

There was a significant difference between male and female subjects in their willingness to donate certain organs. Although the percentages were similar for most organs, females were much less willing to donate the heart (40.3%) and cornea (42.3%) than males (80.0% and 59.4% respectively). Different levels of knowledge cannot account for the male/female differences; both sexes were equally correct in identifying the location and function of organs.

Because of space limitations. only a small amount of the data relating the image of the organs (as revealed by the ratings on the semantic differential scales) and the willingness of subjects to donate the organ can be presented. Table 3 presents the ratings of selected semantic differential scales for the brain, blood, kidney, and cornea. The table is separated by those subjects who indicated a willingness to donate the organ versus those subjects not willing to donate.

TABLE 3

SEMANTIC-DIFFERENTIAL RATINGS OF SELECTED ORGANS

In general, those subjects unwilling to donate the particular organ expressed an image of the organ being more sacred, more emotional, more mysterious, and less understandable than those subjects willing to donate the organs. These data suggest that the images held by subjects might determine willingness to donate specific organs.

GENERAL DISCUSSION

There are three issues arising from the present research which deserve further discussion. The first involves the knowledge and image people have of their own organs. The second concerns the relation between knowledge and image, on the one hand, and willingness to donate specific organs, on the other. The third reflects implications of these results for theoretical accounts of consumer behavior. Each of these issues will be discussed below.

Knowledge and Image of Organs

The accuracy results imply the existence of three categories of organs. In the first category are "well-known" organs: cornea, heart, brain. and lungs. Subjects were generally quite accurate in identifying the location and function of these organs. The semantic-differential results revealed that this group of organs was viewed as highly active, strong, and vital, while being moderately complex, personal, and understandable. An exception within this category was the brain which was seen as more mysterious and emotional.

In the second category are the "mystery" organs of pancreas, liver, spleen, and kidney. Subjects were relatively inaccurate in identifying both the location and function of these organs. > e semantic-differential results showed that this set of organs was seen as less understandable and emotional and more mysterious. As noted in the Results, the thyroid let to a mix of responses, with an accurate identification of location but not function.

In the final category are the "tissue" organs of bone, skin, and blood. Because these organs are non-uniquely situated, it was not possible to determine accuracy of location. However, the semantic-differential results revealed that this set of organs was rated as more understandable and less mysterious and active. Not surprisingly, bone was viewed as less active, soft, and warm than the others.

The responses to the "catch" organs deserve some comment. Roughly a third of the subjects incorrectly located an abomasum (part of a cow's stomach) on the diagram in Figure 1. Subjects had comparable error rates for identifying the function of a crop (part of a bird's gullet) and the abomasum. Combined with the low accuracy results on some non-catch organs (e.g., spleen), these findings indicate that many people have surprisingly little knowledge of the location or function of their own body parts.

Willingness to Donate

Subjects' willingness to donate various organs was evaluated using two measures: 1) ranking of organs according to willingness to donate and 2) percentage of subjects willing to donate each organ. Despite the difference in measurement procedures, there was strong agreement between the two measures (see Table 2). Subjects were most willing to donate blood and kidneys and least willing to donate brain tissue, skin, and bone.

Efforts to relate willingness to donate to various knowledge measures were marginally successful. There was no relation, for instance, between rankings of importance and willingness to donate specific organs. In particular, subjects considered the heart and brain important, but were unwilling to donate them; conversely, they also considered blood to be important and were quite willing to be donors. Perhaps this can be explained, in part, by the difference between donations which presuppose death (e.g., heart and brain tissue) and those that do not (e.g., blood).

The relationships between accuracy of location/function and willingness to donate were somewhat stronger, but failed to reach significance. Cornea and heart, for instance, were identified quite accurately but were only moderately likely to be donated. Kidneys, on the other hand, were high on the list to be donated but could be accurately identified by half the subjects.

In contrast to the knowledge measures, there were some notable differences in the semantic-differential measures of image as a function of willingness to donate for specific organs. Those subjects unwilling to donate their brain tissue, blood, kidney, and cornea considered them to be more sacred, emotional, mysterious, and less understandable. Similar but less extreme patterns were observed for other organs.

Implications for Consumer Behavior

There have been relatively few studies of organ donation from a consumer-behavior perspective (or from any other perspective for that matter). Nonetheless, the topic is relevant both because it is inherently interesting and because it offers a relatively unique opportunity to evaluate the usefulness of several consumer behavior concepts.

One concept that has been applied to analyses of organ donation has been that of self-image. Belk and Austin (1986), for instance, fount significant relations between willingness to donate and various measures of self. The greater an organ is identified with self, the less an individual is willing to donate. Similarly, Pessemier, Bemmaor, and Hanssens (1977) reported that living donors who placed less importance on body image were more likely to donate.

The present study extends these previous findings in two directions. First, the concept of organ image was explored from a somewhat different direction. By using a series of adjective dichotomies in a semantic-differential format, a "profile" of each organ could be constructed. These profiles revealed the presence of important differences between how people think about their organs.

A second extension from prior research was the examination here of both image and knowledge about organs. Somewhat surprisingly, there appeared to be relatively little relation between these two types of measures. Whereas the various image messages were predictive of willingness to donate, there was no significant connection between knowledge measures and willingness to donate. Thus, being a donor appears to be related more to what we feel about organs than what we know about them.

The inability of the cognitive knowledge measures to predict organ donation was unexpected. Most accounts of consumer behavior from either a high-involvement hierarchy-of-effects motel (Lavidge & Steiner 1961) or a low-involvement learning motel (Krugman 1965) agree that cognition is central to commitment to action. Yet, organ donation appears to be a behavior that occurs in the absence of a significant cognitive component. This may, of course, reflect the use of inappropriate cognitive measures in this study. There is, however, collateral evidence to support the absence-of-cognition interpretation.

The failure to find cognitive correlates of organ donation was supported by interviews with committed donors. When asked why they signet organ donor carts, subjects responded that "it was simply the right thing to do" or "I gave it no thought" I just did it." Similarly, those who donated kidneys while living reported "there was nothing to think about" and "it was the natural thing to do" (Fellner & Marshall 1981). Such comments suggest that organ donors think little about their behavior. They donate because it "feels right."

Another line of supporting evidence comes from subjects' comments after completing the extensive McIntyre et al. (1987) survey on organ donation. Signed organ donors indicated that they had learned a great deal after filling out what was intended to be a neutral, non-informational questionnaire. This illustrates that committed donors have apparently thought little about their actions. The seeming absence of a cognitive component for such an important behavior presents interesting challenges to conceptions of donation behavior specifically and to consumer behavior generally.

REFERENCES

Belk, Russel W. and Mark C. Austin (1986), "Organ Donation Willingness as a Function of Extended Self and Materialism," in Advances in Health Care Research, ed. M. Ven Venkatesen, Association for Health Care Research.

Brams, Marvin (1977), "Transplantable Human Organs: Should Their Sale be Authorized by State Statutes?," American Journal of Law and Medicine, 3 (Summer), 183-195.

Caplan, Arthur (1983), "Organ Transplants: The Cost of Success," The Hasting Center Report, (December), 23-33.

Chapman, David (1983), "Retailing Human Organs Under the Uniform Commercial Code," The John Marshall Law Review, 16. 393-417.

Evans, Roger, Diane Manninen, Bernard Gersh, Gary Hart and Jonathan Rodin (1984), "The Need for and Supply of Donor Hearts for Transplantation," The Journal of Heart Transplantations, 4 (November), 57-60.

Fellner, Carl H. and John R. Marshall (1981), "Kidney Donors Revisited," in Altruism and Helping Behavior, eds. J. P. Rushton and R. M. Sorrentino, Hillsdale, NJ: Lawrence Erlbaum Associates.

Fulton, Julie, Robert Fulton and Roberta Simmons (1977), "The Cadaver Donor and the Gift of Life," The Gift of Life: a e Social and Psychological Impact of Organ Transplantation, eds. Roberta G. Simmons, Susan D. Klein, and Richard L. Simmons, New York: John Wiley and Sons, 338-376.

The Gallup Organization, Inc. (1983), "Attitudes and Opinions of the American Public toward Kidney Donation," National Kidney Foundation, New York.

Koop, C. Everett (1983), "Increasing the Supply of Solid Organs for Transplantation," Public Health Reports, 98 (November-December), 566-572.

Krugman, Herbert (1965), "The Impact of Television Advertising: Learning Without Involvement," Public Opinion Quarterly, 29, 3-49-356.

Lavidge, R. J. and G. A. Steiner (1961), "A Model for Predictive Measurements of Advertising Effectiveness," Journal of Marketing, 24, 59-62.

Manninen, Diane and Roger Evans (1985), "Public Attitudes and Behavior Regarding Organ Donation," The Journal of the American Medical Association, 253 (June), 3111-3115.

McIntyre, Pat, Mark A. Barnett, Richard J. Harris, James Shanteau, John Skowronski and Michael Klassen (1987), "Psychological Factors Influencing Decisions to Donate Organs," in Advances in Consumer Research, eds. Melanie Wallendorf and Paul Anderson, Provo, Utah: Association f or Consumer Research.

Pessemier, Edgar, Albert Bemmaor and Dominique Hanssens (1977). "Willingness to Supply Human Body Parts: Some Empirical Results," The Journal of Consumer Research, (December), 131-140.

Prottas, Jeffrey (1983), "Encouraging Altruism: Public Attitudes and the Marketing of Organ Donation," Health and Society, 61(2), 278-306.

Stark, June, Peggy Riley, Anne Osiecki and Leslie Cook (1984), "Attitudes Affecting Organ Donation in the Intensive Care Unit," Heart and Lung, 13 (July), 400-404.

Stuart. F. (1984), "Need Supply and Legal Issues Related to Organ Transplantation in the United States," Transplantation Proceedings, 16 (February), 87-94.

Thukral, Vinod and Gaylord Cummins (1986), "The Vital Organ Shortage," Advances in Nonprofit Marketing, Volume 2. ed. Russell Belk, In Press.

"Transplants Put Squeeze on Insurers," The Morning Call, November 20, 1985, B2.

----------------------------------------