Organ Donation Awareness among Family Members of ICU Patients

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

 

The survey results presented in the manuscript are very relevant and have the potential to be utilized in policy recommendations. However, the concluding part of the paper is very short and does not provide a more comprehensive view of how the findings could be used in facilitating donation policy. To maximize the worth of the paper, it would be beneficial if the authors proposed a more extensive examination of how the data could be employed to promote donations in Romania.

Some other points for clarification:

Lines 66-69 read: “A total of 251 family members with relatives hospitalized in the I.C.U. responded to our questionnaire (one adult family member per patient). None of the respondents had their relatives declared brain death organ donors”. Also, on line 254 the authors repeat that “the sampling process was limited to I.C.U. patient's relatives, none of whom had their relatives declared brain death organ donors”. However, it is stated on line 234 that “The total number of family interviews for organ donation in brain death donors in Emergency Clinical County Hospital of Oradea was 96, with a family refusal rate of 47,9%,” (line 234). Were the relatives of the brain death donors interviewed as well or this is a reference to another study?

The phrase on line 245 is not entirely clear: “…conclusion that a positive social media presence was established; however, communication is incoherent, an incoherence that can lead to misconceptions and confusion [49].”

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review this research paper! In general, the article focuses on an important problems in medical ethics – willingness to donate organs for transplantation. The scarcity of organs for transplantation is an issue requiring solutions, indeed. The authors are analyzing the willingness to donate organs for transplantation in Romania; however, the article has some shortcomings that might be addressed to improve the clarity and coherence of the paper.

1) The most important question is about the sample of respondents. The authors have distributed the questionnaire to 251 family members of patients hospitalized in the I.C.U., but there is a lack of justification for this choice of non-representative sample. The only characteristic for this convenience sample provided by the authors is: “None of the respondents had their relatives declared brain death organ donors”. To strengthen the paper, the authors should provide a justification for choosing this specific group of respondents in the methodology part. Why was this particular group of respondents chosen (except for convenience)? Bearing in mind that the questionnaire does not include questions about their relatives who are ICU patients and questions were only about their own choices, why it was important to include specifically relatives of ICU patients in this research study?

2) Adding some additional methodology details might be beneficial. How was the questionnaire distributed (in paper or electronically)? How was the questionnaire developed? Is the data set accessible in an open access repository?

3) The introduction might benefit from adding more information about the organ donation regulations in Romania.

4) What is the reason for stating that most of the respondents “seem to be familiar with the diagnosis of brain death” if 52.2% of them “are not convinced that the diagnosis of brain death is equivalent to irreversible death” (page 10, line 204-205)? How the authors define “being familiar”?

5) The authors state that “The total number of family interviews for organ donation in brain death donors in Emergency Clinical County Hospital of Oradea was 96, with a family refusal rate of 47,9%, a higher refusal rate than the national refusal rate for the same period (22,5%) [19–22].” (page 11, lines 234-236). Which time period is meant here? Is it the time when the survey was administered?

6) The authors state “Although the results demonstrated that most respondents expressed willingness to donate organs, there is still a high refusal rate.” What is meant by “a high refusal rate” in this sentence – is it the refusal rate in the Romania? If so, is the sample involved in this research study representative? How is the willingness to donate in this sample related to the high refusal rate in the country?

7)The conclusions are rather wage, e.g., what is meant by the sentence in the conclusion that “Respondents willing to donate have registered a high rate; however, none were in the situation to decide this kind of action for their relatives.” (page 11, lines 262-263)? How the sentence “the extreme emotional distress that may occur in obtaining consent for organ donation can negatively influence the families' decision to donate, leading to a high rate of refusal” (page 11, lines 263-265) is based on the survey results that are analyzed in the paper?

I hope these comments will be helpful for your work!

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The authors' response to the critical remarks has been short and insufficient. I can only repeat that the concluding part of the amended manuscript with two additional sentences does not provide a sufficient explanation of how the findings of the survey could be used in facilitating the organ donation policy in Romania. This is particularly important because the survey does not directly ask questions about the family member's refusal or acceptance to donate from the brain-dead donor, which is a key issue within the opt-in model of organ donation.

The authors provide some statements from the relevant literature, which are not explicitly linked with the survey results or the interpretation of these results. For example, they seem to agree that “An opt-out system removes … emotional discomfort bestowed on family members and would lead, according to empirical data [10,11], to higher organ donation rates;”. Could the survey results be used to facilitate the change of the donation system from the opt-in to opt-out one? If yes, how?

The authors claim that “sustained campaigns to promote public awareness about organ donation by medical specialists through all available media channels” should be carried out. What are the insights and specific messages coming from the analysis of the survey results that should be used in these campaigns? Are there any target groups that should be prioritized to make the campaign more efficient?

The authors note, that “In the Emergency Clinical County Hospital of Oradea, there were 96 family interviews for organ donation from 2018 to 2021, with a family refuse rate of 47,9%, 240 higher than the national refusal rate for the same period (22,5%) [19–22]”. This is a very interesting observation. However, has the survey provided data to explain this situation?

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

I appreciate the amendments done by the authors. The additional information in the introduction and regarding methodology is helpful; however, there are still several issues that should be addressed to improve the paper:

1)      The authors have added the sentence “Convenience sampling was preferred to avoid additional psychological distress for the family members of I.C.U. patients” to the methodology part (lines 70-73), but unfortunately, this sentence does not explain or justify why the convenience sample was used. How exactly can convenience sampling help to avoid distress for family members? Convenience sampling is an approach when instead of selecting a representative sample, researchers select those research participants who are most readily available and easiest to access. Could you please provide a clearer justification for choosing a convenience sample?

2)      The authors state that the data “are available from the corresponding author upon reasonable request”. Could you please explain what is the reasoning behind not sharing the data in open access?

3)      The conclusions are still the weakest part of the paper. I still do not see how the second part of the sentence “Respondents willing to donate have registered a high rate; however, none were in the situation to decide this kind of action for their relatives” is a conclusion based on the data which was analysed. It is just a fact about the sample and might be mentioned in the methodology as a characteristic of the sample. Additionally, the first part of this sentence in the current form is hard to understand and it might be expanded.

4)      As mentioned previously, the sentence “In addition to the psychological distress for the family members of I.C.U. patients, the extreme emotional distress that may occur in obtaining consent for organ donation can negatively influence the families' decision to donate” is not based on the survey results, because the questionnaire did not include questions about emotional distress and decision-making process for donation.  My suggestion would be to delete this part of the conclusion or move it to the discussion part (or clearly show how it follows from the results if it stays in the conclusions).

5)      I agree with your conclusion that “Our findings may help Romanians become more aware of the value of organ donation and may be helpful information for future study and policy-making”, but could you please detail how exactly your results may be useful for future research and policy making, e.g., what particular changes in policies or legal framework might be necessary? What should be researched in future studies?

I hope that the comments will be helpful for improving the clarity of the paper.

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Round 3

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript can be published in its present form.

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for the amendments done! The clarity of the paper has improved.