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Organ donation and transplantation services represent a microcosm of modern healthcare organisations. They are complex adaptive systems. They face perpetual problems of matching supply and demand. They operate under fierce time and resource constraints. And yet they have received relatively little attention from a systems perspective. The purpose of this paper is to consider some of the fundamental issues in evaluating, improving and policy reform in such complex systems.

The paper advocates an approach based on programme theory evaluation.

The paper explains how the death to donation to transplantation process depends on the accumulation of series of embedded, institutional sub-processes. Evaluators need to be concerned with this whole system rather than with its discrete parts or sectors. Policy makers may expect disappointment if they seek to improve donation rates by applying nudges or administrative reforms at a single point in the implementation chain.

These services represent concentrated, perfect storms of complexity and the paper offers guidance to practitioners with bio-medical backgrounds on how such services might be evaluated and improved. For the methodological audience the paper caters for the burgeoning interest in programme theory evaluation while illustrating the design phase of this research strategy.

Transplantation extends and improves lives, but the shortage of organs is one of the main factors limiting the number of transplants in Italy, as well as in other countries. This study investigated the awareness about organ donation and the socio-demographic factors associated with donation will in a general population.

In 2019, a survey was carried out by computer-assisted web interviewing. A questionnaire was sent via e-mail to 39,360 individuals (i.e. students, administrative and teaching staff of the University of Milano-Bicocca, Italy). The response rate was 10.6% and 4,191 weighted cases were used in the analysis.

This study showed a strong, positive attitude towards donation: over 96% of respondents stated to be keen on organ donation. Of the respondents, 40.8% considered themselves informed on medical procedures involving organ donation, and only 15.8% thought to have sufficient legal information. Overall, only 17.7% of respondents thought that the information available was sufficient to make informed decisions. According to the respondents, ethical and religious implications were the main reasons (30% of answers) that limited the level of information. Just 57.9% of respondents had already recorded their willingness to donate. Among them, renewal of the identity card was the most common motivation (55.8%) and the main motivation reported for lack of expression of donation will was the lack of opportunity or time (61.5%).

A positive attitude towards donation demands a wide public education programme and opportunities to declare one's will to donate to increase the population of potential organ donors.

Recent technological developments in healthcare have enabled an increased number of organ transplantation surgeries. At the same time, there is an increase in the number of people awaiting organ transplant, coupled with the difficulty in donation. To bridge this gap, this study aims to propose to evaluate the effect of three types of beliefs (clinical beliefs, financial incentive beliefs and beliefs on the social benefits of altruism and solidarity) on the intention to donate organs. Moreover, this paper uses the attitudes in relation to donation to explain the effect of these beliefs on the intention to donate organs.

The research was conducted using a survey of 422 Brazilian participants and a mediation analysis to test the mediation hypotheses.

The results suggest that the effect of three types of beliefs (clinical, economic order and social solidarity) influence the intention to donate organs indirectly through the formation of attitudes concerning organ donation.

This article contributes to the understanding of the formation of organ donation intentions and the role of different types of beliefs in the formation of such intentions.

The findings extend the discussions regarding the role of beliefs in the formation of attitudes and intentions of organ donation and have significant value in creating public policies that further promote organ donation.

In this chapter I consider the need for consent in two cases of posthumous donation of parts of one’s body: organ donation and the donation of sperm to allow one’s partner to conceive a child after one’s death. What kind of consent is appropriate in these cases and why? In both cases, jurisdictions tend to prefer explicit consent, although many countries now adopt presumed consent (opt-out) in the case of organ donation, and there has been a recent plea for presumed consent in the case of sperm donation as well. In this chapter I first argue that arguments in favour of presumed consent are inadequate as they stand, and then describe another way of understanding opt-out schemes, one that focuses on different models of what is at stake and on the ethical requirements incurred on such models.

By the end of this chapter, you should be able to demonstrate an understanding of:

How sustainability messages have diffused into mainstream discourse?

The role of behavioural economics, specifically nudge theory, in encouraging sustainable behaviours.

The visual elements in marketing that support nudge theory.

How businesses are aligning with consumer concern for sustainability to illustrate their ‘wokeness’ to social issues.

This study aims to develop a hierarchical model that uncovers the relationships between challenges confronting Africa's organ transplant supply chain systems.

Eleven challenges (variables) were identified after a comprehensive review of the existing literature. The contextual interactions among these variables were analysed from the perspectives of health-care stakeholders in two sub-Saharan Africa (SSA) countries (Nigeria and Uganda), using Delphi-interpretive structural modelling-cross-impact matrix multiplication applied to classification (MICMAC) techniques.

The findings reveal that weak regulatory frameworks, insufficient information systems and a lack of necessary skills make it challenging for critical actors to perform the tasks effectively. The interaction effects of these challenges weaken organ supply chains and make it less efficient, giving rise to negative externalities such as black markets for donated organs and organ tourism/trafficking.

This paper establishes a solid foundation for a critical topic that could significantly impact human health and life once the government or non-profit ecosystem matures. The MICMAC analysis in this paper provides a methodological approach for future studies wishing to further develop the organ supply chain structural models.

The study provides valuable insights for experts and policymakers on where to prioritise efforts in designing interventions to strengthen organ transplantation supply chains in developing countries.

This study is one of the first to empirically examine the challenges of organ transplant supply chains from an SSA perspective, including theoretically grounded explanations from data collected in two developing countries.

The shortage of organ donors is an under-researched global issue that demands immediate attention. This attention should begin at the government level and related organizations. In Malaysia, the shortage of organ donations has been a pressing issue faced by the Ministry of Health Malaysia (MOH) for a considerable length of time. In reaction to this issue, the MOH deployed the Organ Donation Awareness Strategic Campaign Plan by using the platform of social media to disseminate information regarding organ donation to the public. However, the number of registrations is still low among Malaysians. Moreover, the observation from the literature shows that there are limited studies which have been initiated to focus on social media in the context of organ donation campaigns.

The quantitative research design has been used to understand the issue. Three hundred and eighty-four completed questionnaires were collected from the target sample, which comprised university students in Malaysia. For this study, partial least squares structural equation modelling was used for data analysis.

The result shows that information usefulness is vital because it will lead individuals to adopt organ donation information on social media. More specifically, predictors that positively influence youth or university students to accept information as useful are visual information, information sharing, accessibility of information, needs of information and attitude towards information. Subsequently, information usefulness positively influences information adoption. In the meantime, information quality and credibility do not significantly affect information usefulness.

The findings of this study may assist MOH or interested parties in designing a sound marketing strategy in the context of organ donation promotion by providing empirical evidence.

The study provides empirical evidence about information characteristics in the context of organ donation promotion.

Environmental sustainability in health care is an important issue due to the limited available healthcare resources and increase in demand. For instance, organ recycling and transplantation may reduce the increasing pressure on healthcare resources. The purpose of this paper is to set out to identify and interrelate the inhibitors that significantly influence the recycling of human organs and their implications to the environment in developing economies such as India.

The study uses Delphi–ISM–regression, a three-step method, to investigate the possible reasons for the poor supply chain efficiency of organ recycling and to explore the consequence of excessive use of healthcare resources on the environment. The Delphi technique facilitates the identification, synthesis, and prioritization of the inhibitors. Then, using focused group discussion, the interpretive structure modeling (ISM) presents the interaction among the inhibitors into a hierarchy. Further, on the basis of 257 valid responses received on the structured survey instrument, the regression model examines the influence of identified constructs on one of the identified root causes.

The ISM presents the hierarchy-based model that depicts high driving power and low dependence inhibitors leading to reduced organ recycling rate. “Negative Intentions of family members” toward organ donation t “Willingness to discuss with family” and “Perceived Behavioral Control” emerged as the significant factors influencing organ recycling rate, which adversely impact the environment sustainability.

The patients on the organ waiting list put pressure on the availability of medical resources and, ultimately, on the environment through the consumption of different drugs and disposable of medical wastes. The study suggests policymakers and hospitals improve on the existing policies for an efficient supply chain of human organ recycling. The Indian situation echoes the situation in most of the emerging economies, and similar solutions can apply there too.