Understanding public skepticism toward organ donation and its commercialization: the important role of reciprocity.

QUESTION We explored ideas and motives behind public attitudes toward organ donation and its commercialization in the context of recent academic and political debates on attempts to increase the number of donor organs by means of financial incentives. METHODS We analyzed 4 focus group discussions (FGs) conducted in Germany between 2005 and 2008 with various participants: (1) recipients of a cadaveric donation, (2) recipients of a living donation, (3) living organ donors, and (4) lay people (N((a-d)) = 30). In our analysis we used the method of qualitative content analysis to extract the major argument classes and moral viewpoints about organ donation and its commercialization. RESULTS We found a thorough concordance in the critical assessment of most commercial strategies over the 4 groups of participants. Slight deviations between groups were most likely due to different perspectives resulting from the various ways the groups were affected. Overall, we observed a strong tendency to assess the practice of organ procurement in terms of reciprocity. CONCLUSIONS The current political and legal discourse neglects the central role of reciprocity for lay people and patients. Targeted legal and practical solutions should (re) consider strategies to integrate the highly valued idea of reciprocity in organ donation practice: for example, the club model and the paradigm of anonymity in cadaveric organ allocation.