This research examines donor motivations using a research design from earlier investigations evaluating the persuasiveness of the National Kidney Foundation’s (NKF) altruistic “gift of life” frame. Earlier studies produced mixed results, showing, in particular, substantially more support for material incentives among an international sample of nursing professionals as compared to a convenience sample of college students. The purpose of this exploratory study is to compare nurses and social workers on each of three measures used as indicators of kidney donor motivation: 1) social distance between donor and recipient; 2) support for material incentives as a component of motivation to undergo a living kidney donation; and 3) self-ratings concerning compassion fatigue and worker burnout as possible factors influencing donor motivations among nursing and social work professionals. A total of 159 social workers and nurses participated in a survey that addressed not only the relationship between material incentives, social distance and motivation to donate; but also work-related burnout and compassion fatigue as structural factors that might reduce donor motivation. This study does not shy away from a debate surrounding “cash for organs” and other controversial ideas. Instead, ethical concerns were incorporated into the research model in an effort to explore what motivates an individual to undergo living kidney donation surgery.
The data for this research are based on a self-administered, self-reported survey using a non-representative sample of convenience administered at the National Kidney Foundation (NKF) 2015 Spring Clinical Meetings to social workers, nurses, and other healthcare professionals. The study assessed the willingness of NKF member nurses and social workers to undergo a living kidney donation with a modified version of the Bogardus Social Distance Scale (Bogardus, 1925; 1933), which is regarded as a valid measure of the level of comfort individuals have in associating with individuals who are increasingly “distant” or dissimilar on various key traits. The researchers also used a cumulative summated-rating scale linking various material rewards to willingness to donate. This ethical-motivation scale (EMS) was developed in accordance with ethical issues raised in the literature on donor compensation and consists of nine items of increasing monetary or material value. To measure compassion fatigue, an 11-item summated rating scale was utilized, again using issues raised in the literature on burnout and compassion fatigue. SPSS 22 was utilized for the statistical analysis of these data. Percentages and simple cross tabulations were used for nominal and ordinal variables to observe bivariate relationships. Descriptive statistics, including means and standard deviations, were used for the three ordinal-level scales. A Cronbach’s alpha was used to test the reliability and internal consistency of the ethical-motivation scale and produced α = .82. The Cronbach’s alpha for the modified Bogardus Social Distance Scale was α = .72 A Spearman correlation technique was used to examine the relationship between the social distance scale and the ethical-motivation scale.
The nurses and social workers in this study were compared on each of three measures used as indicators of kidney donor motivation: 1) social distance between donor and recipient; 2) support for material incentives as a component of motivation to undergo a living kidney donation; and 3) self-ratings concerning compassion fatigue and worker burnout as possible factors influencing donor motivations among nursing and social work professionals. With respect to social distance, a modified Bogardus Social Distance Scale based on the hypothesis that those with the least social distance from the respondent would elicit the most willingness to donate. The data supports the hypothesis that as social distance increases, the willingness of respondents to donate a kidney decreases. 95.8% of nursing, social work, and other healthcare respondents indicated they would donate one of their kidneys to an immediate family member. Regarding a family member, 74.4%, or 21.4% less, were willing to donate a kidney to a member of their extended family. Regarding donation to a friend, 71.3%, or 24.5% less, were willing to donate a kidney to a close friend. In contrast to the high willingness associated with donations to immediate and extended family, however, only 22.9% of nursing, social work and other healthcare respondents were willing to donate a kidney to an acquaintance and only 14.5% were willing to donate to a stranger. Hence, 81.3% fewer respondents were willing to donate a kidney to a stranger than to an immediate family member. This result is statistically significant at p >.001. A comparison between nurses and social workers on the Bogardus Social Distance Scale supports the hypothesis that social workers are more altruistic. Compared to nurses, social workers are 6.3% more willing to donate when it comes to donation to an immediate family member; 9.6% more willing when it comes to an extended family member; and 11.7% more willing when it comes to a close friend. In addition, despite the low level of willingness to donate to unrelated others among both groups, social workers are 23.8% more willing to donate to an acquaintance than are nurses, and 22% more willing to donate to a total stranger. Thus, the range of difference in willingness to donate to related and unrelated others is much greater in nurses at 89.6% (p >.09 2df) as compared to 73.9% for social workers (p >.001, 2df). To examine the amount of support associated with material incentives of increasing value, a nine-statement ethical-motivation scale developed by Humphries et al (2009) was utilized. The results indicate nursing and social work respondents agreed that living donors should be compensated for medical expenses, both groups also agreed that donors should be compensated for lost wages and should receive a federal tax deduction. High agreement was also expressed for non-compensated altruistic giving in the nursing respondents as well as the social work respondents.
To assess the persuasiveness of the NKF’s altruistic “gift of life” frame among member nurses and social workers, this research design was developed by a team member and included a measure of compassion fatigue as well as work-related burnout. Results from the use of the Bogardus Social Distance Scale confirm, consistent with prior research studies, that respondents are more willing to donate a kidney to a close other (e.g., a member of their immediate family) than to a distant other (e.g., a stranger). Thus, this research, considered in conjunction with prior research, provides strong empirical evidence that, regardless of target population, social distance is the single most important motivating factor in altruistic living kidney donation.
Additionally, a comparison of nurses and social workers using the Bogardus Social Distance Scale reveals that nurses are less willing than social workers to participate in a living kidney donation. For nurses, these findings are consistent with earlier research and support the hypothesis that nurses are “pragmatic” in their orientation. In contrast, the greater willingness among social workers to donate a kidney supports the hypothesis of an “idealistic” orientation. However, on the ethical-motivation scale item that suggests donating a live kidney should be a “free-will donation and purely altruistic", nurses express somewhat more agreement than social workers. Both nurses and social workers expressed low support for cash payouts and other high-value rewards. Furthermore, on the compassion fatigue scale, both nurses and social workers reported that while they “feel physically and emotionally exhausted at the end of the work day,” they found work personally rewarding and were not “burned out.” Compassion fatigue also does not appear to explain the greater social distance expressed by the current sample of nurses in that the results on the compassion fatigue scale are comparable for both nurses and social workers. This may be due to cultural rather than structural factors, such as the different professional worldviews and socialization experiences of nurses and social workers. Despite lack of support for high-value material rewards, results from the ethical-motivation scale show strong support among both nurses and social workers for limited material incentives in the form of compensation for medical expenses, lost wages, and a federal tax deduction. These findings suggest that the “gift of life” frame is not persuasive when it comes to motivating individuals to undergo a live kidney donation, particularly when it involves an unrelated other. Specifically, the results show that unless the recipient has a close relationship to the donor, there is a low willingness to donate. Given this, the research team is in favor of re-framing living donation to emphasize both justice and rights. Specifically, these authors argue that material compensation could be construed as a just reward that preserves the rights of a selfless donor to autonomy, integrity, and dignity. In the view of these authors, this restorative frame avoids the perception of “cash for organs” that lacked resonance with the nurses and social workers in this study.