Willingness for deceased organ donation under different legislative systems in Hong Kong: population-based cross-sectional survey

Under the current opt-in system, the deceased organ donation rate remains low in Hong Kong. An opt-out system and an opt-in system combined with organ allocation priority (ie, priority to donors as transplant recipients) have been proposed to encourage willingness among the general population towards deceased organ donation. This study aimed to compare willingness, and its determinants, across these three legislative systems. A random telephone survey of Hong Kong permanent residents aged ≥18 years was conducted between August and October 2016 using an anonymous questionnaire. Willingness towards deceased organ donation was compared between the legislative systems with McNemar's test. Determinants of willingness were tested by logistic regression. The proportion of those willing to consider deceased organ donation under the current opt-in system would significantly increase after combining it with allocation priority (64.5% vs 73.4%; P=0.018). "Fairness or reciprocity" was the major reported reason underlying the increase. In contrast, willingness would decrease after introducing the opt-out system (60.1%), although not significantly (P=0.336). The reduction might be attributable to a "belief of being forced to donate". Under the allocation priority system, reduced willingness to donate was associated with advanced age, lower educational attainment, and lower monthly household income. Under the opt-out system, reduced willingness was associated with being married, having a lower household income, and distrust of local government. An opt-in system with allocation priority could induce willingness to donate, whereas an opt-out system may reduce willingness. The findings have implications for policy-making and promotion of organ donation.