Donating organs: A theory-driven inventory of motives
, Maria T.M. Sastrea and Etienne Mulletb
Department of Psychology, Mirail University, Toulouse, France; b
Institute of Advanced
Studies, Ethics and Work, Paris, France
(Received 2 April 2010; final version received 12 January 2011)
Two studies examined the motives that lay behind patients’ acceptance or
reluctance at donating organs after death. They also examined the way these
motives were related to demographic characteristics, personality, and signing a
donor card. Six separable motives for donation were found: Financial Incentive,
Humanistic or Religious Duty, Positive Consideration from Others, Living on
Through a Receiver, Gift of Life, and Close Others. Five motives for not donating
were found: Preserving the Absolute Integrity of the Corpus, Strict Individualism,
Lack of Control over the Use of the Organs, Anonymity of the Procedure, and
Respecting Family Wishes. These motives were linked to personality factors in a
meaningful way. Willingness to sign was higher among female participants and
among participants with lower scores on Integrity of the Corpus and higher scores
on Duty and Gift of Life. When Integrity of the Corpus scored highly, however, the
effect of the other factors was practically eliminated. In other words, Integrity of
the Corpus acted as a protected value: Trying to change people’s belief that the
integrity of the corpus at death is a sacrosanct issue would come with its own
Keywords: organ donation; metamotivational theory; motives; personality
The determinants of organ donation have been intensely examined. Many factors
that could possibly explain the willingness to donate have been considered:
organizational (Matesanz & Dominguez-Gil, 2007); demographic, including cultural
(Mocan & Tekin, 2007); cognitive (Shanteau & Skowronski, 1990); attitudinal
(Skowronski, 1997); representational (Moloney, Hall, & Walker, 2005); personal
(Besser, Amir, & Barkan, 2004); affective (Van den Berg, Manstead, Van der Pilgt, &
Wigboldus, 2005). Motivational factors have generally not been considered as much,
although findings that were difficult to explain (e.g. the specific behavior of
minorities) have been tentatively related to motivational factors.
Among the motives that have been suggested for explaining willingness to donate
are (a) financial incentives (Crowley-Matoka & Lock, 2006), (b) moral and religious
reasons (a ‘‘gift of life’’) (Hu¨bner & Kaiser, 2006), (c) improving self-esteem and
making a good impression to others (Brug, Van Vugt, Van den Borne, Brouwers, &
Van Hooff, 2000), (d) altruism and solidarity (Sanner, 2006), (e) helping a known
*Corresponding author. Email: email@example.com
Psychology, Health & Medicine
Vol. 16, No. 4, August 2011, 418–429
ISSN 1354-8506 print/ISSN 1465-3966 online
2011 Taylor & Francis
individual or a family member who is ill (Shanteau & Skowronski, 1990), and (f) as a
way of living on through another person (Crowley-Matoka & Lock, 2006). Among
the motives suggested for explaining unwillingness to donate are (a) lack of
knowledge (Radecki & Jaccard, 1997), (b) absolute respect for the dead body (Sque,
Payne & Macleod Clark, 2006), (c) respect for laws of nature (Sanner, 2006), (d)
distrust about the physicians (Sanner, 2006), (e) fear that organs being removed
before death (Callender & Miles, 2001), (f) possible body disfigurement, (g)
absorption by the receiver of one’s identity (Sanner, 2006), (h) respecting the family’s
wishes (Radecki Breitkopf, 2006), and (i) not distressing an already bereaved family
(Sque et al., 2006).
In the present set of studies, the theoretical framework chosen for examining the
motives was a theory able to encompass the diversity of motives found in the
literature: Apter’s (2001) metamotivational theory. This framework had already
been used by Apter and Spirn (1997) for examining the motives that lay behind
donating blood (see also Kpanake, Dassa, & Mullet, 2009). It classifies people’s ways
of dealing with the world using four fundamental domains: goals and means; rules
and constraints; transactions or exchanges with other people, things, or situations;
relationships with other people, things, or situations. As shown in Table 1, each
domain is characterized by two or more possible states of mind, which may, on a
priori grounds, correspond with one or two categories of motives.
The objectives of the studies were (a) inventorying the motives for donating or
not donating organs, using Apter’s framework, (b) ordering these motives as a
function of their perceived importance, (c) finding out how demographic
characteristics were associated with these motives, and (d) finding out how these
motives are associated with the willingness to sign a donor card.
Study 1 was exploratory in character. Two questionnaires containing a whole range
of motives for donating organs, or not donating, were used. Through factor
analyses, two motivational structures were delineated. We expected that these
motivational structures would be interpretable in the chosen framework. Based on
the review of literature, we expected people to describe their motives at donating
organs as primarily reflecting allocentric sympathy type concerns (Sanner, 2006),
conformist type concerns (Hu¨bner & Kaiser, 2006), proautic mastery type concerns
(Crowley-Matoka & Lock, 2006), and autocentric sympathy type concerns (Brug
et al., 2000). We also expected that the receiver’s identity would be part of a specific
motive (Skowronsky, 1997). Regarding the motives for not donating organs, we
expected people to describe ones primarily reflecting autocentric mastery type
concerns (Sanner, 2006), conformist type concerns (Sque et al., 2006), autocentric
sympathy type concerns, and allocentric sympathy type concerns (Radecki
The sample was a convenience sample of unpaid volunteers. The participants were
contacted during daylight hours in the campus of the university or in the main streets
of Toulouse (a city of 1,000,000 inhabitants in southwestern France). The research
assistant was instructed to solicit every third passerby until 400 individuals were
Psychology, Health & Medicine 419
Table 1. Domains and states in Apter’s metamotivational theory. Examples of corresponding possible motives for donating or not donating organs.
Domain State Characteristic Possible motive for donating Possible motive for not donating
Telic Focusing on goals and
achievement with a serious
Funerals would be paid
Paratelic Focusing on the activity itself and
on present moment with a
Fear that organs be removed
before complete death
Conformist Following social codes, rules, and
laws; showing respect or
obedience; adopting a
Accomplishing a civic act Preserving the integrity of the
corpus at death
Negativist Opposing social expectations and
rules; expressing hostility or
dissidence; adopting an
Denying that there is not really a
shortage of organs
Mastery Trying to dominate people, things,
Being a necessary part of another
No means for knowing who is the
Sympathy Feeling affection toward other
people or things
Organs would benefit a member of
Autocentric Being the focus of other’s
concerns and interests
Giving the impression that one
was a generous person
Intra-autic Focusing on one’s own concerns
Can considerably alter my
Allocentric Identifying with and focusing on
the needs and interests of others
Improving the quality of life of
Would not like to hurt several
members of the family
Proautic Living through (usually) powerful
or sympathetic others
Having the impression of a form
of psychic continuity after
Unwillingness to have one’s spirit
to be absorbed into someone
420 M. Guedj et al.
contacted. The individuals approached were told that our research team was
conducting a survey on organ donation and were given either some examples of the
questions or shown the first page of the questionnaire. The participation rate was
67%, that is, 271 questionnaires were completed.
The participants were 184 females and 87 males aged 18–73 years (M ¼ 37.5
years, SD ¼ 12.5 years). Twenty-six percent of participants lived alone, 38% were
married, 25% were in cohabitation, 8% were divorced, and 2% were widowed.
Fifteen percent of participants had not completed secondary school, 46% had
completed secondary school but did not have a university degree, and 39% had a
university degree. Sixty-seven percent declared that they believed in God, and 6%
were regular church attendees.
Questionnaire D comprised 48 items referring to motives for donating organs after
death (see Table 2). Questionnaire N comprised 50 items referring to motives for not
donating (see Table 3). The common wording of all items – ‘‘One of the reasons why
I would be (un)willing to donate organs. . .’’ – was chosen to reflect the fact that
several motives could be operating at the same time. The two extremes of the 17-
point response scales were labeled ‘‘complete disagreement’’ and ‘‘complete
agreement.’’ Half of the items were inspired by Parisi and Katz (1986). The other
items were created during focus groups sessions. Fifteen persons considering organ
donation were contacted before the study and instructed to list all the possible
motives for donating (or not donating) organs (personal motives as well as motives
they were told by other patients and/or family members and friends).
Participants responded individually, at home or at the university. The experimenter
was, in most cases, not present when the participants filled out the questionnaires
(mainly in order not to influence them). Completion of the questionnaires took
approximately 30 minutes. Half of the sample was presented the donating organs
version first and the other version second (and inversely).
An exploratory factor analysis was conducted on the 48 motives for donating
organs. As many items did not load (50.30) on any factor, they were removed, and a
second exploratory factor analysis was conducted on the 28 remaining items. Based
on the scree test, six interpretable factors emerged. This solution was retained and, as
we wanted to have independent factors, subjected to VARIMAX rotation.
The first factor explained 20% of the variance. It was called Gift of Life since it
loaded items expressing the idea that many ill people are waiting for organs and that
it would not be tolerable to let them suffer. A mean score was computed by simply
averaging the values observed on the four items with the highest loadings. For this
first factor, the score was the highest observed (M ¼ 14.84, SD ¼ 2.84). The second
factor (11% of the variance) was called Positive Consideration from Others
(M ¼ 4.23, SD ¼ 3.34). The third factor (10%) was called Living on Through a
Receiver since it loaded items expressing the idea that one can survive by donating
Psychology, Health & Medicine 421
organs to other people (M ¼ 5.16, SD ¼ 4.24). The fourth factor (8%) was called
Financial Incentive since it expressed the view that financial compensation to the
family would be a great incentive (M ¼ 2.69, SD ¼ 2.55). The fifth factor (8%) was
called Humanistic or Religious Duty (M ¼ 6.54, SD ¼ 3.51). Finally, the sixth factor
(5%) was strongly loaded on just two items. It was called Close Others since it loaded
on items expressing the view that donating organs to a family member is easier than
donating organs to an unknown person (M ¼ 12.08, SD ¼ 4.12).
Table 2. Results of the confirmatory analysis conducted on the items about willingness to
One of the reasons that would encourage
me to donate organs Factors
would be that. . . I II III IV V VI t
. . . my family would be compensateda
. 0.86 17.40
. . . I have no direct descendantsa
. . . my funerals would be paidb
. 0.93 19.53
. . . nobody has ever helped me in the pastb
. . . my religion or my philosophical views
encourages me to do soc
. . . everybody in my family would donate
. . . it is a more and more common decision
. . . it is a civic actd
. . . it would attract the positive
consideration of close otherse
. . . it is a very special experiencee
. . . people would keep the impression that I
was a generous personf
. . . this decision is still considered as a
somewhat heroic onef
. . . there are many persons waiting for an
. . . it could save childreng
. . . it can improve the quality of life of
. . . it can save many livesh
. . . I would have the impression of a form of
psychic continuity after deathi
. . . the heart is where the emotions liei
. . . I would be happy to live on through
. . . I would have the impression that one
part of myself will be able to enjoy
. . . my organs would benefit a member of
. . . someone would ask me personally. 0.52 5.10
M 3.56 6.55 5.42 14.3 6.71 11.6
SD 3.19 3.65 3.70 3.19 4.67 4.45
Cronbach’s a (correlation) 0.79 0.70 0.75 0.86 0.86 0.34
Notes: Scores ranged from 1 to 17. I, Financial Incentive; II, Humanistic or Religious Duty; III, Positive
Consideration from Others; IV, Gift of Life; V, Living on Through a Receiver; VI, Close Others. The items
with the same superscript have been pooled.
422 M. Guedj et al.
The same procedure was applied to the motives for not donating organs; 23 items
were selected, and a five-factor structure was retained. The first factor (14%) was
called Lack of Control over the Use of the Organs since it loaded items expressing the
idea that one cannot know exactly what has been done with the organs (M ¼ 6.81,
SD ¼ 4.48). The second factor (11%) was called Respecting Family Wishes since it
loaded items expressing the idea that the family would be upset if one of its members
donates organs (M ¼ 2.80, SD ¼ 3.04). The third factor (12%) was called Anonymity
Table 3. Results of the confirmatory analysis conducted on the items about willingness not
to donate organs.
One of the reasons that would prevent Factors
me to donate organs would be that. . . I II III IV V t
. . . we must try to preserve the integrity
of the corpus at deatha
. . . I consider that my body belongs to
myself, and only myselfa
. . . I think that we must, above all, live
. . . I am responsible for the complete
integrity of the corpusb
. . . I do not really like lifec
. 0.72 15.29
. . . there is not really a shortage of organsc
. . . everybody in my family is willing to
donate organs!d 0.74 14.11
. . . I am not concerned by other’s problemsd
. . . it can considerably alter my physical
. . . the consequences for my own body are
. . . I will not be informed about what is
going to be done with themf
. . . I am not informed about the surgical
procedure for taking the organsf
. . . the receiver will not know in advance
that I am the donorg
. . . I have no means for knowing who is
. . . the whole procedure is completely
. . . I will not be able to meet before with
. . . my family is hostile to the principle of
. . . I would not like to hurt several
members of my familyi
. . . my close relationships are against
. . . this would be going against my
M 5.03 2.30 7.75 4.37 3.39
SD 3.98 2.19 4.52 4.13 3.37
Cronbach’s a (correlation) 0.78 0.83 0.76 0.87 0.85
Notes: Scores ranged from 1 to 17. I, Integrity of the Corpus; II, Individualism; III, Lack of Control; IV,
Anonymity; V, Respecting Family Wishes. The items with the same superscript have been pooled.
Psychology, Health & Medicine 423
of the Procedure (M ¼ 3.44, SD ¼ 3.57). The fourth factor (13%) was called Strict
Individualism since it expressed the view that each person is fully responsible for their
own destiny (M ¼ 2.00, SD ¼ 2.03). Finally, the fifth factor (12%) was called
Preserving the Absolute Integrity of the Corpus (M ¼ 4.38, SD ¼ 3.90).
Study 2 was confirmatory in character. It was also aimed at examining the
associations between demographic and personality characteristics and the motives,
the association between the motives and other variables, and the willingness to sign a
donor card. We expected that willingness to sign would be higher among female
participants than among male participants (Mocan & Tekin, 2007) and among
the participants showing the strongest conformist type and allocentric sympathy type
motives (Besser et al., 2004). In addition, we expected that willingness to sign would
be more strongly associated with the negative motives than the positive ones (see
Brug et al., 2000; Skowronsky, 1997).
Participants were 102 adults (71 females and 31 males) aged 18–77 years (M ¼ 36.7
years, SD ¼ 16.5 years) who did not participate in Study 1. They were recruited in
the same way as in Study 1. Forty-four percent of them lived alone, 25% were
married, 18% were in cohabitation, 12% were divorced, and 2% were widowed.
Twenty-eight percent of participants had not completed secondary school, 42% had
completed secondary school but did not have a university degree, and 29% had a
university degree. Sixty-three percent of them declared that they believed in God,
and 18% were regular church attendees.
Material and procedure
The first two questionnaires (of motives) were composed on the basis of the results in
Study 1: 22 of the 28 donation items and 20 of the 23 nondonation items were
selected, the ones with the highest loadings on each factor. These items are shown in
Tables 2 and 3. The third questionnaire was composed of 50 items taken from the
International Pool of Items of Personality (IPIP; Goldberg, 1999). The fourth
questionnaire was the Behavioral Commitment Toward Organ Donation (BCTOD)
questionnaire (Parisi & Katz, 1986).
The first three questionnaires were presented in close succession but, as in Study 1,
counterbalanced. The BCTOD questionnaire was presented later after the participants
had completed another task that was unrelated to the study to give a break.
A confirmatory factor analysis was conducted on the motives for donating. The model
tested is shown in Table 2. In view of obtaining a number of participants–number of
variables ratio that was as high as possible, two parcels were created for each factor by
424 M. Guedj et al.
averaging the values of two related items. The Global Fit Index value was 0.94; the
Comparative Fit Index value was 0.98; the root mean square error of adjustment value
was 0.02 (0.00–0.06); the w2
/df ratio was 1.02. A second confirmatory factor analysis
was conducted on the 20 retained motives for not donating (see Table 3). The
corresponding values were 0.94, 0.98, 0.04 (0.00–0.09), and 1.24.
Table 4 shows the correlations between demographic characteristics and
personality and motives. Gender mainly impacted on Individualism. This motive
was less strongly endorsed by female participants than by male participants. Age was
negatively associated with Positive Consideration. Education was negatively
associated with Individualism. Being already a blood donor was negatively associated
with Financial Incentives. Personally knowing someone in need of a transplant was
negatively associated with Integrity of the Corpus. Neuroticism was positively
associated with Living on Through a Receiver. Extraversion was positively associated
with Positive Consideration. Conscientiousness was positively associated with
Financial Incentives. Agreeableness was negatively associated with Strict Individualism. (Openness did not significantly correlate with any motive). Table 4 also shows
the correlations between motives and willingness to sign a donor card. The strongest
link was with Integrity of the Corpus.
Table 4. Correlations between motives and other variables.
Factors Gender Age Education Blood Knows
Financial incentives 70.14 70.27* 70.08 70.29* 70.02
Humanistic or Religious Duty 0.03 70.03 0.15 0.02 0.06
Positive Consideration from Others 70.04 70.33* 70.05 70.14 70.15
Gift of Life 0.19* 0.08 0.25* 0.19* 70.15
Living on Through a Receiver 70.02 70.12 70.04 0.01 0.01
Close Other 0.12 70.05 0.04 0.06 70.11
Integrity of the Corpus 70.17 70.13 70.14 70.21* 70.21*
Strict Individualism 70.38* 70.09 70.28* 70.18 70.00
Lack of Control over the Use
of the Organs
70.01 70.24* 70.04 70.20* 70.02
Anonymity of the Procedure 70.10 70.22* 70.04 70.21* 0.06
Respecting Family Wishes 70.09 70.07 70.12 70.20* 70.02
Factors Personality Donor’s card
NE C A
Financial incentives 0.09 0.15 0.21* 70.10 70.18
Humanistic or Religious Duty 0.05 70.01 0.01 0.25* 0.28*
Positive Consideration from Others 0.10 0.26* 0.05 70.00 70.14
Gift of life 0.15 70.04 70.11 0.35* 0.32*
Living on through a receiver 0.27* 0.08 0.01 0.18 0.11
Close Other 0.18 70.06 70.08 0.25* 0.04
Integrity of the Corpus 0.19* 0.09 70.02 70.19* 70.52*
Strict Individualism 70.07 0.11 0.02 70.40* 70.28*
Lack of Control over the Use
of the Organs
0.11 70.04 70.16 0.04 70.31*
Anonymity of the Procedure 0.07 0.04 70.02 0.06 70.11
Respecting Family Wishes 0.02 0.05 0.11 70.05 70.30*
Notes: N, neuroticism; E, extraversion; C, conscientiousness; A, agreeableness. *p 5 0.01.
Psychology, Health & Medicine 425
A stepwise regression analysis was conducted with willingness to sign as the
criterion and (a) the demographic characteristics variables (except blood donation),
which were entered first; (b) the personality measurements, which were entered
second; (c) the motives, which were entered third. Demographic characteristics
explained 18% of the variance, F(7, 94) ¼ 2.95, p 5 0.01. Personality measurements
explained an additional 3%, nonsignificant. The motives explained an additional
31%, F(11, 78) ¼ 4.60, p 5 0.001.
A second stepwise regression analysis was conducted with the predictors entered
separately. Only three motives – Integrity of the Corpus (b ¼ 70.47), Duty
(b ¼ 0.25), and Gift (b ¼ 0.16), and only one demographic characteristic, Gender
(b ¼ 0.18) – were significantly associated with willingness to sign, and they explained
42% of the variance, F(4, 97) ¼ 17.64, p 5 0.001. Willingness to sign was
significantly higher among female participants and among participants with lower
scores on Integrity of the Corpus and higher scores on Duty and Gift of Life.
These three motive scores were dichotomized, and willingness to sign was plotted
against these factors. As shown in Figure 1, an Integrity of the Corpus 6 Duty
interaction was present, F(1, 98) ¼ 6.59, p 5 0.02, as well as an Integrity of the
Corpus 6 Gift interaction, F(1, 98) ¼ 6.82, p 5 0.02.
These two studies were aimed at inventorying the motives of people for donating, or not
donating, organs after death, using a broad motivational framework. Overall, evidence
for 11 separable motives was found, and these motives were, as expected, interpretable
in Apter’s Metamotivational framework. Financial Incentive was a telic factor,
Humanistic or Religious Duty and Preserving the Absolute Integrity of the Corpus
were conformist factors, Strict Individualism was a negativist factor, Lack of Control
over the Use of the Organs was an autocentric mastery factor, Positive Consideration
from Others and Anonymity of the Procedure were autocentric sympathy factors, Living
on Through a Receiver was a proautic mastery factor, and Gift of Life and Respecting
Family Wishes were clearly allocentric sympathy factors. Finally, Close Others was also
an allocentric sympathy type factor that can be considered as specific to the situation.
As expected, allocentric sympathy type concerns (Gift of Life and Close Others)
were the dominant motives at donating organs. Conformist type concerns (Duty),
proautic mastery type concerns (Living on Through a Receiver), and autocentric
sympathy type concerns (Positive Consideration), although clearly identified,
received, however, much lower scores. As expected, the autocentric mastery type
concerns and conformist concerns were the dominant motives for not donating
organs, but their corresponding scores were comparatively low. These results are
consistent with Apter and Spirn’s (1997) findings.
These two studies also examined the associations between demographic and
personality characteristics and the motives. The pattern of associations was
consistent with our interpretation of the factors. For instance, Individualism was
shown to be linked with gender (females scoring lower), negatively linked with
education and agreeableness. As another example, Positive Consideration was shown
to be negatively linked with age and positively linked with extraversion.
Finally, the two studies examined the association between the motives and the
other variables, and willingness to sign a donor card. As expected, willingness to sign
was higher among female participants, even when the other predictors were taken
426 M. Guedj et al.
into account. This result is consistent with Mocan and Tekin’s (2007) findings. As
expected, it was also strongly associated with both conformist motives and with
allocentric sympathy motives. Sque, Payne, and Macleod Clark (2006) had already
suggested that ‘‘gift of life’’ and ‘‘sacrifice’’ were the two key concepts for
understanding organ donor’s decision making. The dominant predictor was
Preserving the Absolute Integrity of the Corpus, that is, a conformist type motive
for not donating organs. Interestingly, the effect of Duty (the other conformist
factor) and Gift of Life (the allocentric sympathy type factor) interacted with this
factor. When Integrity of the Corpus scored highly, the effect of the other factors was
practically eliminated, that is, this motive acted as a protected value, a value that
cannot be subjected to tradeoff. This result is consistent with early findings by Parisi
Figure 1. Interaction between the Integrity of the Corpus Motive and the Duty Motive (top
panel). Interaction between the Integrity of the Corpus Motive and the Gift Motive (bottom
panel). Scores of willingness to sign, which range from 1 to 5, are on the Y-axis.
Psychology, Health & Medicine 427
and Katz (1986) who had already shown an interaction of a similar form between
positive and negative attitudes (see also Hu¨bner & Kaiser, 2006).
These findings help explain why, despite the fact that, with regard to organ
donation, positive views tend to dominate in our societies and generous, altruistic
motives are strongly endorsed, at the very moment of signing a donor card (or at the
very moment of allowing doctors to extract organs from a relative’s dead body),
many people hesitate. Even if it is not very strongly expressed, the belief that the
integrity of the corpus must be preserved at death acts as the main deterrent to
donation. As stated by Sanner (2006, p. 148), ‘‘It is probably easier to explain legal
rules, logistics, and surgery techniques than to help people come to terms with their
partly subconscious and not always clearly articulated uneasiness.’’ Changing
people’s religious or philosophical beliefs is difficult, and it comes with its own
ethical issues. To what extent are we allowed to ‘‘change’’ some people’s belief that
the integrity of the corpus is a sacrosanct issue? In the case of many families, it would
amount to changing deep cultural habits and, in some cases, religious values.
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Donating organs: A theory-driven inventory of motives