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Perceptions of Organ Donation of Religious Individuals

Research Background
In recent years, organ donation has become a widely-discussed topic. Not only in the UK, but in several westernized countries the area of organ donation has been in the public eye (Wigmore, Stephen J.; Forsythe, 2004). In the UK, the organ donation-issue has mainly received attention due to lack of donors. According to Sharp and Randhawa (2014), the UK has one of the weakest organ donation rates in the developed world and the poor donation rates are allegedly results of high family refusal rates and lack of registered donors. Hence, indicators of a problem.
Not only is there a problem on a more general basis, also other problems related to the sphere of organ donation have arisen. Currently, many westernized countries face increasing multiculturalism and immigrants tend to retain their religious position abroad – a retention of religious positions that has highlighted new issues. For instance, reports reveal that there is good evidence that religious people from indigenous and migrant ethnic minorities are more likely to develop renal failure, but less likely to receive renal transplants (Oliver et al., 2011). Therefore, this research will examine how religious individuals perceive organ donation in order to come up with explanation for this paradox.
In addition, the UK Organ Donation Taskforce has explicitly stressed need for detecting the most effective methods through which the altruistic view of organ donation can be promoted to religious people and especially the BAME population (black, Asian, and minority ethnic) (Randhawa and Neuberger, 2016). Former researches have tried to identify these communicative methods by gathering faith leaders to reflect on it. However, this research will instead focus on the perception and the promotion of organ donation from the religious individuals’ point of view instead of the faith leaders point of view.
So, to sum up, this research will fill out the missing element in existing literature by highlighting the perception of organ donation from the religious individuals’ point of view instead of from the faith leaders’. Moreover, the research will try to identify effective communicative methods to promote the altruistic view of organ donation to the religious individuals.
Ideally, the knowledge produced in this research will contribute to further understanding around the topic that hereby can be used to improve marketing campaigns and ultimately lead to more donors.
To study the above, the following questions will be taken into consideration:
Broad question

  1.   How does religious individuals in the UK perceive organ donation and how can the altruistic view best be promoted to religious people?

Specific questions

  1. How is existing marketing campaigns affecting religious groups?
  2. In what way is religious people influenced by other factors than marketing campaigns?
  3. How does the “gift-of-life-metaphor” resonate among the religious individuals?
  4. What meaning does specific religious individuals attach to different organs and what implication would that have to a marketing campaign?

Rationale of Research Strategy
This research will be informed by the philosophical paradigm; interpretivism. The research will try to find understanding by examining social action from a subjective point of view (Bryman and Bell, 2015). In other words, the knowledge acquired is rather socially constructed than objectively determined and perceived (Carson et al., 2001). Accordingly, this research will not take a scientific research approach that is often used in quantitative- and survey research (in quantitative- and survey research, a positivist research approach is more likely to be used (Carson et al., 2001)).
The rationale behind choosing interpretisvism as the dominant position is grounded in the research aim, the research questions and in the chosen research strategy. This research tries to highlight the perception of organ donation by use of in-depth interviews. Thus, a topic that is hard to measure and quantify, but also it is a research strategy that highly depends on the researcher’s ability to interpret social actions such as body language e.g. According to Black (2006) interpretivist research is more receptive to capture meanings in human interaction than positivist research, which is why an interpretive position will inform this research.  As a researcher, I will be involved in the research and with the interviewed participants. But also, as a researcher I will try to examine perspectives and world views by asking open-ended questions. Therefore, interpretisvism is suitable.
Furthermore, this research implies an ontological position described as constructionist. Since this research employs in-depth interviews it nearly unavoidable not to bias the research as a researcher. But this is not necessarily a bad thing. A constructionist position implies that “social properties are outcomes of the interactions between individuals” (Bryman and Bell, 2015, p. 392). Involving in the research allows the researcher to be more tolerant of the viewpoints of the interviewee. Therefore, a constructionist view is used with the purpose of gaining further meaning and knowledge from the interviews.
In relation to approaches this research will take an inductive approach. The research will generate theory by researching. In other words, the outcome of the research is theory (Bryman and Bell, 2015). The inductive approach will help me addressing my research questions by making it possible to generate a theory based on my research. That is, I can make inferences on the basis of what my sample of participants say and do and thereby generate a theory. If I e.g. find that Muslims in my research perceive organ donations as a positive thing, the inductive approach allows me to draw the conclusion that Muslims in general have a positive perception of organ donation.
The problem about this approach, some argue, is that it presupposes that things remain the same. More specifically, it is argued that inductive thinking is problematic because we can never be convinced that a recurring result will continue to arise (Deutsche Forschungsgemeinschaft., 2013). Concerning this research adversaries of induction would likely argue that because Muslims, e.g., may have a positive attitude towards organ donation in this research, it is not known whether they will perceive organ donation positively tomorrow. Also, they might argue that because Muslims have a positive view on organ donation in this research, it does not mean that every Muslim in general view organ donation as something positive. Ergo adversaries would continuously test if the hypothesis was true.
Nevertheless, the inductive approach is suitable as it lets me as a researcher make inferences from the relatively small sample.
Regarding data collection method, data will be collected employing in-depth interviews. More specifically, in-depth interviewing will be undertaken using semi structured interviews. Hence, only one method will be used and other research strategies such as ethnography/participant observation and focus group interviewing will not be used.
The main reason for employing in-depth interviews in preference to ethnography/participant observation is that in-depth interviewing enables a specific focus (Bryman and Bell, 2015). This research pursues to examine the perceptions of organ donation from religious person’s point of view in relation to marketing.
Since this research has a relatively specific focus, namely to do research on organ donation, in-depth interviewing will be more appropriate. Issues to do with organ donation may unlikely crop up on a regular basis when examining Muslims, Christians and so on. Thus, to let the research centre on organ donation, in-depth interviewing seems suitable as it allows me to ask questions in relation to organ donation. Accordingly, observation would be inappropriate, as it is a more open-ended research strategy.
Furthermore, a leading motive for utilising in-depth interviewing rather than focus groups is that organ donation is very sensitive topic (Mercer, 2013). According to Bryman and Bell (2015), sensitive topics or topics that may lead to discomfort for participants can be unsuitable to examine in a focus group setting. Instead Bryman and Bell (2015) suggest that individual interviews should be undertaken. They explain it as follows: “focus groups may not be appropriate because of their potential for causing discomfort among participants. When such discomfort might arise, individual interviews are likely to be preferable” (Bryman and Bell, 2015, pp. 526-527).
In fact, I considered using focus groups for the questions related to effective marketing methods, as marketing is expected to be a less sensitive to reflect on. For instance, the specific research question: “How is existing marketing campaigns affecting religious groups?” could be studied using focus groups, but since the overall topic is still within the area of organ donation, focus groups were avoided completely.
Consequently, in-depth interviewing will characterize this research of different reasons.
Research Process
This research will conduct a longitudinal research. The idea is that a longitudinal research will allow to highlight changes – changes in the perception of organ donation and changes in how to most effectively promote the altruistic view. Hereby changes can be implemented in new marketing material continuously. The process of data collection will go on until data saturation is reached. However, the time limit of the study is 6 months.
The overall sampling method that will be used is a non-probability sampling method where the sample is deliberately rather than randomly selected (Bryman and Bell, 2015). The motive for choosing this sampling method is that the objective of this research is to examine religious individuals. Hence, the sample should consist of people with religious characteristics and not of a randomly selected group of people. In continuation of non-probability sampling, the snowball-sampling method will be employed. Snowball sampling will be carried out by turning to religious communities such as churches, mosques and synagogues around the UK. More specifically, a person whom is willing to act gatekeeper will be found – for instance a faith leader. Then he/she will be asked to find people in his/her social circle, who are not faith leaders, but religious, and whom are willing to participate in a research. Thereby, a greater sample of people will be gathered. The rational for choosing snowball sampling is that organ donation is a sensitive topic (Mercer, 2013), which according to Biernacki and Waldorf (1981) makes snowballing method particularly applicable method. By using a gatekeeper, more reliability will likely be obtained and accordingly access to the religious individuals will be admitted even though organ donation is a sensitive topic.
As mentioned, semi structured interviews will be used in the research. The semi structured interview is chosen grounded in the fact that it allows structure but also probing and leeway in how to reply (Bryman and Bell, 2015). Hence, the lack of probing in the structured interview and the absence of structure in the unstructured interviews are avoided. In other words, choosing a semi structured interviewing approach will allow me as the researcher to run through my list of specific questions in relation to organ donation. But if rich data or surprising evidence occur during the interview, the semi structured interview lets me “jump” back and forth to let the participants further probe into the aspect.
The interview guide is developed in a way where mainly open-ended research questions are asked. That is, to encourage the respondents to reflect on the topic and not just answer yes/no. By asking open-ended questions respondents rich and unusual data will more likely emerge, as respondents can answer in their own terms and not in the term imposed on them by the closed answers (Bryman and Bell, 2015). For the same reason, leading questions and my own opinion are attempted to be eluded.
If rich data emerge during the interview or if further reflections on a certain topic are needed, probing and prompting will be used. Probing will be employed through different techniques depending on what perspectives that appear during the interview. A few examples of probing techniques are employed e.g. by asking “can you spell out that for me?”. Probing is used, since it will encourage the respondents to work on their own material, which will often lead to insight that would not have been achieved without urging to speak (Gillham, 2000). Some probing and prompting are not included in the research guide. That is, probing and prompts that will have a more informal character, e.g. “uh-huh” and “please go on”. The informal probing and prompts will only be used when appropriate. How the interview turns out and the interviewee specifically responds cannot be predicted (Gillham, 2000).
Therefore, some prompts and probing will only be used when suitable.
Finally, projective techniques in the form of psycho-drawing will be employed. Psycho-drawing will be employed as organ donation is a sensitive topic (Mercer, 2013). Drawing sometimes enhance the participants’ way of expressing themselves. If the topic is sensitive, they might find it hard to express themselves orally and thereby drawing will be easier (Guenette and Marshall, 2009).
Reflection
From a positivist point of view, the main challenge of this research is that knowledge generated in this research will be highly value-laden. Not only will the results of this research be explained by my interpretation as the researcher, but also it will be rationalised by the participants’ interpretation. Building on this, the interpretation likewise depends on my personal background (Creswell, 2003).
This is problematic according to the supporters of positivism. They argue that interpretivism implies that the knowledge produced will be non-scientific and not objective. They further argue that only things that can be measured and observed is true (Rubin and Rubin, 2012). Accordingly, it seems unsuitable to take an interpretivist position. However, supporters of interpretivism reason “that all observation is both theory- and value-laden and investigation of the social world is not, and cannot be, the pursuit of a detached objective truth” (Ponelis, 2015, p. 538). In short, understanding of the social world cannot be found without interpretation. The understanding of human behaviour and the world must be established from a subjective point of view and clarification must be found within the frame of reference of the participant rather than by passively observing an action from an objective point of view (Ponelis, 2015).
Therefore, is it acknowledged that findings and conclusions in this research will be drawn based on value-laden data and by a value-laden interpreter.
Nevertheless, it still is important to be aware of the potential biases that can occur in an interview setting. For instance, the interviewee will actively try to make sense of who the interviewer is and what the intention of the research is (Alvesson and Deetz, 2000). Moreover, some studies have shown that respondents may infer the interviewer’s own attitudes and opinions and be influenced by them (Hart, 1948). Hence, it is crucial to understand the role as the researcher/interviewer, for which reason some initiatives will be done to overcome or reduce the potential biases. One main point, that will be underlined in the introduction of the interview is that it is critical that the individual respondents are honest and speak openly. In that respect, it will be stressed that only the interviewee’s perception and views on organ donation will be used to draw conclusions. Therefore, it will be emphasized that the interviewee should try to avoid considering my opinion as the interviewer and researcher and instead focus on only their own.
However, other aspects will also be taken into consideration in relation to the interviewees interpretation of the interviewer. For instance, the way in which questions are formulated in will be considered. I will try to avoid asking leading- and closed questions and also, I will abstain from stating my own opinion. Moreover, a neutral behaviour and a neutral way of dressing will be employed. Finally, active listening will be attempted to be used.
All this in order to avoid imposing a certain perception or opinion in the mind-set of the participant and thereby biasing the interview.
The final reflection that should be made in relation to the research and the potential biases is the sampling method. As mentioned in the “research process”-part, this research employs snowball-sampling. Snowball-sampling is a highly-biased sampling method. Mainly, it is biased as the interviewees will tend to have the similar characteristics as the gatekeeper resulting in a homogeneous sample (Saunders, Lewis and Thornhill, 2009).
Therefore, there might be a chance that the research will not give a representative picture of the perception of organ donation from a religious point of view. However, since the samples will be collected around the UK, not only a unilateral perspective will be given, but different perspectives from different religious people will define the research.
Consequently, the research has certain challenges and limitations in which it is important to be aware of as a researcher, but also as a reader of this paper. The above shows different ways of overcoming some of the challenges. However, some problematics might still be hard to deal with.
Bibliography
Alvesson, M. and Deetz, S. (2000) Doing Critical Management Research. Thousand Oaks, Calif. ; London : Sage.
Biernacki, P. and Waldorf, D. (1981) ‘Snowball Sampling: Problems and Techniques of Chain Referral Sampling’, Sociological Methods & Research, 10(2), pp. 141–163.
Black, I. (2006) ‘The presentation of interpretivist research’, Qualitative Market Research: An International Journal, 9(4), pp. 319–324.
Bryman, A. and Bell, E. (2015) Business Research Methods. Oxford: Oxford University Press.
Carson, D. et al. (2001) Qualitatative Marketing Research. United Kingdom: Sage Publications Ltd.
Creswell, J. W. (2003) Research design – Qualitative Quantitative and mixed methods approaches. London: Sage.
Deutsche Forschungsgemeinschaft., P. F. (2013) Theory Building in Qualitative Research: Reconsidering the Problem of InductionForum Qualitative Sozialforschung / Forum: Qualitative Social Research. Deutsche Forschungsgemeinschaft. Available at: http://www.qualitative-research.net/index.php/fqs/article/view/1851/3497 (Accessed: 22 November 2017).
Gillham, B. (2000) The research interview. London : Continuum.
Guenette, F. and Marshall, A. (2009) ‘Time line drawings: Enhancing participant voice in narrative interviews on sensitive topics.’, International Journal of Qualitative Methods, 8(1), pp. 85–92.
Hart, W. C. (1948) ‘Bias in Interviewing in Studies of Opinions, Attitudes, and Consumer Wants’, Proceedings of the American Philosophical Society, 92(5), pp. 399–404.
Mercer, L. (2013) ‘Improving the rates of organ donation for transplantation’, Nursing Standard, 27(26), pp. 35–40.
Oliver, M. et al. (2011) ‘Organ donation, transplantation and religion’, Nephrology Dialysis Transplantation, 26(2), pp. 437–444.
Ponelis, S. R. (2015) ‘Using Interpretive Qualitative Case Studies for Exploratory Research in Doctoral Studies : A Case of Information Systems Research in Small and Medium Enterprises’, International Journal of Doctoral Studies, 10, pp. 535–550.
Randhawa, G. and Neuberger, J. (2016) ‘Role of Religion in Organ Donation – Development of the United Kingdom Faith and Organ Donation Action Plan’, Transplantation Proceedings, 48(3), pp. 689–694.
Rubin, H. J. and Rubin, I. (2012) Qualitative Interviewing: The Art of Hearing Data. Thousand Oaks, Calif. : SAGE.
Saunders, M., Lewis, P. and Thornhill, A. (2009) Research methods for business students. 5th ed. Financial Times Prentice Hall.
Sharp, C. and Randhawa, G. (2014) ‘UK Polish Migrant Attitudes Toward Deceased Organ Donation: Findings from a Pilot Study’, Journal of Immigrant and Minority Health, 17(4), pp. 1157–1162.
Wigmore, Stephen J.; Forsythe, J. L. R. (2004) ‘Incentives to promote organ donation’, Transplantation, 77(1), pp. 159–161.
Appendix A – Interview Guide
Introduction

  • Tell the respondents that I am the moderator.
  • Explain the research area.
  • Ask for permission to do video recording.
  • State the length of the interview – Here it should be noted that the first part concerns perception whereas the last part is related to marketing.
  • Ask participants to sign the consent form.
  • Tell the participants that there is no right or wrong answers – encourage them to speak openly and honestly.
  • Ask them if they have any questions before we start.

Warming up session

  • Ask brainstorming questions
    • “What do you think when I say organ donation?”
  • Please do a drawing of your views on organ.

Specific Topic questions
Perception

  • Are you religious and in what way?
  • What is your view on religion?
    • People who donate their organs are _____?
    • What do you mean when you say people are ____?
  • What do you think your religion’s view on organ donation is?
    • To what extent do you agree with that view?
  • Describe how you perceive organ donation.
    • How do you think other like-minded religious people perceive it?
  • Please give me a specific example of any reactions or memories you have had when talking about organ donation with like-minded religious people.

Marketing and other factors

  • Existing marketing campaigns are ___?
    • Can you spell that out for me?
  • What is your view on the existing marketing campaigns concerning organ donation?
    • How would you improve these marketing campaigns to better aim at you (and your religious friends)?
  • What have affected your view on organ donation? Please explain in what way.
    • How would you affect people with the same mind-set as you in respect to organ donation and the altruistic view on it?
  • Have other things than marketing influenced your view on organ donation? Please elaborate on it.
    • Would you take other factors into consideration when designing a marketing campaign? Which factors and why?
  • What medias do you use?
    • Would they be appropriate to effectively aim at you when talking about organ donation? Why? Why not? Which medias what be more appropriate?

Gift-of-life

  • When I mention the “gift-of-life” what words spring to your mind?
    • Can you tell me more about why you say so?
    • So, to sum up, what would you say the “gift-of-life-metaphor” is an expression of?
  • What thoughts came to your mind when you first came across the metaphor?

Meaning of different organs

  • What meaning do you attach to different organs?
    • Do any organs mean more to you than others? Please reflect on it.
    • What meaning do you believe people with the same religious mind-set would attach to different organs?
    • How should it be reflected in a marketing campaign in order to increase donor rates?

Closing
Tell the participants that the research is about to end, but that the last thing you would ask them to do is to describe down to earth how they would design some marketing material considering what we have talked about.
After this is done, say:

  • Thanks for their collaboration.
  • Tell them that their opinion is useful.
  • And ask them if they have any ending things they want to say.


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